【作者】 张军；

【导师】 马哲；

【作者基本信息】 河北医科大学 ， 口腔医学（专业学位）， 2021， 硕士

【摘要】 目的:本研究旨在运用循证医学的方法,系统地探讨牙周非手术治疗(Non-surgical periodontal therapy,NSPT)对冠状动脉粥样硬化性心脏病(Coronary heart disease,CHD)伴慢性牙周炎(Chronic periodontitis,CP)患者疗效的影响,本研究的指标主要包括:血清超敏C反应蛋白(High sensitive C-reactive protein,hs-CRP)、白介素-8(Interleukin-8,IL-8)、肿瘤坏死因子-α(Tumor necrosis factor-alpha,TNF-α)、高密度脂蛋白(High-density lipoprotein,HDL)、总胆固醇(Total cholesterol,TC)、低密度脂蛋白(Low-density lipoprotein,LDL)、甘油三酯(Triglyceride,TG),探讨NSPT是否能在控制局部炎症的基础上,对全身炎症也起到一定的控制作用,为研究口腔疾病与全身性疾病之间的相关性提供新思路。方法:通过检索Pub Med、Cochrane library、Web of Science、OVID、Science Direct、EMbase、CNKI(中国期刊网全文数据库)、万方和维普数据库,搜集建库至2020年9月时间内,探讨NSPT对CHD伴CP患者疗效的随机对照临床试验研究。同时手动检索相关文献的参考文献。由两名研究人员根据纳入排除标准分别独立进行文献的筛选和纳入文章基本信息及数据的提取工作。纳入研究的方法学偏倚风险评估工具为Cochrane协作网推荐的风险评估工具。本研究选择加权均数差(Weighed mean difference,WMD)和95%可信区间(Confidence interval,CI)表示效应量,纳入文章的异质性大小用Q检验和I~2统计量来表示,根据异质性大小选择随机效应模型或固定效应模型对合并效应量进行分析,发表偏倚需采用Begg’s检验法,通过更换效应模型来检验各合并效应量的敏感性,并通过STATA(version 16.0)软件进行Meta分析。结果:1.通过检索,符合纳入排除标准的共有16篇文献,共1331名患者。2.血清超敏C反应蛋白的Meta分析结果随诊1个月的血清hs-CRP改变(WMD=-0.81,95%CI range-1.80 to0.18,P=0.108;χ~2=7.71,P=0.021,I~2=74.1%)差异无统计学意义;随诊3个月血清hs-CRP改变(WMD=-1.00,95%CI range-1.92 to-0.08,P=0.033;χ~2=23.56,P<0.001,I~2=83.0%)差异具有统计学意义;随诊6个月血清hs-CRP改变(WMD=-0.40,95%CI range-0.50 to-0.29,P<0.001,χ~2=0.05,P=0.831,I~2=0%)差异具有统计学意义。3.白细胞介素-8的Meta分析结果随诊1个月的IL-8改变(WMD=-3.18,95%CI range-5.75 to-0.60,P=0.016;χ~2=0.02,P=0.882,I~2=0%)差异具有统计学意义;随诊3个月IL-8改变(WMD=-4.30,95%CI range-7.27 to-1.34,P=0.004;χ~2=0.26,P=0.613,I~2=0%)差异具有统计学意义。4.肿瘤坏死因子-α的Meta分析随诊1个月的TNF-α改变(WMD=-5.19,95%CI range-6.67 to-3.71,P<0.001;χ~2=0.34,P=0.559,I~2=0%)差异具有统计学意义;随诊3个月TNF-α改变(WMD=-3.93,95%CI range-7.56 to-0.30,P=0.034;χ~2=14.35,P=0.002,I~2=79.1%)差异具有统计学意义。5.血脂的Meta分析随诊1个月的TG改变(WMD=-0.21,95%CI range-0.35 to-0.07,P=0.003;χ~2=0.09,P=0.762,I~2=0%)差异具有统计学意义;随诊3个月TG改变(WMD=-0.07,95%CI range-0.25 to 0.11,P=0.442;χ~2=2.44,P=0.655,I~2=0%)差异无统计学意义。随诊6个月TG改变(WMD=-0.24,95%CI range-0.48 to 0.00,P=0.053;χ~2=0.20,P=0.658,I~2=0%)差异无统计学意义。随诊1个月的TC改变(WMD=-0.00,95%CI range-0.21 to 0.21,P=0.970;χ~2=0.01,P=0.940,I~2=0%)差异无统计学意义;随诊3个月TC改变(WMD=-0.10,95%CI range-0.29 to 0.08,P=0.275;χ~2=3.00,P=0.392,I~2=0%)差异无统计学意义。随诊6个月TC改变(WMD=-0.50,95%CI range-0.88 to-0.11,P=0.011;χ~2=1.66,P=0.197,I~2=39.8%)差异具有统计学意义。随诊1个月的HDL改变(WMD=0.02,95%CI range-0.05 to 0.10,P=0.542;χ~2=0.08,P=0.779,I~2=0%)差异无统计学意义;随诊3个月HDL改变(WMD=-0.05,95%CI range-0.12 to 0.03,P=0.255;χ~2=1.29,P=0.525,I~2=0%)差异无统计学意义。随诊1个月的LDL改变(WMD=0.01,95%CI range-0.18 to 0.19,P=0.955;χ~2=0.13,P=0.723,I~2=0%)差异无统计学意义;随诊3个月LDL改变(WMD=0.01,95%CI range-0.18 to 0.19,P=0.832;χ~2=15.49,P<0.001,I~2=87.1%)差异无统计学意义。6.经检验,本Meta分析各观察指标结果均不存在发表偏倚,敏感性分析显示NSPT后随访1个月患者的血清hs-CRP结果稳定性差,其余结果稳定性好。结论:1.本Meta分析结果显示NSPT后CHD伴CP患者TNF-α、IL-8、TG在1个月随访期临床疗效优于未行NSPT组;NSPT后CHD伴CP患者hs-CRP、TNF-α、IL-8在3个月随访期临床疗效优于未行NSPT组;NSPT后CHD伴CP患者hs-CRP、TC在6个月随访期临床疗效优于未行NSPT组。2.NSPT后CHD伴CP患者hs-CRP、TC、HDL、LDL在1个月随访期时临床疗效与未行NSPT患者相比差异无统计学意义;NSPT后CHD伴CP患者TC、TG、HDL、LDL在3个月随访期临床疗效与未行NSPT患者相比差异无统计学意义;NSPT后CHD伴CP患者TG在6个月随访期临床疗效与未行NSPT患者相比差异无统计学意义。3.关于NSPT对CHD伴CP患者疗效研究的高质量文献仍然较少,仍需要更多大样本量、长期观察、高质量的临床随机对照试验加以研究。更多还原

