血液透析患者龋病和牙周健康状况的系统评价

doi:10.7518/hxkq.2017.02.009

摘要/Abstract

摘要：

目的对接受维持性血液透析的终末期肾病患者的龋病和牙周健康状况进行系统评价。方法计算机检索中国学术期刊全文数据库（CNKI）、万方数据库、PubMed、Web of Science、Cochrane Library数据库,收集国内外公开发表的研究血液透析患者口腔健康状况的病例对照和横断面研究,检索时间截止2016年5月。由2名研究者根据纳入与排除标准对相关文献进行筛选,并对文献进行质量评价和提取数据,对同质研究采用Revman 5.3软件进行Meta分析。结果研究最终纳入16篇文献,Meta分析结果显示,血液透析患者人群的牙菌斑指数（MD=0.62,95%CI为0.51~0.72）、牙石指数（MD=1.09,95%CI为0.56~1.63）、牙周袋深度（MD=0.63,95%CI为0.29~0.98）、附着丧失（MD=0.63,95%CI为0.56~0.69）均高于对照组（P<0.01）,而龋失补牙数（MD=1.12,95%CI为-1.08~3.32）与对照组无统计学差异（P=0.32）。结论行血液透析治疗的终末期肾病患者的龋病状况与健康对照人群无明显差异,但口腔卫生和牙周状况较差,在临床治疗时需得到重视。

关键词: 血液透析, 肾衰竭, 牙周病, 龋病, Meta分析

Abstract:

Objective This study aimed to systematically evaluate the oral health status of patients suffering from chronic renal failure and undergoing hemodialysis (HD). Methods Electronic databases, namely, China National Knowledge Infras-tructure, Wanfang Data base, PubMed, Web of Science, and Cochrane Library, were searched until May 2016 for cross-sectional and case-control studies that investigated the oral health status of patients suffering from chronic renal failure and undergoing HD. Two reviewers independently screened the trials, extracted the data, assessed the quality, and conducted a Meta-analysis with RevMan 5.3 in accordance with the inclusion and exclusion criteria. Results Sixteen studies satisfied the eligibility criteria. Meta-analysis revealed that plaque index (MD=0.62, 95%CI: 0.51-0.72), calculus index (MD=1.09, 95%CI: 0.56-1.63), probing depth (MD=0.63, 95%CI: 0.29-0.98), and attachment loss (MD=0.63, 95%CI: 0.56-0.69) were significantly higher in the patients undergoing HD than in the healthy control group (P<0.01). No significant differences in decayed missing filled teeth (MD=1.12, 95%CI: -1.08-3.32) were observed between the patients undergoing HD and the healthy control group (P=0.32). Conclusion The prevalence of caries in patients undergoing HD is similar to that in the healthy control group. However, these patients are at a higher risk of acquiring periodontal diseases than the healthy control group. Thus, the oral health status of these patients should be further evaluated in clinical treatments.

Key words: hemodialysis, renal failure, periodontal disease, caries, Meta-analysis

中图分类号:

R780.1

魏习, 胡波, 彭海洋, 刘畅, 宋锦璘, 唐明. 血液透析患者龋病和牙周健康状况的系统评价[J]. 华西口腔医学杂志, 2017, 35(2): 155-161.

Xi Wei, Bo Hu, Haiyang Peng, Chang Liu, Jinlin Song, Ming Tang. Oral health status of patients undergoing hemodialysis: a Meta-analysis[J]. West China Journal of Stomatology, 2017, 35(2): 155-161.

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作者	年份	国家	研究类型	平均年龄/岁		透析时间/月	性别（男/女）
作者	年份	国家	研究类型	HD组	对照组	透析时间/月	HD组	对照组
Chhokra M^[6]	2013	印度	横断面研究	38.03±7.41	40.55+5.45	未提及	13/27	14/26
Castillo A^[7]	2007	西班牙	横断面研究	61.5±18.04	58.9±18.7	43.4±38.96	24/28	24/28
王立飞^[9]	2003	中国	病例对照研究	未提及	未提及	未提及	33/14	20/15
房付春^[10]	2013	中国	病例对照研究	53.28±9.54	53.48±8.58	47.71±50.67	71/59	71/59
Chamani G^[11]	2009	伊朗	横断面研究	53.12±16.73	45.17±12.02	未提及	42/26	17/13
刘涛^[12]	2015	中国	病例对照研究	58.4±11.7	58.4±11.7	49.2±43.2	41/44	41/44
Tiwari V^[13]	2013	印度	病例对照研究	未提及	未提及	未提及	28/2	28/2
Torres SA^[14]	2009	巴西	病例对照研究	41.7±7.2	41.7±7.2	29±22	12/4	10/4
Bayraktar G^[15]	2008	土耳其	病例对照研究	46±15	46±18	39±25	23/18	22/39
Marakoglu I^[16]	2003	土耳其	病例对照研究	50.4±14.2	50.2±12.4	未提及	20/16	20/16
Pakpour AH^[17]	2015	伊朗	病例对照研究	57.7±17.01	55.8±15.9	52.12±29.86	322/190	158/97
Cengiz MI^[18]	2009	土耳其	病例对照研究	47.85±14.61	44.80±10.22	未提及	37?31	21?20
Gavaldá C^[19]	1999	英国	病例对照研究	58.9±14.9	55.7±10.7	59.8±43.9	53/52	29/24
Bots CP^[20]	2006	荷兰	横断面研究	42.6±9.2	41.3±8.4	28.6±16.9	30/12	326/482
Bayraktar G^[21]	2009	土耳其	横断面研究	46±14	45±18	27±21	56/44	46/65
Davidovich E^[22]	2005	美国	病例对照研究	14.3±1.11	12.6±1.04	未提及	14/8	15/23
Tadakamadla J^[23]	2014	印度	病例对照研究	46.27±1.42	43.14±2.31	未提及	未提及	未提及

文献	①	②	③	④	⑤-A	⑤-B	⑥	⑦	⑧	NOS总分
Chhokra M 2013^[6]	0	0	1	1	1	1	1	1	1	7
Castillo A 2007^[7]	1	0	1	1	1	1	1	1	1	8
房付春2013^[10]	1	1	1	1	1	0	1	1	1	8
Chamani G 2009^[11]	1	1	1	1	1	0	1	1	1	8
刘涛 2015^[12]	1	1	1	1	1	0	1	1	1	8
Tiwari V 2013^[13]	1	1	1	1	1	0	1	1	1	8
Torres SA 2010^[14]	1	0	1	1	1	0	1	1	1	7
Bayraktar G 2008^[15]	1	1	1	1	1	0	1	1	1	8
Marakoglu I 2003^[16]	0	0	1	1	1	0	1	1	1	6
Pakpour AH 2015^[17]	1	1	1	1	1	0	1	1	1	8
Cengiz MI 2009^[18]	0	0	1	1	1	1	1	1	1	7
Gavaldá C 1999^[19]	0	0	1	1	1	1	1	1	1	7
Bots CP 2006^[20]	1	1	1	0	1	0	1	1	1	7
Bayraktar G 2009^[21]	1	1	1	0	1	1	1	1	1	8
Davidovich E 2005^[22]	1	1	0	1	1	0	1	1	1	7
Tadakamadla J 2014^[23]	0	1	0	1	1	0	1	1	1	6