Periodontal disease, inflammatory alterations and preeclampsia : clinical and immunological evaluation / Doença periodontal, alterações inflamatorias e pre-eclampsia : avaliação clinica e imunologica
AUTOR(ES)
Gabriel Tilli Politano
DATA DE PUBLICAÇÃO
2009
RESUMO
Introduction: Periodontitis, an infectious disease affecting the supporting structures of the teeth, leads to local and systemic liberation of various inflammatory mediators. Preeclampsia, a disorder that occurs only during pregnancy and the postpartum period is characterized by high blood pressure and the presence of protein in the urine and also seems to have an immunological etiology, with increased plasma levels of some cytokines. Objectives: the aim of the present study was to explore existing literature surrounding the association between periodontitis and preeclampsia as well as to evaluate the influence of Tumor necrosis factor-alpha (TNFa) and Interleukin-6 (IL-6). This work also aimed to evaluate the association between periodontitis and preeclampsia development, including the analysis of systemic inflammatory cytokines. Methods: A review of the literature on the relationship between periodontal disease and preeclampsia was initially performed, followed by a case-control analysis of 116 pregnant women, 58 with preeclampsia (cases) and 58 normotense pregnant women (controls). Peripheral blood samples were also collected for laboratorial analysis of IL-6 and TNFa messenger RNA (mRNA) systemic expression, through realtime polymerase chain reaction (Real Time PCR). All participants underwent a clinical periodontal examination in order to assess the presence or absence of periodontal disease. Crude and adjusted odds ratio were calculated by multivariate logistic regression for exposure factors. Student s t-test, MannWhitney U-test, Fisher s exact test and Chi-Square test were used to ensure homogeneity of the groups. Mann-Whitney U-test was also used for intragroup comparison regarding level of cytokines and periodontal data. Correlations between all periodontal data and cytokines expression were determined by Spearman rank test. Population attributable risks were estimated using Levin s Formula. Results: the results showed increased TNFa mRNA expression from pre-eclamptic women as compared with normal pregnant women. There were no statistically significant differences in IL-6 between case and control groups. There was an association between periodontitis and preeclampsia [adjusted odds ratio = 3,73 (IC 95% 1,32 to 10,58)]. There was no correlation between periodontitis and IL-6 and TNFa messenger RNA (mRNA) expression. Conclusion: There was a significant clinical correlation between periodontitis and preeclampsia; however, an immunologic correlation via inflammatory cytokines could not be determined in our study. In addition, the high expression of TNF-a mRNA in pregnant women emphasizes the immunological mechanisms involved in periodontal disease
ASSUNTO(S)
pre-eclampsia doença periodontal periodontal disease citocinas cytokines preeclampsia