【Abstract】 Objective:This study was to explore the curative effect of non-surgical periodontal therapy(NSPT)in patients with coronary heart disease(CHD)associated with chronic periodontitis(CP),the influence of the index of the present study mainly includes:serum high sensitive C-reactive protein(hs-CRP),interleukin-8(IL-8),tumor necrosis factor-alpha(TNF-α),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL),low-density lipoprotein(LDL),to explore whether NSPT could control local inflammation and systemic inflammation to some extent,so as to provide a new idea for the study of the correlation between oral diseases and systemic diseases.Methods:By searching Pub Med,Cochrane Library,Web of Science,Ovid,Science Direct,Embase,CNKI(China National Knowledge Internet),Wanfang and VIP databases,we collected the clinical randomized controlled trials on the effects of NSPT on systemic inflammation in patients with CHD with CP from the self-established databases to September 2020.At the same time,the references of related literature were searched.According to the inclusion and exclusion criteria,two researchers independently screened the literatures and extracted the basic information and data of the included articles.The risk assessment tool recommended by the Cochrane Collaboration was used to assess the risk of methodological bias in the included studies.This study chooses the weighted mean difference(WMD)and 95%confidence interval(CI)said effect quantity,Q test and I~2 test were used to test heterogeneity into article inspection,according to the size of the heterogeneity choose random effect model or fixed effect model to analyze consolidation effect quantity,Begg’s test is used to test the publication bias,by changing the effect of model to test the combined effects of sensitivity,and this meta-analysis was performed using STATA(version 16.0)software.Results:1.A total of 1331 patients were included in 16 articles that met the inclusion and exclusion criteria.2.Meta-analysis of hs-CRPThere was no statistical differences of the changes of serum hs-CRP after1-month follow-up(WMD=-0.81,95%CI range-1.80 to 0.18,P=0.108;χ~2=7.71,P=0.021,I~2=74.1%).The changes of serum hs-CRP after 3-month follow-up(WMD=-1.00,95%CI range-1.92 to-0.08,P=0.033;χ~2=23.56,P<0.001,I~2=83.0%)were statistically significant.The changes of serum hs-CRP after 6-month follow-up(WMD=-0.40,95%CI range-0.50 to-0.29,P<0.001;χ~2=0.05,P=0.831,I~2=0%)were statistically significant.3.Meta-analysis of IL-8The changes of IL-8 after 1-month follow-up(WMD=-3.18,95%CI range-5.75 to-0.60,P=0.016;χ~2=0.02,P=0.882,I~2=0%)were statistically significant.The changes of IL-8 after 3-month follow-up(WMD=-4.30,95%CI range-7.27 to-1.34,P=0.004;χ~2=0.26,P=0.613,I~2=0%)were statistically significant.4.Meta-analysis of TNF-αThe changes of TNF-αafter 1-month follow-up(WMD=-5.19,95%CI range-6.67 to-3.71,P<0.001;χ~2=0.34,P=0.559,I~2=0%)were statistically significant.The changes of TNF-αafter 3-month follow-up(WMD=-3.93,95%CI range-7.56 to-0.30,P=0.034;χ~2=14.35,P=0.002,I~2=79.1%)were