目的 探討口炎清顆粒聯(lián)合奧硝唑和頭孢丙烯治療急性智齒冠周炎的臨床療效。方法 選取2019年1月—2022年5月北京航天總醫(yī)院收治的180例急性智齒冠周炎患者，隨機(jī)分為對(duì)照組和治療組，每組各90例。在冠周沖洗基礎(chǔ)上，對(duì)照組給予奧硝唑片聯(lián)合頭孢丙烯片治療，其中奧硝唑片2片/次，2次/d，頭孢丙烯片2片/次，2次/d。在對(duì)照組基礎(chǔ)上，治療組口服口炎清顆粒，2袋/次，2次/d。兩組患者療程均為7 d。觀察兩組患者臨床療效，比較治療前后兩組患者主要癥狀消失時(shí)間，冠周袋內(nèi)菌群變化，外周血中性粒細(xì)胞CD64及血清降鈣素原（PCT）、血清淀粉樣蛋白A（SAA）、C反應(yīng)蛋白（CRP）水平，齦溝液中白細(xì)胞介素-1β（IL-1β）、前列腺素E₂（PGE₂）和可溶性細(xì)胞間黏附分子-1（sICAM-1）水平。結(jié)果 治療后，治療組臨床有效率（96.67%）顯著高于對(duì)照組（88.89%，P＜0.05）。治療組牙齦紅腫、疼痛及張口受限的消失時(shí)間均較對(duì)照組顯著縮短（P＜0.05）。與治療前相比，治療后兩組冠周袋內(nèi)細(xì)菌值及革蘭陰性菌（G^－菌）、螺旋體比例均顯著下降（P＜0.05），革蘭陽(yáng)性菌（G^＋菌）比例均顯著上升（P＜0.05），且治療組冠周袋內(nèi)細(xì)菌值及G^－菌、螺旋體比例均顯著低于對(duì)照組（P＜0.05），G^＋菌比例顯著高于對(duì)照組（P＜0.05）。治療后，兩組外周血中性粒細(xì)胞CD64及血清PCT、SAA、CRP水平均顯著降低（P＜0.05），且均以治療組下降更顯著（P＜0.05）。治療后，兩組齦溝液中IL-1β、PGE₂和sICAM-1水平均較治療前顯著下降（P＜0.05），且均以治療組降低更顯著（P＜0.05）。結(jié)論 口炎清顆粒聯(lián)合奧硝唑及頭孢丙烯對(duì)急性智齒冠周炎患者具有確切的臨床療效，是迅速緩解患者癥狀的安全有效途徑，其作用可能與該治療方案能顯著維持冠周袋內(nèi)菌群穩(wěn)態(tài)、控制機(jī)體細(xì)菌感染以及下調(diào)齦溝液中IL-1β、PGE₂和sICAM-1表達(dá)有關(guān)。

Objective To explore the clinical curative effect of Kouyanqing Granules combined with ornidazole and cefprozil in treatment of acute wisdom tooth pericoronitis. Methods Patients (180 cases) with acute wisdom tooth pericoronitis in Beijing Aerospace General Hospital from January 2019 to May 2022 were randomly divided into control and treatment group, and each group had 90 cases. Patients in the control group was po administered with Ornidazole Tablets and Cefprozil Tablets, 2 Ornidazole Tablets at a time, twice daily, 2 Cefprozil Tablets at a time, twice daily. Patients in the treatment group were po administered with Kouyanqing Granules on the basis of the control group, 2 bags/time, twice daily. Patients in two groups were treated for 7 d. After treatment, the clinical evaluation was evaluated, and the disappearance time of main symptoms, the changes of flora in pericoronoid pocket, peripheral blood neutrophil CD64 and serum PCT, SAA, CRP levels, the levels of IL-1β, PGE2 and sICAM-1 in gingival crevicular fluid in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group (96.67%) was significantly higher than that of the control group (88.89%, P < 0.05). After treatment, the disappearance time of gingival swelling, pain, and limitation of mouth opening in the treatment group was significantly shorter than that in the control group (P < 0.05). Compared with those before treatment, the bacterial value and the proportion of Gram-negative bacteria and spirochetes in the pericoronal bag in two groups were significantly decreased (P < 0.05), while the proportion of Gram-positive bacteria was significantly increased (P < 0.05). After treatment, the bacterial value and the proportion of Gram-bacteria and spirochetes in the pericoronal bag in the treatment group were significantly lower than those in the control group (P < 0.05), and the proportion of Gram-positive bacteria in the treatment group was significantly higher than that in the control group (P < 0.05). Compared with those before treatment, the levels of peripheral blood neutrophil CD64 and serum PCT, SAA and CRP in two groups were significantly decreased after treatment (P < 0.05), and especially in the treatment group (P < 0.05). After treatment, the levels of IL-1β, PGE2 and sICAM-1 in gingival crevicular fluid in two groups were significantly lower than those before treatment (P < 0.05), and the levels in the treatment group were more significantly lower than those in the control group (P < 0.05). Conclusion Kouyanqing Granules combined with ornidazole and cefprozil in treatment of acute wisdom tooth pericoronitis has definite clinical effect and is a safe and effective way to relieve patients' symptoms quickly. Its effect may be related to the fact that this treatment scheme can significantly maintain the steady state of microflora in pericoronal pocket, control bacterial infection and down-regulate the expression of IL-1β, PGE2 and sICAM-1 in gingival crevicular fluid.

R988.2

航天醫(yī)科2020年科研項(xiàng)目（2020YK23）