我们应该在糖尿病患者的牙周治疗中同时开处方全身抗生素吗?
Sophie Rimmer1, Marianne Dobson2
1Dental Core Trainee, Dundee Dental Hospital & Research School, Dundee, UK. sophie.rimmer@nhs.scot.
Evidence-based dentistry
|March 5, 2025
概括
系统性抗生素结合缩放和根平移 (SRP) 改善了2型糖尿病患者的血糖控制. 辅助抗生素对那些基线HbA1c水平较高和牙周口袋更深的人来说更有好处.
科学领域:
- 牙周病学 牙周病学
- 内分泌学 在内分泌学.
- 微生物学 微生物学
背景情况:
- 严重的牙周炎和2型糖尿病 (T2DM) 具有双向的炎症关系.
- 有效的牙周炎管理可能会对T2DM患者的血糖控制产生积极影响.
研究的目的:
- 评估系统性阿莫西西林和甲尼达作为缩放和根除 (SRP) 的辅助剂对严重牙周炎和T2DM患者的血糖控制的影响.
- 在3个月的时间内评估对全身炎症和牙周参数的影响.
主要方法:
- 一个单一中心的随机对照试验 (RCT) 涉及49名T2DM和严重牙周炎的患者.
- 参与者接受了单独的SRP或SRP与阿莫西西林和甲尼达的7天疗程.
- 主要结局是HbA1c的变化;次要结局包括牙周参数和炎症标志物.
主要成果:
- 单独使用SRP和使用辅助抗生素的SRP都显著改善了HbA1c水平 (p < 0.004).
- 辅助抗生素使用与HbA1c的较大降低有关,特别是在基线HbA1c较高 (>7.5%) 的患者中.
- 与单独使用SRP (p=0.008) 相比,SRP+抗生素组在最初口袋深度>6毫米的地点探测深度的统计学上显著改善 (p=0.008).
结论:
- 在T2DM患者中,SRP和附加抗生素的SRP都对血糖控制和牙周健康有益.
- 辅助抗生素可以为基线控制较差 (HbA1c>7.5%) 个体提供增强的血糖改善.
- 系统性抗生素在减少严重牙周炎病例的探针深度方面提供了适度的额外好处.
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