陈锦芬

[摘要] 目的 探讨抗生素类药物联合维生素C在复发性口腔溃疡中的应用价值。 方法 选取2015年4月～2016年7月解放军第一七四医院收治的复发性口腔溃疡患者90例，按随机数字表法分为对照组和研究组，每组各45例。对照组予以常规对症治疗，控制相关诱因，缓解紧张情绪，生理盐水漱口，甲硝唑片治疗；在此基础上，研究组予以头孢曲松钠+维生素C口服，治疗2周。采取血液样本，测定血清细胞因子、免疫功能及血液流变学指标，对比临床疗效及并发症发生情况。 结果 与治疗前比较，两组治疗2周后血清IL-2水平升高，IL-8、TNF-α及CRP水平降低，血清CD3+、CD4+、CD4+/CD8+水平升高，CD8+水平降低，全血黏度、血浆黏度、全血还原黏度及红细胞聚集指数降低（P < 0.05）；与对照组比，研究组治疗2周后血清IL-2水平较高，IL-8、TNF-α及CRP水平较低，血清CD3+、CD4+、CD4+/CD8+水平较高，CD8+水平较低，全血黏度、血浆黏度、全血还原黏度及红细胞聚集指数较低（P < 0.05）。研究组有效率高于对照组（P < 0.05）。 结论 抗生素类药物联合维生素C对复发性口腔溃疡的疗效确切，显著改善炎症及血液流变学指标，提高免疫功能，值得推广。

[关键词] 维生素C；复发性口腔溃疡；炎性反应；血液流变学；免疫功能

[中图分类号] R78 [文献标识码] A [文章编号] 1673-7210（2017）09（c）-0132-04

[Abstract] Objective To evaluate the application of antibiotics combined with Vitamin C in patients with recurrent oral ulcer. Methods 90 patients with recurrent oral ulcer from April 2015 to July 2016 in 174 Hospital of PLA were divided into control group and study group by random number table， with 45 cases in each group. The control group was treated by conventional symptomatic treatment， control related factors， relieve tension， saline mouthwash， metronidazole； besides， the study group was treated by Ceftriaxone Sodium + Vitamin C， which were treated for 2 weeks. Serum cytokines， immune function and hemorheological indexes were measured before and after treatment. The clinical efficacy and complications were also compared. Results Compared with before treatment， levels of serum IL-2， IL-8， TNF-α and CRP were decreased， levels of CD3+， CD4+， CD4+/CD8+ were increased and level of CD8+ was decreased， whole blood viscosity， plasma viscosity， whole blood reduced viscosity and erythrocyte aggregation index decreased in two groups 2 weeks after treatment （P < 0.05）. Compared with the control group， in the study group， levels of IL-2， IL-8， TNF-α and CRP were significantly lower （P < 0.05）， levels of CD3+， CD4+， CD4+/CD8+ were higher， and level of CD8+ was lower， and whole blood reduced viscosity and erythrocyte aggregation index were lower （P < 0.05）， the effective rate in the control group was lower than the study group （P < 0.05）. Conclusion The combination of antibiotics and Vitamin C is effective in the treatment of recurrent aphthous ulcer. It can improve the inflammation and hemorheological indexes and improve the immune function.

[Key words] Vitamin C； Recurrent oral ulcer； Inflammatory reaction； Hemorheology； Immune function

復发性口腔溃疡（recurrent aphthous ulcer，RAU）又称复发性阿弗他溃疡，好发于青年及中年人群，溃疡部位红肿、灼痛明显，病情反复发作，给日常生活带来极大影响[1]。治疗上多以局部对症治疗为主，虽然能暂时缓解疼痛、红肿症状，但长期复发率高，临床具有一定局限性[2]。故及时、有效降低复发性口腔溃疡的反复发作，对预后及生活质量的提高意义重大。随着临床研究机制的深入，RAU的起病、进展与血清微量元素稀缺、维生素缺乏等具有相关性，维生素缺乏是导致RAU反复发作的重要机制，外源性补充维生素C是RAU常用的治疗措施之一[3]。且胡仁梅[4]发现维生素C作为人体所需要的营养素，与广谱抗生素联合具有增强局部杀菌，提高临床疗效的作用。……