益生菌辅助牙周非手术治疗对中重度牙周炎在不同随访周期下疗效的meta分析

The effect of probiotics as an adjunct in the treatment of moderate and severe periodontitis at different longitudinal intervals:a meta-analysis

目的系统评价益生菌辅助牙周非手术治疗(non-surgical periodontal treatment,NSPT)对中重度牙周炎在不同随访周期下的疗效及安全性。方法计算机全面检索PubMed、Cochrane Library、Embase、Clinical Trial gov.、中国知网、万方、维普、中国生物医学数据库中关于益生菌联合NSPT对中重度牙周炎疗效的随机对照试验。使用Cochrane质量评分标准,对纳入的文献进行质量评价,用Stata 14.0软件进行meta分析。结果纳入22项随机对照研究,涉及747例患者,试验组369例,对照组378例。Meta分析显示,在1个月和3个月的随访周期,试验组的探诊深度(PD)和临床附着水平(CAL)显著下降[1个月,PD:MD=0.38(95%CI:0.08~0.68),P<0.05;CAL:MD=0.30(95%CI:0.07~0.53),P<0.05。3个月,PD:MD=0.21(95%CI:0.05~0.37),P<0.05;CAL:MD=0.18(95%CI:0.06~0.29),P<0.01];但在6、9、12个月时,2组差异无统计学意义。在1、3、6个月时,试验组的探诊后出血比例显著减低[1个月,MD=13.48(95%CI:0.78~26.18),P<0.05;3个月,MD=3.90(95%CI:2.09~5.71),P<0.01;6个月,MD=5.11(95%CI:2.42~7.80),P<0.01];但在9、12个月时,差异无统计学意义。对3个月PD和CAL作了多因素meta回归,未能找到异质性的来源。随访周期为3个月时,2组牙周致病菌的数量差异无统计学意义。试验组中重度牙周炎的进展速度和需接受牙周手术的位点数量显著下降[牙周炎进展速度:OR=0.62(95%CI:0.39~0.98),P<0.05;需接受牙周手术的位点数量:OR=0.53(95%CI:0.29~0.99),P<0.05]。结论益生菌联合NSPT在短期内可以改善中重度牙周炎的临床指标,该辅助疗法安全有效、不良反应小,但长期效果不显著。

Objective To assess the effect of probiotic as an adjunct to non-surgical periodontal treatment(NSPT)at different longitudinal intervals and evaluate the drug safety in moderate and severe periodontitis.Methods PubMed,Embase,Cochrane Library,Clinical Trial gov.,CNKI,VIP,WanFang and CBM database were searched for randomized controlled trials(RCTs)on the efficacy of probiotics combined with NSPT in the treatment of moderate to severe periodontitis.Then the quality of the RCTs was evaluated with the criteria introduced by Cochrane Collaboration.Meta-analysis was carried out with Stata 14.0.Results A total of 22 researches including 747 patients were selected.Meta-analysis showed the changes of clinical attachment level(CAL)and probing depth(PD)in the treatment group were significant at 1 and 3month follow-ups[1 month,PD:MD=0.38(95%CI:0.08-0.68),P<0.05;CAL:MD=0.30(95%CI:0.07-0.53),P<0.05.3 month,PD:MD=0.21(95%CI:0.05-0.37),P<0.05;CAL:MD=0.18(95%CI:0.06-0.29),P<0.01],but the differences were not statistically significant at 6,9 and 12 months.With respect to probing on bleeding(BOP),there were a significant reduction at 1,3 and 6 month follow-ups[1 month,MD=13.48(95%CI:0.78-26.18),P<0.05;3 month,MD=3.90(95%CI:2.09-5.71),P<0.01;6 month,MD=5.11(95%CI:2.42-7.80),P<0.01],but the differences were not statistically significant at 9 and 12 month.Meta-regression for 3-month PD and CAL was performed,but we failed to find the source of heterogeneity.In terms of periodontal pathogen levels,there were no significant differences between groups at 3 months.However,probiotics reduced the risks of periodontitis progress,as well as the sites in need of surgeries[the progression of periodontitis:OR=0.62(95%CI:0.39-0.98),P<0.05;the sites in need of surgeries:OR=0.53(95%CI:0.29-0.99),P<0.05].Conclusion Probiotics combined with NSPT can improve the clinical parameters in moderate and severe periodontitis at a short time.This adjuvant therapy is safe and effective,but the long-term effect is not significant.