Jin Wenqin, Li Lingfeng, Ai Huangping, Jin Zhao, Zuo Yuling
Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, Sichuan 610072, China.
College of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Evid Based Complement Alternat Med. 2022 Aug 27;2022:3853303. doi: 10.1155/2022/3853303. eCollection 2022.
The aim of this systematic review and meta-analysis was to assess the efficacy and safety of traditional Chinese medicine based on the method of "nourishing kidney and clearing heat" as an adjuvant in the treatment of diabetes mellitus patients with periodontitis.
An electronic literature search was conducted in the China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Scientific Journals Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, EMBASE, Web of Science, and Cochrane Library databases for articles published until October 2021. The primary outcomes were probing pocket depth (PPD), clinical attachment loss (CAL), plaque index (PLI), and sulcular bleeding index (SBI), while the secondary outcomes were tooth mobility (TM), glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total effective rate, and adverse effects.
Eleven randomized controlled trials (RCT) were included in the meta-analysis. The pooled results showed PPD (WMD = 1.07, 95%CI: (0.82, 1.33), < 0.00001, = 89%), CAL (WMD = 0.78, 95%CI: (0.62, 0.93), < 0.00001, = 58%), PLI (WMD = 0.44, 95%CI: (0.09, 0.79), =0.01, I = 97%), SBI (WMD = 0.87, 95%CI: (0.79, 0.95), < 0.00001, = 37%), TM (WMD = 0.26, 95%CI: (0.21, 0.30), < 0.00001, = 31%), HbA1c (WMD = 0.48, 95%CI: (0.28, 0.67), < 0.00001, I = 26%), FBG (WMD = 1.34, 95%CI: (0.96, 1.72), < 0.00001, = 52%), total effective rate (RR = 1.24, 95%CI: (1.14, 1.34), < 0.00001, = 0%), and adverse effects (RR = 0.78, 95%CI: (0.20, 3.03), =0.72, = 0%) in the traditional Chinese medicine based on the method of "nourishing kidney and clearing heat" + routine western medicine treatment (periodontal basic treatment, PBT, with or without antibiotic) group were significantly improved compared to control group, but no significant difference was observed for PLI at 2-3 months and 6 months.
This review supports traditional Chinese medicine based on the method of "nourishing kidney and clearing heat" as an adjuvant to routine western medicine treatment in the management of diabetes mellitus patients with periodontitis. Within the limits of the evidence, the well-designed, long-term efficacy, and high-quality multicenter RCTs need to be further confirmed.
本系统评价和荟萃分析旨在评估基于“补肾清热”法的中药作为辅助治疗糖尿病合并牙周炎患者的疗效和安全性。
在中国知网（CNKI）、万方数据、维普中文科技期刊数据库（VIP）、中国生物医学文献数据库（CBM）、PubMed、EMBASE、Web of Science和Cochrane图书馆数据库中进行电子文献检索，检索截至2021年10月发表的文章。主要结局指标为探诊深度（PPD）、临床附着丧失（CAL）、菌斑指数（PLI）和龈沟出血指数（SBI），次要结局指标为牙齿松动度（TM）、糖化血红蛋白（HbA1c）、空腹血糖（FBG）、总有效率和不良反应。
荟萃分析纳入了11项随机对照试验（RCT）。汇总结果显示，与对照组相比，基于“补肾清热”法的中药+常规西药治疗（牙周基础治疗，PBT，加或不加抗生素）组的PPD（加权均数差[WMD]=1.07，95%置信区间[CI]：(0.82, 1.33)，P<0.00001，I²=89%）、CAL（WMD=0.78，95%CI：(0.62, 0.93)，P<0.00001，I²=58%）、PLI（WMD=0.44，95%CI：(0.09, 0.79)，P=0.01，I²=97%）、SBI（WMD=0.87，95%CI：(0.79, 0.95)，P<0.00001，I²=37%）、TM（WMD=0.26，95%CI：(0.21, 0.30)，P<0.00001，I²=31%）、HbA1c（WMD=0.48，95%CI：(0.28, 0.67)，P<0.00001，I²=26%）、FBG（WMD=1.34，95%CI：(0.96, 1.72)，P<0.00001，I²=52%）、总有效率（风险比[RR]=1.24，95%CI：(1.14, 1.34)，P<0.00001，I²=0%）和不良反应（RR=0.78，95%CI：(0.20, 3.03)，P=0.72，I²=0%）均有显著改善，但在2 - 3个月和6个月时PLI无显著差异。
本评价支持基于“补肾清热”法的中药作为常规西药治疗糖尿病合并牙周炎患者的辅助治疗。在现有证据范围内，精心设计、长期疗效和高质量的多中心RCT有待进一步证实。
