中重度慢性牙周炎患者牙周洁刮治前后血清C反应蛋白水平变化的系统评价和Meta分析

doi:10.7518/hxkq.2020.04.006

华西口腔医学杂志 ›› 2020, Vol. 38 ›› Issue (4): 385-392.doi: 10.7518/hxkq.2020.04.006

中重度慢性牙周炎患者牙周洁刮治前后血清C反应蛋白水平变化的系统评价和Meta分析

常雅琴¹(), 房方方¹, 秦莎莎², 董迎春³, 陈斌¹()

1.南京大学医学院附属口腔医院牙周病科,南京 210008
2.西安市疾病预防控制中心非传染性疾病防治科,西安 710054
3.南京大学医学院附属口腔医院麻醉科,南京 210008

收稿日期:2019-12-09 修回日期:2020-04-18 出版日期:2020-08-01 发布日期:2020-08-03
通讯作者: 陈斌 E-mail:361734128@qq.com
作者简介:常雅琴,医师,学士,E-mail： 469814099@qq.com
基金资助:
南京市医学科技发展资金(QRX17176);江苏省科教强卫医学青年人才(QNRC2016117);中央高校基本科研业务费(14-380473)

Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis

Chang Yaqin¹(), Fang Fangfang¹, Qin Shasha², Dong Yingchun³, Chen Bin¹()

1. Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
2. Dept. of Non-Communicable Diseases Prevention and Control, Xi’an Center for Disease Control and Prevention, Xi’an 710054, China
3. Dept. of Anesthesiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China

Received:2019-12-09 Revised:2020-04-18 Online:2020-08-01 Published:2020-08-03
Contact: Chen Bin E-mail:361734128@qq.com
Supported by:
Nanjing Medical Science and Technology Development Fund(QRX17176);Jiangsu Province Science and Education Strong Health Medical Talent(QNRC2016117);Fundamental Research Funds for the Central Universities(14-380473)

摘要/Abstract

摘要：

目的探索牙周洁刮治（SRP）对中重度慢性牙周炎患者血清C反应蛋白（CRP）水平的影响。方法检索PubMed、Web of Science、EMBASE、Cochrane、中国知网、万方数据库、维普数据库,检索时间截止2019年7月8日。由2名研究人员独立筛选文献、提取数据及评估偏倚风险。利用RevMan 5.3软件对数据进行Meta分析。结果共纳入13篇临床随机对照试验,12篇前瞻性临床试验。Meta分析结果显示,与治疗前相比,SRP后2个月、3个月血清CRP水平降低（P<0.05）,6个月时血清CRP水平差异无统计学意义（P=0.49）。结论有限的证据表明,对于无系统性疾病的中重度慢性牙周炎患者来说,SRP治疗可以在短期内降低血清CRP水平。

关键词: 中重度慢性牙周炎, 牙周洁刮治, 血清C反应蛋白

Abstract:

Objective To evaluate the effect of scaling and root planing (SRP) on serum C-reactive protein (CRP) levels in patients with moderate to severe chronic periodontitis. Methods We searched the PubMed, Web of Science, EMBASE, Cochrane, CNKI, Wanfang, and VIP databases from the inception to July 8th, 2019. Two reviewers independently screened literature, extracted data, and evaluated the bias risk of included studies. Then, a meta-analysis was performed using RevMan 5.3 software. Results A total of 13 randomized controlled clinical trials and 12 prospective clinical trials were included. Meta-analysis showed that serum CRP levels decreased at 2 and 3 months after SRP (P<0.05), and no significant difference in serum CRP levels was found at 6 months (P=0.49). Conclusion SRP can reduce serum CRP levels in systematically healthy patients with moderate to severe chronic periodontitis at 2 and 3 months after SRP.

Key words: moderate to severe chronic periodontitis, scaling and root planing, serum C-reactive protein

中图分类号:

R781.4

常雅琴, 房方方, 秦莎莎, 董迎春, 陈斌. 中重度慢性牙周炎患者牙周洁刮治前后血清C反应蛋白水平变化的系统评价和Meta分析[J]. 华西口腔医学杂志, 2020, 38(4): 385-392.

