国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (6): 850-858.doi: 10.7518/gjkq.2026648

• 论著 • 上一篇    

光动力疗法和全身抗菌药物辅助治疗Ⅲ期或Ⅳ期牙周炎合并2型糖尿病患者的临床疗效比较

叶兴如1(),左玉2,马玉3()   

  1. 1.苏州口腔医院牙周病科 苏州 215000
    2.桂林医科大学附属口腔医院口腔修复科 桂林 541004
    3.苏州英博口腔门诊部 苏州 215000
  • 收稿日期:2025-03-18 修回日期:2026-09-18 出版日期:2026-11-01 发布日期:2026-10-29
  • 通讯作者: 马玉
  • 作者简介:叶兴如，主治医师，硕士，Email：694337259@qq.com

Comparing the clinical efficacy of photodynamic therapy and systemic antimicrobial drug in the adjunct treatment of patients with stage Ⅲ or Ⅳ periodontitis complicated with type 2 diabetes mellitus

Xingru Ye1(),Yu Zuo2,Yu Ma3()   

  1. 1.Dept. of Periodontics, Suzhou Stomatological Hospital, Suzhou 215000, China
    2.Dept. of Prosthodontics, Affiliated Stomatological Hospital of Guilin Medical College, Guilin 541004, China
    3.Suzhou Yingbo Dental Clinic, Suzhou 215000, China
  • Received:2025-03-18 Revised:2026-09-18 Online:2026-11-01 Published:2026-10-29
  • Contact: Yu Ma

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摘要：

目的 比较光动力疗法（PDT）和全身抗菌药物辅助龈下刮治和根面平整术（SRP）治疗Ⅲ期或Ⅳ期牙周炎合并2型糖尿病（T2DM）患者的临床疗效。 方法 将51名Ⅲ期或Ⅳ期牙周炎合并T2DM患者按照区组随机法分为3组：SRP组、SRP+阿莫西林（AMX）+甲硝唑（MTZ）组、SRP+PDT组，根据不同分组进行相应治疗。随访6个月，比较3组的糖化血红蛋白（HbA1c）、探诊深度（PD）、临床附着丧失（CAL）、牙龈指数（GI）、骨丧失率（BLR）、白细胞介素-6（IL-6）水平。 结果 51名研究对象中，4名因未按时随访退出研究，47名纳入统计分析。在基线时3组间的年龄、性别以及各观察指标的差异均无统计学意义（P>0.05）。1）与基线相比，3组治疗后1、3、6个月PD均降低（P<0.05）；治疗后1、3个月SRP+AMX+MTZ组和SRP+PDT组的PD均低于SRP组（P<0.05），且治疗后3个月SRP+PDT组的PD低于SRP+AMX+MTZ组（P<0.05）。2）治疗后3、6个月，SRP组和SRP+AMX+MTZ组CAL低于基线（P<0.05）；治疗后1、3、6个月SRP+PDT组CAL低于基线（P<0.05）。3）与基线相比，3组治疗后1、3、6个月GI均降低（P<0.05）；治疗后1个月SRP+PDT组GI低于SRP组和SRP+AMX+MTZ组（P<0.05），治疗后3个月SRP+PDT组GI低于SRP组（P<0.05）。4）与基线相比，3组治疗后1、3、6个月IL-6水平均降低（P<0.05）。5）3组治疗前后不同时间以及3组间各时间点HbA1c、BLR差异均无统计学意义（P>0.05）。 结论 PDT辅助SRP可改善Ⅲ期或Ⅳ期牙周炎合并T2DM患者牙周临床指标，短期内对PD和GI改善具有一定优势，也许可以作为全身抗菌药物辅助SRP的潜在替代选择。

关键词: 光动力疗法, 阿莫西林, 甲硝唑, 龈下刮治和根面平整术, 牙周炎, 2型糖尿病

Abstract:

