【目的】 评价清胃散治疗侵袭性牙周炎的临床疗效及其对龈沟液炎症因子、氧化应激指标和基质金属蛋白酶（MMPs）的 影响。【方法】 采用随机对照临床试验设计，选取2022年1月至2024年12月佛山市中医院口腔科收治的100例胃火炽盛型侵 袭性牙周炎患者，按随机数字表法分为对照组和观察组，每组各50例。对照组给予西医常规治疗（包括牙周基础治疗和抗生 素治疗），观察组在对照组的基础上加用清胃散治疗，疗程为4周。观察2组患者治疗前后牙周指标[牙周探诊深度（PD）、临 床附着丧失（CAL）、菌斑指数（PLI）、探诊出血指数（SBI）]、牙齿松动度、咀嚼功能、口腔健康影响程度量表（OHIP-14）评分 的变化情况，检测2组患者的龈沟液炎症因子[白细胞介素1β（IL-1β）、干扰素γ（IFN-γ）、肿瘤坏死因子α（TNF-α）、可溶性 细胞间黏附分子 1（sICAM-1）]、氧化应激指标[丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）]及 MMP-8、MMP-13、MMP-3 水平，评估 2 组患者的临床疗效。【结果】（1）疗效方面，治疗 4 周后，观察组的总有效率为 96.00%（48/50），对照组为84.00%（42/50），组间比较（χ2检验），观察组的疗效明显优于对照组（P＜0.05）。（2）牙周状况方面， 治疗后，2组患者的SBI、PLI评分和CAL、PD值及牙齿松动度均较治疗前降低（P＜0.05），且观察组的降低幅度均明显优于 对照组（P＜0.05）。（3）咀嚼功能和生活质量方面，治疗后，2组患者的咀嚼功能均较治疗前升高（P＜0.05），OHIP-14评分均 较治疗前降低（P＜0.05），且观察组对咀嚼功能的升高幅度及对OHIP-14评分的降低幅度均明显优于对照组（P＜0.05）。（4）炎 症因子方面，治疗后，2组患者的龈沟液IL-1β、IFN-γ、TNF-α、sICAM-1水平均较治疗前降低（P＜0.05），且观察组的降低 幅度均明显优于对照组（P＜0.05）。（5）氧化应激方面，治疗后，2 组患者的龈沟液 MDA 水平均较治疗前降低（P＜0.05）， GSH-Px、SOD水平均较治疗前升高（P＜0.05），且观察组对龈沟液MDA水平的降低幅度及对龈沟液GSH-Px、SOD水平的升 高幅度均明显优于对照组（P＜0.05）。（6）MMPs方面，治疗后，2组患者的龈沟液MMP-8、MMP-13、MMP-3水平均较治疗前 降低（P＜0.05），且观察组的降低幅度均明显优于对照组（P＜0.05）。【结论】 清胃散联合西医常规治疗能有效改善胃火炽盛型 侵袭性牙周炎患者的牙周状况，提高咀嚼功能和生活质量，其机制可能与减轻炎症反应、调节氧化应激平衡、抑制MMPs介 导的组织破坏有关。

Objective To evaluate the clinical efficacy of Qingwei San in treating aggressive periodontitis （AP） and to observe its effects on inflammatory factors，oxidative stress markers，and matrix metalloproteinases（MMPs） in gingival crevicular fluid. Methods A randomized controlled trial was conducted. One hundred patients with AP of intense stomach fire syndrome，treated in the Department of Stomatology at Foshan Hospital of Traditional Chinese Medicine from January 2022 to December 2024，were selected and randomly divided into a control group and an observation group using a random number table， with 50 patients in each group. The control group received conventional western medical treatment （including periodontal basic therapy and antibiotic therapy）. The observation group received oral use of Qingwei San in addition to the conventional treatment. The treatment course was 4 weeks for both groups. Periodontal parameters [probing depth （PD）， clinical attachment loss （CAL）， plaque index （PLI）， sulcus bleeding index （SBI）]， tooth mobility， masticatory function， and Oral Health Impact Profile-14（OHIP-14） scores were observed before and after treatment. Levels of inflammatory factors [interleukin-1β （IL-1β）， interferon-gamma （IFN- γ）， tumor necrosis factor-alpha （TNF- α）， soluble intercellular adhesion molecule-1（sICAM-1）]，oxidative stress markers [malondialdehyde （MDA），superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）]， and MMP-8， MMP-13 and MMP-3 in gingival crevicular fluid were detected. The clinical efficacy of the two groups was assessed. Results （1） Regarding efficacy， after 4 weeks of treatment，the total effective rate was 96.00% （48/50） in the observation group，significantly higher than 84.00% （42/50） in the control group. Intergroup comparison （by chi-square test） showed that the efficacy of the observation group was significantly superior to that of the control group （P＜0.05）.（2） Regarding periodontal status，after treatment，SBI，PLI scores，CAL，PD values，and tooth mobility were decreased in both groups compared to those before treatment （P＜0.05）， and the reductions of the observation group was significantly superior to that of the control group （P＜0.05）.（3） Regarding masticatory function and quality of life， after treatment， masticatory function was improved in both groups （P＜0.05）， and OHIP-14 scores were decreased （P＜0.05）. The improvement in masticatory function and the reduction in OHIP-14 scores of the observation group were significantly superior to those of the control group （P＜0.05）.（4） Regarding inflammatory factors，after treatment，levels of IL-1β，IFN-γ，TNF-α，and sICAM-1 in gingival crevicular fluid decreased in both groups compared to those before treatment （P＜0.05）， and the reduction of the observation group was significantly superior to that of the control group （P＜0.05）.（5） Regarding oxidative stress， after treatment， MDA level in gingival crevicular fluid was decreased in both groups （P＜0.05），while GSH-Px and SOD levels were increased （P＜0.05）. The reduction in MDA and the increases in GSH-Px and SOD of the observation group were significantly superior to those of the control group （P＜0.05）.（6） Regarding MMPs，after treatment，levels of MMP-8，MMP-13，and MMP-3 in gingival crevicular fluid were decreased in both groups compared to those before treatment （P＜0.05），and the reductions of the observation group was significantly superior to that of the control group （P＜0.05）. Conclusion Qingwei San combined with conventional western medical treatment can effectively improve periodontal status， enhance masticatory function and quality of life in patients with AP of intense stomach fire syndrome. The mechanism may be related to alleviating inflammatory response， regulating oxidative stress balance，and inhibiting MMPs-mediated tissue destruction.

R276.8

国家自然科学基金面上项目（编号：82074342）；广州市科技计划项目（编号：2024A04J3302）；广东省中医药局科研项目（编号： 20251135）