脱钙异体冻干骨联合富血小板衍生物治疗牙周骨内缺损疗效的Meta分析

doi:10.7518/hxkq.2017.06.014

摘要/Abstract

摘要：

目的系统评价脱钙异体冻干骨（DFDBA）联合富血小板衍生物治疗牙周病导致的骨内缺损的有效性。方法在PubMed、Web of Science、Embase、Cochrane Library、中国学术期刊网全文数据库等数据库中检索2016年5月之前发表的关于DFDBA联合富血小板衍生物治疗牙周病导致的骨内缺损的临床随机对照研究（RCT）。对纳入的文献研究进行质量评价。应用RevMan 5.3软件进行Meta分析。结果 9篇RCT文献纳入Meta分析,共194例患者,303个位点。Meta分析结果显示:DFDBA联合富血小板衍生物试验组较对照组可以降低短期组（6个月）和长期组（12~18个月）的牙周袋探诊深度,均数差（MD）分别为0.75 mm[95%可信区间（CI）（0.31 mm,1.20 mm）,P=0.001 0]、0.87 mm[95%CI（0.02 mm,1.72 mm）,P=0.04];增加短期组（6个月）和长期组（12~18个月）的临床附着水平,MD分别为0.65 mm[95%CI（0.08 mm,1.22 mm）,P=0.03]、1.31 mm[95%CI（0.60 mm,2.01 mm）,P=0.000 3];减少长期组（12~18个月）的牙龈退缩[MD为-0.58 mm,95%CI（-0.78 mm,-0.38 mm）,P<0.000 01];增加短期组（6个月）和长期组（12~18个月）的骨充填高度,MD分别为0.52 mm[95%CI（0.03 mm,1.00 mm）,P=0.04]、1.26 mm[95%CI（0.65 mm,1.86 mm）,P=0.000 1]。结论 DFDBA联合富血小板衍生物能有效治疗牙周病导致的骨内缺损,效果优于单用组。但因为此次纳入研究较少,质量不高且样本量较小,所以仍需高质量的、大样本的RCT来进一步验证。

关键词: 脱钙异体冻干骨, 富血小板血浆, 富血小板纤维蛋白, 骨内缺损

Abstract:

Objective This review aims to systematically evaluate the effect of decalcified freeze-dried bone allograft (DFDBA) combined with rich platelet derivatives on the treatment of human periodontal intrabony defects. Methods A search in PubMed, Web of Science, Embase, Cochrane Library, CNKI, and other electronic databases was conducted to iden-tify randomized controlled trials (RCT) of the use of DFDBA combined with rich platelet derivatives in the treatment of human periodontal intrabony defects, performed before May 2016. The quality of the RCTs was assessed.RevMan 5.3 software was applied for Meta-analysis. Results A total of nine RCTs were included. A total of 194 patients and 303 defects were involved. Short-term (6 months) and long-term (12 to 18 months) groups were included. Meta-analysis results revealed that DFDBA combined with rich platelet derivatives was superior to DFDBA or rich platelet derivatives alone for probing depth reduction in the short-term [MD=0.75 mm, 95% confidence intervals (CI) (0.31 mm, 1.20 mm), P=0.001 0] and long-term groups [MD=0.87 mm, 95%CI (0.02 mm, 1.72 mm), P=0.04], clinical attachment level gain in the short-term [MD=0.65 mm, 95%CI (0.08 mm, 1.22 mm), P=0.03] and long-term groups [MD=1.31 mm, 95%CI (0.60 mm, 2.01 mm), P<0.000 3], gingival recession reduction in the long-term group [MD=-0.58 mm, 95%CI (-0.78 mm, -0.38mm), P<0.000 01], bone fill gain in the short-term [MD=0.52 mm, 95%CI (0.03 mm, 1.00 mm), P=0.04] and long-term groups [MD=1.26 mm, 95%CI (0.65 mm, 1.86 mm), P<0.000 1]. Conclusion DFDBA combined with platelet rich derivatives is probably effective in the treatment of human periodontal intrabony defects. It is probably superior to DFDBA or platelet rich derivatives alone. Consi-dering the limitation of the included studies, high-quality and large-sample RCTs are required to evaluate the effect.

Key words: decalcified freeze-dried bone allograft, platelet-rich plasma, platelet-rich fibrin, intrabony defects

中图分类号:

R781.4

魏雪, 钟晓波, 何斌, 邓彦涵, 骆书美. 脱钙异体冻干骨联合富血小板衍生物治疗牙周骨内缺损疗效的Meta分析[J]. 华西口腔医学杂志, 2017, 35(6): 636-642.

Xue Wei, Xiaobo Zhong, Bin He, Yanhan Deng, Shumei Luo. Decalcified freeze-dried bone allograft combined with rich platelet derivatives for the treatment of human periodontal intrabony defects: a Meta-analysis[J]. West China Journal of Stomatology, 2017, 35(6): 636-642.

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纳入研究	实验设计	样本量（试验	年龄（试验组/	干预措施		随访时	结局指标
纳入研究	实验设计	组/对照组）	对照组）/岁	试验组	对照组	间/月	结局指标
Khosropanah等^[10]	口内对照	12/12	45±10/45±10	DFDBA+PRP	DFDBA	6	PD、CAL、BF
Kukreja等^[11]	平行对照	10/10	20~47/20~47	DFDBA+PRP	DFDBA	6	PD、CAL、REC、BF
Bharti等^[12]	口内对照	10/10	未提及/未提及	DFDBA+PRF	DFDBA	6	PD、CAL、REC、BF
Markou等^[13]	平行对照	12/12	53±7/50±6	DFDBA+PRP	PRP	6	PD、CAL、REC
Agarwal等^[14]	口内对照	30/30	52±7/52±7	DFDBA+PRF	DFDBA	12	PD、CAL、REC、BF
Agarwal等^[15]	口内对照	24/24	30~65/30~65	DFDBA+PRP	DFDBA	12	PD、CAL、REC、BF
Piemontese等^[16]	平行对照	30/30	58±8/57±11	DFDBA+PRP	DFDBA	12	PD、CAL、REC、BF
Agarwal等^[17]	未提及	10/9	未提及/未提及	DFDBA+PRP+OFD	PRP+ODF	12	PD、CAL、REC、BF
Ilgenli等^[18]	未提及	16/12	26~48/28~54	DFDBA+PRP	PRP	18	PD、CAL、BF

纳入研究	随机方法	分配隐藏	盲法	结果数据的完整性（退出/失访）	选择性报告研究结果	其他偏倚来源
Ilgenli等^[18]	是	不清楚	否	完整	不清楚	不清楚
Piemontese等^[16]	是	不清楚	双盲	完整	不清楚	不清楚
Markou等^[13]	是	不清楚	双盲	完整	不清楚	不清楚
Bharti等^[12]	不清楚	不清楚	否	完整	不清楚	不清楚
Agarwal等^[15]	是	不清楚	双盲	完整	不清楚	不清楚
Kukreja等^[11]	是	不清楚	单盲	完整	不清楚	不清楚
Khosropanah等^[10]	是	不清楚	双盲	完整	不清楚	不清楚
Agarwal等^[17]	不清楚	不清楚	否	2人失访	不清楚	不清楚
Agarwal等^[14]	是	不清楚	双盲	2人失访	不清楚	不清楚