乾癬患者之牙周炎風險探討：全國回溯型世代研究

牙周炎與乾癬疾病有共同的危險因子與共病，皆屬自體免疫疾病，但兩者間的相關性至今尚未被了解，故本論文之目的為釐清牙周炎與乾癬之間的因果關係，確認乾癬疾病是否為牙周炎之危險因子。論文使用台灣全民健康保險研究資料庫之百萬歸人檔做資料分析，收集2003-2012年期間罹患乾癬的患者，以及其在2003-2013年間之就醫紀錄，追蹤此期間患者罹患牙周炎之情形。並將乾癬疾病患者之牙周炎發生率與未得乾癬疾病的人比較，得到牙周炎危險比。研究會根據牙周處置將牙周炎分為輕度、中度、與重度，並將乾癬疾病分為乾癬與乾癬與關節炎。結果顯示：乾癬關節炎患者有較高的牙周炎發生率，得到中重度牙周炎風險高於不分類牙周炎。乾癬患者則與健康者無異。。就中重度牙周炎之危險比：乾癬之牙周炎危險比為0.85 (95% CI [0.65–1.11]) 、乾癬關節炎為1.66 (95% CI [0.99–2.78])，在統計成邊緣差異。但若計算一年後之牙周炎危險比，發現乾癬關節炎之牙周風險顯著提升，中重度牙周炎風險仍高於中重度牙周炎風險仍高於不分類牙周炎。不分類牙周炎危險比值從第0-11個月的0.65，一年後增加到1.34，中重度牙周炎則是從1.09到1.79。從結果可知—乾癬關節炎患者較乾癬患者、一般人有較高的風險得到牙周炎，尤其在診斷後一年，而且具有得到中重度牙周炎之傾向，故定期牙周照護對於乾癬關節炎患者有一定的必要性。

Periodontitis and psoriatic disease, including psoriasis and psoriatic arthritis (PsA), share the common risk factors and co-morbidities. However, the risk of periodontitis in patients with psoriatic disease still needs further investigation. This study was a nationwide population-based retrospective cohort study assessing the risk of periodontitis from psoriatic disease exposure. Patients with newly diagnosed psoriatic disease from 2003 to 2012 were identified from the Taiwanese National Health Insurance Research Database. The 1:4 ratio propensity score matched controls were selected from no psoriatic disease participations. The subsequent risk of periodontitis was evaluated in exposure and comparison groups. A total of 3,487 psoriatic disease patients and 13,948 controls were identified. Incidence rate of periodontitis was higher in patients with PsA. The adjusted hazard ratio (aHRs) for moderate/severe periodontitis were 0.85 (95% CI [0.65–1.11]) in PS group and 1.66 (95% CI [0.99–2.78]) in PsA group. The aHRs of PsA were increased over time, aHRs was changed from 0.65 (0–11 months from index date) to 1.34 (12 months from index date) in all types of periodontitis and from 1.09 to 1.79 in moderate/severe periodontitis group, respectively. The increased risk of periodontitis was observed, especially the association between PsA and moderate/severe periodontitis. The patients with psoriatic disease should receive regular periodontal evaluation.