非手术牙周治疗对于Ⅱ型糖尿病人血糖控制的系统评价

Meta-analysis of the effect of non-surgical periodontal treatment( NSPT) on HbA1c level of diabetes patients

目的:系统评价非手术牙周治疗(non-surgical periodontal treatment,NSPT)对于Ⅱ型糖尿病患者血糖控制的疗效。方法:计算机检索MEDLINE(1948～2017. 12),EMBASE(1984～2017. 12),Cochrane Central Register of Controlled Trials(2017年第6期),人工检索纳入文献的参考文献列表以及下列期刊:Diabetes care,Diabetes,Journal of Periodontology,Journal of Clinical Periodontology,Journal of Dental Research。按照Cochrane系统评价方法查找探索NSPT对Ⅱ型糖尿病患者Hb A1c影响的所有随机对照试验(RCT),进行数据提取和质量评价后,采用STATA软件进行Meta分析。结果:共纳入14个RCT,总人数1395人,纳入文献选择的随访时间为3、4、6个月。Meta分析结果表明:接受NSPT 3个月后,患者Hb A1c降低0. 75%,95%CI(-1. 20,-0. 31);接受NSPT 4个月后,患者的Hb A1c下降0. 24%,95%CI(-0. 54,0. 06),差异无统计学意义;,接受NSPT 6个月后,患者Hb A1c的水平降低0. 66%,95%CI(-1. 31,-0. 01)。亚组分析结果显示:接受NSPT 3个月后,对基线Hb A1c≤8%的患者,Hb A1c均值降幅较低,下降均值为0. 25%,95%CI(-0. 44,-0. 06),而对于基线Hb A1c> 8%的患者,NSPT可使得Hb A1c均值下降1. 59%,95%CI(-2. 26,-0. 92);接受NSPT 6个月后,对基线Hb A1c≤8%的患者,Hb A1c均值未见明显下降,下降均值为0. 25%,95%CI (-0. 62,0. 11);而对于基线Hb A1c> 8%的患者,NSPT可使得Hb A1c均值下降2. 29%,95%CI(-2. 99,-1. 58)。结论:NSPT可能有助于Ⅱ型糖尿病患者的血糖控制。NSPT对血糖控制的效果显著依赖于治疗前血糖控制情况,治疗前血糖控制差的患者(Hb A1c基线> 8%)从NSPT中获益最大(3月:-1. 59%,6月:-2. 29%)。仍需高质量、大样本、多中心、长期随访的随机对照试验进一步论证本结论的可信度。

Objective：To evaluate the effect of non-surgical periodontal treatment（NSPT） on HbA1 c level of diabe- tes patients. Methods ：The following databases as MEDLINE （via OVID, 1948 to December 2017 ）, EMBASE （via OVID, 1984 to December 2017） , Cochrane Central Register of Controlled Trials（ CENTRAL, issue 6 2017） were searched with Eng- lish language limitation. Manual search included searching the reference lists of included studies and the following journals： Diabetes care, Diabetes, Journal of Periodontology, Journal of Clinical Periodontology and Journal of Dental Research. The quality of included randomized controlled trials （RCTs）was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using STATA 14. 0. Results：A total of 14 RCTs were included. The results of meta-a- nalysis showed that at 3-month follow-up, HbA1 c was reduced by 0. 75 % in NSPT group （SMD = -0. 75 % ,95% CI - 1.20 to - 0. 31 ,P = 0. 000）. At 4- month follow- up, HbA1 c was reduced by 0. 24% in NSPT group（ SMD = - 0. 24% ,95% CI - 0. 54 to 0. 06,P 〉0. 05） and at 6- month follow- up,HbAlc was reduced by 0. 66% in NSPT group（SMD = -0. 66% ,95% CI - 1.31 to -0. 01 ,P = 0. 000）. Subgroup analysis was applied based on the baseline of HbA1 c level,which indicated that at 3- month follow- up, for patients with HbAlc less than 8%, HbAlc was reduced by 0. 25% in NSPT group （ SMD = -0. 25% ,95% CI -0. 44 to -0. 06,P =0. 143） ,for those with HbAlc more than 8% ,HbAlc was reduced by 1.59% in NSPT group（ SMD = - 1.59% ,95% CI - 2. 26 to - 0. 92, P = 0. 000） and at 6- month follow- up, for patients with HbA1 c less than 8% ,HbAlc was reduced by 0. 25% in NSPT group（SMD = -0. 25% ,95% CI -0. 62 to 0. 11 ,P =0. 021 ） ,forthose with HbAlc more than 8%, HbA1 c was reduced by 2. 29% in NSPT group （SMD = -2. 29%, 95% CI -2. 99 to - 1.58, P = 0. 000）. Conclusion ： NSPT might be effective for reducing HbA1 c level of diabetes patients. The effects of NSPT significantly rely on the HbA1 c level before receiving NSPT. Patients with HbA1 c more than 8 % before receiving NSPT bene- fit most（ 3-month follow-up： - 1.59%, 6-month follow-up： -2. 29% ）. But this conclusion still need to be confirmed by per- forming more high quality,large sample RCTs with long-term follow-up.