赵然+胡秋斌+余彩琴+陈敏+陈焕

摘 要 目的：探讨米诺环素联合奥硝唑治疗对局限型侵袭性牙周炎的疗效。方法：选取局限型侵袭性牙周炎36例（患牙127颗），按随机数字表法分为观察组（17例，60牙）和对照组（19例，67牙），两组患者均行龈下刮治和根面平整术治疗，对照组患者予以奥硝唑口服治疗，观察组患者则在此基础上予以牙周袋内注入盐酸米诺环素缓释软膏，另选取同期行体检的健康志愿者22例，作为正常组。于观察组、对照组患者治疗前及末次治疗后4周、正常组于体检当天采集血清CRP、TNF-a、IL-17水平，并于末次治疗后4周检测牙周指标。术后随访1年，统计并比较复发率。结果：正常组血清CRP、TNF-a、IL-17水平均明显低于观察组、对照组治疗前、后（P<0.05）；治疗后，观察组、对照组患者上述指标以及菌斑指数、龈沟出血指数、牙周探诊深度、临床附着丧失均明显降低，且观察组降低幅度均明显大于对照组（P<0.05）；两组复发率比较差异无统计学意义。结论：局限型侵袭性牙周炎行牙周基础治疗后，采用局部米诺环素用药联合全身奥硝唑辅助治疗具有较好的临床疗效，并可有效改善血清炎性因子水平，提高牙周治疗效果。

关键词 局限型侵袭性牙周炎 米诺环素 奥硝唑 疗效 炎性因子

中图分类号：R978.14； R781.42 文献标识码：B 文章编号：1006-1533（2016）05-0031-03

Efficacy of minocycline combined with ornidazole in the treatment of 17 cases of patients with localized aggressive periodontitis*

ZHAO Ran**， HU Qiubin， YU Caiqin， CHEN Min， CHEN Huan

（Department of Dental， Boai Hospital of Zhongshan City， Zhongshan 528403， China）

ABSTRACT Objective： To discuss the efficacy of minocycline combined with ornidazole in the treatment of patients with localized aggressive periodontitis. Methods： Thirty-six cases of patients （127 teeth） with localized aggressive periodontitis were randomly divided into an observation group （17 cases， 60 teeth） and a control group （19 cases， 67 teeth）. All the patients were treated by scaling down and root planning. In addition， the control group was given oral ornidazole ，while the observation group was given minocycline hydrochloride sustained release ointment periodontal pocket injection on the basis of the control group treatment. Twenty-two cases of healthy volunteers were recruited as a normal group. The serum level of C-reaction protein（CRP）， tumor necrosis factor-a （TNF-a）， interleukin-17 （IL-17） were detected before and 4 weeks after last treatment in both observation and control groups and on the day they received body examination in the normal group. Periodontal index was detected in all groups 4 weeks after last treatment. The recurrence rates were compared after 1 year of follow-up. Results： The serum levels of CRP， TNF-a， IL-17 were significantly lower in the normal group than the observation group and the control group before and after treatment （P<0.05）. These levels and others such as the plaque index， sulcus bleeding index， probing depth and clinical attachment loss were significantly lower in the observation group and the control group after the treatment than before（P<0.05） and furthermore their reduction extent was more notable in the observation group than the control group （P<0.05）. There were no significant differences in the recurrence rates between the two groups. Conclusion： Minocycline combined with ornidazole possess better clinical efficacy for localized aggressive periodontitis， which can effectively improve the serum levels of inflammatory factors and the efficacy on periodontitis after periodontal basic treatment was performed.

KEY WORDS localized aggressive periodontitis； minocycline； ordovician； efficacy； inflammatory factors

侵袭性牙周炎是牙周炎的一个亚类，以牙周附着快速丧失、牙槽骨迅速吸收致牙齿松动、移位，甚至脱落为主要特征，具有发病快、发展迅速等特点，多发于青少年人群，严重危害人类的牙周系统[1]。根据波及牙齿的多少可将侵袭性牙周炎分为局限型和广泛型，其中局限型侵袭性牙周炎是指少数几个牙出现病变，主要为切牙和第一恒磨牙，且一般呈对称分布，其发病率较广泛型侵袭性牙周炎低，但若不能及时有效治疗也可对周围牙齿造成影响[2]。目前，局限型侵袭性牙周炎的发病机制尚未明确，大多学者均认为菌斑微生物感染在局限型侵袭性牙周炎发生、发展中发挥主要作用，故去除菌斑微生物是治疗局限型侵袭性牙周炎的关键[3]。……