国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (3): 296-307.doi: 10.7158/gjkq.2025024

• 牙周专栏 • 上一篇    

间充质干细胞用于牙周再生临床疗效的系统评价与Meta分析

李天元1,2(),朱彤欣2,柳庆2,董迎春3,陈斌2()   

  1. 1.中国人民解放军联勤保障部队第九〇四医院口腔科 常州 213000
    2.南京大学医学院附属口腔医院（南京市口腔医院）牙周病科 南京大学口腔医学研究所 南京 210008
    3.南京大学医学院附属口腔医院（南京市口腔医院）麻醉科 南京大学口腔医学研究所 南京 210008
  • 收稿日期:2024-05-26 修回日期:2024-09-22 出版日期:2025-05-01 发布日期:2025-04-30
  • 通讯作者: 陈斌
  • 作者简介:李天元，医师，硕士，Email：719022084@qq.com
  • 基金资助:
    国家自然科学基金(82401135);江苏省自然科学基金(BK20220199);南京市卫生科技发展专项资金(ZKX22054)

Clinical efficacy of mesenchymal stem cells on periodontal regeneration: a systematic review and meta-analysis

Tianyuan Li1,2(),Tongxin Zhu2,Qing Liu2,Yingchun Dong3,Bin Chen2()   

  1. 1.Dept. of Stomatology, the 904th Hospital of Joint Logistics Unit of the Chinese People’s Liberation Army, Changzhou 213000, China
    2.Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Research Institute of Stomatology, Nanjing University, Nanjing 210008, China
    3.Dept. of Anesthesiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Research Institute of Stomatology, Nanjing University, Nanjing 210008, China
  • Received:2024-05-26 Revised:2024-09-22 Online:2025-05-01 Published:2025-04-30
  • Contact: Bin Chen
  • Supported by:
    National Natural Science Foundation of China(82401135);Natural Science Foundation of Jiangsu Pro-vince(BK20220199);Nanjing Health Science and Technology Development Special Fund Project(ZKX22054)

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摘要：

目的 通过Meta分析比较使用与不使用间充质干细胞（MSC）的牙周手术患者在临床附着水平（CAL）、牙周探诊深度（PPD）、牙龈退缩（GR）和骨缺损深度（BDD）上的差异，评估MSC在牙周再生中的临床疗效。 方法 在PubMed、Cochrane Library、Embase、Scopus、中国知网、万方数据和中国生物医学文献网数据库中，检索2024年4月1日以前使用MSC治疗牙周炎患者牙周缺损的随机对照研究。由两位研究者进行文献筛选、数据资料提取，并评估纳入研究的偏倚风险。采用RevMan 5.4与Stata 15.1软件进行数据分析。 结果 Meta分析共纳入6项研究，结果显示：与对照组相比，MSC治疗组有更明显的CAL改善、PPD减少和BDD降低（P<0.05）；但在GR指标上，两组疗效的差异无统计学意义（P>0.05）。 结论 与传统的牙周再生方法相比，应用MSC可能具有一定优势；但由于研究间的潜在异质性以及纳入研究数量及质量的限制，应审慎看待该结论。未来仍需大样本、多中心的高质量随机对照临床试验进一步评估MSC应用于牙周再生的临床疗效。

关键词: 间充质干细胞, 牙周再生, 牙周炎, 牙槽骨丧失

Abstract:

Objective This study aimed to compare the differences in clinical attachment level (CAL), periodontal probing depth (PPD), gingival recession (GR), and bone defect depth (BDD) between patients undergoing periodontal surgeries with and without mesenchymal stem cells (MSCs) and to evaluate the clinical efficacy of MSCs in periodontal regeneration through a meta-analysis. Methods PubMed, Cochrane Library, Embase, Scopus, CNKI, Wanfang Data, and CBM were comprehensively searched for randomized controlled studies (RCTs) about MSC therapy for perio-dontal defects in patients with periodontitis up to April 1, 2024. Literature selection, data collection, and evaluation of bias were conducted by two researchers independently, and then data were analyzed through RevMan 5.4 software and Stata 15.1 software. Results Six studies were enrolled. The meta-analysis results showed that the experimental group had more significant improvement in CAL and decrease in PPD and BDD (P<0.05). However, no signi-ficant difference was found in efficacy between the two groups in terms of GR (P>0.05). Conclusion Compared with traditional periodontal regeneration methods, the application of MSCs may have some advantages. However, potential he-terogeneity among the included RCTs and limitations on the quantity and quality of these studies necessitate cautious interpretation of the findings. Further high-quality RCTs with a large sample size and a multicentral character are required to prove the efficacy of MSCs in periodontal regeneration.

