口腔扁平苔藓外周血中辅助性T细胞/调节性T细胞平衡与临床特征相关性分析

目的 了解口腔扁平苔藓（OLP）患者外周血中辅助性T细胞17（Th17）与调节性T细胞（Treg）的平衡变化,探讨它们在OLP发病机制中的作用及意义。方法 选取17例正常组和33例OLP患者（网纹型15例,糜烂型18例）的外周血,应用流式细胞术（FCM）检测Th17、Treg细胞的表达水平,实时荧光定量聚合酶链反应（qPCR）检测它们的转录因子维甲酸相关孤核受体γt（RORγt）和叉头状转录因子3（Foxp3）mRNA的表达。结果 OLP外周血中Th17、Treg细胞及RORγt、Foxp3 mRNA表达均升高（P<0.05）,但Treg细胞和Foxp3 mRNA表达在OLP两型间差异无统计学意义。Th17/Treg比值在OLP中升高（P<0.05）,其中糜烂型OLP显著高于正常组及网纹型OLP（P<0.01）,但网纹型OLP与正常组相比差异无统计学意义。Spearman相关分析显示Th17细胞和Th17/Treg比值与体征计分、RAE计分存在正相关关系（r=0.66,P=0.00;r=0.66,P=0.00;r=0.52,P=0.00;r=0.50,P=0.00）;同时Th17细胞与Treg细胞也存在正相关关系（r=0.39,P=0.03）。结论 OLP外周血中Th17和Treg细胞以及它们的比例均增高,Th17/Treg失衡在糜烂型OLP的发病过程中起了一定作用。     

T细胞免疫和细胞凋亡在口腔扁平苔藓发病中的作用

目的通过探讨口腔扁平苔藓（OLP）中细胞凋亡情况及CD4＋、CD8＋T细胞和CD4/CD8比例的变化分析细胞免疫与细胞凋亡的关系,进一步了解OLP的发病机制。方法应用免疫组化SP法检测27例OLP组织中CD4＋、CD8＋T细胞的表达水平,并用原位末端转移酶标记法（TUNEL）定位检测17例OLP中细胞凋亡情况。结果OLP组固有层中CD4＋、CD8＋T细胞明显高于对照组（P＜0.05）,CD4/CD8值降低。OLP组中上皮内细胞凋亡指数高于对照组,固有层淋巴细胞凋亡指数明显低于对照组。结论OLP组固有层中CD4＋、CD8＋T细胞浸润的增加、CD4/CD8比值的变化及OLP中上皮细胞和固有层淋巴细胞凋亡异常,说明细胞免疫功能紊乱和细胞凋亡异常在OLP发病中起重要作用。     

调节性T细胞和Th17细胞在OLP中的表达

目的：通过观察调节性T细胞（regulatory Tcells,Treg）和Thl7细胞（helper Tcells17,Th17）在口腔扁平苔藓（OLP）组织中的表达情况,探讨其在OLP发生发展过程中的变化。方法：应用免疫组织化学双标记技术检测35例OLP患者和19例对照组口腔黏膜组织中CD25＋Foxp3＋、CD4＋IL-17＋细胞的表达。结果：OLP组病损组织中有大量CD25＋Foxp3＋细胞浸润,较对照组显著增多,两者差异非常显著（P〈0．01）。CD4＋IL-17＋细胞在OLP组织中的表达较正常口腔黏膜组织有增加趋势,但差异无统计学意义（P〉0．05）。经进一步统计学分析,CD25＋Foxp3＋细胞和CD4＋IL-17＋细胞数量改变在OLP组织中表达呈正相关（P〈0．05）。结论：Treg细胞的数量在OLP组织中增多,Thl7细胞可能协同Treg细胞,在OLP发生发展过程中发挥了一定的作用。     

辅助性T17细胞在牙周炎小鼠中的免疫状态研究

目的 研究辅助性T（Th）17细胞在牙周炎小鼠中的免疫状态。方法 将7周龄C57BL/6雌性小鼠随机分为牙周炎组和对照组,每组4只。牙周炎组采用口腔涂抹牙龈卟啉单胞菌（P. gingivalis）的方法建立牙周炎动物模型。对照组涂抹PBS液。在涂抹结束后的第4周取材,流式细胞仪检测CD4+维甲酸相关核孤儿受体（ROR）γτ+（Th17）细胞;酶联免疫吸附（ELISA）检测Th17细胞相关的细胞因子白细胞介素（IL）-17A的蛋白表达。结果 牙周炎小鼠牙龈组织、颈部淋巴结和外周血中CD4+ RORγτ+（Th17）细胞在总CD4+ T细胞中的比例和细胞数量显著高于对照组（P<0.01）。与对照组相比,牙周炎组IL-17A的表达增加（P<0.05）。结论 在牙周炎的发生发展中,Th17细胞介导的细胞免疫应答增强,牙龈组织、颈部淋巴结和外周血可能是Th17细胞介导免疫应答的主要场所。     

