克拉霉素和甲硝唑治疗慢性牙周炎疗效的Meta分析

Efficacies of clarithromycin and metronidazole in treatment of chronic periodontitis:A Meta-analysis

目的:系统评价全身应用克拉霉素和甲硝唑治疗慢性牙周炎的临床疗效,为临床治疗慢性牙周炎合理用药提供循证医学证据。方法:计算机检索中国知网、维普、万方、中国生物医学文献、PubMed、ScienceDirect和EMBase等数据库有关克林霉素和甲硝唑对比治疗慢性牙周炎的文献,检索时限从建库到2017年6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,使用RevMan 5.3软件对实验数据进行Meta分析。结果:最终纳入5个随机对照实验(RCT),共516例慢性牙周炎患者,纳入指标按照随访时间进行亚组分析,与甲硝唑组比较,克拉霉素组慢性牙周炎患者随访1个月和3个月时牙周探诊深度(PD)减少、附着丧失(AL)获得和龈沟出血指数(SBI)减少方面更加明显,PD、AL和SBI差异均有统计学意义(MD=-0.53,95%CI:-0.67～0.39,P<0.01;MD=-0.31,95%CI:-0.39～-0.24,P<0.01;MD=-0.23,95%CI:-0.29～-0.16,P<0.01)。结论:在牙周基础治疗过程中,在短期观察中慢性牙周炎患者全身应用克拉霉素辅助治疗比甲硝唑更有效。

Objective:To evaluate the efficacies of clarithromycin and metronidazole in the treatment of chronic periodontitis,and to provide the evidence-based medical evidence for the rational use of drugs in the treatment of chronic periodontitis.Methods:CNKI,VIP,Wanfang,Chinese Biomedical Literature Database,PubMed,ScienceDirect and EMbase database from inception to June,2017 were searched by computer for the literatures about the treatment of clarithromycin and metronidazole for chronic periodontitis.Two reviewers independently screened the literatures,extracted the data and evaluated the bias risk of included studies.Then Meta-analysis was performed using RevMan 5.3 software.Results:A total of 5 randomized controlled trial(RCT)involving 516 patients with chronic periodontitis were included.Subgroup analysis was performed according to the follow-up time.Compared with metronidazole group,the probing depth(PD)reduction,attachment loss(AL)gain,and sulcus bleeding index(SBI)reduction of the patients with chronic periodontitis in clarithromycin group at 1 month and 3 months after follow-up were more significant;the differences in PD,AL,and SBI were significant(MD=-0.53,95%CI:-0.67-0.39,P<0.01;MD=-0.31,95%CI:-0.39--0.24,P<0.01;MD=-0.23,95%CI:-0.29--0.16,P<0.01).Conclusion:Systemic antibiotic use of clarithromycin in the treatment of the patients with chronic periodontitis after non-surgical periodontal therapy has a significant additional effect than metronidazole in short-term observation.