国际口腔医学杂志

国际口腔医学杂志 ›› 2022, Vol. 49 ›› Issue (3): 305-316.doi: 10.7518/gjkq.2022054

• 论著 • 上一篇    下一篇

光动力疗法辅助治疗牙周炎治疗效果的Meta分析

马玉1(),左玉2,张鑫1()   

  1. 1.苏州大学附属口腔医院综合科 苏州 215000
    2.桂林医学院附属口腔医院口腔修复科 桂林 541004
  • 收稿日期:2021-06-10 修回日期:2021-12-28 出版日期:2022-05-01 发布日期:2022-05-09
  • 通讯作者: 张鑫
  • 作者简介:马玉，主治医师，硕士，Email：137874636@qq.com

Photodynamic therapy as an adjunct to periodontitis: a meta-analysis

Ma Yu1(),Zuo Yu2,Zhang Xin1()   

  1. 1.Dept. of Ge-neral Dentistry, The Affiliated Stomatological Hospital of Soochow University, Suzhou 215000, China
    2.Dept. of Prostho-dontics, The Affiliated Stomatological Hospital of Guilin Medical College, Guilin 541004, China
  • Received:2021-06-10 Revised:2021-12-28 Online:2022-05-01 Published:2022-05-09
  • Contact: Xin Zhang

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摘要： 目的

评价光动力疗法（PDT）辅助龈下刮治和根面平整术（SRP）治疗牙周炎的临床效果。

方法

通过计算机检索PubMed、Embase、Web of science/SCI、万方数据库、中国知网、维普数据库已发表的一次文献，采用布尔运算法则组合医学主题词+自由词，检索时间由建库至2020年12月，语言类型为中文或英文，同时手工检索相关期刊，获取SRP+PDT治疗牙周炎的随机对照试验。根据纳入排除标准筛选文献，利用Cochrane偏倚风险评价工具进行文献质量评价，使用 RevMan 5.3软件对被纳入的文献进行Meta分析。结局指标采用临床附着丧失（CAL）、探诊深度（PD）、菌斑指数（PI）、探诊出血（BOP）。

结果

共纳入21篇文献。Meta分析显示，使用SRP+PDT治疗的试验组在治疗1个月时，PD和BOP的差异有统计学意义（PD：SMD=-0.81，95%CI为-1.40~ -0.21，P=0.008；BOP：SMD=-0.61，95%CI为-1.05~-0.16，P=0.008）；治疗3个月时，仅PD的差异有统计学意义（SMD=-0.57，95%CI为-0.91~-0.23，P=0.001）；治疗6个月时，CAL和PD的差异有统计学意义（CAL：SMD=-0.46，95%CI为-0.88~-0.03，P=0.04；PD：SMD=-0.57，95%CI为-1.04~-0.11，P=0.02）；试验组均低于对照组。

结论

PDT辅助SRP可在短期（6个月）内改善CAL，减少PD，但尚无证据显示在改善PI和BOP方面，PDT辅助SRP优于单纯SRP。

关键词: 光动力疗法, 龈下刮治和根面平整术, 牙周炎, Meta分析

Abstract: Objective

This study aimed to evaluate the clinical efficacy of photodynamic therapy (PDT) adjunctive to scaling and root planning (SRP) in patients with chronic periodontitis.

Methods

Published literature on PubMed, Embase, Web of Science/SCI, Wanfang, CNKI, and VIP was searched by Boolean algorithm combined with medical subject words and free words. The time was also searched from their inception until December 2020, and the language type was Chinese or English. Then, a manual search was performed to obtain a randomized controlled trial of PDT adjunctive to SRP in the treatment of periodontitis. Literature was screened out on the basis of the inclusion and exclusion criteria. The Cochrane bias risk assessment tool was used to evaluate literature quality. Revman 5.3 software was used for meta-analysis. Outcome indicators included clinical attachment loss, probing depth, plaque index, and bleeding on probing.

