口炎清颗粒联合奥硝唑和头孢丙烯治疗急性智齿冠周炎的临床研究

Clinical study on Kouyanqing Granules combined with ornidazole and cefprozil in treatment of acute wisdom tooth pericoronitis

目的 探讨口炎清颗粒联合奥硝唑和头孢丙烯治疗急性智齿冠周炎的临床疗效。方法 选取2019年1月—2022年5月北京航天总医院收治的180例急性智齿冠周炎患者,随机分为对照组和治疗组,每组各90例。在冠周冲洗基础上,对照组给予奥硝唑片联合头孢丙烯片治疗,其中奥硝唑片2片/次,2次/d,头孢丙烯片2片/次,2次/d。在对照组基础上,治疗组口服口炎清颗粒,2袋/次,2次/d。两组患者疗程均为7 d。观察两组患者临床疗效,比较治疗前后两组患者主要症状消失时间,冠周袋内菌群变化,外周血中性粒细胞CD64及血清降钙素原(PCT)、血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)水平,龈沟液中白细胞介素-1β(IL-1β)、前列腺素E2(PGE2)和可溶性细胞间黏附分子-1(sICAM-1)水平。结果 治疗后,治疗组临床有效率(96.67%)显著高于对照组(88.89%,P<0.05)。治疗组牙龈红肿、疼痛及张口受限的消失时间均较对照组显著缩短(P<0.05)。与治疗前相比,治疗后两组冠周袋内细菌值及革兰阴性菌(G-菌)、螺旋体比例均显著下降(P<0.05),革兰阳性菌(G+菌)比例均显著上升(P<0.05),且治疗组冠周袋内细菌值及G-菌、螺旋体比例均显著低于对照组(P<0.05),G+菌比例显著高于对照组(P<0.05)。治疗后,两组外周血中性粒细胞CD64及血清PCT、SAA、CRP水平均显著降低(P<0.05),且均以治疗组下降更显著(P<0.05)。治疗后,两组龈沟液中IL-1β、PGE2和sICAM-1水平均较治疗前显著下降(P<0.05),且均以治疗组降低更显著(P<0.05)。结论 口炎清颗粒联合奥硝唑及头孢丙烯对急性智齿冠周炎患者具有确切的临床疗效,是迅速缓解患者症状的安全有效途径,其作用可能与该治疗方案能显著维持冠周袋内菌群稳态、控制机体细菌感染以及下调龈沟液中IL-1β、PGE2和sICAM-1表达有关。

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 Grampositive 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-1in gingival crevicular fluid.