背景:本系统综述和荟萃分析的目的是评估非手术牙周治疗(NSPT)对伴有或不伴有肥胖的牙周炎患者炎症相关细胞因子/脂肪细胞因子的影响。
方法:我们遵循系统评价和荟萃分析声明的首选报告项目,并将研究(CRD420223775331)注册在前瞻性国际系统评价注册。截至2022年12月,我们从六个数据库中筛选了随机对照试验和对照临床试验。使用RoB-2和ROBINS-I工具进行随机试验和非随机试验的质量评估。分别。采用随机效应模型进行Meta分析。
结果:我们在系统分析中纳入了17篇参考文献,和16在荟萃分析中。促炎生物标志物的基线结果,包括血清白细胞介素(IL)-6,血清和龈沟液(GCF),肿瘤坏死因子(TNF)-a,血清C反应蛋白(CRP)/hs-CRP,血清和GCF抵抗素,肥胖受试者高于正常体重受试者。NSPT对细胞因子/脂肪细胞因子水平的影响,包括IL-6,TNF-a,CRP/hs-CRP,抵抗素,脂联素,瘦素和视黄醇结合蛋白4(RBP4),然后在系统分析和荟萃分析中进行分析。NSPT三个月后,血清(MD=-0.54,CI=-0.62--0.46),和GCF(MD=-2.70,CI=-4.77--0.63)的IL-6水平以及血清RBP4(MD=-0.39,CI=-0.68-0.10)在牙周炎肥胖个体中降低。NSPT还改善了无肥胖牙周炎个体三个月后的GCF脂联素水平(MD=2.37,CI=0.29-4.45)。
结论:肥胖状态改变了细胞因子/脂肪细胞因子的基线水平(血清IL-6,血清和GCFTNF-a,血清CRP/hs-CRP,和血清和GCF抵抗素)。然后NSPT可以改变生物体液中特定的促炎介质和抗炎介质的水平,肥胖和非肥胖个体。NSPT可以降低肥胖患者3个月后血清和GCFIL-6水平以及血清RBP4水平,此外,没有足够的证据证明与体重正常的患者相比,肥胖患者的其他细胞因子水平有统计学上的显着下降。NSPT还可以在3个月后增加正常体重个体的GCF脂联素水平。我们的发现暗示了潜在的理想随访间隔和敏感的生物标志物,用于临床生物分析,以个性化决策NSPT的影响,这是由于患者的BMI值。
The objective of this systematic
review and meta-analysis was to evaluate the effects of non-surgical periodontal therapy (NSPT) on inflammatory-related cytokines/adipocytokines in periodontitis patients with or without obesity.
We followed the preferred reporting items for systematic reviews and meta-analyses statement and registered the study (CRD42022375331) in the Prospective International Register of Systematic Reviews. We screened randomized-controlled trials and controlled clinical trials from six databases up to December 2022. Quality assessment was performed with RoB-2 and ROBINS-I tools for randomized trials and non-randomized trials, respectively. Meta-analysis was carried out using a random-effect model.
We included seventeen references in the systematic analysis, and sixteen in the meta-analysis. Baseline results of pro-inflammatory biomarkers, including serum interleukin (IL)-6, serum and gingival crevicular fluid (GCF), tumor necrosis factor (TNF)-a, serum C-reactive protein (CRP)/hs-CRP, and serum and GCF resistin, were higher in obesity subjects than in normal weight subjects. The effect of NSPT with respect to levels of cytokines/adipocytokines, including IL-6, TNF-a, CRP/hs-CRP, resistin, adiponectin, leptin and retinol binding protein 4 (RBP4), were then analyzed in the systematic and meta-analysis. After three months of NSPT, serum (MD = -0.54, CI = -0.62 - -0.46), and GCF (MD = -2.70, CI = -4.77 - -0.63) levels of IL-6, along with the serum RBP4 (MD = -0.39, CI = -0.68-0.10) decreased in periodontitis individuals with obesity. NSPT also improved GCF adiponectin levels after three months (MD = 2.37, CI = 0.29 - 4.45) in periodontitis individuals without obesity.
Obese status altered the baseline levels of cytokines/adipocytokines (serum IL-6, serum and GCF TNF-a, serum CRP/hs-CRP, and serum and GCF resistin). Then NSPT can shift the levels of specific pro-inflammatory mediators and anti-inflammatory mediators in biological fluids, both in obesity and non-obesity individuals. NSPT can reduce serum and GCF IL-6 levels together with serum RBP4 level in individuals with obesity after 3 months, besides, there is no sufficient evidence to prove that obese patients have a statistically significant decrease in the levels of other cytokines compared to patients with normal weight. NSPT can also increase GCF adiponectin level in normal weight individuals after 3 months. Our findings imply the potential ideal follow-up intervals and sensitive biomarkers for clinical bioanalysis in personalized decision-making of effect of NSPT due to patients\' BMI value.