富血小板血漿聯合植骨材料與單用植骨材料比較治療牙周病骨內缺損療效的Meta分析_《中國循證醫學雜志》

作者：

高云飛 ¹ ,  郭良微 ¹ , 周晉 ² , 李思敏 ¹

1. 哈爾濱醫科大學附屬口腔醫院牙周病科（哈爾濱 150001）；2. 哈爾濱醫科大學第一臨床學院血液科（哈爾濱 150001）;

關鍵詞：

富血小板血漿植骨材料牙周病骨內缺損系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130131

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目的　系統評價富血小板血漿聯合植骨材料治療牙周骨內缺損的療效。
方法　計算機檢索PubMed、The Cochrane Library、EMbase、CNKI、CBM和WanFang Data，查找富血小板血漿（platelet-rich plasma，PRP）聯合植骨材料與單用植骨材料比較治療牙周骨內缺損的隨機對照試驗（RCT），檢索時限均從建庫至2012年8 月。由2名研究員按照納入和排除標準篩選文獻、提取資料，并評價納入研究的方法學質量后，采用RevMan 5.2軟件進行Meta分析。
結果　最終納入11個RCT，共342例受試者。7個研究的合并分析結果顯示，PRP聯合植骨材料組的臨床附著喪失增加程度低于單用植骨材料組［WMD=0.70，95%CI（0.51，0.90），P lt;0.000 01］。7個研究的合并分析結果顯示，兩組的牙齦退縮程度差異無統計學意義［WMD= –0.01，95%CI（–0.15，0.13），P=0.86］。9個研究的合并分析結果顯示，PRP聯合植骨材料組菌斑指數的減少程度與植骨材料組之間差異無統計學意義［WMD= ?0.04，95%CI（?0.09，0.02），P=0.20］。
結論　在臨床附著喪失方面，PRP聯合植骨材料組療效優于單用植骨材料組，然而，在牙齦退縮、菌斑指數方面，兩者療效無差異。受納入研究數量限制，且測量指標不全面，上述結論尚待開展更多高質量、大樣本的研究予以證實。

引用本文： 高云飛,郭良微,周晉,李思敏. 富血小板血漿聯合植骨材料與單用植骨材料比較治療牙周病骨內缺損療效的Meta分析. 中國循證醫學雜志, 2013, 13(6): 741-746. doi: 10.7507/1672-2531.20130131 復制

