目的 探究米诺环素治疗慢性牙周炎的临床疗效及其对外周血T细胞亚群及程序性死亡分子-1（PD-1）、程序性死亡分子-1配体（PD-L1）表达的影响。方法 选择2015年1月-2017年1月在榆林市星元医院口腔科接受治疗的96例慢性牙周炎患者为研究对象。根据随机数字表法将患者分为对照组和观察组，每组各48例。对照组患者采用龈下刮治及根面平整进行治疗。观察组患者在对照组治疗的基础上在牙周袋底部缓慢注入盐酸米诺环素软膏，0.2 g/次，1次/周，边注射边后退。两组均治疗4周。观察两组患者的临床疗效，同时比较两组治疗前后的牙龈指数（GI）、菌斑指数（PLI）、牙槽骨吸收、附着丧失（CAL）以及牙周袋深度（PD）、C反应蛋白（CRP）、白细胞介素-10（IL-10）、龈沟出血指数（SBI）、外周血T淋巴细胞亚群和表面PD-1、PD-L1的表达情况。结果 治疗后，对照组患者临床总有效率为72.92%，显著低于观察组的91.67%（P<0.05）。治疗后，两组患者GI、PLI、PD、CAL和牙槽骨吸收等指标均显著降低（P<0.05）；且观察组以上各指标均显著低于对照组（P<0.05）。治疗后，两组患者龈沟液中CRP水平和SBI评分均显著降低，而龈沟液中IL-10水平显著升高（P<0.05）；且观察组龈沟液中CRP、IL-10水平和龈沟出血指数均优于对照组（P<0.05）。治疗后，两组患者外周血T淋巴细胞亚群中CD4⁺和CD4⁺/CD8⁺均显著降低，CD8⁺显著升高（P<0.05）；且观察组外周血T淋巴细胞亚群中CD4⁺和CD4⁺/CD8⁺均显著低于对照组，CD8⁺比例高于对照组（P<0.05）。治疗后，两组患者外周血CD4⁺和CD8⁺T淋巴细胞表面的PD-1和PD-L1表达水平均显著降低（P<0.05）；且观察组外周血CD4⁺和CD8⁺T淋巴细胞表面的PD-1和PD-L1表达水平均显著低于对照组（P<0.05）。结论 米诺环素治疗慢性牙周炎可有效改善患者各项牙周指标，改善牙周组织炎症反应抑制作用，在慢性牙周炎临床治疗中具有重要价值。

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.

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