口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (11): 752-760.DOI: 10.12016/j.issn.2096-1456.2021.11.005
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
作者简介:
徐腾飞,住院医师,硕士研究生,Email: 基金资助:
XU Tengfei1(),CHEN Bin1,AO Huizhi1,SUN Weibin1,WU WenLei2(
)
Received:
2021-03-09
Revised:
2021-04-25
Online:
2021-11-20
Published:
2021-07-20
Contact:
WenLei WU
Supported by:
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。
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.
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[ | 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[ | 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[ | 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[ | 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[ | 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[ | 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[ | 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[ | 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 |
表1 纳入研究的基本特征
Table 1 Characteristics of the included studies
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[ | 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[ | 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[ | 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[ | 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[ | 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[ | 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[ | 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[ | 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 |
图2 偏倚风险图
Figure 2 Risk of bias graph T: test group; C: control group; RCT: randomized controlled trial; SRP: subgingival scaling and root planing; aPDT: antimicrobial photodynamic therapy; LED: light emitting diode; PD: probing depth; CAL: clinical attachment level; HbA1c: glycosylated hemoglobin; BOP: bleeding on probing; GR: gingival recession; PI: periodontal index; PLI: plaque index; BI: bleeding index; GCF: gingival crevicular fluid; AGEs: advanced glycation end products; IL1-β: interleukin1-β
图3 抗菌光动力疗法辅助糖尿病患者治疗后3个月探诊深度变化的Meta分析
Figure 3 Meta-analysis changes in probing depth values of patients with diabetes after 3 months of treatment assisted by antibacterial photodynamic therapy
图4 抗菌光动力疗法辅助糖尿病患者治疗后6个月探诊深度变化的Meta分析
Figure 4 Meta-analysis changes in probing depth values of patients with diabetes after 6 months of treatment assisted by antibacterial photodynamic therapy
图5 抗菌光动力疗法辅助糖尿病患者治疗后3个月临床附着水平变化的Meta分析
Figure 5 Meta-analysis changes in the clinical attachment level values of patients with diabetes after 3 months of treatment assisted by antibacterial photodynamic therapy
图6 抗菌光动力疗法辅助糖尿病患者治疗后6个月临床附着水平变化的Meta分析
Figure 6 Meta-analysis changes in the clinical attachment level values of patients with diabetes after 6 months of treatment assisted by antibacterial photodynamic therapy
图7 抗菌光动力疗法辅助糖尿病患者治疗后3个月探诊出血变化的Meta分析Figure 7 Meta-analysis changes in the bleeding on probing values of patients with diabetes after 3 months of treatment assisted by antibacterial photodynamic therapy
图8 抗菌光动力疗法辅助糖尿病患者治疗后6个月探诊出血变化的Meta分析
Figure 8 Meta-analysis changes in the bleeding on probing values of patients with diabetes after 6 months of treatment assisted by antibacterial photodynamic therapy
图9 抗菌光动力疗法辅助糖尿病患者治疗后糖化血红蛋白变化的Meta分析
Figure 9 Meta-analysis changes in the glycosylated hemoglobin values of patients with diabetes after treatment assisted by antibacterial photodynamic therapy
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