目的 觀察牛黃清胃丸聯(lián)合鹽酸米諾環(huán)素軟膏治療種植體周圍炎的臨床療效及安全性。方法 選取上海市第五人民醫(yī)院口腔科2013年6月-2015年6月就診的種植體周圍炎患者66例,所有患者隨機分為對照組和治療組,每組各33例。對照組將鹽酸米諾環(huán)素軟膏注射器頭部深入牙周袋底,緩慢注入,直至袋口略有藥物溢出,1次/周。治療組在對照組治療的基礎(chǔ)上口服牛黃清胃丸,2丸/次,2次/d。兩組均連續(xù)治療4周。觀察兩組患者的臨床療效,比較治療前后兩組患者的臨床檢測指標菌斑指數(shù)(plaque index,PLI)、牙齦出血指數(shù)(sulcus bleeding index,SBI)、種植體周圍袋深度(pocket depth,PD),測定兩組患者實驗室檢測指標齦溝液中腫瘤壞死因子-α(tumor necrosis Factor,TNF-α)、白細胞介素-1β(interleukin-1β,IL-1β)、基質(zhì)金屬蛋白酶-8(matrix metaloproteinase-8,MMP-8)、單核細胞趨化蛋白-1(monocyte chemoattractant protein-1,MCP-1)水平。結(jié)果 治療后,對照組和治療組的總有效率分別為81.82%、90.91%,兩組總有效率比較差異具有統(tǒng)計學意義(P<0.05)。治療后,兩組患者PLI、PD、SBL均值均較治療前顯著降低,同組治療前后比較差異具有統(tǒng)計學意義(P<0.05);且治療組這些指標的降低程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P<0.05)。治療后,兩組患者齦溝液中TNF-α、IL-1β、MMP-8、MCP-1水平均顯著下降,同組治療前后比較差異具有統(tǒng)計學意義(P<0.05、0.01);且治療組這些指標的降低程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P<0.05)。治療過程中治療組和對照組患者均未出現(xiàn)明顯的不良反應。結(jié)論 牛黃清胃丸聯(lián)合鹽酸米諾環(huán)素治療種植體周圍炎具有較好的療效,能明顯改善患者的臨床療效,促進菌斑消退,減輕全身炎癥水平,且安全可靠,不良反應少,具有一定的臨床推廣應用價值。

Objective To observe clinical efficacy and safety of Niuhuang Qingwei Pills combined with Minocycline Hydrochloride Ointments in treatment of peri-implantitis. Methods The patients (66 cases) with peri-implantitis in The Fifth People's Hospital of Shanghai from June 2013 to June 2015 were randomly divided into control and treatment groups, and each group had 33 cases. The patients in the control group were slowly injected with Minocycline Hydrochloride Ointments by syringe into peri-implant pocket until slight drug overflow, once a week. The patients in the treatment group were po administered with Niuhuang Qingwei Pills on the basis of the control group, 2 pills/time, twice daily. The patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and clinical examination index of plaque index (PLI), sulcus bleeding index (SBI), and probing depth (PD) were compared before and after treatment. The laboratory examination index of concentration of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), matrix metaloproteinase-8 (MMP-8), and monocyte chemoattractant protein-1(MCP-1) in the gingival crevicular fluids were detected and compared. Results After treatment, the efficacies in the control and treatment groups were 81.82% and 90.91%, respectively, and there were differences between the two groups (P < 0.05). After treatment, the levels of PLI, PD, and SBI in two groups were obviously decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the levels of TNF-a, IL-1β, MMP-8, and MCP-1 in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05, 0.01). After treatment, the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). There were no obvious adverse reactions in two groups. Conclusion Niuhuang Qingwei Pills combined with Minocycline Hydrochloride Ointments has clinical curative effect in treatment of peri-implantitis, can improve the clinical efficacy, promote plaque regression, and reduce the level of systemic inflammation, with higher security and no adverse reaction, , which has a certain clinical application value.