牙周治疗干预类风湿性关节炎的系统评价  

Periodontal therapy for rheumatoid arthritis:A systematic review

作　　者：吕宗凯[1] 李春洁[2] 吕俊[2] 何武林[3] 高雳[1,3] 吴亚菲[1,3] 

机构地区：[1]四川大学华西口腔医院牙周科 [2]四川大学华西口腔医学院口腔颌面外科教研室 [3]口腔疾病研究国家重点实验室,四川大学,成都610041

出　　处：《华西口腔医学杂志》2011年第4期375-378,共4页West China Journal of Stomatology

基　　金：四川大学大学生科研训练计划基金资助项目(20101071)

摘　　要：目的评价牙周治疗措施在缓解类风湿性关节炎(RA)患者症状和体征中的效果及安全性。方法电子检索Medline(OVID,1950年—2010年9月)、荷兰医学文摘(EMBASE,1984年—2010年9月)、Cochrane图书馆临床随机对照试验库(CENTRAL,2010年第3期)、中国生物医学文献数据库(1978年—2010年9月),手检相应中文口腔期刊,收集牙周治疗措施缓解RA患者症状和体征的临床随机对照试验和临床对照试验。2位研究者独立按照Cochrane临床研究方法学质量评价标准和CONSORT质量评价标准对文献进行偏倚风险和报告质量评价并提取数据。采用Revman 5.0.23进行Meta分析。结果最终纳入文献4篇,涉及患者150名,其中1篇为低度偏倚风险文献,余均为中度偏倚风险文献。Meta分析显示,单纯牙周治疗并不能明显降低RA患者的28个关节的疾病活动度评分(DAS28)(P=0.06),牙周治疗联合抗肿瘤坏死因子-α(TNF-α)治疗与单纯抗TNF-α治疗相比差异无统计学意义(P=0.24),但对亚组合并分析显示牙周治疗能够明显降低DAS28水平(P=0.03)。同时,牙周治疗在缓解RA患者的临床体征、红细胞沉降率和牙周状况方面疗效明显(P<0.05),但各研究对牙周治疗缓解RA患者症状的结论不尽相同。所有研究均未报道不良事件。结论牙周治疗在缓解RA患者的体征和牙周状况方面可能具有积极作用,但对于症状的缓解尚无定论。Objective To assess the effect and safety of periodontal therapy in relieving the symptoms and clinical signs of rheumatoid arthritis（RA）.Methods The electronic search was conducted in Medline（OVID,1950—2010 Sep）,EMBASE（1984—2010 Sep）,CENTRAL（2010,Issue 3）,CBM（1978—2010 Sep） and the Chinese journals on stomatology were hand-searched.Clinical randomized controlled trials as well as clinical controlled trials were selected regar-ding the targeted issue.Two investigators evaluated the reporting quality and risk of bias of those included trials in accordance with CONSORT statement and Cochrane risk of bias assessment tools,and collected data of included studies in duplicate.Revman 5.0.23 was applied for Meta-analysis.Results Four trials met the inclusion criteria and a total of 150 patients were enrolled in the trials,one had low risk of bias and others had moderate risk of bias.Metaanalysis showed that pure periodontal therapy could not decrease disease activity score in 28 joints（DAS28）（P=0.06）, and there was no statistically significant difference between periodontal therapy with anti-tumor necrosis factor-α（TNFα） medication and pure anti-TNF-α medication（P=0.24）.But the subgroup analysis showed that a significantly decreased DAS28 was achieved by periodontal therapy（P=0.03）,and the interventions provided a remarkable effect on alleviating clinical signs and erythrocyte sedimentation rate of RA（P0.05）.Results of the symptoms relief differed from the studies.No adverse events were reported.Conclusion The evidence available currently indicates that periodontal therapy may play a positive role in remitting the clinical signs and periodontal status of RA except the relief of the symptoms.

关 键 词：牙周治疗 牙周炎 类风湿性关节炎 系统评价 循证口腔医学 

分 类 号：R781.4[医药卫生—口腔医学]