目的 观察牛黄清胃丸联合盐酸米诺环素软膏治疗种植体周围炎的临床疗效及安全性。方法 选取上海市第五人民医院口腔科2013年6月-2015年6月就诊的种植体周围炎患者66例,所有患者随机分为对照组和治疗组,每组各33例。对照组将盐酸米诺环素软膏注射器头部深入牙周袋底,缓慢注入,直至袋口略有药物溢出,1次/周。治疗组在对照组治疗的基础上口服牛黄清胃丸,2丸/次,2次/d。两组均连续治疗4周。观察两组患者的临床疗效,比较治疗前后两组患者的临床检测指标菌斑指数(plaque index,PLI)、牙龈出血指数(sulcus bleeding index,SBI)、种植体周围袋深度(pocket depth,PD),测定两组患者实验室检测指标龈沟液中肿瘤坏死因子-α(tumor necrosis Factor,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、基质金属蛋白酶-8(matrix metaloproteinase-8,MMP-8)、单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP-1)水平。结果 治疗后,对照组和治疗组的总有效率分别为81.82%、90.91%,两组总有效率比较差异具有统计学意义(P<0.05)。治疗后,两组患者PLI、PD、SBL均值均较治疗前显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些指标的降低程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者龈沟液中TNF-α、IL-1β、MMP-8、MCP-1水平均显著下降,同组治疗前后比较差异具有统计学意义(P<0.05、0.01);且治疗组这些指标的降低程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗过程中治疗组和对照组患者均未出现明显的不良反应。结论 牛黄清胃丸联合盐酸米诺环素治疗种植体周围炎具有较好的疗效,能明显改善患者的临床疗效,促进菌斑消退,减轻全身炎症水平,且安全可靠,不良反应少,具有一定的临床推广应用价值。

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.