国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (5): 528-535.doi: 10.7518/gjkq.2021102

• 论著 • 上一篇    下一篇

牙周非手术治疗对慢性肾脏病危险因素及全身炎症水平影响的Meta分析

周万航1(),李嫣斐2,许日聪3,万启军3()   

  1. 1.中国医科大学口腔医学院 辽宁省口腔疾病重点实验室 沈阳 110000
    2.中山大学光华口腔医学院•附属口腔医院修复科 广东省口腔医学重点实验室 广州 510055
    3.深圳大学第一附属医院 深圳市第二人民医院肾内科 深圳 518000
  • 收稿日期:2021-03-03 修回日期:2021-06-12 出版日期:2021-09-01 发布日期:2021-09-10
  • 通讯作者: 万启军
  • 作者简介:周万航,硕士,Email: 729559308@qq.com
  • 基金资助:
    国家自然科学基金(81900639);深圳市医学重点学科建设经费(SZXK009)

Effects of non-surgical periodontal treatment on risk factors of chronic kidney disease and systematic inflammatory levels in patients with chronic kidney disease and periodontal disease: a Meta-analysis

Zhou Wanhang1(),Li Yanfei2,Xu Ricong3,Wan Qijun3()   

  1. 1. School of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang 110000, China
    2. Dept. of Prosthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
    3. Dept. of Kidney, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People,s Hospital, Shenzhen 518000, China
  • Received:2021-03-03 Revised:2021-06-12 Online:2021-09-01 Published:2021-09-10
  • Contact: Qijun Wan
  • Supported by:
    National Natural Science Foundation of China(81900639);Shenzhen Key Medical Discipline Construction Fund(SZXK009)

摘要:

目的 系统评价牙周非手术治疗对慢性肾脏病(CKD)部分危险因素及全身炎症水平的影响,为CKD与牙周病的联合防治提供循证依据。方法 系统检索PubMed、Embase、Cochrane library、Science Direct、Scopus、Web of Science、CNKI、万方、维普中发表的相关文献,检索时间为从建库到2020年7月。由2名评价者独立筛选文献,评价文献质量,提取数据并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 最终纳入6项随机对照试验(RCT),共432例患者。Meta分析结果显示:与无牙周干预的对照组相比,牙周非手术治疗能显著降低治疗前后CKD伴牙周病患者24 h尿蛋白定量分析水平[MD=-0.32,95%CI(-0.50,-0.14),P=0.000 4]、45岁以下患者血清C反应蛋白(CRP)[MD=-1.25,95%CI(-1.38,-1.12),P<0.000 01]及治疗后3、6个月白细胞介素-6(IL-6)水平[MD=-0.82,95%CI(-1.64,0.00),P=0.05;MD=-1.17,95%CI(-2.05,-0.30),P=0.009],并提高患者血清白蛋白(Alb)水平[MD=0.19,95%CI(0.11,0.27),P<0.000 01]。然而,对45岁以上患者血清CRP[MD=-0.06,95%CI(-0.48,0.36),P=0.77]及治疗后6周的血清IL-6[MD=-0.24,95%CI(-1.14,0.67),P=0.61]等,两组差异无统计学意义(P>0.05)。结论 牙周非手术治疗可降低CKD患者24 h尿蛋白定量分析水平,提高血清Alb水平,并可改善45岁以下患者的CRP和IL-6表达状况。

关键词: 牙周非手术治疗, 慢性肾脏病, 牙周病, Meta分析, 系统评价

Abstract:

