抗生素辅助牙周非手术治疗对侵袭性牙周炎疗效的Meta分析

Efficacy of Systemic Antibiotic Combined with Non-surgical Periodontal Therapy for Aggressive Periodontitis:A Meta-analysis

目的系统评价抗生素辅助牙周非手术治疗对侵袭性牙周炎患者的临床疗效。方法计算机检索PubMed、EMbase、The Cochrane Library(2016年1期)、WanFang Data、CBM、VIP和CNKI数据库,搜集抗生素辅助牙周非手术治疗侵袭性牙周炎的相关随机对照试验(RCT),检索时限均为建库至2016年1月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入8个RCT,共236名侵袭性牙周炎患者。Meta分析结果显示:抗生素辅助牙周非手术治疗相较于单纯牙周非手术治疗,不仅能改善患者3个月、6个月和12个月的牙周探诊深度[3个月:MD=0.33,95%CI(0.25,0.41),P<0.000 01;6个月:MD=0.53,95%CI(0.44,0.62),P<0.000 01;12个月:MD=0.52,95%CI(0.23,0.81),P=0.000 4],还能改善患者3个月、6个月和12个月的临床附着丧失[3个月:MD=0.43,95%CI(0.30,0.56),P<0.000 01;6个月:MD=0.44,95%CI(0.33,0.55),P<0.000 01;12个月:MD=0.43,95%CI(0.20,0.65),P=0.000 2]。结论现有证据表明,牙周非手术治疗辅助使用抗生素(甲硝唑和阿莫西林)治疗侵袭性牙周炎可获得更好的临床疗效。但受纳入研究数量和质量的限制,上述结论可能存在偏倚,需开展更多高质量研究予以验证。

Objective To systematically evaluate the clinical efficacy of systemic antibiotic combined with non- surgical periodontal therapy for aggressive periodontitis. Methods We searched PubMed, EMbase, The Cochrane Library, WanFang Data, CBM, VIP and CNKI databases from inception to January, 2016, to collect randomized controlled trials （RCTs） about non-surgical periodontal therapy combined with systemic antibiotics for aggressive periodontitis. Two reviewers independently screened literature, extracted data and evaluated the bias risk of included studies. Then metaanalysis was performed using RevMan 5.3 software. Results A total of 8 RCTs involving 236 patients were included. The results of meta-analysis showed, compared with non-surgical periodontal therapy alone, non-surgical periodontal therapy combined with systemic antibiotics showed a significant additional probing depth reduction at 3-, 6- and 12 months follow-up （MD=0.33, 95%CI 0.25 to 0.41, P〈0.000 01; MD=0.53, 95%CI 0.44 to 0.62, P〈0.000 01; MD=0.52, 95%CI 0.23 to 0.81, P=0.000 4）, and a significant clinical attachment gain at 3-, 6- and 12 months follow-up （MD=0.43, 95%CI 0.30 to 0.56, P〈0.000 01; MD=0.44, 95%CI 0.33 to 0.55, P〈0.000 01; MD=0.43, 95%CI 0.20 to 0.65, P=O.O00 2）. Conclusion Current evidence shows that the treatment of patients with aggressive periodontitis, systemic antibiotic （Metronidazole and Amoxicillin） combined with non-surgical periodontal therapy has a significant additional effect than non-surgical therapy alone. However, because of the limitation of quality and quantity of included studies, the above conclusion still needs to be further proved by conducting more high-quality and large-scale RCTs.