中国实用口腔科杂志

中国实用口腔科杂志

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全身应用不同抗生素辅助牙周基础治疗对侵袭性牙周炎疗效的Meta分析

贡宏纯1，2，袁志瑶1，雷浪1，李厚轩1   

  1. 1. 南京大学医学院附属口腔医院，南京市口腔医院牙周病科，江苏  南京  210008； 2. 苏州口腔医院牙周科，江苏 苏州  215000
  • 出版日期:2020-04-15 发布日期:2020-05-27
  • 基金资助:
    南京市医学科技发展资金资助（QRX17025；QRX17081）

  • Online:2020-04-15 Published:2020-05-27

摘要： 目的    系统评价全身应用不同抗生素辅助牙周基础治疗对侵袭性牙周炎（aggressive periodontitis，AgP）的临床效果。方法    检索PubMed、Cochrane Library、Web of Science、中国知网、万方和维普等数据库，查找全身应用抗生素辅助治疗AgP临床疗效的随机对照试验（randomized controlled trial，RCT）。通过牙周探诊深度（probing depth，PD）和临床附着丧失（clinical attachment loss，CAL）的变化，评价牙周治疗的临床疗效；采用RevMan5.3和ADDIS v1.16.8软件，进行统计分析。结果    本研究共纳入21项RCT，705例患者。Meta分析结果显示：全身应用阿莫西林联合甲硝唑辅助治疗AgP相比于单纯牙周基础治疗的PD和CAL改善更多［ΔPD：MD = 0.49，95%CI（0.42，0.55），P < 0.05；ΔCAL：MD = 0.46，95%CI（0.38，0.53），P < 0.05］。网状Meta分析结果显示：全身应用不同抗生素辅助牙周基础治疗后3个月效果较佳的药物为阿莫西林联合甲硝唑、阿奇霉素和多西环素；治疗后6个月效果较佳的药物为克林霉素、阿莫西林联合甲硝唑和阿奇霉素。结论    现有研究证据表明，全身应用抗生素辅助牙周基础治疗的方式对AgP能够获得较好的临床疗效。

关键词: 抗生素, 牙周基础治疗, 侵袭性牙周炎, Meta分析

Abstract: Objective　To systematically evaluate the clinical effects of systemic application of different antibiotics in assisting periodontal treatment for aggressive periodontitis（AgP）. Methods　Pubmed，Cochrane Library，Web of Science，CNKI，Wanfang，Weipu Data and other databases were searched for randomized controlled trial（RCT）on the clinical efficacy of systemic application of antibiotics for adjuvant treatment of AgP. The clinical efficacy of periodontal treatment was evaluated by probing depth（PD）and clinical attachment loss（CAL）. Statistical analysis was performed using RevMan5.3 and ADDIS v1.16.8. Results　Totally 21 RCTs with 705 subjects were included in the study. Meta-analysis showed that PD/CAL had a bigger change in systemic application of amoxicillin and metronidazole for adjuvant treatment of AgP compared with simple periodontal treatment ［ΔPD：MD = 0.49，95%CI（0.42，0.55），P < 0.05；ΔCAL：MD = 0.46，95%CI（0.38，0.53），P < 0.05］. The results of network Meta-analysis showed that better results after  three months of treatment were shown in amoxicillin combined with metronidazole，azithromycin and deoxytetracycline；better results after 6 months were in clindamycin，amoxicillin with metronidazole and azithromycin. Conclusion　The available evidence indicates that systemic antibiotics-assisted periodontal therapy can achieve good clinical outcomes for AgP.

Key words: antibiotics, periodontal initial therapy, aggressive periodontitis, Meta-analysis