statistically significant.5.Meta-analysis of blood lipidsThe changes of TG after 1-month follow-up(WMD=-0.21,95%CI range-0.35 to-0.07,P=0.003;χ~2=0.09,P=0.762,I~2=0%)were statistically significant.There was no statistical differences of the changes of TG after3-month follow-up(WMD=-0.07,95%CI range-0.25 to 0.11,P=0.442;χ~2=2.44,P=0.655,I~2=0%).There was no statistical differences of the changes of TG after 6-month follow-up(WMD=-0.24,95%CI range-0.48 to 0.00,P=0.053;χ~2=0.20,P=0.658,I~2=0%).There was no statistical differences of the changes of TC after 1-month follow-up(WMD=-0.00,95%CI range-0.21 to 0.21,P=0.970;χ~2=0.01,P=0.940,I~2=0%).There was no statistical differences of the changes of TC after 3-month follow-up(WMD=-0.10,95%CI range-0.29 to 0.08,P=0.275;χ~2=3.00,P=0.392,I~2=0%).The changes of TC after 6-month follow-up(WMD=-0.50,95%CI range-0.88 to-0.11,P=0.011;χ~2=1.66,P=0.197,I~2=39.8%)were statistically significant.There was no statistical differences of the changes of HDL after 1-month follow-up(WMD=0.02,95%CI range-0.05 to 0.10,P=0.542;χ~2=0.08,P=0.779,I~2=0%).There was no statistical differences of the changes of HDL after 3-month follow-up(WMD=-0.05,95%CI range-0.12 to 0.03,P=0.255;χ~2=1.29,P=0.525,I~2=0%).There was no statistical differences of the changes of LDL after 1-month follow-up(WMD=0.01,95%CI range-0.18 to 0.19,P=0.955;χ~2=0.13,P=0.723,I~2=0%).There was no statistical differences of the changes of LDL after 3-month follow-up(WMD=0.01,95%CI range-0.18 to 0.19,P=0.832;χ~2=15.49,P<0.001,I~2=87.1%).6.According to the test,the results of each observational indicator in this meta-analysis did not have publication bias.Sensitivity analysis showed that hs-CRP of patients followed up for 1 month after NSPT was poor in stability,while other results were good in stability.Conclusions:1.The results of this meta-analysis showed that TNF-α,IL-8,and TG in patients with CHD with CP after NSPT were better than those in the group without NSPT at 1-month follow-up period.The clinical efficacy of hs-CRP,TNF-αand IL-8 in patients with CHD with CP after NSPT was better than that in the group without NSPT at 3-month follow-up period.The clinical efficacy of hs-CRP and TC in patients with CHD with CP after NSPT was better than that in the group without NSPT at 6-month follow-up period.2.At 1-month,the clinical efficacy of hs-CRP,TC,HDL and LDL in patients with CHD and CP after NSPT showed no statistical difference compared with the patients without NSPT.At 3-month,the clinical efficacy of TC,TG,HDL and LDL in patients with CHD and CP after NSPT showed no statistical difference compared with the patients without NSPT.At 6-month,the clinical efficacy of TG in patients with CHD and CP after NSPT showed no statistical difference compared with the patients without NSPT.3.There are still few high-quality literatures on the efficacy of NSPT in patients with CHD with CP,and more large sample size,long-term observation,and high-quality clinical randomized controlled trials are still needed for research.更多还原