Objective The aim of this study was to evaluate the effects of non-surgical periodontal treatment on risk factors of chronic kidney disease (CKD) and systemic inflammatory levels in patients with CKD and periodontal disease so as to provide a theoretical reference for co-management. Methods Eligible studies as of July 2020 were searched systematically in PubMed, Embase, Cochrane Library, S-cience Direct, Scopus, Web of Scienc, CNKI, Wanfang, and VIP. Two independent reviewers screened the literature, evaluated the quality of the studies, extracted the data, and evaluated the risk of bias of the included stu-dies in duplicate. Meta-analysis was then conducted with RevMan 5.3. Results Six randomized controlled trials involving 432 participants were included. Meta-analysis showed that compared with the control group, the patients who received non-surgical periodontal treatment had lower 24-hour urinary protein quantity [MD=-0.32, 95% CI (-0.50, -0.14), P=0.000 4], serum C-reactive protein (CRP) in patients under 45 years old [MD=-1.25, 95% CI (-1.38, -1.12), P<0.000 01], serum interleukin-6 (IL-6) after 3 and 6 months of treatment [MD=-0.82, 95% CI (-1.64, 0.00), P=0.05; MD=-1.17, 95% CI (-2.05, -0.30), P=0.009], and higher serum albumin (Alb) [MD=0.19, 95% CI (0.11, 0.27), P<0.000 01]. Meanwhile, the changes in serum CRP in patients over 45 years old [MD=-0.06, 95% CI (-0.48, 0.36), P=0.77] and serum IL-6 after 6 weeks of treatment [MD=-0.24, 95% CI (-1.14, 0.67), P=0.61] had no statistically significant difference between the two groups. Conclusion Non-surgical periodontal treatment has favorable effects on controlling 24-hour urinary protein quantity and serum Alb and reducing systemic inflammatory (CRP and IL-6) levels in patients under 45 years old.

Key words: non-surgical periodontal treatment, chronic kidney disease, periodontal disease, Meta-analysis, systematic review

中图分类号: 

  • R781.4

图1

文献筛选流程"

表 1

纳入研究的基本特征"

纳入研究 国家 样本量
(T/C)
性别
(男/女)
平均年龄/岁
(T/C)
牙周干预措施 随访时间 主要结局指标
T C
Guo等[14] 中国 26/27 24/29 58.1±8.4/56.9±8.5 NSPT+OHI OHI 6周 ③④
Fang等[15] 中国 48/49 55/42 53.71±5.89/55.53±6.74 NSPT+OHI+EXT N 6周,3、6个月 ①④
Wehmeyer等[13] 美国 25/26 33/18 52.7±10.6/54.1±9.0 NSPT+OHI+EXT+AT OHI 3、6个月 ①④
李浩萍等[16] 中国 36/36 39/33 40.28±6.30/39.87±6.13 NSPT+OHI N 8周 ②③
马欣等[17] 中国 52/46 56/42 39.2±5.2 NSPT+OHI N 6周 ②③
张晋玮等[18] 中国 31/30 30/31 48.87±4.74/48.35±4.53 NSPT+OHI N 1个月

表 2

纳入研究的偏倚风险评价"

纳入研究 随机分组 分配隐藏 盲法 随访偏倚 报告偏倚 其他偏倚
Guo等[14] 不清楚 不清楚 不清楚
Fang等[15] 随机数字表 双盲
Wehmeyer等[13] 随机数字表
李浩萍等[16] 不清楚 不清楚 不清楚
马欣等[17] 不清楚 不清楚 不清楚
张晋玮等[18] 随机数字表 不清楚 不清楚

图2

2组患者24 h尿蛋白定量分析的Meta分析"

图3

2组患者Alb的Meta分析"

图4

2组患者血清CRP的Meta分析"

图5

2组患者血清IL-6的Meta分析"