Results

A total of 21 articles were included. Meta-analysis showed that at 1 month after SRP+PDT treatment, PD and BOP diffe-rences were statistically significant (PD: SMD=-0.81, 95%CI was -1.40 to -0.21, P=0.008; BOP: SMD=-0.61, 95%CI was -1.05 to -0.16, P=0.008). At 3 months after treatment, only PD difference was statistically significant (SMD=-0.57, 95%CI was -0.91 to -0.23, P=0.001). At 6 months after treatment, CAL and PD differences were statistically significant (CAL: SMD=-0.46, 95%CI was -0.88 to -0.03, P=0.04; PD: SMD=-0.57, 95%CI was -1.04 to -0.11, P=0.02). The experimental group was lower than the control group.

Conclusion

PDT adjunctive to SRP improved CAL and reduced PD in the short term (6 months), but no evidence that PDT adjunctive to SRP was superior to pure SRP in improving PI and BOP was found.

Key words: photodynamic therapy, scaling and root planning, periodontitis, meta-analysis

中图分类号: 

  • R 783

表 1

纳入研究的基本特征"

作者发表年国家

研究人数

（男/女）

样本量（试验组/对照组）年龄/岁

研究

设计

激光参数光敏剂参数
波长/nm额定功率/mWPDT次数种类质量浓度/g·L-1放置时间/s
Grzech-Le?niak等[6]2019波兰40（15/25）40（20/20）50.3±11.6FMD6355001甲苯胺蓝－－
Vohra等[11]2018沙特阿拉伯52（26/26）52（23/29）50.1±9.98FMD6701501亚甲基蓝10－
Segarra-Vidal等[12]2017西班牙40（12/28）40（20/20）55±2FMD6701501亚甲基蓝0.05－
Monzavi等[26]2016伊朗50（25/25）50（25/25）49.6±8.5FMD8102003吲哚菁绿5－
Betsy等[27]2014印度88（37/51）88（44/44）39.6±8.7FMD655601亚甲基蓝10180
Raut等[28]2018印度50（28/22）50（25/25）49.8±5.1FMD8108001吲哚菁绿560
Alwaeli等[29]2015马来西亚16（5/11）32（16/16）40.9±13.34SMD6601001吩噻嗪氯化物－60
Lui等[30]2011中国24（10/14）48（24/24）50SMD9401 5003亚甲基蓝100180
Raj等[31]2016印度20（8/12）40（20/20）35~50SMD6352003甲苯胺蓝160
Harmouche等[32]2019法国36（14/22）72（36/36）50.25±5.98SMD625~6352 0003甲苯胺蓝0.160
Theodoro等[33]2012巴西33（12/21）33（22/11）43.12±8.2FMD6604001甲苯胺蓝0.1－
Petelin等[34]2015斯洛文尼亚27（9/18）27（18/9）47±2.8FMD660603吩噻嗪氯化物－180
Corrêa等[35]2015巴西20（11/9）40（20/20）48.1±7.5SMD660601亚甲基蓝1060
Siva等[36]2020巴西19（8/11）38（19/19）34~66SMD6601001－－－
Chondros等[37]2009荷兰24（10/14）24（12/12）49.5±8.47FMD670751吩噻嗪氯化物－60
Polansky等[38]2009澳大利亚58（22/36）58（29/29）48.7FMD680751－－－
Birang等[39]2015伊朗20（7/13）40（20/20）37.2±8.6SMD8105003－－－
Rahman等[40]2020印度15（8/7）15（10/5）－FMD8105001吲哚菁绿5180
Shingnapurkar等[41]2016印度30（15/15）60（30/30）－SMD8102001吲哚菁绿5180
Bassir等[42]2013伊朗16（8/8）32（16/16）50.3±8.7SMD625~6352 0003甲苯胺蓝0.1180
Malgikar等[43]2016印度24（15/9）48（24/24）35.83±7.81SMD9801 5001亚甲基蓝10180

表 2

纳入文献的质量评价结果"

