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局部或全身使用抗生素作为糖尿病患者非手术牙周治疗辅助手段的疗效：一项随机临床试验的系统评价和荟萃分析

The Efficacy of Topical or Systemic Antibiotics as Adjuvants to Non-Surgical Periodontal Treatment in Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

作者信息

de Molon Rafael Scaf, Rodrigues Joao Victor Soares, Deroide Mariella Boaretti, da Silva Barbirato Davi, Garcia Valdir Gouveia, Theodoro Leticia Helena

机构信息

Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University-UNESP, Aracatuba 16015-050, SP, Brazil.

Department of Basic and Oral Biology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo (FORP/USP), Av. Café, S/N-Ribeirão Preto, São Paulo 14040-904, SP, Brazil.

出版信息

J Clin Med. 2024 Aug 13;13(16):4763. doi: 10.3390/jcm13164763.

DOI:10.3390/jcm13164763
PMID:39200907
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11355856/
Abstract

Periodontitis and diabetes mellitus (DM) exhibit a bidirectional relationship and are globally significant systemic chronic conditions. The utilization of antibiotics alongside non-surgical periodontal treatment (NSPT) has been a subject of investigation in numerous clinical studies involving human subjects. Thus, the objective of this systematic review is to address the following question: "What is the efficacy of scaling and root planing (SRP) associated with antimicrobials in patients with type 2 DM and periodontitis?". A systematic review of the literature was conducted encompassing databases such as MEDLINE/PubMed, Scopus, and Web of Science up to July 2024. Additionally, alerts were configured to capture studies published from the initial search until manuscript submission. Randomized clinical trials assessing clinical periodontal parameters in DM patients undergoing SRP and receiving either topical or systemic antibiotics were compared against a control group (SRP only). Two investigators independently screened articles, extracted data, and evaluated their quality. The selection process, study characteristics, risk of bias, impact of antibiotics on clinical parameters, and certainty of evidence were elucidated in both textual and tabular formats. Meta-analysis was performed separately with forest plots generated for treatment modalities, period of evaluation, and type of antibiotics used. Following the analysis of abstracts and full articles, a total of 30 randomized clinical trials were incorporated into this review, comprising 9 studies on the association of topical antibiotics and 21 studies on systemic antibiotic administration. The principal periodontal parameters assessed included probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP). Analysis of the results led to the conclusion that adjunctive periodontal treatment with either topical or systemic antibiotics confers subtle clinical benefits. Nevertheless, owing to the heightened emergence of resistant bacteria and potential side effects, the use of antibiotic therapy in periodontal treatment should be judiciously administered.

摘要

牙周炎和糖尿病呈现出双向关系，是全球范围内具有重要意义的全身性慢性疾病。在众多涉及人类受试者的临床研究中，抗生素与非手术牙周治疗（NSPT）联合使用一直是研究的主题。因此，本系统评价的目的是回答以下问题：“在2型糖尿病和牙周炎患者中，与抗菌药物联合使用的龈下刮治和根面平整（SRP）的疗效如何？” 我们对文献进行了系统评价，涵盖了截至2024年7月的MEDLINE/PubMed、Scopus和Web of Science等数据库。此外，还设置了提醒功能，以捕捉从初始搜索到稿件提交期间发表的研究。将评估接受SRP并接受局部或全身抗生素治疗的糖尿病患者临床牙周参数的随机临床试验与对照组（仅SRP）进行比较。两名研究人员独立筛选文章、提取数据并评估其质量。以文本和表格形式阐明了选择过程、研究特征、偏倚风险、抗生素对临床参数的影响以及证据的确定性。分别使用针对治疗方式、评估期和所用抗生素类型生成的森林图进行荟萃分析。在对摘要和全文进行分析后，本评价共纳入了30项随机临床试验，其中9项研究局部抗生素的联合使用，21项研究全身抗生素的给药。评估的主要牙周参数包括探诊深度（PPD）、临床附着水平（CAL）、菌斑指数（PI）和探诊出血（BoP）。结果分析得出的结论是，局部或全身使用抗生素辅助牙周治疗具有轻微的临床益处。然而，由于耐药菌的出现增加以及潜在的副作用，牙周治疗中抗生素的使用应谨慎进行。

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