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
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
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 文献筛选流程

Figure 1 Flow chart of literature screening

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^[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

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^[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

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

图10 发表偏移漏斗图

Figure 10 Publish offset funnel plots

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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

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