抗菌光动力疗法对2型糖尿病牙周炎患者牙周治疗效果和血糖控制影响的系统评价与Meta分析

doi:10.12016/j.issn.2096-1456.2021.11.005

口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (11): 752-760.doi: 10.12016/j.issn.2096-1456.2021.11.005

抗菌光动力疗法对2型糖尿病牙周炎患者牙周治疗效果和血糖控制影响的系统评价与Meta分析

徐腾飞¹(),陈斌¹,敖慧芝¹,孙卫斌¹,吴文蕾²()

1.南京大学医学院附属口腔医院牙周科, 江苏南京（210008）
2.南京大学医学院附属口腔医院高级专家诊疗科, 江苏南京（210008）

收稿日期:2021-03-09 修回日期:2021-04-25 出版日期:2021-11-20 发布日期:2021-07-20
通讯作者: 吴文蕾 E-mail:87719270@qq.com;wlwu@nju.edu.cn
作者简介:徐腾飞,住院医师,硕士研究生,Email： 87719270@qq.com
基金资助:
国家自然科学基金项目(51972167)

Effect of the antimicrobial photodynamic therapy in the treatment of periodontitis in type 2 diabetes mellitus: a systematic review and meta-analysis

XU Tengfei¹(),CHEN Bin¹,AO Huizhi¹,SUN Weibin¹,WU WenLei²()

1. Department of Periodontal, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
2. Department of Senior Expert Diagnosis and Treatment, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China

Received:2021-03-09 Revised:2021-04-25 Online:2021-11-20 Published:2021-07-20
Contact: WenLei WU E-mail:87719270@qq.com;wlwu@nju.edu.cn
Supported by:
National Natural Science Foundation of China(51972167)

摘要/Abstract

摘要：

目的采用系统评价和Meta分析的方法评价抗菌光动力疗法（antimicrobial photodynamic therapy,aPDT）对2型糖尿病（type-2 diabetes mellitus,T2DM）合并牙周炎患者的牙周治疗效果,为T2DM合并牙周炎的患者提供更好的治疗方法。方法通过检索PubMed、Cochrane、Embase、Web of Science、CNKI、CBM、万方数据库及手工检索杂志中相关临床随机对照试验（randomized controlled trial,RCT）,采用RevMan 5.3软件进行Meta分析并进行系统评价。结果共纳入8篇RCT,Meta分析结果显示,治疗后3个月,与单纯龈下刮治+根面平整术（subgingival scaling and root planing,SRP）相比,aPDT辅助SRP治疗在改善探诊深度（probing depth,PD）上效果更好,差异有统计学意义[WMD=-0.32,95%CI（-0.45, -0.2）,P< 0.05],但在治疗后6个月时两组差异无统计学意义[WMD=-0.15,95%CI（-0.40, 0.10）,P=0.23]。在6个月的随访期间内,两组的临床附着水平（clinical attachment level,CAL）、探诊出血（bleeding on probing,BOP）和血清糖化血红蛋白（glycosylated hemoglobin,HbA1c）水平差异均无统计学意义（P> 0.05）。结论 aPDT辅助T2DM患者牙周非手术治疗在短期内能改善PD,但在改善CAL、BOP和HbA1c疗效上效果不显著。

关键词: 抗菌光动力疗法; 2型糖尿病; 牙周炎; 龈下刮治; 根面平整术; 牙周治疗; Meta分析; 随机对照试验; 血糖控制

Abstract:

Objective This systematic review and meta-analysis was undertaken to evaluate the efficacy of antibacterial photodynamic therapy (aPDT) in the treatment of periodontitis in type-2 diabetes mellitus (T2DM) patients and to provide better treatment for patients with T2DM complicated with periodontitis.Methods The PubMed, Cochrane, Embase, Web of Science, CNKI, CBM, and Wanfang databases were searched for relevant randomized controlled trials (RCTs). RevMan 5.3 was applied for the meta-analysis, and a systematic evaluation was conducted. Results A total of 8 RCTs were included. The results showed that compared to simple subgingival scaling and root planing (SRP), aPDT assisted SRP had a better effect on improving the probing depth (PD) at 3 months after treatment, The difference was statistically significant [WMD=-0.32,95%CI（-0.45, -0.2）, P < 0.05], but 6 months after treatment, there was no significant difference in the two groups [ WMD=-0.15,95%CI（-0.40, 0.10）,P=0.23]. During the 6-month follow-up period, there were no significant differences in the clinical attachment level (CAL), bleeding on probing (BOP) or hemoglobin A1c (HbA1c) between the two groups (P> 0.05).Conclusion aPDT-assisted periodontal nonsurgical treatment in T2DM patients can improve PD in the short term but has no significant effect on the improvement of CAL, BOP and HbA1c.