Chang Yaqin, Fang Fangfang, Qin Shasha, Dong Yingchun, Chen Bin. Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis[J]. West China Journal of Stomatology, 2020, 38(4): 385-392.

图/表 8

图 1

表 1

纳入文献基本特征

文献	年份		研究		人数		年龄/岁		性别（男/		吸烟		牙周炎程		干预措施		用药情况	随访	测量
文献	年份		类型		人数		年龄/岁		女）		吸烟		度/类型		干预措施		用药情况	周期	方法
Ebersole等^[9]	1997		RCT		T：8		35~63		NR		NR		中重度		T：SRP+口服		T：服用某药;	2 年	ELISA
															药物
					C：26										C：SRP		C：服用安慰剂
Ide等^[7]	2003		RCT		T：24		T：47.8±7.5		T：13/11		N		中重度		T：OHI+SRP		N	3个月	ELISA
					C：15		C：46.0±6.2		C：10/5						C：无
D’Aiuto等^[8]	2005		RCT		T1：21		T1：48±7		T1：11/10		Y		重度广泛型		T1：OHI+SRP		T2：局部用盐酸	2个月	免疫比浊法
					T2：20		T2：49±7		T2：12/8						T2：OHI+SRP+		米诺环素
															局部用药
					C：24		C：48±6		C：15/9						C：无
D’Aiuto等^[10]	2006		RCT		T：20		T：47±7		T：10/10		Y		重度广泛型		T：OHI+SRP+		T：局部用米诺	6个月	免疫比浊法
															局部用药		环素
					C：20		C：48±7		C：12/8						C：OHI+SPR
Kamil等^[11]	2011		RCT		T：18		T：46.7±3.4		T：10/8		N		重度		T：OHI+SRP		N	3个月	免疫比浊法
					C：18		C：45.4±3.3		C：10/8						C：OHI
Shetty等^[12]	2013		RCT		T：20		25~55		NR		N		中重度		T：OHI+SRP+		T：服用某药;	6个月	免疫比浊法
															口服药物
					C：20										C：OHI+SRP		C：服用安慰剂
Caúla等^[13]	2014		RCT		T：32		T：44.4		T：20/12		Y		重度		T：OHI+SRP		N	6个月	化学免疫测
					C：32		C：44.0¹		C：19/13						C：无				定
文献		年份		研究		人数		年龄/岁		性别（男/		吸烟		牙周炎程		干预措施	用药情况	随访	测量
文献		年份		类型		人数		年龄/岁		女）		吸烟		度/类型		干预措施	用药情况	周期	方法
Al Habash-		2015		RCT		T：20		T：39.7±13.7		T：6/14		N		重度		T：SRP+臭氧	T：局部用臭氧	3个月	ELISA
neh等^[14]																水冲洗	水冲洗
						C：21		C：39.0±10.2		C：7/14						C：SRP+蒸馏
																水冲洗
Graziani等^[15]		2015		RCT		T：19		T：48±9		T：9/10		Y		中度以上		T：OHI+Q-SRP	NR	90 d	免疫比浊法
						C：19		C：46±12		C：10/9						C：OHI+FM-
																SRP
王崇丽等^[16]		2015		RCT		T：50		NR		NR		NR		中重度		T：OHI+ SRP	NR	3个月	ELISA
						C：50										C：健康对照组
白驹^[17]		2017		RCT		T：42		40.72±4.19		45/40		NR		中重度		T：SRP+盐酸	T：局部用盐酸	6个月	NR
																米诺环素	米诺环素
						C：43										C：SRP
Suryapra-		2018		RCT		T：15		30~50		NR		N		中重度		T：SRP+克拉	NR	6个月	ELISA
sanna等^[18]																霉素
						C：15										C：SRP
Graziani等^[19]		2019		RCT		T：19		50.89±10.08		8/11		Y		中重度		T：SRP+局部	NR	3个月	NR
																用药
						C：19										C：SRP
陈群等^[20]		2009		CCT		20		57.0±12.3		14/6		NR		中重度		OHI+ SRP	NR	3个月	NR
Acharya等^[21]		2010		CCT		15		45.1±7.1		NR		N		中重度		OHI+SRP	NR	2个月	ELISA
Graziani等^[22]		2010		CCT		14		49¹（15）²		8/6		Y		广泛型重度		OHI+SRP	NR	6个月	NR
Pej?i?等^[23]		2011		CCT		20		43.4±7.8		0/20		N		广泛型中重度		OHI+SRP	NR	2个月	ELISA
周于翔^[24]		2011		CCT		6		40~77		NR		NR		广泛型中重度		OHI+SRP	NR	3个月	免疫比浊法
兰倩等^[25]		2013		CCT		27		43.12±6.01		17/10		N		广泛型中重度		OHI+SRP	NR	3个月	NR
Torumtay等^[26]		2016		CCT		25		48.32±7.39		NR		N		中重度		OHI+SRP	NR	6个月	ELISA
Yang等^[27]		2018		CCT		31		（50±8）³		11/20		NR		中重度		SRP	NR	8 周	ELISA
薛媛等^[28]		2018		CCT		80		41.3±5.2		28/52		N		中重度		OHI+SRP	NR	6个月	免疫比浊法
Marcaccini		2009		CCT		25		44.90±5.5		9/16		N		重度		OHI+SRP	NR	3个月	免疫比浊法
等^[29]
罗志晓等^[30]		2005		CCT		22		40-55		10/12		N		中重度		OHI+SRP	NR	2个月	ELISA
全茂伟等^[31]		2019		CCT		40		51.2±7.3		23/17		NR		中重度		OHI+SRP	不用抗生素	6个月	透射免疫比
																			浊法