1.	Miani PK, do Nascimento C, Sato S, et al. In vivo evaluation of a metronidazole-containing gel for the adjuvant treatment of chronic periodontitis: preliminary results. Eur J Clin Microbiol Infect Dis, 2012, 31(7): 1611-1618.
2.	Kawase T, Okuda K, Wolff LF, et al. Platelet-rich plasmaderived fibrin clot formation stimulates collagen synthesis in periodontal ligament and osteo-blastic cells in vitro. J Periodontol, 2003, 74(6): 858-864.
3.	Roldan JC, Jepsen S, Miller J, et al. Bone formation in the presence of platelet-rich plasma vs. bone morphogenetic protein-7. Bone, 2004, 34(1): 80-90.
4.	Higgins JPT, Green S (editors). Cochrane Handbook for SystematicReviews of Interventions Version 5.1.0 [updated March 2011]. TheCochrane Collaboration, 2011. Available from www.cochranehand-book.org.
5.	Okuda K, Tai H, Tanabe K, et al. Platelet-rich plasmacombined with a porous hydroxyapatite graft for the treatment of intrabony periodontal defects in humans:A comparative controlled clinical study. J Periodontol, 2005,76(6): 890-898.
6.	Ouyang XY, Qiao J. Effect of platelet-rich plasma in the treatment of periodontal intrabony defects in humans. Chin Med J (Engl), 2006, 119(18): 1511-1521.
7.	Demir B, Sengün D, Berberog?lu A. Clinical evaluation of platelet-rich plasma and bioactive glass in the treatment of intra-bony defects. J Clin Periodontol, 2007, 34(8): 709-715.
8.	Piemontese M, Aspriello SD, Rubini C, et al. Treatment of periodontal intrabony de-fects with demineralized freeze-dried bone allograft in combination with platelet-rich plasma: A comparative clinical trial. J Periodontol, 2008, 79(5): 802-810.
9.	Döri F, Nikolidakis D, Hu´sza´r T, et al. Effect of platelet-rich plasma on the healing of intrabony defects treated with an enamel matrix protein derivative and a natural bone mineral. J Clin Periodontol, 2008, 35(1): 44-50.
10.	Döri F, Kova´cs V, Arweiler NB, et al. Effect of Platelet-Rich Plasma on the Healing of Intrabony Defects Treated With an Anorganic Bovine Bone Mineral: A Pilot Study. J Periodontol, 2009, 80(10): 1599-1605.
11.	康軍, 沙月琴, 歐陽翔英. 脫礦凍干骨粉與富血小板血漿聯合治療牙周骨內缺損. 北京大學學報(醫學版), 2010, 42(1): 24-27.
12.	Kaushick BT, Jayakumar ND, Padmalatha O, et al. Treatment of human periodontal infrabony defects with hydroxyapatite + b tricalcium phosphate bone graft alone and in combination with platelet rich plasma: A randomized clinical trial. Indian J Dent Res, 2011, 22(4): 505-510.
13.	Saini N, Sikril P, Gupta H. Evaluation of the relative efficacy of autologous platelet-rich plasma in combination with β-tricalcium phosphate alloplast versus an alloplast alone in the treatment of human periodontal infrabony defects: A clinical and radiological study. Indian J Dent Res, 2011, 22(1): 107-115.
14.	Lilian Maria Menezes, MDS/Jyoti Rao, MDS. Long-term clinical evaluation of platelet-rich plasma in the treatment of human periodontal intraosseous defects: A comparative clinical trail. Quintessence Int, 2012, 43(7): 571-582.
15.	Hassan KS, Alagl AS, Abdel-Hady A. Torus mandibularis bone chips combined with platelet rich plasma gel for treatment of intrabony osseous defects: clinical and radiographic evaluation. Int J Oral Maxillofac Surg, 2012, 41(12): 1519-1526.
16.	仇建軍, 張長青, 袁霆. 富血小板血漿及所含相關因子在組織修復再生中的應用與作用. 中國組織工程研究與臨床康復, 2009, 13(41): 8131-8134.
17.	Marx RE. Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dent, 2001, 10(4): 225-228.
18.	Del Fabbro M, Bortolin M, Taschieri S, et al. Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis. J Periodontol, 2011, 82(8): 1100-1111.
19.	Kotsovilis S, Markou N, Pepelassi E, et al. The adjunctive use of platelet-rich plasma in the therapy of periodontal intraosseous defects:a systematic review. J Periodont Res, 2010, 45(3): 428-443.

