摘要
目的钙通道阻滞剂(CCB)是治疗心血管疾病的常用药物,文献报道其所致药物性牙龈增生(DIGO)的患病率为7.3%~77.6%,不同文献得出的结果差别较大,本研究旨在通过系统综述及Meta分析,以明确CCB与DIGO的关系及其影响因素。方法两位不同的研究者分别系统地搜索了PubMed、Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)和万方等数据库,以获取CCB所致DIGO的临床研究(发表于1984年1月1日至2019年11月30日,无语言限制)。提取每个符合条件的研究数据,使用相对危险度(RR)和95%置信区间(95%CI)进行系统评价分析,以评估CCB引起牙龈增生的概率及其危险因素。结果通过搜索初步获得了921篇文献,经过筛选共13篇文献纳入Meta分析(n=4432名参与者)。Meta分析结果显示:服用CCB的研究对象牙龈增生发生率是未服用CCB组的4.55倍[RR=4.55,95%CI(3.25,6.36),I2=57%,P=0.006]。亚组分析及Meta回归分析的结果均显示,“地区”和“牙龈增生诊断标准”是研究间异质性的来源。不同牙龈增生诊断标准其合并RR值不同,且国内研究合并RR值[RR=5.83,95%CI(4.11,8.26)]明显高于国外研究合并RR值[RR=2.91,95%CI(1.98,4.29)]。结论服用CCB可导致牙龈增生,“地区”“牙龈增生诊断标准”是研究间异质性的主要来源。我国服用CCB的患者其患牙龈增生的风险可能会更高,这可能与我国患者牙周健康状况较差有关。同时牙龈指数、出血指数及菌斑指数等因素与CCB引起的DIGO相关,不同研究危险因素可能不一致。需服用CCB的患者应该在服药前进行牙周治疗,这可能会预防DIGO的发生,同时在服药过程中,需定期进行牙周检查及相关牙周治疗,以避免或减轻DIGO的程度,避免引起牙齿松动等严重后果。
Objective Calcium channel blocker(CCB)is commonly used in the treatment of cardiovascular diseases.It is reported that the prevalence of drug-induced gingival overgrowth(DIGO)is 7.3%-77.6%.The results obtained from some studies are quite different.The purpose of this study was to clarify the relationship between CCB and DIGO and its influencing factors through systematic reviews and Meta-analysis.Methods Two independent researchers systematically searched PubMed,Cochrane Library,CBM(China Biology Medicine),CNKI,and Wanfang for clinical studies of DIGO caused by CCB(published from January 1,1984 to November 30,2019;no language restrictions).With each eligible study data extracted,the relative risk(RR)and 95%confidence interval(95%CI)were used for the analysis of systematic review to assess the probability and risk factors of gingival hyperplasia caused by CCB.Results We obtained 921 articles through searching and 13 articles were included in the Meta-analysis(n=4432 participants).The Meta-analysis results showed that the probability of gingival hyperplasia in subjects taking CCB was 4.55 times that of those without CCB[RR=4.55,95%CI(3.25,6.36),I2=57%,P=0.006].The results of the subgroup analysis and the Meta-regression analysis showed that the′Region′and′Diagnostic criteria for gingival hyperplasia′were the sources of heterogeneity among studies.Different gingival hyperplasia diagnostic criteria have different combined RR values,and the combined RR value among domestic studies[RR=5.83,95%CI(4.11,8.26)]was significantly higher than that among foreign studies[RR=2.91,95%CI(1.98,4.29)].Conclusions Taking CCB can lead to gingival hyperplasia.′Region′and′Diagnostic criteria for gingival hyperplasia′are the main sources of research heterogeneity.Patients taking CCB in China may have a higher risk of gingival hyperplasia,which may be related to poorer periodontal health of the patients.At the same time,factors such as gingival index,bleeding index,and plaque index were related to DIGO caused by CCB.Risk factors in different studies may be inconsistent.Patients who need to take CCB should have periodontal treatment before taking the medicine,which may prevent the occurrence of drug-induced gingival hyperplasia.Periodic periodontal examinations and related periodontal treatments are recommended to be performed regularly to avoid or reduce the degree of DIGO and avoid serious consequences such as loose tooth.
作者
吴杰
张若楠
王晓晓
于然
宋江园
Wu Jie;Zhang Ruonan;Wang Xiaoxiao;Yu Ran;Song Jiangyuan(Department of Stomatology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration,Wuhan 430022,China;Department of Stomatology,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Research Center for Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华口腔医学研究杂志（电子版）》
CAS
2021年第1期24-33,共10页
Chinese Journal of Stomatological Research(Electronic Edition)
基金
国家自然科学基金(青年科学基金项目81800984)。
关键词
钙通道阻滞剂
牙龈增生
META分析
危险因素
治疗
Calcium channel blockers
Gingival hyperplasia
Meta-analysis
Risk factors
Treatment
