牙周炎与绝经后骨质疏松症相关性的Meta分析

Association between Periodontitis and Postmenopausal Osteoporosis: A Meta-analysis

目的系统评价评价牙周炎与绝经后骨质疏松症之间的关系。方法计算机检索PubMed(1966～2010.12)、EMbase(1974～2010.12)、CBM(1978～2010.12)、VIP(1989～2010.12)、CNKI(1979～2010.12)和万方数字化期刊全文数据库(1997～2010.12),并手工检索相关杂志及会议论文集中未发表的文献。由2位研究者按照纳入和排除标准筛选文献、提取资料并评价质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入4个病例对照研究,合计678例患者,其中绝经后骨质疏松症组263例,非骨质疏松症组415例。4个研究的合并分析结果显示,绝经后骨质疏松症组临床附着丧失(clinical attachment loss,CAL)程度重于非骨质疏松症组[WMD=0.60,95%CI(0.23,0.96)]。2个研究的合并分析结果显示,绝经后骨质疏松症组牙龈退缩程度高于非骨质疏松症组[WMD=0.78,95%CI(0.41,1.14)]。2个研究合并分析结果显示,两组患者的菌斑指数、牙龈指数、牙周探诊深度之间差异均无统计学意义[WMD=0.17,95%CI(0.00,0.35);WMD=0.05,95%CI(–0.09,0.19);WMD=–0.08,95%CI(–0.24,0.09)]。1个研究发现绝经后骨质疏松症组患者牙周炎患病率高于非骨质疏松症组(P<0.05),与后者相比,前者更容易罹患牙周炎[OR=2.45,95%CI(1.38,4.34),P<0.01];该研究还认为,骨质疏松症与牙槽嵴高度发生重度丧失之间存在相关性[OR=4.20,95%CI(1.57,11.22),P<0.01]。结论绝经后骨质疏松症患者更易罹患牙周炎或其牙周炎病情容易加重。鉴于本系统评价纳入研究数量太少且病例不多,以及测量指标不全面等影响本Meta分析论证强度及全面性的因素存在,以上结论尚需开展更多高质量研究证实。

Objective To explore the relationship between periodontitis and postmenopausal osteoporosis.Meth-ods Databases were electronically searched from PubMed（1966 to December,2010）,EMbase（1974 to December,2010）,CBM（1978 to December,2010）,VIP（1989 to December,2010）,CNKI（1979 to December,2010） and WanFang Data（January,2007 to December,2010）,and the references listed in all papers were also retrieved.e literature was screened according to the inclusion and exclusion criteria by two reviewers independently;the methodology quality was evaluated a er data abstraction;and then the RevMan 5.0 so ware was used for meta-analyses.Results Four trials were included.Among the total 678 patients involved,263 were postmenopausal osteoporosis patients,while the other 415 were non-osteoporosis patients.e results of meta-analyses showed that： a） Clinical attachment loss（CAL） of the postmenopausal osteoporosis patients was significantly higher than that of the non-osteoporosis patients（WMD=0.60,95%CI 0.23 to 0.96）;b） e level of gingival recession of the postmenopausal osteoporosis patients was signi cantly higher than that of the non-osteoporosis patients（WMD=0.78,95%CI 0.41 to 1.14）;c） ere were no signi cant di erences in plaque index（PI）,gingival index（GI） and periodontal probing depth（PPD） between the two groups（WMD=0.17,95%CI 0.00 to 0.35;WMD=0.05,95%CI –0.09 to 0.19;and WMD=–0.08,95%CI –0.24 to 0.09）;d） e results of one study indicated that the rate of periodontitis in the postmenopausal osteoporosis patients was higher than that of the non-osteoporosis patients（OR=2.45,95%CI 1.38 to 4.34,P0.01）;the severe alveolar crest height loss was related to osteoporosis（OR=4.20,95%CI 1.57 to 11.22,P0.01）.Conclusion Postmenopausal osteoporosis patients are more prone to su er from periodontitis or turn to the worse stage of periodontitis.In consideration of the factors such as small scales and incomplete measure indexes of the included studies,which have in uences on the intensity and comprehensiveness of this conclusion,more high-quality studies are required.