【摘要】：目的:目前有多項(xiàng)流行病學(xué)研究探討了飲酒與牙周炎發(fā)生風(fēng)險(xiǎn)之間的關(guān)系,但是結(jié)論并不一致。本研究擬通過(guò)Meta分析的方法,定量綜合分析多項(xiàng)觀察性研究的結(jié)果,以探究飲酒和牙周炎發(fā)生風(fēng)險(xiǎn)之間的關(guān)系,并進(jìn)一步評(píng)價(jià)飲酒量大小與牙周炎發(fā)生之間的劑量-反應(yīng)關(guān)系。方法:制定檢索策略及文獻(xiàn)納入標(biāo)準(zhǔn),檢索Pub Med、Web of Science及Embase三個(gè)數(shù)據(jù)庫(kù),獲取飲酒與牙周炎發(fā)生風(fēng)險(xiǎn)關(guān)系研究的全部相關(guān)英文文獻(xiàn),對(duì)檢索到的文獻(xiàn)進(jìn)行嚴(yán)格的篩選,以期獲得最全面的文獻(xiàn)。對(duì)符合標(biāo)準(zhǔn)的文獻(xiàn)提取數(shù)據(jù),進(jìn)行Meta分析。本研究運(yùn)用隨機(jī)效應(yīng)模型計(jì)算合并的相對(duì)危險(xiǎn)度(Relative Risk,RR)及其95%置信區(qū)間(95%CI),使用限制性立方樣條法探究劑量-反應(yīng)關(guān)系。采用Q檢驗(yàn)探討研究間的異質(zhì)性,利用I2值定量評(píng)估異質(zhì)性的大小,采用敏感性分析來(lái)探討單個(gè)研究對(duì)總的合并效應(yīng)值的影響,運(yùn)用漏斗圖法和Egger線性回歸檢驗(yàn)法來(lái)判斷是否存在發(fā)表偏倚。結(jié)果:共有17篇文獻(xiàn),包含18個(gè)研究,符合納入標(biāo)準(zhǔn)。所有研究總的調(diào)查對(duì)象為90147人,包括了來(lái)自歐洲、亞洲和美洲的不同人群。在這18個(gè)研究中,橫斷面研究14個(gè),隊(duì)列研究4個(gè)。其中,有6個(gè)研究提供了飲酒量和牙周炎發(fā)生風(fēng)險(xiǎn)關(guān)系的數(shù)據(jù),可以被納入進(jìn)行劑量-反應(yīng)關(guān)系分析。Meta分析總的合并效應(yīng)顯示:飲酒與牙周炎發(fā)生風(fēng)險(xiǎn)相關(guān),并且飲酒能夠顯著增加牙周炎的發(fā)生風(fēng)險(xiǎn)。相對(duì)于飲酒攝入的最低劑量,飲酒攝入的最高劑量與牙周炎發(fā)生風(fēng)險(xiǎn)的合并RR值為1.59(95%CI:1.37-1.85)。將研究對(duì)象按性別進(jìn)行分析,結(jié)果顯示在男性和女性人群中飲酒都是牙周炎的一個(gè)危險(xiǎn)因素,RR值分別為1.25(95%CI:1.11-1.41)和2.15(95%CI:1.36-3.41)。亞組分析結(jié)果顯示:(1)按研究設(shè)計(jì)類(lèi)型分析,隊(duì)列研究和橫斷面研究結(jié)果均表明飲酒是牙周炎發(fā)生的危險(xiǎn)因素,其RR值分別為1.28(95%CI:1.04-1.57)和1.66(95%CI:1.39-1.99);(2)按研究對(duì)象所在大洲進(jìn)行分析,亞洲、歐洲以及美洲合并分析結(jié)果也都表明飲酒能夠增加牙周炎的發(fā)生風(fēng)險(xiǎn),其RR值分別為1.45(95%CI:1.15-1.82)、1.76(95%CI:1.13-2.74)和1.76(95%CI:1.34-2.32);(3)按混雜因素中是否調(diào)整體質(zhì)指數(shù)進(jìn)行分析,在調(diào)整了體質(zhì)指數(shù)和未調(diào)整體質(zhì)指數(shù)兩組中,飲酒都能夠增加牙周炎的發(fā)生風(fēng)險(xiǎn),其RR值分別為1.57(95%CI:1.29-1.90)和1.62(95%CI:1.37-1.92)。劑量-反應(yīng)關(guān)系分析發(fā)現(xiàn),飲酒與牙周炎發(fā)生風(fēng)險(xiǎn)之間存在線性的劑量-反應(yīng)關(guān)系(P for nonlinearity=0.88),飲酒量每天每增加1克,牙周炎的發(fā)生風(fēng)險(xiǎn)將會(huì)增加0.4%。漏斗圖法和Egger線性回歸檢驗(yàn)法(P=0.076)分析結(jié)果均顯示飲酒與牙周炎發(fā)生風(fēng)險(xiǎn)之間不存在發(fā)表偏倚。結(jié)論:飲酒與牙周炎發(fā)生風(fēng)險(xiǎn)有關(guān),并且飲酒是牙周炎發(fā)生的一個(gè)的危險(xiǎn)因素。隨著飲酒量的增加,牙周炎發(fā)生風(fēng)險(xiǎn)也隨著增加,并存在線性的劑量-反應(yīng)關(guān)系。
[Abstract]:Objective: at present, there are many epidemiological studies to explore the relationship between drinking and the risk of periodontitis, but the conclusions are not consistent. The purpose of this study was to quantitatively and comprehensively analyze the results of many observational studies by Meta analysis in order to explore the relationship between alcohol consumption and the risk of periodontitis, and to further evaluate the dose-response relationship between alcohol consumption and periodontitis. Methods: the retrieval strategy and literature inclusion standard were established, Pub Med,Web of Science and Embase databases were searched, all the relevant English literature on the relationship between drinking and periodontitis risk were obtained, and the searched literature was