To assess the short-term adjunctive effect of systemic antibiotics on non-surgical periodontal therapy and to identify predictors of treatment response in the patients with stages Ⅲ/Ⅳ periodontitis, providing ideas for precise clinical medication. A retrospective study was conducted on the patients who received non-surgical periodontal treatment in the Department of Periodontology, Peking University School and Hospital of Stomatology from November 2007 to February 2015. A total of 521 patients with stages Ⅲ/Ⅳ periodontitis were included. Participants were divided into two groups: those who received systemic antibiotic therapy adjunctive to scaling and root planing (SRP) (antibiotic group, n=204) and those who underwent SRP only (non-antibiotic group, n=317). The timing of systemic antibiotic use is divided into before SRP, during SRP, and after SRP. The primary outcome was defined as the relative change in the percentage of sites with probing depth (PD) ≥5 mm. Univariable linear regression was used to identify the association between each variable and treatment efficacy, and multivariable linear regression was utilized to adjust for confounding factors and to determine the relationships of antibiotic therapy, age of the antibiotic group, and timing of antibiotic administration with the treatment efficacy. Furthermore, smooth curve fitting and piecewise linear regression model were employed to assess the potential nonlinear relationship and threshold effect between age and treatment response in the anti-biotic group. The threshold was identified by evaluating a series of potential turning points within predefined intervals and selecting the point with the maximum model likelihood. Both treatment groups exhibited significant improvements in all periodontal parameters following therapy (P < 0.001). After adjustment for potential confounders, multivariable analysis revealed a significantly greater reduction in the percentage of sites with PD≥5 mm in the antibiotic group versus the non-antibiotic group (β=16.33, 95% CI: 13.40－19.27, P < 0.001). Within the antibiotic group, we identified a nonlinear association between age and therapeutic efficacy, with an inflection point at 38 years. The patients aged ≤38 years responded significantly better than those older than 38 years (P=0.022). Furthermore, the timing of antibiotic administration was a significant determinant of outcome. The most pronounced efficacy was achieved when antibiotics were administered concurrently with SRP, surpassing both pre- and post-SRP administration. Our findings suggest that the use of systemic antibiotics as an adjunct to SRP is associated with enhanced short-term clinical outcomes in stages Ⅲ and Ⅳ periodontitis. During SRP, treating younger patients (≤38 years old) with systemic antibiotics as an adjunct may yield better therapeutic effects. 评价全身应用抗生素对Ⅲ期和Ⅳ期牙周炎患者牙周机械治疗短期疗效的辅助作用, 并探索影响疗效的关键因素, 为临床精准用药提供参考。 选择2007年11月至2015年2月在北京大学口腔医院牙周科接受过牙周机械治疗的患者的病例资料进行回顾性分析, 共纳入521例Ⅲ/Ⅳ期牙周炎患者, 根据是否在龈下刮治和根面平整(scaling and root planing, SRP)基础上全身应用抗生素, 将患者分为抗生素组(n=204)和非抗生素组(n=317), 根据抗生素使用时机将抗生素组分为SRP前, SRP中和SRP后3个亚组。主要结局指标为探诊深度(probing depth, PD)≥5 mm的位点百分比变化。通过单因素线性回归分析确定各因素与疗效的关联, 采用多因素线性回归分析确定抗生素使用、抗生素组年龄和用药时机等因素与疗效的关联, 进一步采用平滑曲线拟合与分段线性回归模型评估抗生素组中年龄和疗效的非线性关联和阈值效应, 阈值通过在预定义区间内寻找使模型似然值最大的转折点来确定。 治疗后, 两组患者的牙周指标均显著改善(P < 0.001)。多因素分析校正混杂因素后发现, 与非抗生素组相比, 抗生素组PD≥5 mm位点百分比减少更显著(β=16.33, 95%CI: 13.40~19.27, P < 0.001)。在抗生素组内, 年龄与疗效存在非线性关系, 以38岁为拐点, ≤38岁的患者疗效显著优于>38岁的患者(P=0.022)。此外, 用药时机显著影响疗效, 在SRP治疗期间(SRP中)使用抗生素的疗效最佳, 优于SRP前或SRP后用药。 在SRP基础上辅助全身应用抗生素, 可进一步改善Ⅲ期和Ⅳ期牙周炎患者的短期临床疗效; 在SRP治疗期间, 对年龄较轻(≤38岁)的患者辅以全身抗生素治疗, 可能取得更好的疗效。
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