牙周炎與絕經后骨質疏松癥相關性的Meta分析_《中國循證醫學雜志》

作者：

哈麗婭 ¹ , 趙今 ¹ , 劉弈杉 ¹ ,  鐘良軍 ²

1. 新疆醫科大學第一附屬醫院牙周科（烏魯木齊?830054）；2. 杭州師范大學附屬醫院口腔科（杭州?310015）;

關鍵詞：

牙周病牙周炎絕經后骨質疏松癥 Meta分析病例對照研究

DOI：

10.7507/1672-2531.20110234

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目的　系統評價評價牙周炎與絕經后骨質疏松癥之間的關系。
方法　計算機檢索PubMed（1966～2010.12）、EMbase（1974～2010.12）、CBM（1978～2010.12）、VIP（1989～ 2010.12）、CNKI（1979～2010.12）和萬方數字化期刊全文數據庫（1997～2010.12），并手工檢索相關雜志及會議論文集中未發表的文獻。由2位研究者按照納入和排除標準篩選文獻、提取資料并評價質量后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入4個病例對照研究，合計678例患者，其中絕經后骨質疏松癥組263例，非骨質疏松癥組415例。4個研究的合并分析結果顯示，絕經后骨質疏松癥組臨床附著喪失（clinical attachment loss，CAL）程度重于非骨質疏松癥組［WMD=0.60，95%CI（0.23，0.96）］。2個研究的合并分析結果顯示，絕經后骨質疏松癥組牙齦退縮程度高于非骨質疏松癥組［WMD=0.78，95%CI（0.41，1.14）］。2個研究合并分析結果顯示，兩組患者的菌斑指數、牙齦指數、牙周探診深度之間差異均無統計學意義［WMD=0.17，95%CI（0.00，0.35）；WMD=0.05，95%CI（–0.09，0.19）；WMD= –0.08，95%CI（–0.24，0.09）］。1個研究發現絕經后骨質疏松癥組患者牙周炎患病率高于非骨質疏松癥組（P lt;0.05），與后者相比，前者更容易罹患牙周炎［OR=2.45，95%CI（1.38，4.34），P lt;0.01］；該研究還認為，骨質疏松癥與牙槽嵴高度發生重度喪失之間存在相關性［OR=4.20，95%CI（1.57，11.22），P lt;0.01］。
結論　絕經后骨質疏松癥患者更易罹患牙周炎或其牙周炎病情容易加重。鑒于本系統評價納入研究數量太少且病例不多，以及測量指標不全面等影響本Meta分析論證強度及全面性的因素存在，以上結論尚需開展更多高質量研究證實。

引用本文： 哈麗婭,趙今,劉弈杉,鐘良軍. 牙周炎與絕經后骨質疏松癥相關性的Meta分析. 中國循證醫學雜志, 2011, 11(12): 1377-1383. doi: 10.7507/1672-2531.20110234 復制

1.	孟煥新, 主編. 牙周炎學. 第3版. 北京: 人民衛生出版社, 2008: 20-31.
2.	Cobb CM, Williams KB, Gerkovitch MM. Is the prevalence of periodontitis in the USA in decline? Periodontol, 2000, 2009, 50: 13-24.
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4.	卞金有, 主編. 預防口腔醫學. 第4版. 北京: 人民衛生出版社, 2006: 30-31.
5.	Geurs NC. Osteoporosis and periodontal disease. Periodontol, 2000, 2007, 44: 29-43.
6.	Groen JJ, Duyvensz F, Halsted JA. Diffuse alveolar atrophy of the jaw (non-inflammatory form of paradental disease and pre-senile osteoporosis. Gerontol Clin, 1960, 2: 68-86.
7.	Boehm, TK, Scannapieco FA. The epidemiology, consequences and management of periodontal disease in older adults. J Am Dent Assoc, 2007, 138(Suppl): S26-S33.
8.	World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser, 1994, 843: 1-129.
9.	曹采方, 主編. 牙周炎學. 第2版. 北京: 人民衛生出版社, 2000: 120.
10.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of Epidemiology and Community Medicine, University of Ottawa. http: //www.ohri.ca/programs/-clinical_epidemiology/oxford.htm.
11.	Leonardi-bee J, Smyth A, Britton J, et al. Environmental tobacco smoke and fetal health: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2008, 93(5): F351-F361.
12.	von Wowern N, Klausen B, Kollerup G. Osteoporosis: A risk factor in periodontal disease. J Periodontol, 1994, 65: 1134-1138.
13.	Mohammad AR, Brunsvold M, Bauer R. The strength of association between systemic postmenopausal osteoporosis and periodontal disease. Int J Prosthodont, 1996, 9(5): 479-483.
14.	Brennan RM, Genco RJ, Hovey KM, et al. Clinical attachment loss, systemic bone density, and subgingival calculus in postmenopausal women. J Periodontol, 2007, 78(11): 2104-2111.
15.	Al Habashneh R, Alchalabi H, Khader YS, et al. Association between periodontal disease and osteoporosis in postmenopausal women in Jordan. J Periodontol, 2010, 81(11): 1613-1621.
16.	Weyant RJ, Pearlstein ME, Churak AP, et al. The association between osteopenia and periodontal attachment loss in older women. J Periodontol, 1999, 70(9): 982-991.
17.	Shen EC, Gau CH, Hsieh YD, et al. Periodontal status in post-menopausal osteoporosis: a preliminary clinical study in Taiwanese women. J Chin Med Assoc, 2004, 67(8): 389-393.
18.	Wactawski-Wende J, Hausmann E, Hovey K, et al. The association between osteoporosis and alveolar crestal height in postmenopausal women. J Periodontol, 2005, 76(11 Suppl): 2116-2124.
19.	Famili P, Cauley J, Suzuki JB, et al. Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women. J Periodontol, 2005, 76(1): 11-15.
20.	Yoshihara A, Seida Y, Hanada N, et al. A longitudinal study of the relationship between periodontal disease and bone mineral density in community-dwelling older adults. J Clin Periodontol, 2004, 31(8): 680-684.
21.	Hildebolt CF, Pilgram TK, Yokoyama-Crothers N, et al. The pattern of alveolar crest height change in healthy postmenopausal women after 3 years of hormone/estrogen replacement therapy. J Periodontol, 2002, 73(11): 1279-1284.
22.	Elders PJ, Habets LL, Netelenbos JC, et al. The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age. J Clin Periodontol, 1992, 19(7): 492-496.
23.	Kribbs PJ. Comparison of mandibular bone in normal and osteoporotic women. J Prosthet Dent, 1990, 63(2): 218-222.
24.	Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. JADA, 2003, 134(2): 220-225.

1. 孟煥新, 主編. 牙周炎學. 第3版. 北京: 人民衛生出版社, 2008: 20-31.
2. Cobb CM, Williams KB, Gerkovitch MM. Is the prevalence of periodontitis in the USA in decline? Periodontol, 2000, 2009, 50: 13-24.
3. Holtfreter B, Schwahn C, Biffar R, et al. Epidemiology of periodontal diseases in the Study of Health in Pomerania. J Clin Periodontol, 2009, 36(2): 114-123.
4. 卞金有, 主編. 預防口腔醫學. 第4版. 北京: 人民衛生出版社, 2006: 30-31.
5. Geurs NC. Osteoporosis and periodontal disease. Periodontol, 2000, 2007, 44: 29-43.
6. Groen JJ, Duyvensz F, Halsted JA. Diffuse alveolar atrophy of the jaw (non-inflammatory form of paradental disease and pre-senile osteoporosis. Gerontol Clin, 1960, 2: 68-86.
7. Boehm, TK, Scannapieco FA. The epidemiology, consequences and management of periodontal disease in older adults. J Am Dent Assoc, 2007, 138(Suppl): S26-S33.
8. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser, 1994, 843: 1-129.
9. 曹采方, 主編. 牙周炎學. 第2版. 北京: 人民衛生出版社, 2000: 120.
10. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of Epidemiology and Community Medicine, University of Ottawa. http: //www.ohri.ca/programs/-clinical_epidemiology/oxford.htm.
11. Leonardi-bee J, Smyth A, Britton J, et al. Environmental tobacco smoke and fetal health: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2008, 93(5): F351-F361.
12. von Wowern N, Klausen B, Kollerup G. Osteoporosis: A risk factor in periodontal disease. J Periodontol, 1994, 65: 1134-1138.
13. Mohammad AR, Brunsvold M, Bauer R. The strength of association between systemic postmenopausal osteoporosis and periodontal disease. Int J Prosthodont, 1996, 9(5): 479-483.
14. Brennan RM, Genco RJ, Hovey KM, et al. Clinical attachment loss, systemic bone density, and subgingival calculus in postmenopausal women. J Periodontol, 2007, 78(11): 2104-2111.
15. Al Habashneh R, Alchalabi H, Khader YS, et al. Association between periodontal disease and osteoporosis in postmenopausal women in Jordan. J Periodontol, 2010, 81(11): 1613-1621.
16. Weyant RJ, Pearlstein ME, Churak AP, et al. The association between osteopenia and periodontal attachment loss in older women. J Periodontol, 1999, 70(9): 982-991.
17. Shen EC, Gau CH, Hsieh YD, et al. Periodontal status in post-menopausal osteoporosis: a preliminary clinical study in Taiwanese women. J Chin Med Assoc, 2004, 67(8): 389-393.
18. Wactawski-Wende J, Hausmann E, Hovey K, et al. The association between osteoporosis and alveolar crestal height in postmenopausal women. J Periodontol, 2005, 76(11 Suppl): 2116-2124.
19. Famili P, Cauley J, Suzuki JB, et al. Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women. J Periodontol, 2005, 76(1): 11-15.
20. Yoshihara A, Seida Y, Hanada N, et al. A longitudinal study of the relationship between periodontal disease and bone mineral density in community-dwelling older adults. J Clin Periodontol, 2004, 31(8): 680-684.
21. Hildebolt CF, Pilgram TK, Yokoyama-Crothers N, et al. The pattern of alveolar crest height change in healthy postmenopausal women after 3 years of hormone/estrogen replacement therapy. J Periodontol, 2002, 73(11): 1279-1284.
22. Elders PJ, Habets LL, Netelenbos JC, et al. The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age. J Clin Periodontol, 1992, 19(7): 492-496.
23. Kribbs PJ. Comparison of mandibular bone in normal and osteoporotic women. J Prosthet Dent, 1990, 63(2): 218-222.
24. Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. JADA, 2003, 134(2): 220-225.

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牙周炎與絕經后骨質疏松癥相關性的Meta分析

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《中國循證醫學雜志》

牙周炎與絕經后骨質疏松癥相關性的Meta分析

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