strictly screened. With a view to obtaining the most comprehensive literature. The data were extracted from the literature in accordance with the standard and analyzed by Meta. In this study, the combined relative risk (Relative Risk,RR) and its 95% confidence interval (95%CI) were calculated by random effect model, and the dose-response relationship was investigated by restricted cubic splicing method. Q test was used to explore the heterogeneity between the studies, I2 value was used to quantitatively evaluate the heterogeneity, and sensitivity analysis was used to explore the influence of a single study on the total combined effect value. Funnel diagram method and Egger linear regression test are used to judge whether there is publication bias. Results: there were 17 literatures, including 18 studies, which met the inclusion criteria. A total of 90147 people were surveyed, including different populations from Europe, Asia and the United States. Of these 18 studies, 14 were cross-section studies and 4 were cohort studies. Among them, six studies provided data on the relationship between alcohol consumption and the risk of periodontitis, which could be included in the dose-response relationship analysis. Meta-analysis showed that drinking was associated with the risk of periodontitis. And drinking can significantly increase the risk of periodontitis. Compared with the minimum dose of drinking, the combined RR value of the maximum dose of drinking and the risk of periodontitis was 1.59 (95%CI:1.37-1.85). The subjects were analyzed by sex, and the results showed that drinking alcohol was a risk factor for periodontitis in both men and women. The RR values were 1.25 (95%CI:1.11-1.41) and 2.15 (95%CI:1.36-3.41), respectively. The results of subgroup analysis showed that: (1) according to the design type of the study, the results of cohort study and cross-section study showed that drinking was a risk factor for periodontitis. The RR values were 1.28 (95%CI:1.04-1.57) and 1.66 (95%CI:1.39-1.99), respectively. (2) by continent, the results of combined analysis in Asia, Europe and America also showed that drinking increased the risk of periodontitis, with RR values of 1.45 (95%CI:1.15-1.82), respectively. 1.76 (95%CI:1.13-2.74) and 1.76 (95%CI:1.34-2.32); (3) according to whether the body mass index was adjusted or not, drinking could increase the risk of periodontitis in both the adjusted body mass index group and the unadjusted body mass index group. The RR values are 1.57 (95%CI:1.29-1.90) and 1.62 (95%CI:1.37-1.92), respectively. Dose-response relationship analysis showed that there was a linear dose-response relationship between alcohol consumption and the risk of periodontitis (P for nonlinearity=0.88). The risk of periodontitis increased by 0.4% for every 1 g of alcohol consumption per day. The results of funnel diagram and Egger linear regression test (P 鈮，

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