[1] Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives[J]. Lancet, 2013, 382(9888):260-272.
doi: 10.1016/S0140-6736(13)60687-X
[2] Chandy S, Joseph K, Sankaranarayanan A, et al. Evaluation of C-reactive protein and fibrinogen in patients with chronic and aggressive periodontitis: a clinico-biochemical study[J]. J Clin Diagn Res, 2017, 11(3): ZC41-ZC45.
[3] Sabharwal A, Gomes-Filho IS, Stellrecht E, et al. Role of periodontal therapy in management of common complex systemic diseases and conditions: an update[J]. Periodontol 2000, 2018, 78(1):212-226.
doi: 10.1111/prd.2018.78.issue-1
[4] Kshirsagar AV, Moss KL, Elter JR, et al. Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study[J]. Am J Kidney Dis, 2005, 45(4):650-657.
pmid: 15806467
[5] 周万航, 李嫣斐, 郭留云, 等. 牙周病与慢性肾病关系研究进展[J]. 中国实用口腔科杂志, 2019, 12(10):622-627.
Zhou WH, Li YF, Guo LY, et al. Research progress on the relationship between periodontal disease and chronic kidney disease[J]. Chin J Pract Stomatol, 2019, 12(10):622-627.
[6] Sharma P, Dietrich T, Sidhu A, et al. The periodontal health component of the Renal Impairment In Secondary Care (RIISC) cohort study: a description of the rationale, methodology and initial baseline results[J]. J Clin Periodontol, 2014, 41(7):653-661.
doi: 10.1111/jcpe.12263
[7] Oyetola EO, Owotade FJ, Agbelusi GA, et al. Oral findings in chronic kidney disease: implications for management in developing countries[J]. BMC Oral Health, 2015, 15:24.
doi: 10.1186/s12903-015-0004-z pmid: 25888327
[8] Ricardo AC, Athavale A, Chen JS, et al. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey[J]. BMC Nephrol, 2015, 16:97.
doi: 10.1186/s12882-015-0101-x pmid: 26149680
[9] Grubbs V, Vittinghoff E, Beck JD, et al. Association between periodontal disease and kidney function decline in African Americans: the Jackson heart study[J]. J Periodontol, 2015, 86(10):1126-1132.
doi: 10.1902/jop.2015.150195
[10] Sharma P, Dietrich T, Ferro CJ, et al. Association between periodontitis and mortality in stages 3-5 chro-nic kidney disease: NHANESⅢand linked mortality study[J]. J Clin Periodontol, 2016, 43(2):104-113.
doi: 10.1111/jcpe.2016.43.issue-2
[11] Chambrone L, Foz AM, Guglielmetti MR, et al. Periodontitis and chronic kidney disease: a systema-tic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate[J]. J Clin Periodontol, 2013, 40(5):443-456.
doi: 10.1111/jcpe.12067 pmid: 23432795
[12] Zhao D, Khawaja AT, Jin LJ, et al. Effect of non-surgical periodontal therapy on renal function in chro-nic kidney disease patients with periodontitis: a systematic review and Meta-analysis of interventional studies[J]. Clin Oral Investig, 2020, 24(4):1607-1618.
doi: 10.1007/s00784-019-03066-w
[13] Wehmeyer MM, Kshirsagar AV, Barros SP, et al. A randomized controlled trial of intensive periodontal therapy on metabolic and inflammatory markers in patients with ESRD: results of an exploratory study[J]. Am J Kidney Dis, 2013, 61(3):450-458.
doi: 10.1053/j.ajkd.2012.10.021 pmid: 23261122
[14] Guo N, Lin G. Effects of nonsurgical periodontal therapy on serum inflammatory factor levels in patients with chronic kidney disease and periodontitis[J]. Biomed Res, 2017, 28(9):3899-3902.
[15] Fang FC, Wu BL, Qu Q, et al. The clinical response and systemic effects of non-surgical periodontal the-rapy in end-stage renal disease patients: a 6-month randomized controlled clinical trial[J]. J Clin Perio-dontol, 2015, 42(6):537-546.