Key words: antibacterial photodynamic therapy; 2 diabetes mellitus; periodontitis; subgingival scaling; root planning; periodontal therapy; meta-analysis; randomized controlled trail; blood sugar control

中图分类号:

徐腾飞,陈斌,敖慧芝,孙卫斌,吴文蕾. 抗菌光动力疗法对2型糖尿病牙周炎患者牙周治疗效果和血糖控制影响的系统评价与Meta分析[J]. 口腔疾病防治, 2021, 29(11): 752-760.

XU Tengfei,CHEN Bin,AO Huizhi,SUN Weibin,WU WenLei. Effect of the antimicrobial photodynamic therapy in the treatment of periodontitis in type 2 diabetes mellitus: a systematic review and meta-analysis[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(11): 752-760.

图/表 11

图1

表1

图2

图3

图4

图5

图6

图7

图8

图9

图10

参考文献 29

[1]	Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification[J]. J Clin Periodontol, 2018, 45(20):S1-S8. doi: 10.1111/jcpe.12935. doi: 10.1111/jcpe.2018.45.issue-S20
[2]	成杪莹, 梁丹, 唐智群, 等. 牙周炎与全身系统性疾病关系的研究现状[J]. 口腔疾病防治, 2018, 26(9):606-612. doi: 10.12016/j.issn.2096-1456.2018.09.012.
	Cheng MY, Liang D, Tang ZQ, et al. Research status of the relationship between periodontitis and systemic disease[J]. J Prev Treat Stomatol Dis, 2018, 26(9):606-612. doi: 10.12016/j.issn.2096-1456.2018.09.012.
[3]	Borgnakke WS. IDF diabetes atlas: diabetes and oral health-a two-way relationship of clinical importance[J]. Diabetes Res Clin Pract, 2019, 157:107839. doi: 10.1016/j.diabres.2019.107839. doi: 10.1016/j.diabres.2019.107839
[4]	Miranda TS, Feres M, Retamal-Valdés B, et al. Influence of glycemic control on the levels of subgingival periodontal pathogens in patients with generalized chronic periodontitis and type 2 diabetes[J]. J Appl Oral Sci, 2017, 25(1):82-89. doi: 10.1590/1678-77572016-0302. doi: 10.1590/1678-77572016-0302
[5]	Özberk SS, Gündoğar H, Özkaya M, et al. The effect of photobiomodulation therapy on nonsurgical periodontal treatment in patients with type 2 diabetes mellitus: a randomized controlled, single-blind, split-mouth clinical trial[J]. Lasers Med Sci, 2020, 35(2):497-504. doi: 10.1007/s10103-019-02897-z. doi: 10.1007/s10103-019-02897-z
[6]	Al-Zawawi AS, Bukhari IA, Bello-Correa FO, et al. Influence of root debridement with adjunct photodynamic therapy on periodontal parameters and gingival crevicular fluid cortisol levels among patients with and without type-2 diabetes mellitus[J]. Photodiagnosis Photodyn Ther, 2020, 32:102076. doi: 10.1016/j.pdpdt.2020.102076. doi: 10.1016/j.pdpdt.2020.102076
[7]	Baeza M, Morales A, Cisterna C, et al. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis[J]. J Appl Oral Sci, 2020, 28, e20190248. doi: 10.1590/1678-7757-2019-0248. doi: 10.1590/1678-7757-2019-0248
[8]	Elsadek MF, Ahmed BM, Alkhawtani DM, et al. A comparative clinical, microbiological and glycemic analysis of photodynamic therapy and Lactobacillus reuteri in the treatment of chronic periodontitis in type-2 diabetes mellitus patients[J]. Photodiagnosis Photodyn Ther, 2020, 29:101629. doi: 10.1016/j.pdpdt.2019.101629. doi: 10.1016/j.pdpdt.2019.101629
[9]	Mirza S, Khan AA, Al-Kheraif AA, et al. Efficacy of adjunctive photodynamic therapy on the clinical periodontal, HbA1c and advanced glycation end product levels among mild to moderate chronic periodontal disease patients with type 2 diabetes mellitus: a randomized controlled clinical trial[J]. Photodiagnosis Photodyn Ther, 2019, 28:177-182. doi: 10.1016/j.pdpdt.2019.08.003. doi: S1572-1000(19)30277-7 pmid: 31394300
[10]	Ivanaga CA, Miessi DMJ, Nuernberg MAA, et al. Antimicrobial photodynamic therapy (aPDT) with curcumin and LED, as an enhancement to scaling and root planing in the treatment of residual pockets in diabetic patients: a randomized and controlled split-mouth clinical trial[J]. Photodiagnosis Photodyn Ther, 2019, 27:388-395. doi: 10.1016/j.pdpdt.2019.07.005. doi: S1572-1000(19)30150-4 pmid: 31301434
[11]	Barbosa FI, Araújo PV, Machado LJC, Magalhães CS, Guimarães MMM, Moreira AN. Effect of photodynamic therapy as an adjuvant to non-surgical periodontal therapy: periodontal and metabolic evaluation in patients with type 2 diabetes mellitus[J]. Photodiagnosis Photodyn Ther, 2018, 22:245-250. doi: 10.1016/j.pdpdt.2018.04.013. doi: 10.1016/j.pdpdt.2018.04.013
[12]	Castro Dos Santos NC, Andere NM, Araujo CF, et al. Local adjunct effect of antimicrobial photodynamic therapy for the treatment of chronic periodontitis in type 2 diabetics: split-mouth double-blind randomized controlled clinical trial[J]. Lasers Med Sci, 2016, 31(8):1633-1640. doi: 10.1007/s10103-016-2030-8. doi: 10.1007/s10103-016-2030-8
[13]	Al-Zahrani MS, Bamshmous SO, Alhassani AA, et al. Short-term effects of photodynamic therapy on periodontal status and glycemic control of patients with diabetes[J]. J Periodontol, 2009, 80(10):1568-1573. doi: 10.1902/jop.2009.090206. doi: 10.1902/jop.2009.090206 pmid: 19792844