Objective This study aimed to compare the clinical efficacy of photodynamic therapy (PDT) and systemic antimicrobial drug as adjuncts to scaling and root planing (SRP) in patients with stage Ⅲ or Ⅳ periodontitis complicated with type 2 diabetes (T2DM). Methods Fifty-one patients with stage Ⅲ or Ⅳ periodontitis complicated with T2DM were randomly divided into three groups by block randomization: SRP group, SRP+amoxicillin (AMX)+me-tronidazole (MTZ) group, SRP+PDT group. Correspon-ding treatments were administered according to group assignment. During the 6-month follow-up, glycosylated hemoglobin (HbA1c), probing depth (PD), clinical attachment loss (CAL), gingival index (GI), bone loss rate (BLR), and interleukin-6 (IL-6) were compared among the three groups. Results Of the 51 participants, four were lost to follow-up, and 47 were included in the statistical analysis. At baseline, there were no significant differences in age, sex and relevant observation indicators among the three groups (P>0.05). 1) The PD decreased at 1, 3, and 6 months after treatment in all three groups compared with baseline (P<0.05). At 1 and 3 months after treatment, PD in the SRP+AMX+MTZ group and SRP+PDT group was lower than that in the SRP group (P<0.05). At three months after treatment, PD in the SRP+PDT group was lower than that in the SRP+AMX+MTZ group (P<0.05). 2) The CAL of SRP group and SRP+AMX+MTZ group were lower than the baseline at 3 and 6 months after treatment (P<0.05). The CAL in the SRP+PDT group was also lower than the baseline at 1, 3 and 6 months after treatment (P<0.05). 3) The GI decreased at 1, 3, and 6 months after treatment in all three groups compared with baseline (P<0.05). The GI of SRP+PDT group was lower than that of SRP group and SRP+AMX+MTZ group at 1 month after treatment (P<0.05). The GI in the SRP+PDT group was lower than that of SRP group at 3 months after treatment (P<0.05). 4) The IL-6 decreased at 1, 3, and 6 months after treatment in all three groups compared with baseline (P<0.05). 5) HbA1c and BLR showed no significant pre-post or intergroup differences (P>0.05). Conclusion Adjunctive PDT can improve periodontal indicators in these patients, with short-term advantages in PD and GI, and may be serve as a potential alternative to systemic antimicrobial drug.

Key words: photodynamic therapy, amoxicillin, metronidazole, scaling and root planing, periodontitis, type 2 dia-betes mellitus

中图分类号: 

  • R781.4＋2

表 1

3组研究对象基线时的基本信息"

项目SRP组SRP+AMX+MTZ组SRP+PDT组F值P值
年龄/岁51.71±6.7648.94±9.1150.38±10.660.360.70
性别-0.81
男性7（50.00%）7（41.18%）6（37.50%）
女性7（50.00%）10（58.82%）10（62.50%）
FPG/（mmol/L）10.78±3.1110.24±2.6910.11±2.010.270.76
HbA1c/%11.10±2.2111.32±2.9310.77±2.040.210.81
PD/mm7.44±1.286.37±1.936.45±1.871.750.19
CAL/mm5.43±0.605.30±1.075.44±1.380.090.91
GI/分2.50±0.762.35±0.932.62±0.810.430.65
BLR/%64.21±13.0061.62±15.2063.66±13.290.150.86
IL-6/（pg/mL）15.97±3.6816.48±4.7717.16±1.800.410.67

表 2

3组治疗前后各指标差异分析"

项目SRP组SRP+AMX+MTZ组SRP+PDT组F/P交互F/P时间F/P组别
HbA1c/%0.06/0.990.41/0.660.39/0.68
基线11.10±2.2111.32±2.9310.77±2.04
治疗后3个月10.90±1.7411.09±2.7610.47±1.64
治疗后6个月11.10±3.0511.17±2.8610.44±1.53
PD/mm1.75/0.14156.22/<0.01**8.75/<0.01**
基线7.44±1.286.37±1.936.45±1.87
治疗后1个月3.50±0.68①2.61±1.00a①2.10±0.97a①
治疗后3个月3.23±0.60①2.77±0.58a①1.95±0.72ab①
治疗后6个月2.74±0.73①3.03±1.06①2.63±1.05①
CAL/mm0.37/0.9012.98/<0.01**0.26/0.77
基线5.43±0.605.30±1.075.44±1.38
治疗后1个月4.74±1.534.46±1.104.13±1.40①
治疗后3个月4.06±1.65①3.71±1.32①3.83±1.64①
治疗后6个月3.93±1.53①4.21±1.43①4.02±0.84①
GI/分2.67/0.02*37.10/<0.01**1.96/0.15
基线2.50±0.762.35±0.932.62±0.81
治疗后1个月1.79±0.80①1.53±1.07①0.88±0.72ab①
治疗后3个月1.79±0.70①1.59±1.00①1.12±0.62a①
治疗后6个月1.64±0.93①1.47±0.80①1.19±0.75①
BLR/%0.01/0.993.65/0.060.17/0.84
基线64.21±13.0061.62±15.2063.66±13.29
治疗后6个月60.96±11.4358.85±13.9660.81±12.36
IL-6/（pg/mL）0.57/0.64257.11/<0.01**0.22/0.81
基线15.97±3.6816.48±4.7717.16±1.80
治疗后1个月6.28±0.78①5.56±1.58①5.48±1.63①
治疗后3个月5.93±1.09①5.39±1.60①5.57±0.79①
治疗后6个月6.53±2.14①6.38±1.51①6.31±1.28①

图1

3组治疗前后各指标变化趋势"

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