Key words: mesenchymal stem cell, periodontal regeneration, periodontitis, alveolar bone loss

中图分类号: 

  • R781.4

图1

文献筛选流程图"

表 1

纳入研究的基本特征"

纳入文献国家受试者人数年龄/岁

干细胞

类型

缺损数量（T/C）

缺损类型

（T/C）

试验组

治疗

对照组

治疗

基线/mm结局指标随访时间/月
TCTC
Ferrarotti等[11]意大利

男：8

女：7

男：6

女：8

39~69自体牙髓干细胞15/14

骨下袋：

一壁（7/5）；

二壁（4/5）；

三壁（4/4）

①牙髓干细胞+胶原海绵支架；

②微创手术

①生理盐水+胶原海绵支架；

②微创手术

CAL：10.0±1.6

PPD：8.3±1.2

GR：1.7±1.2

BDD：6.4±1.4

CAL：9.4±1.5

PPD：7.9±1.3

GR：1.5±0.8

BDD：5.6±1.0

CAL

PPD

GR

BDD

12
Chen等[12]中国

男：2

女：18

男：6

女：15

18~65自体牙周膜干细胞20/21骨下袋异种骨替代材料+细胞膜片异种骨替代材料

CAL：5.15±1.52

PPD：6.43±1.92

GR：0.70±1.09

CAL：5.28±1.60

PPD：5.68±1.59

GR：0.62±0.89

CAL

PPD

GR

12

Abdal-Wa?

hab等[10]

埃及

男：5

女：5

男：4

女：6

32~50自体牙龈成纤维细胞+牙龈间充质干细胞10/10

骨下袋

二壁（7/6）；

三壁（3/4）

牙龈成纤维细胞+牙龈MSC+β-磷酸三钙+胶原膜β-磷酸三钙+胶原膜

CAL：6.30±2.06

PPD：7.50±2.42

CAL：5.30±0.95

PPD：6.50±0.53

CAL

PPD

6
Apatzidou等[8]希腊

男：3

女：6

男：7

女：11

20~68自体骨髓间充质干细胞

9/18

（阳性对照组：10；阴性对照组：8）

骨下袋

一壁（0/5）；

二壁（3/3）；

三壁（6/10）

①骨髓MSC+自体纤维蛋白/血小板裂解液+胶原支架；

②微创手术

阳性对照组：

①自体纤维蛋白/血小板裂解液+胶原支架；

②微创手术

阴性对照组：

微创手术

CAL：7.3±1.5

PPD：6.7±1.6

BDD：4.9±2.2

GR：0.7±1.0

阳性对照组：

CAL：9.1±2.7

PPD：7.6±2.4

BDD：4.3±0.9

GR：1.5±1.3

CAL

PPD

BDD

GR

12
Hernández-Monjaraz等[9]墨西哥

男：7

女：4

男：7

女：3

55~64同种异体牙髓干细胞11/10骨下袋牙髓干细胞+冻干聚乙烯吡咯烷酮海绵+胶原膜冻干聚乙烯吡咯烷酮海绵+胶原膜PPD：5.66±0.41PPD：5.58±0.38PPD6
Sánchez等[6]西班牙

男：7

女：3

男：7

女：3

T：38~60

C：49~65

自体牙周膜干细胞10/10

骨下袋

一壁（3/0）；

二壁（7/10）

①牙周膜干细胞+异种骨替代材料；

②冠向复位瓣

①生理盐水+异种骨替代材料；

②冠向复位瓣

CAL：10.60±2.22

PPD：6.60±1.07

GR：4.00±1.76

CAL：9.90±1.66

PPD：6.80±1.03

GR：3.20±1.81

CAL

PPD

GR

12

图2

纳入研究的偏倚风险评估图A：每个纳入研究在不同偏倚项目的偏倚风险；B：以百分比形式呈现所有纳入研究不同偏倚项目的偏倚风险。"

图3

Meta分析对比MSC组与对照组牙周手术术后CAL的变化a、b、c分别表示同一研究中的不同随访时间组。"

图4

Meta分析（A）和亚组分析（B）对比MSC组与对照组牙周手术术后PPD的变化1、2分别表示同一研究中唇/颊侧和舌/腭侧数据；a、b、c分别表示同一研究中的不同随访时间组。"

图5

Meta分析对比MSC组与对照组牙周手术术后GR的变化1、2分别表示同一研究中唇/颊侧和舌/腭侧数据；a、b、c分别表示同一研究中的不同随访时间组。"

图6

Meta分析对比MSC组与对照组牙周手术术后BDDa、b分别表示同一研究中的不同随访时间组。"

图7

PPD的敏感性分析1、2分别表示同一研究中唇/颊侧和舌/腭侧数据；a、b、c分别表示同一研究中的不同随访时间组。"

图8

MSC治疗组与对照组牙周手术术后PPD比较的漏斗图"

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