[14]	侯佳, 陶洪. 光动力疗法对Ⅱ型糖尿病患者合并慢性牙周炎的治疗效果[J]. 口腔医学研究, 2016, 32(10):1067-1069. doi: 10.13701/j.cnki.kqyxyj.2016.10.016.
	Hou J, Tao H. Effect of photodynamic therapy on patients with type Ⅱ diabetes mellitus and chronic periodontitis[J]. J Oral Sci Res, 2016, 32(10):1067-1069. doi: 10.13701/j.cnki.kqyxyj.2016.10.016.
[15]	Ramos UD, Ayub LG, Reino DM, et al. Antimicrobial photodynamic therapy as an alternative to systemic antibiotics: results from a double-blind, randomized, placebo-controlled, clinical study on type 2 diabetics[J]. J Clin Periodontol, 2016, 43(2):147-155. doi: 10.1111/jcpe.12498. doi: 10.1111/jcpe.12498
[16]	Al-Khureif AA, Mohamed BA, Siddiqui AZ, et al. Repeated application of photodynamic and antibiotic therapy as an adjunct to root surface debridement in patients with grade C and stage Ⅲ or Ⅳ aggressive periodontitis[J]. Photodiagnosis Photodyn Ther, 2020, 29:101610. doi: 10.1016/j.pdpdt.2019.101610. doi: S1572-1000(19)30556-3 pmid: 31785387
[17]	Akram Z, Hyder T, Al-Hamoudi N, et al. Efficacy of photodynamic therapy versus antibiotics as an adjunct to scaling and root planing in the treatment of periodontitis: a systematic review and meta-analysis[J]. Photodiagnosis Photodyn Ther, 2017, 19:86-92. doi: 10.1016/j.pdpdt.2017.05.007. doi: 10.1016/j.pdpdt.2017.05.007
[18]	Deas DE, Moritz AJ, Sagun RS Jr, et al. Scaling and root planing vs. conservative surgery in the treatment of chronic periodontitis[J]. Periodontol 2000, 2016, 71(1):128-139. doi: 10.1111/prd.12114. doi: 10.1111/prd.2016.71.issue-1
[19]	Cao R, Li Q, Wu Q, et al. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis[J]. BMC Oral Health, 2019, 19(1):176. doi: 10.1186/s12903-019-0829-y. doi: 10.1186/s12903-019-0829-y
[20]	Quintero AJ, Chaparro A, Quirynen M, et al. Effect of two periodontal treatment modalities in patients with uncontrolled type 2 diabetes mellitus: a randomized clinical trial[J]. J Clin Periodontol, 2018, 45(9):1098-1106. doi: 10.1111/jcpe.12991. doi: 10.1111/jcpe.12991 pmid: 30024030
[21]	Al-Askar M, Al-Kheraif AA, Ahmed HB, et al. Effectiveness of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periodontal inflammation among patients with prediabetes[J]. Photodiagnosis Photodyn Ther, 2017, 20:91-94. doi: 10.1016/j.pdpdt.2017.09.005. doi: S1572-1000(17)30427-1 pmid: 28899771
[22]	Duarte PM, Feres M, Yassine LLS, et al. Clinical and microbiological effects of scaling and root planing, metronidazole and amoxicillin in the treatment of diabetic and non-diabetic subjects with periodontitis: a cohort study[J]. J Clin Periodontol, 2018, 45(11):1326-1335. doi: 10.1111/jcpe.12994. doi: 10.1111/jcpe.2018.45.issue-11
[23]	Rapone B, Ferrara E, Corsalini M, et al. The effect of gaseous ozone therapy in conjunction with periodontal treatment on glycated hemoglobin level in subjects with type 2 diabetes mellitus: an unmasked randomized controlled trial[J]. Int J Environ Res Public Health. 2020, 17(15):5467. doi: 10.3390/ijerph17155467 doi: 10.3390/ijerph17155467
[24]	Sampath Kumar A, Maiya AG, Shastry BA, et al. Exercise and insulin resistance in type 2 diabetes mellitus: a systematic review and meta-analysis[J]. Ann Phys Rehabil Med. 2019, 62(2):98-103. doi: 10.1016/j.rehab.2018.11.001. doi: S1877-0657(18)31483-0 pmid: 30553010
[25]	Li S, Zheng Z, Tang X, et al. Impact of HbA1c variability on subclinical left ventricular remodeling and dysfunction in patients with type 2 diabetes mellitus[J]. Clin Chim Acta, 2020, 502:159-166. doi: 10.1016/j.cca.2019.12.006. doi: 10.1016/j.cca.2019.12.006
[26]	Costa KL, Taboza ZA, Angelino GB, et al. Influence of periodontal disease on changes of glycated hemoglobin levels in patients with type 2 diabetes mellitus: a retrospective cohort study[J]. J Periodontol, 2017, 88(1):17-25. doi: 10.1902/jop.2016.160140. doi: 10.1902/jop.2016.160140
[27]	Leite FRM, Nascimento GG, Baake S, et al. Impact of smoking cessation on periodontitis: a systematic review and meta-analysis of prospective longitudinal observational and interventional studies[J]. Nicotine Tob Res, 2019, 21(12):1600-1608. doi: 10.1093/ntr/nty147. doi: 10.1093/ntr/nty147
[28]	Sethi KS, Raut CP. Antimicrobial photodynamic therapy using indocyanine green as a photosensitizer in treatment of chronic periodontitis: a clinico-microbial study[J]. Indian J Dent Res, 2019, 30(6):870-876. doi: 10.4103/ijdr.IJDR_14_17. doi: 10.4103/ijdr.IJDR_14_17
[29]	Zhao Y, Pu R, Qian Y, et al. Antimicrobial photodynamic therapy versus antibiotics as an adjunct in the treatment of periodontitis and peri-implantitis: a systematic review and meta-analysis[J]. Photodiagnosis Photodyn Ther, 2021, 34:102231. doi: 10.1016/j.pdpdt.2021.102231. doi: 10.1016/j.pdpdt.2021.102231

