克拉霉素和甲硝唑治疗慢性牙周炎疗效的Meta分析
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摘要
目的:系统评价全身应用克拉霉素和甲硝唑治疗慢性牙周炎的临床疗效,为临床治疗慢性牙周炎合理用药提供循证医学证据。方法:计算机检索中国知网、维普、万方、中国生物医学文献、PubMed、ScienceDirect和EMBase等数据库有关克林霉素和甲硝唑对比治疗慢性牙周炎的文献,检索时限从建库到2017年6月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用RevMan 5.3软件对实验数据进行Meta分析。结果:最终纳入5个随机对照实验(RCT),共516例慢性牙周炎患者,纳入指标按照随访时间进行亚组分析,与甲硝唑组比较,克拉霉素组慢性牙周炎患者随访1个月和3个月时牙周探诊深度(PD)减少、附着丧失(AL)获得和龈沟出血指数(SBI)减少方面更加明显,PD、AL和SBI差异均有统计学意义(MD=-0.53,95%CI:-0.67～0.39,P<0.01;MD=-0.31,95%CI:-0.39～-0.24,P<0.01;MD=-0.23,95%CI:-0.29～-0.16,P<0.01)。结论:在牙周基础治疗过程中,在短期观察中慢性牙周炎患者全身应用克拉霉素辅助治疗比甲硝唑更有效。
Objective:To evaluate the efficacies of clarithromycin and metronidazole in the treatment of chronic periodontitis,and to provide the evidence-based medical evidence for the rational use of drugs in the treatment of chronic periodontitis.Methods:CNKI, VIP, Wanfang,Chinese Biomedical Literature Database,PubMed,ScienceDirect and EMbase database from inception to June,2017 were searched by computer for the literatures about the treatment of clarithromycin and metronidazole for chronic periodontitis.Two reviewers independently screened the literatures,extracted the data and evaluated the bias risk of included studies.Then Meta-analysis was performed using RevMan 5.3 software.Results:A total of 5 randomized controlled trial(RCT)involving516 patients with chronic periodontitis were included.Subgroup analysis was performed according to the follow-up time.Compared with metronidazole group,the probing depth(PD)reduction,attachment loss(AL)gain,and sulcus bleeding index(SBI)reduction of the patients with chronic periodontitis in clarithromycin group at 1 month and 3 months after follow-up were more significant;the differences in PD,AL,and SBI were significant(MD=-0.53,95%CI:-0.67-0.39,P<0.01;MD =-0.31,95% CI:-0.39--0.24,P<0.01;MD =-0.23,95% CI:-0.29--0.16,P<0.01).Conclusion:Systemic antibiotic use of clarithromycin in the treatment of the patients with chronic periodontitis after non-surgical periodontal therapy has a significant additional effect than metronidazole in short-term observation.
Objective:To evaluate the efficacies of clarithromycin and metronidazole in the treatment of chronic periodontitis,and to provide the evidence-based medical evidence for the rational use of drugs in the treatment of chronic periodontitis.Methods:CNKI, VIP, Wanfang,Chinese Biomedical Literature Database,PubMed,ScienceDirect and EMbase database from inception to June,2017 were searched by computer for the literatures about the treatment of clarithromycin and metronidazole for chronic periodontitis.Two reviewers independently screened the literatures,extracted the data and evaluated the bias risk of included studies.Then Meta-analysis was performed using RevMan 5.3 software.Results:A total of 5 randomized controlled trial(RCT)involving516 patients with chronic periodontitis were included.Subgroup analysis was performed according to the follow-up time.Compared with metronidazole group,the probing depth(PD)reduction,attachment loss(AL)gain,and sulcus bleeding index(SBI)reduction of the patients with chronic periodontitis in clarithromycin group at 1 month and 3 months after follow-up were more significant;the differences in PD,AL,and SBI were significant(MD=-0.53,95%CI:-0.67-0.39,P<0.01;MD =-0.31,95% CI:-0.39--0.24,P<0.01;MD =-0.23,95% CI:-0.29--0.16,P<0.01).Conclusion:Systemic antibiotic use of clarithromycin in the treatment of the patients with chronic periodontitis after non-surgical periodontal therapy has a significant additional effect than metronidazole in short-term observation.
引文
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[2]KEPIC T J,O’LEARY T J,KAFRAWY A H.Total calculus removal:an attainable objective?[J].J Periodontol,1990,61(1):16-20.