作者随机分配方法分配方案隐藏方式研究人员或患者的盲法结果评估者的盲法结果数据的完整性选择性报告研究结果其他偏倚来源
Grzech-Le?niak等[6]计算机生成的随机化表未描述未描述未描述完整未描述未描述
Vohra等[11]抛硬币按顺序编号的密封不透明信封未描述未描述完整未描述无
Segarra-Vidal等[12]计算机生成的随机化表按顺序编号的密封不透明信封未描述正确完整无选择性报告无
Monzavi等[26]区组随机化按顺序编号的密封不透明信封正确正确完整无选择性报告无
Betsy等[27]随机数字表按顺序编号的密封不透明信封未描述正确完整无选择性报告无
Raut等[28]抽签法未描述未描述正确完整未描述未描述
Alwaeli等[29]计算机生成的随机化表按顺序编号的密封不透明信封未描述正确完整无选择性报告无
Lui等[30]未描述未描述未描述正确完整未描述未描述
Raj等[31]抛硬币未描述未描述未描述完整未描述未描述
Harmouche等[32]计算机生成的随机化表按顺序编号的密封不透明信封正确正确完整无选择性报告无
Theodoro等[33]计算机生成的随机化表未描述未描述未描述完整未描述未描述
Petelin等[34]未描述未描述未描述未描述完整未描述未描述
Corrêa等[35]计算机生成的随机化表按顺序编号的密封不透明信封未描述正确完整未描述未描述
Siva等[36]未描述未描述未描述未描述完整未描述未描述
Chondros等[37]抛硬币未描述未描述正确完整未描述未描述
Polansky等[38]计算机生成的随机化表未描述未描述正确完整未描述未描述
Birang等[39]随机数字表未描述正确未描述完整无选择性报告未描述
Rahman等[40]区组随机化按顺序编号的密封不透明信封未描述正确完整无选择性报告无
Shingnapurkar等[41]抛硬币未描述未描述未描述完整未描述未描述
Bassir等[42]计算机生成的随机化表按顺序编号的密封不透明信封正确正确完整无选择性报告无
Malgikar等[43]计算机生成的随机化表按顺序编号的密封不透明信封未描述正确完整无选择性报告无

表　3

CAL、PD、PI和BOP的Meta分析结果"

指标时间/月SMD95%CIP值
CAL1-0.09-0.31~0.130.41
3-0.18-0.40~0.050.13
6-0.46-0.88~-0.030.04*
PD1-0.81-1.40~-0.210.008*
3-0.57-0.91~-0.230.001*
6-0.57-1.04~-0.110.02*
PI1-0.22-0.46~0.020.07
3-0.11-0.32~0.090.28
60.19-0.14~0.530.26
BOP1-0.61-1.05~-0.160.008*
3-0.11-0.70~0.490.72
6-0.26-1.47~0.950.67

图2

CAL的meta分析结果"

图3

PD的Meta分析结果"

表　4

根据光敏剂种类的亚组分析结果"

指标时间/月吩噻嗪染料组吲哚菁绿组
SMD95%CIP值SMD95%CIP值
PD1-0.49-1.08~0.100.100-1.52-2.24~-0.80<0.000 1*
3-0.41-0.71~-0.110.007-1.92-3.08~-0.770.001 0*

表　5

根据光敏剂放置时间的亚组分析结果"

指标时间/月60 s组180 s组
SMD95%CIP值SMD95%CIP值
PD3-0.40-0.77~-0.030.03*-0.79-1.39~-0.180.01*
6-0.35-0.88~0.180.19-0.74-1.39~-0.090.03*
CAL6-0.31-0.77~0.140.18-0.90-1.98~0.190.11

表　6

根据PDT次数的亚组分析结果"

指标时间/月1次组3次组
SMD95%CIP值SMD95%CIP值
PD1-0.38-0.89~0.120.14-1.46-2.78~-0.140.03*
3-0.42-0.80~-0.050.03*-0.87-1.61~-0.130.02*
6-0.54-1.06~-0.010.05-0.80-2.45~0.850.34
CAL6-0.32-0.68~0.030.04*-1.28-3.90~1.340.08

表　7

根据研究设计亚组的分析结果"

指标时间/月FMD组SMD组
SMD95%CIP值SMD95%CIP值
PD1-0.70-1.75~0.350.19-0.90-1.74~-0.060.03*
3-0.71-1.32~-0.100.02*-0.45-0.84~-0.070.02*
6-0.64-1.32~0.040.07-0.42-0.94~0.090.10
CAL6-0.58-1.25~0.090.09-0.24-0.61~0.130.20

图4

BOP在6个月时的敏感性分析结果"

图5

CAL在6个月时的发表偏倚检测结果"

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