Study	Year	Design	Sample size（T/C)	Age（years）	Intervention (T/C)	Photosensitizer	Types and parameters of laser	Follow-up（months）	Clinical parameters
Elsadek, et al^[8]	2020	RCT	20/20	48.6 ± 6.5	T: SRP+aPDT C: SRP	Methylene blue with a concentration of 0.005%	670 nm diode laser, 150 mW power,60 s/ site	3	PD, BOP, CAL, GR
Mirza, et al^[9]	2019	RCT	15/15	T: 51.45 C: 52.93	T: SRP+aPDT C: SRP	Methylene blue with a concentration of 0.005%	670 nm diode laser, 150 mW power,60 s	6	PD, CAL, BOP, P I, HbA1c, AGEs, GCF
Ivanaga, et al^[10]	2019	RCT	25/25	55 ± 10.2	T:SRP+aPDT C:SRP	Curcumin with a concentration of 100 mg/L	465-485 nm LED, 60 s	6	PD, CAL, BOP, GR, PI
Barbosa, et al^[11]	2018	RCT	6/6	35-65	T: SRP+aPDT C: SRP	Methylene blue with a concentration of 10 mg/mL	Diode laser, 40 mW power, 120 s /tooth	6	PD, CAL, BOP, PI, HbA1c
Castro Dos Santo, et al^[12]	2016	RCT	20/20	51.60 ± 10.05	T: SRP+aPDT C: SRP	Methylene blue with a concentration of 0.005%	660 nm diode laser, 60 s/tooth	6	PD, CAL, GR, PI
Ramos, et al^[15]	2016	RCT	15/15	T：48.9 ± 9.5 C：49.3 ± 7.4	T: SRP+aPDT C: SRP	Phenothiazine chloride with a concentration of 10 mg/mL	Red laser, 70 mW power, 60 s/tooth	3	PD, CAL, BOP, GR, HbA1c, IL1-β
Hou, et al^[14]	2016	RCT	24/24	55.62 ± 11.9	T: SRP+aPDT C: SRP	Methylene blue with a concentration of 0.1 g/L	660 nm laser, type unknown, 60 s	3	PD, CAL, BI, PLI, HbA1c
Al-Zahrani, et al^[13]	2009	RCT	15/15	52.21 ± 8.35	T: SRP+aPDT C: SRP	Methylene blue with a concentration of 0.001%	670 nm diode laser, 60 s/tooth	3	PD, CAL, BI, HbA1c

抗菌光动力疗法对2型糖尿病牙周炎患者牙周治疗效果和血糖控制影响的系统评价与Meta分析

Effect of the antimicrobial photodynamic therapy in the treatment of periodontitis in type 2 diabetes mellitus: a systematic review and meta-analysis

RichHTML

PDF (PC)

摘要/Abstract

引用本文

使用本文

图/表 11

参考文献 29

相关文章 15

Metrics

推荐阅读 10

[1]	宋冰清,任彪,程磊. 具核梭杆菌与牙周炎关系的研究进展[J]. 口腔疾病防治, 2021, 29(8): 557-561.
[2]	尹馨,任秀云. 光动力疗法在牙周炎治疗领域的应用研究进展[J]. 口腔疾病防治, 2021, 29(8): 562-566.
[3]	单超,王婷婷,赵今. 白细胞介素-18与慢性牙周炎相关性的研究进展[J]. 口腔疾病防治, 2021, 29(7): 485-489.
[4]	王延峰,曾佳骏,袁乔,栾庆先. 单纯机械治疗对慢性牙周炎患者龈下菌群微生态的影响[J]. 口腔疾病防治, 2021, 29(6): 368-376.
[5]	顾雯佳,陆海霞,张羽,冯希平. 牙周炎与消化系统癌症相关性研究进展[J]. 口腔疾病防治, 2021, 29(5): 346-350.
[6]	郝思远,王甲河,张晓奇,邹静,王艳. 双歧杆菌预防龋病有效性和安全性的系统评价与Meta分析[J]. 口腔疾病防治, 2021, 29(4): 241-248.
[7]	邓宇杰,杨晓彬,陈浩,赖金环,周苗. 口腔门诊治疗中1 429例患者应用笑气镇静技术的回顾性分析[J]. 口腔疾病防治, 2021, 29(4): 249-253.
[8]	杨万娟,徐杰. 牙周炎患者龈下菌斑菌群的高通量测序分析[J]. 口腔疾病防治, 2021, 29(3): 157-165.
[9]	夏娇娇,李厚轩. 内窥镜辅助下微创牙周基础治疗的临床疗效评价[J]. 口腔疾病防治, 2021, 29(3): 171-177.
[10]	杨婷,黄世光. 亲环蛋白A与CD147的相互作用及其在牙周炎中的意义[J]. 口腔疾病防治, 2021, 29(3): 189-193.
[11]	董静博,李珍珍,刘晨曦,石培凯. 富血小板纤维蛋白在位点保存中使用效果的meta分析[J]. 口腔疾病防治, 2021, 29(2): 99-105.
[12]	罗咏熙,黄雪莹,冼若婷,余皖鑫,梁莉欣,梁兆佳,陈紫韵,侯丹,余挺. 高尿酸血症对小鼠短期牙周感染牙槽骨破坏的micro-CT分析[J]. 口腔疾病防治, 2021, 29(2): 88-93.
[13]	施少杰,刘向东,宋应亮. 降糖药物骨代谢效应及对糖尿病患者牙种植的影响[J]. 口腔疾病防治, 2021, 29(2): 110-114.
[14]	陈越,吴泽钰,貊燕丽,敬英豪,刘奕杉. HLA-DQB1和HLA-DRB1基因多态性与龋病相关性的系统评价与Meta分析[J]. 口腔疾病防治, 2021, 29(12): 820-827.
[15]	张倩,陈斌,闫福华. 牙周基础治疗后龈沟液中4种生物标志物水平变化及临床意义[J]. 口腔疾病防治, 2021, 29(12): 828-835.