低强度激光缓解正畸疼痛的系统评价  

Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and meta-analysis

作　　者：丁伟峰 段培佳[2] 何武林[2] 万贤凤[2] 温兴涛 

机构地区：[1]佛山市南海区人民医院口腔科,广东佛山528200 [2]广东省口腔医院.南方医科大学附属口腔医院正畸科 [3]广州市荔湾区口腔医院

出　　处：《广东牙病防治》2014年第8期441-445,共5页Journal of Dental Prevention and Treatment

摘　　要：目的评价低强度激光治疗(low-level laser therapy,LLLT)缓解正畸疼痛的治疗效果及风险。方法依据Cochrane Handbook和PRISMA statement的规范化要求,检索1980-2014年2月Cochrane CENTRAL、Medline、PubMed、Embase、CNKI和CBM数据库;同时手工检索纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价由2位评价者依据Cochrane系统评价者手册5.1版独立完成。在独立进行数据提取后,运用Review Manager 5.1软件进行Meta分析。结果共纳入4个随机对照试验、1个不完全随机对照试验和3个临床对照试验,共计4个国家,644例患者。偏倚风险评价显示4个随机对照试验为中度偏倚风险,1个不完全随机对照试验和3个临床对照试验均为高度偏倚风险。Meta分析结果显示:LLLT使正畸后疼痛发生率降低了19%[RR=0.81,95%CI(0.69,0.96),P=0.01]。与空白对照组相比,LLLT缩短了正畸疼痛达峰时间[MD=-0.42,95%CI(-0.74,-0.10),P=0.009],使正畸疼痛呈现提前消退的趋势[MD=-1.37,95%CI(-3.37,0.64),P=0.18],LLLT使6 h内的疼痛强度显著降低[MD=-1.97,95%CI(-2.37,-1.56),P<0.001],24 h内疼痛视觉模拟评分值仍持续降低[MD=-2.50,95%CI(-3.67,-1.32),P<0.001],48 h镇疼效果仍显著(MD=-2.83,95%CI(-3.90,-1.75),P<0.001]。结论由于纳入文献的方法学缺陷和偏倚风险限制,LLLT缓解正畸疼痛的证据存在,但尚显薄弱,需要更多大型优质的临床随机对照试验支撑。Objective To identify the efficacy of Low-level laser therapy（LLLT） in the management of orthodontic pain. Methods This systematic review anti recta-analysis was carried out in accordance with Cochrane Handbook and the PRISMA statement. An extensive literature search for RCTs, quasi-RCTs and CCTs was pertbnned through CEN- TRAL, PubMed, Embase, Medline, CNKI and CBM up to 2014. Risk of bias assessment was pedbrmed via referring to the Cochrane toni for risk of bias assessment. Meta-analysis was implemented using Review Manager 5.1. Results Four RCTs, Iquasi-RCTs and 3 CCTs were selected, including 644 patients from 4 countries. Four RCTs exhibit a moderate risk of bias while 1 quasi-RCTs amt 3 CCTs show a high risk of bias. The recta-analysis demonstrated that 19% risk of incidence of pain was reduced by LLLT （ RR = 0.81, 95% CI range： 0.69 to 0.96, P = 0.01 ）. In addition, compared to the control group, LLLT brought fro＇ward ＂the most painful day＂ （MD = -0.42, 95% CI range： -0. 74 to -0.10, P =0. 009）. Furthermore, the LLLT group also implied a trend of earlier eml of pain compared with the control group （ MD = - 1.37, 95% CI range： -3.37 to 0.64, P =0.18）. LLUL reduced the VAS of pain in 6 hours（ MD = - 1.97, 95% Clrange： -2.37 to - 1.56, P〈0.000 01）. 24 hours（ MD = -2.50, 95% CI range-3.67 to - 1.32, P〈0.000 1）, and 48 hours（MD= -2.83, 95% Cl range- 3. 90 to-1.75, P〈 0.00001）. Conclusion Because of the methodological shortcomings and risk of bias of included trials, LLLT was pnwed with limited evidence in delaying pain onset and reducing pain intensity. In the fitttn＇e, larger and better-designed RCTs will be required to provide clearer recommendations .

关 键 词：低强度激光 正畸疼痛 系统评价 META分析 

分 类 号：R783.5[医药卫生—口腔医学]