Abstract：
The bidirectional associations between periodontitis and inflammatory bowel disease (IBD) with temporal directionality remain inconclusive. This study aims to evaluate the bidirectional associations between periodontitis and IBD through a systematic review and meta-analysis. Five databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library) were systematically searched from inception to 27 February 2024. Two independent reviewers performed a review of the retrieved studies. Longitudinal studies, including cohort and nested case-control studies, were considered eligible for the study design. The pooled risk ratio (RR) and hazard ratio (HR) derived from the meta-analysis were used to assess whether periodontitis (or IBD) was a risk factor for IBD (or periodontitis). Trial sequential analysis (TSA) was performed to evaluate the reliability of the results. Four studies (n = 10 270 912) on the risk of IBD in patients with periodontitis and two (n = 33 420) on the risk of periodontitis in patients with IBD were included. The result suggested that periodontitis did not increase the risk of IBD (pooled RR = 1.04, 95% confidence interval [CI]: 0.99-1.09; p = .164; I-squared statistic [I2] = 27%). For subtypes of IBD, periodontitis was associated with the occurrence of ulcerative colitis (UC) (pooled RR = 1.12, 95% CI: 1.04-1.21; p = .003; I2 = 38%), but not with Crohn\'s disease (CD) (pooled RR = 0.98, 95% CI: 0.92-1.04; p = .475; I2 = 0%). Specifically, the risk of UC was higher among men (pooled HR = 1.11, 95% CI: 1.01-1.22; p = .025; I2 = 0%) and smokers (pooled HR = 1.23, 95% CI: 1.07-1.42; p = .004; I2 = 0%) with periodontitis than their counterparts without periodontitis. Patients with IBD may have a higher risk of developing periodontitis (pooled HR = 1.37, 95% CI: 1.26-1.49; p < .001; I2 = 18%); however, whether IBD subtypes increased the occurrence of periodontitis remained uncertain. The TSA results confirmed the reliability of the primary findings. Based on limited longitudinal evidence, patients with periodontitis do not exhibit an increased risk of developing IBD overall, but they are at increased risk of UC (not CD). On the contrary, patients with IBD have a higher risk of developing periodontitis over time. More high-quality longitudinal studies are needed to determine the effect of specific subtypes of IBD on periodontitis.
摘要：
牙周炎和炎症性肠病（IBD）与时间方向性之间的双向关联仍然没有定论。本研究旨在通过系统评价和荟萃分析评估牙周炎和IBD之间的双向关联。五个数据库(PubMed，Embase,WebofScience,Scopus和Cochrane图书馆）从开始到2024年2月27日进行了系统搜索。两名独立审稿人对检索到的研究进行了审查。纵向研究,包括队列和嵌套病例对照研究，被认为符合研究设计的条件。荟萃分析得出的合并风险比（RR）和风险比（HR）用于评估牙周炎（或IBD）是否是IBD（或牙周炎）的危险因素。进行试验序贯分析(TSA)以评估结果的可靠性。纳入了四项关于牙周炎患者IBD风险的研究（n=10270912）和两项关于IBD患者牙周炎风险的研究（n=33420）。结果表明，牙周炎不会增加IBD的风险（合并RR=1.04，95％置信区间[CI]：0.99-1.09；p=.164；I平方统计量[I2]=27％）。对于IBD的亚型，牙周炎与溃疡性结肠炎（UC）的发生有关（合并RR=1.12，95％CI：1.04-1.21；p=.003；I2=38％），但不与克罗恩病（CD）（合并RR=0.98，95%CI：0.92-1.04；p=.475；I2=0%）。具体来说,患有牙周炎的男性(合并HR=1.11,95%CI:1.01~1.22;p=.025;I2=0%)和吸烟者(合并HR=1.23,95%CI:1.07~1.42;p=.004;I2=0%)患UC的风险高于无牙周炎的男性.IBD患者患牙周炎的风险较高(合并HR=1.37,95%CI:1.26-1.49;p<.001;I2=18%);然而,IBD亚型是否增加牙周炎的发生仍不确定。TSA结果证实了主要发现的可靠性。基于有限的纵向证据，牙周炎患者总体发展为IBD的风险并未增加，但他们患UC（非CD）的风险增加。相反,随着时间的推移,IBD患者患牙周炎的风险更高.需要更多高质量的纵向研究来确定IBD的特定亚型对牙周炎的影响。
