【作者】 王冠；

【导师】 苏本利；

【作者基本信息】 大连医科大学 ， 内科学， 2013， 硕士

【摘要】 目的：采用荟萃分析方法系统评价实施牙周病治疗对合并牙周病的糖尿病患者代谢控制效果的影响，探讨牙周病治疗在糖尿病综合治疗中的作用。方法：计算机检索Cochrane图书馆对照试验注册中心、PubMed、EMBASE数据库，按照循证医学的要求，制定文献纳入、排除标准及检索策略。查找有关牙周病治疗对糖尿病代谢控制影响的研究，检索时限为2000年~2013年3月。文献纳入标准：①公开发表的英文文献，数据资料完整；②研究对象：按照WHO糖尿病诊断标准诊断为糖尿病（包括1型和2型）的患者，合并慢性牙周炎，其种族、国籍、年龄、性别不限；③研究类型：随机对照试验，无论是否采用分配隐藏或盲法；④干预措施：牙周病常规机械治疗，包含或不包含局部抗生素应用、口腔健康指导等辅助治疗与不治疗牙周病或仅予口腔健康指导进行比较；⑤评价结果：糖化血红蛋白、血糖、血脂等代谢指标，超敏C反应蛋白、肿瘤坏死因子-α等与胰岛素抵抗有关的炎症指标。排除重复发表、仅以摘要发表、非随机对照试验、信息不全或数据不完整的文献。由专业文献检索人员负责检索，两名研究者阅读所检索到文献的题目和摘要，根据入选及排除标准独立选择合格的文献，如试验报告不详细或数据缺乏，通过邮件与通讯作者联系，以获取详细完整的信息。对最终纳入的文献采用改良后的JADAD量表进行方法学质量评估。提取的主要资料包括：作者姓名、出版年份、研究地区、研究人数、干预措施、研究时间、两组病人的基线情况和疾病状况、效应指标等。以糖化血红蛋白、空腹血糖、餐后2小时血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、超敏C反应蛋白、肿瘤坏死因子-α的合并均数及标准差分别为效应指标，采用RevMan5.0软件进行统计分析，了解牙周病治疗对糖化血红蛋白、空腹血糖、餐后2小时血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、超敏C反应蛋白、肿瘤坏死因子-α等指标的影响。结果：共纳入6篇随机对照试验文献，涉及470例2型糖尿病患者。荟萃分析结果显示：牙周病治疗组与对照组在糖化血红蛋白[SMD=-0.46，95%CI：（-0.64，-0.29），P<0.00001]、空腹血糖[SMD=-0.88，95%CI：（-1.35，-0.41），P=0.0002]、餐后2小时血糖[SMD=-1.63，95%CI：（-3.15，-0.10），P=0.04]、总胆固醇[SMD=-0.25，95%CI：（-0.50，-0.01），P=0.05]、甘油三酯[SMD=-0.28，95%CI：（-0.47，-0.08），P=0.006]、超敏C反应蛋白[SMD=-0.38，95%CI：（-0.60，-0.16），P=0.0006]方面的差异有统计学意义；在低密度脂蛋白胆固醇[SMD=-0.07，95%CI：（-0.27，0.12），P=0.47]、高密度脂蛋白胆固醇[SMD=0.01，95%CI：（-0.18，0.21），P=0.91]、肿瘤坏死因子-α[SMD=-0.21，95%CI：（-0.43，0.01），P=0.06]方面的差异无统计学意义。结论：牙周病治疗可以改善糖尿病患者的代谢控制，但是深入探讨牙周病治疗对于糖尿病患者代谢控制的影响，为糖尿病综合管理提供有利措施，还需要更多的大样本、前瞻性、高质量的随机对照研究。更多还原

【Abstract】 Objective: A meta-analysis of randomized control trials was conducted to evaluatethe effect of periodontal therapy (PT) on metabolic control in patients with diabetes andperiodontal disease.Methods: Studies of periodontal treatment on metabolic control in diabeticpatients were searched from Cochrane Central Register of Controlled Trials(CENTRAL), PubMed, EMBASE database from2000to March2013. Inclusion criteriawere:①Literatures published in English with complete data;②Studies on people withtype1or2diabetes mellitus (DM) with no limits on race, nationality, sex, and age;③Randomized control trials (RCTs) irrespective of their allocation concealment andblinding methods;④Suitable treatment included mechanical periodontal therapy withor without adjunctives and oral hygiene instruction;⑤Glycosylated hemoglobin(HbA1c), blood glucose (BG), lipid profile, and other metabolic indexes were included.Indexes which closely linked to insulin resistance (IR) such as high-sensitivityC-reactive protein (HsCRP), tumor necrosis factor alpha (TNF-α) were included.Duplicate publications, articles only published as abstracts, non-RCTs, and studies withincomplete data were excluded. Two reviewers independently reviewed the titles andabstracts of identified articles first, and then examined the full-text version of selectedarticles to assess relevance to the research topic. The authors were contacted by E-mailto obtain the missing data. The quality of included studies was evaluated by modifiedJADAD scale. The main information included author’s name, year of publication, studyarea, study population, interventions, study duration, the baseline characteristics and thedisease status of patients in the two groups. Data of mean and standard deviation ofHbA1c, fasting BG (FBG), postprandial2h BG (2hPG), total cholesterol (TC),triglycerides (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), HsCRP, TNF-α were analyzed with RevMan5.0software.Results: Six RCTs involving470type2diabetes patients were retrieved.Meta-analysis suggested that there was significant difference between the PT groupsand the control groups for HbA1c [SMD=-0.46,95%CI:(-0.64,-0.29), P<0.00001],FBG [SMD=-0.88,95%CI:(-1.35,-0.41), P=0.0002],2hPG [SMD=-1.63,95%CI:(-3.15,-0.10), P=0.04], TC [SMD=-0.25,95%CI:(-0.50,-0.01), P=0.05], TG[SMD=-0.28,95%CI:(-0.47,-0.08), P=0.006], HsCRP [SMD=-0.38,95%CI:(-0.60,-0.16), P=0.0006]. But there was no effects of PT on LDL-C [SMD=-0.07,95%CI:(-0.27,0.12), P=0.47], HDL-C [SMD=0.01,95%CI:(-0.18,0.21), P=0.91], and TNF-α[SMD=-0.21,95%CI:(-0.43,0.01), P=0.06].Conclusion: Periodontal therapy could improve metabolic control in diabeticpatients. Further studies of high quality are highly needed.更多还原