Paraskevas Spiros, Huizinga John D, Loos Bruno G
Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University, Amsterdam, The Netherlands.
J Clin Periodontol. 2008 Apr;35(4):277-90. doi: 10.1111/j.1600-051X.2007.01173.x. Epub 2008 Feb 20.
Elevated plasma C-reactive protein (CRP) is regarded as a risk predictor for cardiovascular diseases. This systematic review explored the robustness of observations that CRP is elevated in periodontitis. Similarly, the effect of periodontal therapy on CRP levels was investigated.
Selection of publications was based on: (1) cross-sectional (case-control) studies; (2) longitudinal (treatment) studies; (3) high-sensitivity CRP measurement; (4) median and/or mean (+/-SD) values presented; and (5) subjects with no systemic disorders.
Screening of the initially 448 identified studies and reference checking resulted in 18 suitable papers. The majority of the studies showed that CRP levels are higher in patients than in controls. Often, studies showed that patients had CRP levels >2.1 mg/l. A meta-analysis of 10 cross-sectional studies showed that the weighted mean difference (WMD) of CRP between patients and controls was 1.56 mg/l (p<0.00001). Evidence from available treatment studies (n=6) showed lower levels of CRP after periodontal therapy. Eligible treatment studies in a meta-analysis demonstrated a WMD of reductions of CRP after therapy of 0.50 mg/L (95% CI 0.08-0.93) (p=0.02).
There is strong evidence from cross-sectional studies that plasma CRP in periodontitis is elevated compared with controls. There is modest evidence on the effect of periodontal therapy in lowering the levels of CRP.
血浆C反应蛋白（CRP）升高被视为心血管疾病的风险预测指标。本系统评价探讨了牙周炎患者CRP升高这一观察结果的可靠性。同样，还研究了牙周治疗对CRP水平的影响。
出版物的选择基于以下几点：（1）横断面（病例对照）研究；（2）纵向（治疗）研究；（3）高敏CRP测量；（4）呈现中位数和/或均值（±标准差）；（5）无全身疾病的受试者。
对最初识别出的448项研究进行筛选并核对参考文献后，得到18篇合适的论文。大多数研究表明，患者的CRP水平高于对照组。通常，研究显示患者的CRP水平>2.1mg/L。对10项横断面研究的荟萃分析表明，患者与对照组之间CRP的加权平均差（WMD）为1.56mg/L（p<0.00001）。现有治疗研究（n = 6）的证据表明，牙周治疗后CRP水平降低。荟萃分析中符合条件的治疗研究显示，治疗后CRP降低的WMD为0.50mg/L（95%CI 0.08 - 0.93）（p = 0.02）。
横断面研究有充分证据表明，与对照组相比，牙周炎患者的血浆CRP升高。关于牙周治疗降低CRP水平的效果，证据有限。