表 1

图 2

图 3

表 2

图 4

图 5

图 6

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文献	研究	纳入患	预期	终点指标	终点指	随访时	失访	是否估	对照组的	对照组	组间基	统计分	总分
	目的	者连贯	数据	反映研究	标评价	间是否	率低	计了样	选择是否	是否同	线是否	析是否
	明确	性	收集	目的	客观性	充分	于5%	本量	恰当	步	可比	恰当
Acharya等^[21]	2	0	2	2	0	0	2	0	2	1	1	2	14
Marcaccini等^[29]	2	2	2	2	0	1	1	0	1	2	1	2	16
Pej?i?等^[23]	2	1	2	2	1	0	2	0	2	2	2	2	18
Torumtay等^[26]	2	1	2	2	0	2	2	2	2	2	2	2	21
陈群等^[20]	2	1	2	2	0	1	2	0	2	2	1	2	17
罗志晓等^[30]	2	0	2	2	0	0	2	0	1	0	0	2	11
薛媛等^[28]	2	1	2	2	0	1	2	0	1	2	0	2	15
周于翔^[24]	2	1	2	2	0	1	2	0	2	2	2	2	18
Graziani等^[22]	2	1	2	2	0	2	2	2	/	/	/	/	13
兰倩等^[25]	2	1	2	2	0	1	0	0	/	/	/	/	8
Yang等^[27]	2	2	2	2	0	1	2	0	/	/	/	/	11
全茂伟等^[31]	2	1	2	2	1	2	2	0	/	/	/	/	12

中重度慢性牙周炎患者牙周洁刮治前后血清C反应蛋白水平变化的系统评价和Meta分析

Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis

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[1]	杨禾徐屹赵蕾孟姝吴亚菲. 牙龈卟啉单胞菌与牙周基础治疗关系的实验研究[J]. 华西口腔医学杂志, 2008, 26(02): 147-151.
[2]	谷宇新;李庆星;由彦玲;刘广顺;韩旭. 牙周炎对2型糖尿病患者血清C反应蛋白水平的影响[J]. 华西口腔医学杂志, 2006, 24(05): 435-437.
[3]	吴亚菲!610041,赵川江!610041,张静仪!610041. 牙周治疗前后龈沟液中白细胞介素-6水平的变化[J]. , 2001, 19(02): 0-.