[3]HINRICHS J E,WOLFF L F,PIHLSTROM B L,et al.Effects of scaling and root planing on subgingival microbial proportions standardized in terms of their naturally occurring distribution[J].J Periodontol,1985,56(4):187-194.
[4]CARVALHO L H,D’VILA G B,LEAO A,et al.Scaling and root planing,systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population[J].J Clin Periodontol,2004,31(12):1070-1076.
[5]HAFFAJEE A D,CUGINI M A,DIBART S,et al.The effect of SRP on the clinical and microbiological parameters of periodontal diseases[J].J Clin Periodontol,1997,24(5):324-334.
[6]PIHLSTROM B L,MCHUGH R B,OLIPHANT T H,et al.Comparison of surgical and nonsurgical treatment of periodontal disease A review of current studies and additional results after 61/2 years[J].J Clin Periodontol,1983,10(5):524-541.
[7]RABBANI G M,ASH M M,CAFFESSE R G.The effectiveness of subgingival scaling and root planing in calculus removal[J].J Periodontol,1981,52(3):119-123.
[8]JONES B M,GEARY I,ALAWATTEGAME A B,et al.In-vitro and in-vivo activity of metronidazole against Gardnerella vaginalis,Bacteroides spp.and Mobiluncus spp.in bacterial vaginosis[J].J Antimicrob Chemother,1985,16(2):189-197.
[9]孟焕新.牙周病学[M].3版.北京:人民卫生出版社,2008:234-235.
[10]MOORE P A.Dental therapeutic indications for the newer long-acting macrolide antibiotics[J].J Am Dent Assoc,1999,130(9):1341-1343.
[11]BURRELL R C,WALTERS J D.Distribution of systemic clarithromycin to gingiva[J].J Periodontol,2008,79(9):1712-1718.
[12]张研,高津福.克拉霉素治疗重度慢性牙周炎的效果评价[J].天津医科大学学报,2012,18(1):112-114.
[13]勾瑞东.克拉霉素治疗重度慢性牙周炎的基础与疗效观察[J].全科口腔医学电子杂志,2015,2(12):33-34.
[14]臧晓霞,朱晓茹,刘冰等.比较分析两种不同药物在牙周炎治疗过程中的作用[J].安徽医药,2015,19(20):1182-1184.
[15]戴斌斌.克拉霉素治疗重度慢性牙周炎的基础与临床研究[J].药学与临床,2014,8(11):171.
[16]许月元.克拉霉素治疗重度慢性牙周炎的基础与临床研究[J].世界最新医学信息文摘,2016(31):89.
[17]MOMBELLI A,CIONCA N,ALMAGHLOUTH A.Does adjunctive antimicrobial therapy reduce the perceived need for periodontal surgery?[J].Periodontol 2000,2011,55(1):205-216.
[18]HAFFAJEE A D,SOCRANSKY S S,GUNSOLLEY J C.Systemic anti-infective periodontal therapy.A systematic review[J].Ann Periodontol,2003,8(1):115-181.
[19]GUERRERO A,GRIFFITHS G S,NIBALI L,et al.Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis:a randomized placebo-controlled clinical trial[J].J Clin Periodontol,2005,32(10):1096-1107.
[20]REICHERT C.A randomized,double blind clinical trial comparing four periodontitis treatment strategies.One-year clinical results[J].J Orofac Orthoped,2013,74(3):183-186.
[21]HERRERA D,SANZ M,JEPSEN S,et al.A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients[J].J Clin Periodontol,2002,29(Suppl 3):136-159.
[22]MESTNIK M J,FERES M,FIGUEIREDO L C,et al.The effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized aggressive periodontitis:a 1-year double-blinded,placebo-controlled,randomized clinical trial[J].J Clin Periodontol,2012,39(10):955-961.
[23]冯新珍.甲硝唑缓释药膜治疗牙周炎46例疗效分析[J].中国社区医师:医学专业,2011,13(5):97-98.
[24]RODVOLD K A.Clinical pharmacokinetics of clarithromycin[J].Clin Pharmacokinet,1999,37(5):385-398.
[25]GOTFRIED M H.Macrolides for the treatment of chronic sinusitis,asthma,and COPD[J].Chest,2004,125(2Suppl):52S-60S.
[26]赵琳,张晓莉,王晓非.强直性脊柱炎与牙周炎相关性研究[J].中国实用内科杂志,2017,37(9):841-844.
[2]KEPIC T J,O’LEARY T J,KAFRAWY A H.Total calculus removal:an attainable objective?[J].J Periodontol,1990,61(1):16-20.
[3]HINRICHS J E,WOLFF L F,PIHLSTROM B L,et al.Effects of scaling and root planing on subgingival microbial proportions standardized in terms of their naturally occurring distribution[J].J Periodontol,1985,56(4):187-194.
[4]CARVALHO L H,D’VILA G B,LEAO A,et al.Scaling and root planing,systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population[J].J Clin Periodontol,2004,31(12):1070-1076.
[5]HAFFAJEE A D,CUGINI M A,DIBART S,et al.The effect of SRP on the clinical and microbiological parameters of periodontal diseases[J].J Clin Periodontol,1997,24(5):324-334.
[6]PIHLSTROM B L,MCHUGH R B,OLIPHANT T H,et al.Comparison of surgical and nonsurgical treatment of periodontal disease A review of current studies and additional results after 61/2 years[J].J Clin Periodontol,1983,10(5):524-541.
[7]RABBANI G M,ASH M M,CAFFESSE R G.The effectiveness of subgingival scaling and root planing in calculus removal[J].J Periodontol,1981,52(3):119-123.
[8]JONES B M,GEARY I,ALAWATTEGAME A B,et al.In-vitro and in-vivo activity of metronidazole against Gardnerella vaginalis,Bacteroides spp.and Mobiluncus spp.in bacterial vaginosis[J].J Antimicrob Chemother,1985,16(2):189-197.
[9]孟焕新.牙周病学[M].3版.北京:人民卫生出版社,2008:234-235.
[10]MOORE P A.Dental therapeutic indications for the newer long-acting macrolide antibiotics[J].J Am Dent Assoc,1999,130(9):1341-1343.
[11]BURRELL R C,WALTERS J D.Distribution of systemic clarithromycin to gingiva[J].J Periodontol,2008,79(9):1712-1718.
[12]张研,高津福.克拉霉素治疗重度慢性牙周炎的效果评价[J].天津医科大学学报,2012,18(1):112-114.
[13]勾瑞东.克拉霉素治疗重度慢性牙周炎的基础与疗效观察[J].全科口腔医学电子杂志,2015,2(12):33-34.
[14]臧晓霞,朱晓茹,刘冰等.比较分析两种不同药物在牙周炎治疗过程中的作用[J].安徽医药,2015,19(20):1182-1184.
[15]戴斌斌.克拉霉素治疗重度慢性牙周炎的基础与临床研究[J].药学与临床,2014,8(11):171.
[16]许月元.克拉霉素治疗重度慢性牙周炎的基础与临床研究[J].世界最新医学信息文摘,2016(31):89.
[17]MOMBELLI A,CIONCA N,ALMAGHLOUTH A.Does adjunctive antimicrobial therapy reduce the perceived need for periodontal surgery?[J].Periodontol 2000,2011,55(1):205-216.
[18]HAFFAJEE A D,SOCRANSKY S S,GUNSOLLEY J C.Systemic anti-infective periodontal therapy.A systematic review[J].Ann Periodontol,2003,8(1):115-181.
[19]GUERRERO A,GRIFFITHS G S,NIBALI L,et al.Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis:a randomized placebo-controlled clinical trial[J].J Clin Periodontol,2005,32(10):1096-1107.
[20]REICHERT C.A randomized,double blind clinical trial comparing four periodontitis treatment strategies.One-year clinical results[J].J Orofac Orthoped,2013,74(3):183-186.
[21]HERRERA D,SANZ M,JEPSEN S,et al.A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients[J].J Clin Periodontol,2002,29(Suppl 3):136-159.
[22]MESTNIK M J,FERES M,FIGUEIREDO L C,et al.The effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized aggressive periodontitis:a 1-year double-blinded,placebo-controlled,randomized clinical trial[J].J Clin Periodontol,2012,39(10):955-961.
[23]冯新珍.甲硝唑缓释药膜治疗牙周炎46例疗效分析[J].中国社区医师:医学专业,2011,13(5):97-98.
[24]RODVOLD K A.Clinical pharmacokinetics of clarithromycin[J].Clin Pharmacokinet,1999,37(5):385-398.
[25]GOTFRIED M H.Macrolides for the treatment of chronic sinusitis,asthma,and COPD[J].Chest,2004,125(2Suppl):52S-60S.
[26]赵琳,张晓莉,王晓非.强直性脊柱炎与牙周炎相关性研究[J].中国实用内科杂志,2017,37(9):841-844.