调节性T细胞及Th17细胞与牙周骨吸收的研究进展

调节性T细胞(T regulatory cells,Treg)及Th17细胞均由T细胞在不同条件下分化而成,是参与宿主自身免疫反应的重要细胞。Treg细胞具有免疫抑制功能并能够减轻机体的病理性损伤;Th17细胞参与介导炎症反应,造成与炎症反应常常相伴发生的骨吸收。因此,明确Treg细胞和Th17细胞的免疫功能及其与牙周病骨吸收的关系,对于牙周病的预防与治疗意义重大。     

不同正畸力对大鼠牙周组织压力侧辅助性T细胞17相关因子表达变化的影响

探究不同正畸力下大鼠压力侧牙周组织中辅助性T细胞17（Th17）的特征性转录因子维甲酸相关孤儿受体γt（RORγt）和细胞因子白细胞介素-17（IL-17）表达的变化规律,及其对骨保护素（OPG）表达及破骨细胞（OC）数量的影响,初步探讨在不同力作用下Th17细胞对牙槽骨改建的影响。     

辅助性T细胞亚群与牙周炎的免疫损伤机制

牙周炎症组织破坏与机体针对致病菌及其毒性产物的免疫反应方式有关,辅助性T细胞（Th）亚群通过分泌不同的细胞因子发挥免疫调节功能。较早发现的Th1和Th2分别介导细胞免疫和体液免疫,二者相互抑制保持平衡,牙周炎症的间断性和进展性与Th1/Th2主导的免疫反应的平衡破坏有关。在牙周炎早期和静止期,表现为Th1反应类型;在牙周炎晚期或活动期,则表现为Th2反应类型。Th17具有重要的促进牙周慢性炎症及免疫损伤形成的作用,而调节性T细胞（Treg）则具有炎症抑制作用,而且Th17/Treg在功能和分化上也具有与Th1/Th2类似的相互调节相互抑制的平衡关系。Th17/Treg和Th1/Th2在局部形成复杂的细胞因子网络,是目前进一步研究牙周炎的免疫病理学机制的热点。     

慢性牙周炎伴冠心病患者Th17/Treg细胞平衡的临床意义

目的探讨慢性牙周炎伴冠心病患者外周血中辅助性T细胞17（Th17）、调节性T细胞（Treg）及Th17/Treg细胞平衡表达水平及临床意义。 方法本研究采用2 × 2析因设计,根据冠状动脉造影结果及牙周炎诊断标准,收集2019年3—12月就诊于新疆维吾尔自治区人民医院心内科及门诊口腔科患者113例研究对象,其中健康对照组28例、单纯慢性牙周炎组26例、单纯冠心病组27例和冠心病合并慢性牙周炎组32例。流式细胞术检测外周血Th17、Treg细胞比例,计算Th17/Treg细胞比值。采用方差分析比较各组细胞比例,2 × 2析因分析探讨牙周炎和冠心病对Th17/Treg细胞平衡的交互作用。 结果与健康对照组、慢性牙周炎组及冠心病组相比,冠心病合并慢性牙周炎组Th17细胞比例[（1.4 ± 0.6）%]显著升高,差异有统计学意义（F = 18.40,P<0.001）。与健康对照组[（8.73 ± 2.70）%]相比,冠心病合并慢性牙周炎组Treg细胞比例[（6.26 ± 2.51）%]显著降低,差异有统计学意义（F = 6.29,P = 0.001）。Th17/Treg比值在牙周炎伴冠心病组[0.221（0.317）]与健康对照组[0.055（0.054）]和慢性牙周炎组[0.119（0.115）]比较显著升高,差异有统计学意义（χ² = 40.25,P<0.001）,存在Th17/Treg失衡;析因分析表明,牙周炎与冠心病对Treg细胞水平存在交互效应（F = 3.91,P = 0.041）。 结论牙周炎伴冠心病患者存在Th17/Treg比例失衡,且向Th17细胞偏移,表明Th17/Treg细胞平衡可能参与牙周炎伴冠心病的发生、发展。     

