上颌快速扩弓对龈沟液中RANKL和骨保护素含量的影响

Effect of rapid maxillary expansion on the level of RANKL and osteoprotegerin in the gingival crevicular fluid

目的:观察龈沟液中核因子κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL)、骨保护素水平与上颌快速扩弓过程中牙周组织改建的关系。方法:选取32例安氏Ⅲ类错患者,随机分为对照组(只戴入扩弓器但不加力)和观察组(持续扩弓1周),各16例。以右上颌第一磨牙、左上颌尖牙颊侧为检测位点,分别在扩弓前(基线)、扩弓后24 h、1周、2周、1月、3月时采集龈沟液,采用ELISA法检测龈沟液中RANKL、骨保护素的含量。结果:观察组右上颌第一磨牙和左上颌尖牙龈沟液中RANKL水平在扩弓后24 h时明显升高,1周时达峰值,2周时仍维持较高水平,以后逐渐下降,3个月时下降到扩弓前水平;骨保护素水平24 h时明显降低,1周时达最低值,2周时维持较低水平,以后逐渐上升,3个月时上升到扩弓前水平。从扩弓后24 h至1个月,观察组RANKL和骨保护素含量与对照组比较,差异有统计学意义(P<0.05),而至3个月时已无明显差异(P>0.05)。结论:上颌快速扩弓过程中,龈沟液中的RANKL、骨保护素含量的变化可能与矫形力作用下牙槽骨改建的状态有关。

Objective： To observe the variation of the receptor activator of nuclear factor （ NF）-KB ligand （RANKL） and osteoprotegerin（OPG） levels in the gingival crevicular fluid before and after rapid maxillary expansion. Methods： