富血小板血浆联合植骨材料与单用植骨材料比较治疗牙周病骨内缺损疗效的Meta分析

Platelet-Rich Plasma for the Treatment of Periodontal Intrabony Defects: A Meta-Analysis

目的系统评价富血小板血浆联合植骨材料治疗牙周骨内缺损的疗效。方法计算机检索PubMed、e Cochrane Library、EMbase、CNKI、CBM和WanFang Data,查找富血小板血浆(platelet-rich plasma,PRP)联合植骨材料与单用植骨材料比较治疗牙周骨内缺损的随机对照试验(RCT),检索时限均从建库至2012年8月。由2名研究员按照纳入和排除标准筛选文献、提取资料,并评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入11个RCT,共342例受试者。7个研究的合并分析结果显示,PRP联合植骨材料组的临床附着丧失增加程度低于单用植骨材料组[WMD=0.70,95%CI(0.51,0.90),P<0.000 01]。7个研究的合并分析结果显示,两组的牙龈退缩程度差异无统计学意义[WMD=–0.01,95%CI(–0.15,0.13),P=0.86]。9个研究的合并分析结果显示,PRP联合植骨材料组菌斑指数的减少程度与植骨材料组之间差异无统计学意义[WMD=0.04,95%CI(0.09,0.02),P=0.20]。结论在临床附着丧失方面,PRP联合植骨材料组疗效优于单用植骨材料组,然而,在牙龈退缩、菌斑指数方面,两者疗效无差异。受纳入研究数量限制,且测量指标不全面,上述结论尚待开展更多高质量、大样本的研究予以证实。

Objective To systematically evaluate the clinical effectiveness of platelet-rich plasma （PRP） combined with grafting material for the treatment of periodontal intrabony defects. Methods The following databases such as PubMed, The Cochrane Library, EMbase, CNKI, CBM and WanFang Data were searched on computer from inception to August, 2012 to collect the relevant randomized controlled trials （RCTs） on PRP combined with grafting material versus grafting material alone for periodontal intrabony defects. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies, RevMan 5.2 software was applied for meta-analysis. Results A total of 11 RCTs involving 342 patients were included. The pooled analysis on 7 RCTs showed that there was a significant difference in lower increase of clinical attachment loss （WMD=0.70, 95%CI 0.51 to 0.90, P〈0.000 01） between the PRP combined with grafting material group and the grafting material alone group. But there was no significant difference in the gingival recession （WMD= -0.01, 95%CI -0.15 to 0.13, P=0.86）. The pooled analysis on 9 RCTs showed that there was no significant difference in the reduction of plaque index （WMD= -0.04, 95%CI -0.09 to 0.02, P=0.20） between the two groups. Conclusion PRP combined with grafting mate- rial is superior to grafting material alone in the clinical attachment loss. But, there are no significant differences in gingival recession and plaque index. However, given the limited sample size and incomplete measure indexes of included studies, this conclusion still needs to be further proved by conducting more high-quality and large-scale RCTs.