辅助性T细胞及其平衡与牙周炎

CD4阳性T细胞在细菌或病毒等外部信号的刺激下分化为辅助性T(Th)1、2和17细胞。Th1细胞主要分泌干扰素-γ、白细胞介素(IL)-2和肿瘤坏死因子-β等,这些细胞及细胞因子可导致炎症和组织破坏。Th2细胞主要分泌IL-4、5、6和10等,这些细胞及细胞因子是负性调节者或保护因子。Th17细胞可产生IL-6、1以及转化生长因子-β等,表达IL-23受体,介导前炎症反应。研究显示:Th1细胞可加重牙周组织炎症和牙槽骨的破坏程度;Th2细胞则可有效地减轻病变程度,对牙周组织起到保护作用;Th17细胞在慢性牙周炎炎症反应和骨质破坏中起重要作用。由于Th2细胞主导保护作用,因此对这些目的因子的产生及其生物学效应进行有效的调控,阻断异常的免疫过程,可能是临床评估和控制牙周炎慢性炎症的一条新方向,可为采用细胞因子制剂治疗牙周炎提供理论依据。     

CD4^＋CD25^＋调节性T淋巴细胞及其在口腔中的研究现况

长期以来,由于缺乏确切的细胞表面标志和发挥抑制作用的分子基础,免疫学家对体内是否存在以抑制自身T细胞活化等免疫反应为主要功能的T细胞亚群观点各异;1995年Sakaguchi等人的实验证实了CD4^＋CD25^＋T淋巴细胞具有免疫抑制作用,并将这类具有免疫抑制（或调节）功能的T细胞群统称为调节性T细胞（regulatory T cells）,     

应用上颌前牵引治疗唇腭裂患者术后上颌发育不足的回顾分析

唇腭裂畸形是人类最常见的先天发育性缺陷之一。目前,唇腭裂手术是治疗畸形的主要手段,但术后患者常出现上颌发育不足,通常表现为面中部发育不足、凹陷,前牙反,严重影响了患者的面容美观和心理健康。上颌前牵引是通过牵引装置作用于上颌牙齿来刺激上颌骨周围4个骨缝的改建,进而促进上颌骨向前移位,抑制下颌骨向前生长,改善凹陷的面型。本文就前方牵引治疗唇腭裂患者术后前牙反的报道作一综述。     

上颌前牵引联合扩弓对唇腭裂植骨患者上颌骨影响的有限元分析

目的:探讨唇腭裂患者牙槽突裂植骨前、后上颌对前牵引联合扩弓的生物力学变化特点,研究植骨前、后上颌前牵引联合扩弓对唇腭裂颅上颌复合体的影响,为临床上应用前牵引治疗唇腭裂患者上颌发育不足提供理论依据。方法:采用三维有限元方法,在已建立的完全性唇腭裂上颌复合体有限元模型中模拟植骨,用Ansys12.0软件,分别对植骨前后的模型在双侧上颌尖牙牙槽骨处施加与平面成30°的力,大小为5N/侧。同时,在双侧上颌第一前磨牙和第一磨牙上各加载5mm的横向水平位移,模拟临床上上颌前牵引方式以及扩弓器的作用对其进行前牵引联合扩弓,分析其生物力学变化。结果:在相同前牵引力作用下,植骨后,上颌复合体患侧、健侧的位移分布较植骨前均匀。无论是植骨前还是植骨后,在前牵引联合扩弓的作用下,患侧健侧各标志点的位移值较不扩弓时均增大,各骨缝的应力值显著大于前牵引力单独作用下骨缝的应力值。结论:对完全性唇腭裂患者而言,上颌前牵引联合上颌扩弓治疗,有利于获得更好的前牵引效果。若配合植骨术,则可使上颌前牵引矫治力分布趋于均匀。     

唇裂术后上唇压力对上颌骨发育影响的有限元分析

目的: 探讨唇裂术后上唇压力对上颌骨的影响及抑制机制。方法: 利用ANSYS 17.0软件在腭裂上颌骨有限元模型上添加上唇软组织,赋予材料属性,形成含上唇的唇腭裂上颌骨三维有限元模型,对模型分组,施加上唇压力并进行受力分析。试验组：施加唇裂术后上唇压力,对照组：施加同龄正常儿童上唇压力。结果: 试验组形变值大于对照组,在三维方向上上颌骨形变以Z轴为主,X轴、Y轴次之。牙槽突前段形变最明显,由前向后形变趋势逐渐减小。结论: 上颌骨在三维方向上均有生长抑制,其中以矢状向生长抑制为主,横向及垂直向生长抑制次之,由前向后抑制程度逐渐降低。     

Effects of maxillary protraction combined with chin-cap therapy in unilateral cleft lip and palate patients.