1. Miani PK, do Nascimento C, Sato S, et al. In vivo evaluation of a metronidazole-containing gel for the adjuvant treatment of chronic periodontitis: preliminary results. Eur J Clin Microbiol Infect Dis, 2012, 31(7): 1611-1618.
2. Kawase T, Okuda K, Wolff LF, et al. Platelet-rich plasmaderived fibrin clot formation stimulates collagen synthesis in periodontal ligament and osteo-blastic cells in vitro. J Periodontol, 2003, 74(6): 858-864.
3. Roldan JC, Jepsen S, Miller J, et al. Bone formation in the presence of platelet-rich plasma vs. bone morphogenetic protein-7. Bone, 2004, 34(1): 80-90.
4. Higgins JPT, Green S (editors). Cochrane Handbook for SystematicReviews of Interventions Version 5.1.0 [updated March 2011]. TheCochrane Collaboration, 2011. Available from www.cochranehand-book.org.
5. Okuda K, Tai H, Tanabe K, et al. Platelet-rich plasmacombined with a porous hydroxyapatite graft for the treatment of intrabony periodontal defects in humans:A comparative controlled clinical study. J Periodontol, 2005,76(6): 890-898.
6. Ouyang XY, Qiao J. Effect of platelet-rich plasma in the treatment of periodontal intrabony defects in humans. Chin Med J (Engl), 2006, 119(18): 1511-1521.
7. Demir B, Sengün D, Berberog?lu A. Clinical evaluation of platelet-rich plasma and bioactive glass in the treatment of intra-bony defects. J Clin Periodontol, 2007, 34(8): 709-715.
8. Piemontese M, Aspriello SD, Rubini C, et al. Treatment of periodontal intrabony de-fects with demineralized freeze-dried bone allograft in combination with platelet-rich plasma: A comparative clinical trial. J Periodontol, 2008, 79(5): 802-810.
9. Döri F, Nikolidakis D, Hu´sza´r T, et al. Effect of platelet-rich plasma on the healing of intrabony defects treated with an enamel matrix protein derivative and a natural bone mineral. J Clin Periodontol, 2008, 35(1): 44-50.
10. Döri F, Kova´cs V, Arweiler NB, et al. Effect of Platelet-Rich Plasma on the Healing of Intrabony Defects Treated With an Anorganic Bovine Bone Mineral: A Pilot Study. J Periodontol, 2009, 80(10): 1599-1605.
11. 康軍, 沙月琴, 歐陽翔英. 脫礦凍干骨粉與富血小板血漿聯合治療牙周骨內缺損. 北京大學學報(醫學版), 2010, 42(1): 24-27.
12. Kaushick BT, Jayakumar ND, Padmalatha O, et al. Treatment of human periodontal infrabony defects with hydroxyapatite + b tricalcium phosphate bone graft alone and in combination with platelet rich plasma: A randomized clinical trial. Indian J Dent Res, 2011, 22(4): 505-510.
13. Saini N, Sikril P, Gupta H. Evaluation of the relative efficacy of autologous platelet-rich plasma in combination with β-tricalcium phosphate alloplast versus an alloplast alone in the treatment of human periodontal infrabony defects: A clinical and radiological study. Indian J Dent Res, 2011, 22(1): 107-115.
14. Lilian Maria Menezes, MDS/Jyoti Rao, MDS. Long-term clinical evaluation of platelet-rich plasma in the treatment of human periodontal intraosseous defects: A comparative clinical trail. Quintessence Int, 2012, 43(7): 571-582.
15. Hassan KS, Alagl AS, Abdel-Hady A. Torus mandibularis bone chips combined with platelet rich plasma gel for treatment of intrabony osseous defects: clinical and radiographic evaluation. Int J Oral Maxillofac Surg, 2012, 41(12): 1519-1526.
16. 仇建軍, 張長青, 袁霆. 富血小板血漿及所含相關因子在組織修復再生中的應用與作用. 中國組織工程研究與臨床康復, 2009, 13(41): 8131-8134.
17. Marx RE. Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dent, 2001, 10(4): 225-228.
18. Del Fabbro M, Bortolin M, Taschieri S, et al. Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis. J Periodontol, 2011, 82(8): 1100-1111.
19. Kotsovilis S, Markou N, Pepelassi E, et al. The adjunctive use of platelet-rich plasma in the therapy of periodontal intraosseous defects:a systematic review. J Periodont Res, 2010, 45(3): 428-443.

《中國循證醫學雜志》

富血小板血漿聯合植骨材料與單用植骨材料比較治療牙周病骨內缺損療效的Meta分析

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《中國循證醫學雜志》

富血小板血漿聯合植骨材料與單用植骨材料比較治療牙周病骨內缺損療效的Meta分析

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