[16] 李浩萍, 李明勇. 慢性肾病伴牙周炎患者牙周基础治疗疗效及对肾功能指标的影响[J]. 北华大学学报(自然科学版), 2018, 19(3):374-377.
Li HP, Li MY. Therapeutic effect of periodontal ba-sic treatment in patients with chronic renal disease and periodontitis and its effect on renal function[J]. J Beihua Univ Nat Sci, 2018, 19(3):374-377.
[17] 马欣, 李昊, 丑海燕, 等. 牙周基础治疗对慢性肾脏病伴牙周炎患者牙周指数及龈沟液炎性因子和肾功能指标的影响[J]. 中华实用诊断与治疗杂志, 2018, 32(3):255-257.
Ma X, Li H, Chou HY, et al. Effect of periodontal therapy on periodontal index, gingival crevicular fluid inflammatory factors and renal indexes in patients with chronic kidney disease and periodontitis[J]. J Chin Pract Diagn Ther, 2018, 32(3):255-257.
[18] 张晋玮, 刘建山, 马明, 等. 牙周基础治疗对行腹膜透析牙周炎患者的影响[J]. 天津医药, 2017, 45(3):282-284.
Zhang JW, Liu JS, Ma M, et al. Effects of periodon-tal basic treatment on peritoneal dialysis in patients with periodontitis[J]. Tianjin Med J, 2017, 45(3):282-284.
[19] Stevens PE, Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline[J]. Ann Intern Med, 2013, 158(11):825-830.
doi: 10.7326/0003-4819-158-11-201306040-00007 pmid: 23732715
[20] Cholewa M, Madziarska K, Radwan-Oczko M. The association between periodontal conditions, inflammation, nutritional status and calcium-phosphate metabolism disorders in hemodialysis patients[J]. J Appl Oral Sci, 2018, 26:e20170495.
[21] Lim CC, Teo BW, Ong PG, et al. Chronic kidney disease, cardiovascular disease and mortality: a prospective cohort study in a multi-ethnic Asian population[J]. Eur J Prev Cardiol, 2015, 22(8):1018-1026.
doi: 10.1177/2047487314536873
[22] Melsom T, Solbu MD, Schei J, et al. Mild albumi-nuria is a risk factor for faster GFR decline in the nondiabetic population[J]. Kidney Int Rep, 2018, 3(4):817-824.
[23] Lambers Heerspink HJ, Gansevoort RT. Albumi-nuria is an appropriate therapeutic target in patients with CKD: the proview[J]. Clin J Am Soc Nephrol, 2015, 10(6):1079-1088.
doi: 10.2215/CJN.11511114
[24] Kubo S, Kitamura A, Imano H, et al. Serum albumin and high-sensitivity C-reactive protein are independent risk factors of chronic kidney disease in middle-aged Japanese individuals: the circulatory risk in communities study[J]. J Atheroscler Thromb, 2016, 23(9):1089-1098.
doi: 10.5551/jat.33530
[25] Walther CP, Gutiérrez OM, Cushman M, et al. Serum albumin concentration and risk of end-stage renal disease: the REGARDS study[J]. Nephrol Dial Transplant, 2018, 33(10):1770-1777.
doi: 10.1093/ndt/gfx331
[26] Cohen SA, Kopp RP, Palazzi KL, et al. Association of rise in C-reactive protein with decline in renal function following partial nephrectomy[J]. Can J U-rol, 2015, 22(6):8085-8092.
[27] Kugler E, Cohen E, Goldberg E, et al. C reactive protein and long-term risk for chronic kidney disease: a historical prospective study[J]. J Nephrol, 2015, 28(3):321-327.
doi: 10.1007/s40620-014-0116-6 pmid: 24981713
[28] Li WJ, Chen XM, Nie XY, et al. Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: a meta-analysis[J]. Clinics (Sao Paulo), 2015, 70(4):301-311.
doi: 10.6061/clinics
[29] Santos-Paul MA, Neves RS, Gowdak LHW, et al. Cardiovascular risk reduction with periodontal treatment in patients on the waiting list for renal transplantation[J]. Clin Transplant, 2019, 33(8):e13658.
[30] Huang ST, Yu TM, Ke TY, et al. Intensive periodontal treatment reduces risks of hospitalization for cardiovascular disease and all-cause mortality in the hemodialysis population[J]. J Clin Med, 2018, 7(10):E344.
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