OBJECTIVE: This study investigated the treatment effects of maxillary protraction combined with chin-cap therapy in complete unilateral cleft lip and palate patients at the deciduous and early mixed dentition stages. METHOD: Twenty-six Japanese children (10 boys and 16 girls) with complete unilateral cleft lip and palate were examined. All had undergone pushback operations for palatal repair at approximately 18 months of age. Maxillary protraction began between 5 and 7 years of age and continued for 10 to 38 months. Lateral cephalograms were used to analyze skeletal changes during the first and second years of treatment, and the relationship between pretreatment midfacial morphology and forward displacement of the maxilla during the first year was investigated. RESULTS AND CONCLUSIONS: During the first year of treatment, the mean increase in the ANB angle for all cases was 2.37 degrees. The forward displacement of the maxilla varied considerably, from 0.23 mm to 3.03 mm. The treatment response was significantly smaller in the second year, and no benefit from treatment longer than 1 year was established. The amount of maxillary forward displacement was significantly correlated with the pretreatment posterior upper facial height. Patients with smaller posterior upper facial height showed a poorer treatment response, whereas patients with a greater posterior upper facial height responded better to treatment. Individual differences in maxillary growth acceleration may be related to growth inhibition associated with postsurgical scar tissue on the palates.     

牙槽突裂植骨前后上颌扩弓对上颌牙槽骨位移影响的三维有限元分析

目的　模拟比较牙槽突裂植骨前后上颌扩弓对上颌牙槽骨位移影响。方法　在已建立的植骨前上颌骨有限元模型上,采用ANSYS软件模拟牙槽突裂植骨,形成植骨后上颌骨模型。在2组模型上分别施加相同上颌扩弓力,观察比较牙槽骨区域三维方向位移形变情况。结果　三维方向位移量比较,植骨前扩弓组均显著大于植骨后扩弓组（P<0.05）。水平向位移：植骨前扩弓,由前向后牙槽骨区域位移量逐渐降低;植骨后扩弓,由前向后牙槽骨区域位移量逐渐升高;植骨前后扩弓健侧牙槽骨位移量均显著大于患侧（P<0.05）。垂直向位移：植骨前后扩弓,牙槽骨前内侧均向下移动,牙槽骨后外侧均向上移动。矢状向位移：植骨前扩弓,牙槽骨前内侧向前移动,后外侧向后移动,植骨后扩弓移动趋势相反。结论　单侧完全性唇腭裂患者植骨前扩弓三维方向移动均较植骨后明显,植骨前扩弓建议扩弓器适当向后移动,植骨后扩弓建议扩弓器适当向前移动并配合前牵引治疗,同时治疗中需警惕不对称扩弓及前牙开𬌗的发生。     

单侧完全性唇腭裂植骨患者上颌前牵引矫治的有限元分析

目的:探讨唇腭裂患者牙槽突裂植骨前、后上颌骨前牵引的生物力学变化特点,研究植骨前、后以及植骨区吸收时前牵引对唇腭裂颅上颌复合体的影响,为临床上应用前牵引治疗唇腭裂患者上颌发育不足提供理论依据。方法:采用三维有限元方法,在已建立的唇腭裂上颌复合体有限元模型中模拟植骨及植骨吸收,利用Ansys12.0软件,分别对各个模型在双侧上颌尖牙牙槽骨处施加与平面呈30°的牵引力,大小为每侧5N(约500g),模拟临床上的上颌前牵引,分析其生物力学变化情况。结果:相同加载条件下,植骨前患侧的水平位移显著大于健侧,且患侧与健侧骨缝的应力分布不均匀。植骨后,患侧与健侧的位移差值减小,患侧与健侧骨缝的应力分布趋于更均匀。在所观察的骨缝中,应力最大值出现在翼腭缝,其次为颧颞缝、颧颌缝和颧额缝。结论:植骨前对上颌骨进行前牵引,裂隙有扩大化趋势;植骨有利于上颌前牵引矫治力分布更均匀,健、患侧位移变化趋于接近;且植骨不吸收时,上颌前牵引效果最佳。在模拟植骨发生吸收的几种情况中,植骨区上方发生吸收的上颌前牵引效果比植骨区下方发生吸收的前牵引效果差。     

Maxillary expansion and protraction in correction of midface retrusion in a complete unilateral cleft lip and palate patient

A 7-year-old girl with a cleft lip and palate had a midface retrusion due to growth inhibition of the maxillary complex. She presented for correction of a severe total crossbite with a Class III skeletal pattern. Initially, maxillary expansion was provided to widen the maxilla and then maxillary protraction headgear was worn to improve the sagittal skeletal relation. Fixed orthodontic appliances were placed to align the dentition and Class III elastics were used to establish intercuspation and stability. The maxillary expansion and protraction usually provide effective improvement in skeletal Class III patients with repaired cleft lip and palate patients. The success of the orthopedic procedure essentially depends on the individual growth of the maxilla and the mandible. This case report shows the significant growth of the mandible after maxillary expansion and protraction in late adolescence.     

A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions.

OBJECTIVE: It was hypothesized that, through a repetitive weekly protocol of Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC), the maxilla in cleft patients could be protracted more effectively than with a single course of rapid maxillary expansion (RME). METHODS: Twenty-six consecutive unilateral cleft lip and palate patients at the age of mixed dentition were included in this prospective clinical study. The rapid maxillary expansion group included the first 16 consecutive patients undergoing 1 week of rapid maxillary expansion (1 mm/day) followed by 5 months, 3 weeks of maxillary protraction. The Alternate Rapid Maxillary Expansions and Constrictions group included the next 10 consecutive patients undergoing 9 weeks of Alternate Rapid Maxillary Expansions and Constrictions followed by 3 months, 3 weeks of maxillary protraction. Daily activation of the weekly expansion or constriction was 1.0 mm. Two-hinged expanders and intraoral maxillary protraction springs were used in both groups. Treatment results were evaluated cephalometrically. RESULTS: The amount of maxillary anterior displacement by the 2-hinged expander in the Alternate Rapid Maxillary Expansions and Constrictions group was 3.0 +/- 0.9 mm at A point, significantly greater than the 1.6 +/- 1.0 mm in the rapid maxillary expansion group. The amount of maxillary advancement with intraoral protraction springs in the Alternate Rapid Maxillary Expansions and Constrictions group was 2.9 +/- 1.9 mm at A point, significantly greater than the 0.9 +/- 1.1 mm in the rapid maxillary expansion group. The overall amount of maxillary advancement in the Alternate Rapid Maxillary Expansions and Constrictions group was 5.8 +/- 2.3 mm at A point. This result remained stable, without significant relapse after 2 years. CONCLUSIONS: Maxillary protraction using the 2-hinged expander, a repetitive weekly protocol of Alternate Rapid Maxillary Expansions and Constrictions, and intraoral protraction springs is most effective, with stable results at 2-year follow-up.     

2种前方牵引装置前牵引唇腭裂患者上颌骨的三维有限元分析

目的:建立含微钛板支抗和牙支持式前牵引装置的唇腭裂颅上颌复合体三维有限元模型,探讨其前牵引生物力学效应.方法:选取1例恒牙早期唇腭裂男性志愿者,进行锥形束CT(cone beam CT,CBCT)扫描,构建模型,模拟加力,分析位移变化及应力分布.结果:建立了含微钛板支抗和牙支持式前牵引装置的单、双侧唇腭裂颅上颌复合体三维有限元模型.前牵引时,上牙弓内缩;微钛板支抗模型上颌中上部位移量大于牙支持式模型,后者上颌前部及上尖牙位移量大于前者.微钛板支抗模型应力集中于上颌骨中上部,牙支持式模型的应力集中在上颌尖牙点,且前者应力值及分布范围均大于后者.双侧唇腭裂模型上前牙牙槽嵴处位移小于单侧唇腭裂模型,后者患侧位移和应力分布范围均大于健侧.结论:本研究构建的模型生物力学仿真性好,为唇腭裂上颌骨前牵引治疗的生物力学研究提供了良好的实验载体.微钛板支抗上颌骨前牵引以骨性作用为主,牙支持式上颌骨前牵引以牙性作用为主,前者更有利于效果稳定和侧貌改善.     

Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth

Cleft size at the time of palate repair might affect the difficulty of surgical repair and, thus, indirectly postoperative maxillary growth. This retrospective study aimed to determine whether a correlation existed between the cleft size at the time of palate repair and the growth of the maxilla. Maxillary dental casts of 39 infants with non-syndromic complete unilateral cleft lip and palate, taken at the time of palate repair, were used to measure cleft size. Cleft size was defined as the percentage of the total palatal area. The later growth of the maxilla was determined using lateral and postero-anterior cephalometric radiographs taken at 9 years of age. The Pearson correlation analysis was used for statistical analysis. The results showed negative correlations between cleft size and the maxillary length (PMP–ANS, PMP–A) and the maxillary protrusion (S–N–ANS, SNA). These data suggest that in patients with complete unilateral cleft lip and palate there is a significant correlation between the cleft size at the time of palate repair and the maxillary length and protrusion. Patients with a large cleft at the time of palate repair have a shorter and more retrusive maxilla than those with a small cleft by the age of 9 years.