目的 探究米諾環(huán)素治療慢性牙周炎的臨床療效及其對(duì)外周血T細(xì)胞亞群及程序性死亡分子-1（PD-1）、程序性死亡分子-1配體（PD-L1）表達(dá)的影響。方法 選擇2015年1月-2017年1月在榆林市星元醫(yī)院口腔科接受治療的96例慢性牙周炎患者為研究對(duì)象。根據(jù)隨機(jī)數(shù)字表法將患者分為對(duì)照組和觀察組，每組各48例。對(duì)照組患者采用齦下刮治及根面平整進(jìn)行治療。觀察組患者在對(duì)照組治療的基礎(chǔ)上在牙周袋底部緩慢注入鹽酸米諾環(huán)素軟膏，0.2 g/次，1次/周，邊注射邊后退。兩組均治療4周。觀察兩組患者的臨床療效，同時(shí)比較兩組治療前后的牙齦指數(shù)（GI）、菌斑指數(shù)（PLI）、牙槽骨吸收、附著喪失（CAL）以及牙周袋深度（PD）、C反應(yīng)蛋白（CRP）、白細(xì)胞介素-10（IL-10）、齦溝出血指數(shù)（SBI）、外周血T淋巴細(xì)胞亞群和表面PD-1、PD-L1的表達(dá)情況。結(jié)果 治療后，對(duì)照組患者臨床總有效率為72.92%，顯著低于觀察組的91.67%（P<0.05）。治療后，兩組患者GI、PLI、PD、CAL和牙槽骨吸收等指標(biāo)均顯著降低（P<0.05）；且觀察組以上各指標(biāo)均顯著低于對(duì)照組（P<0.05）。治療后，兩組患者齦溝液中CRP水平和SBI評(píng)分均顯著降低，而齦溝液中IL-10水平顯著升高（P<0.05）；且觀察組齦溝液中CRP、IL-10水平和齦溝出血指數(shù)均優(yōu)于對(duì)照組（P<0.05）。治療后，兩組患者外周血T淋巴細(xì)胞亞群中CD4⁺和CD4⁺/CD8⁺均顯著降低，CD8⁺顯著升高（P<0.05）；且觀察組外周血T淋巴細(xì)胞亞群中CD4⁺和CD4⁺/CD8⁺均顯著低于對(duì)照組，CD8⁺比例高于對(duì)照組（P<0.05）。治療后，兩組患者外周血CD4⁺和CD8⁺T淋巴細(xì)胞表面的PD-1和PD-L1表達(dá)水平均顯著降低（P<0.05）；且觀察組外周血CD4⁺和CD8⁺T淋巴細(xì)胞表面的PD-1和PD-L1表達(dá)水平均顯著低于對(duì)照組（P<0.05）。結(jié)論 米諾環(huán)素治療慢性牙周炎可有效改善患者各項(xiàng)牙周指標(biāo)，改善牙周組織炎癥反應(yīng)抑制作用，在慢性牙周炎臨床治療中具有重要價(jià)值。

Objective To investigate the clinical efficacy of minocycline in treatment of chronic periodontitis and its influence on T cell subsets and expression of PD-1 and PD-L1 in peripheral blood. Methods A total of 96 patients with chronic periodontitis who received treatment in the department of Stomatology, Xingyuan Hospital of Yulin from January 2015 to January 2017 were selected as the study subjects. According to the random number table method, the patients were divided into control group and observation group, 48 patients in each group. Patients in the control group was treated with subgingival scaling and root planning. Patients in the observation group were slowly injected with Minocycline Hydrochloride Ointment at the bottom of the periodontal pocket on the basis of control group, 0.2 g/time, once a week. Both groups were treated for 4 weeks. After treatment, the clinical efficacy in two groups were observed, and the GI and PLI scores, the levels of CAL, PD, CRP and IL-10, SBI score, T lymphocyte subgroup, and the expression of PD-1 and PD-L1 in the peripheral blood before and after treatment were compared. Results After treatment, the total clinical effective rate was 72.92% in the control group, which was significantly lower than 91.67% in the observation group (P<0.05). After treatment, GI, PLI, PD, CAL and alveolar bone resorption were significantly decreased in two groups (P<0.05). Moreover, all indexes above in the observation group were significantly lower than those in the control group (P<0.05). After treatment, CRP level and SBI score in gingival crevicular fluid in two groups were significantly decreased, while IL-10 level in gingival crevicular fluid was significantly increased (P<0.05). And the levels of CRP and IL-10 in gingival crevicular fluid and the SBI score in the observation group were significantly better than those in the control group (P<0.05). After treatment, CD4⁺ and CD4⁺/CD8⁺ in peripheral blood of two groups were significantly decreased, but CD8⁺ was significantly increased (P<0.05). And CD4⁺ and CD4⁺/CD8⁺ in the peripheral of the observation group were significantly lower than those in the control group, CD8⁺ was higher than that in the control group (P<0.05). After treatment, the expression levels of PD-1 and PD-L1 on the surface of CD4⁺ and CD8⁺ in peripheral blood of patients in two groups were significantly decreased (P<0.05). And the expression levels of PD-1 and PD-L1 on the surface of CD4⁺ and CD8⁺ in peripheral blood of the observation group were significantly lower than those of the control group (P<0.05). Conclusion Minocycline in treatment of chronic periodontitis can effectively improve the periodontal indicators, improve the inhibitory effect of periodontal tissue inflammation, has an important value in the clinical treatment of chronic periodontitis.

R988.2