高齢歯科患者における口腔内カンジダ菌の検出に関連する要因

Candida species in the oral cavity usually show little pathogenesis but cause oral candidosis as an opportunistic infection because of a weakening of host immune defences. Therefore it is important to investigate the factors related to Candida in the elderly. The aim of this study was to evaluate th...

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Published inRonen Shika Igaku Vol. 29; no. 4; pp. 340 - 349
Main Authors 佐藤 博, 菊池 雅彦, 江刺 香苗
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本老年歯科医学会 2015
Japanese Society of Gerodontology
Subjects
Online AccessGet full text
ISSN0914-3866
1884-7323
DOI10.11259/jsg.29.340

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Abstract Candida species in the oral cavity usually show little pathogenesis but cause oral candidosis as an opportunistic infection because of a weakening of host immune defences. Therefore it is important to investigate the factors related to Candida in the elderly. The aim of this study was to evaluate the relationship between the detection of Candida in the oral cavity and several factors associated with oral health in frail or dependent elderly. The subjects were 396 patients (126 men and 270 women) aged 70 years and over (mean age:81.5±6.9 years) who underwent general dental treatment or domiciliary dental care. A swab was taken from the buccal mucosa of the subjects and then transferred into a simplified culture for Candida (Stomastat®). After incubation for 24 h at 37℃, the detection of Candida was assessed based on the color of the culture and classified into three categories:negative, pseudo-positive and positive. The influence of some factors associated with oral health such as subjectsʼ age, gender, residence, oral status, walking ability, and systemic diseases were investigated. The detection of Candida was significantly related to utilization of institution, poor oral hygiene, wearing dentures, less present teeth, difficulty in walking, and presence of dementia or other systemic diseases, whereas age and gender were not associated with Candida. Logistic regression analysis indicated that significant factors affecting the detection of Candida were poor oral hygiene and reduced walking ability; however, wearing dentures and systemic diseases including dementia showed no association with Candida. 口腔内カンジダ菌は,通常は病原性を発揮しないが,免疫機能の低下などにより日和見感染として口腔カンジダ症を発症することがあるので,高齢者の口腔内カンジダ菌に関連する要因を明らかにすることは重要である。そこで先行研究の対象者に寝たきり者を含む施設入所者を追加することで,自立した高齢者から寝たきりの高齢者まで,さまざまな状態にある高齢者群を対象に,口腔内カンジダ菌と口腔衛生に関する事項との関連について検討した。 対象者は,訪問診療を含む歯科診療を受診した 70 歳以上の高齢患者 396 名(平均 81.5±6.9 歳,男性 126 名,女性 270 名)である。頰粘膜を滅菌綿棒で擦過して採取した検体をカンジダ菌検出用簡易試験液・ストマスタットに入れ 37℃で 24 時間培養後,陰性,疑陽性,陽性のいずれかに判定した。口腔衛生に関する要因については,年齢,性別,住居の状況,口腔に関する要因,歩行に関する要因,全身疾患に関する事項を調査した。 その結果,口腔内カンジダ菌の検出と年齢・性別との関連は認められなかったが,施設入所者,口腔清掃不良者,現在歯数が少ない人,歩行が困難な人,認知症や他の全身疾患がある人で多く検出された。ロジスティック回帰分析の結果からは,口腔清掃状態および歩行能力の 2 つがカンジダ菌検出と関連する重要な独立した因子であることが明らかとなった。義歯装着や,全身疾患は,カンジダ菌検出と有意な関連を示さなかった。
AbstractList Candida species in the oral cavity usually show little pathogenesis but cause oral candidosis as an opportunistic infection because of a weakening of host immune defences. Therefore it is important to investigate the factors related to Candida in the elderly. The aim of this study was to evaluate the relationship between the detection of Candida in the oral cavity and several factors associated with oral health in frail or dependent elderly. The subjects were 396 patients (126 men and 270 women) aged 70 years and over (mean age:81.5±6.9 years) who underwent general dental treatment or domiciliary dental care. A swab was taken from the buccal mucosa of the subjects and then transferred into a simplified culture for Candida (Stomastat®). After incubation for 24 h at 37℃, the detection of Candida was assessed based on the color of the culture and classified into three categories:negative, pseudo-positive and positive. The influence of some factors associated with oral health such as subjectsʼ age, gender, residence, oral status, walking ability, and systemic diseases were investigated. The detection of Candida was significantly related to utilization of institution, poor oral hygiene, wearing dentures, less present teeth, difficulty in walking, and presence of dementia or other systemic diseases, whereas age and gender were not associated with Candida. Logistic regression analysis indicated that significant factors affecting the detection of Candida were poor oral hygiene and reduced walking ability; however, wearing dentures and systemic diseases including dementia showed no association with Candida. 口腔内カンジダ菌は,通常は病原性を発揮しないが,免疫機能の低下などにより日和見感染として口腔カンジダ症を発症することがあるので,高齢者の口腔内カンジダ菌に関連する要因を明らかにすることは重要である。そこで先行研究の対象者に寝たきり者を含む施設入所者を追加することで,自立した高齢者から寝たきりの高齢者まで,さまざまな状態にある高齢者群を対象に,口腔内カンジダ菌と口腔衛生に関する事項との関連について検討した。 対象者は,訪問診療を含む歯科診療を受診した 70 歳以上の高齢患者 396 名(平均 81.5±6.9 歳,男性 126 名,女性 270 名)である。頰粘膜を滅菌綿棒で擦過して採取した検体をカンジダ菌検出用簡易試験液・ストマスタットに入れ 37℃で 24 時間培養後,陰性,疑陽性,陽性のいずれかに判定した。口腔衛生に関する要因については,年齢,性別,住居の状況,口腔に関する要因,歩行に関する要因,全身疾患に関する事項を調査した。 その結果,口腔内カンジダ菌の検出と年齢・性別との関連は認められなかったが,施設入所者,口腔清掃不良者,現在歯数が少ない人,歩行が困難な人,認知症や他の全身疾患がある人で多く検出された。ロジスティック回帰分析の結果からは,口腔清掃状態および歩行能力の 2 つがカンジダ菌検出と関連する重要な独立した因子であることが明らかとなった。義歯装着や,全身疾患は,カンジダ菌検出と有意な関連を示さなかった。
Author 佐藤 博
江刺 香苗
菊池 雅彦
Author_FL Esashi Kanae
Sato Hiroshi
Kikuchi Masahiko
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  organization: Department of Comprehensive Dentistry, Tohoku University Hospital | 東北大学病院総合歯科診療部
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  fullname: 菊池 雅彦
  organization: Department of Comprehensive Dentistry, Tohoku University Hospital | 東北大学病院総合歯科診療部
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  fullname: 江刺 香苗
  organization: Miyagi Prefecture(Esashi Dental Clinic) | 宮城県(江刺歯科医院)
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Japanese Journal of Gerodontology
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Japanese Journal of Gerodontology
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Japanese Society of Gerodontology
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Snippet Candida species in the oral cavity usually show little pathogenesis but cause oral candidosis as an opportunistic infection because of a weakening of host...
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StartPage 340
SubjectTerms Candida
elderly people
odds ratio
oral hygiene
Stomastat
オッズ比
カンジダ菌
ストマスタット
口腔衛生
高齢者
Title 高齢歯科患者における口腔内カンジダ菌の検出に関連する要因
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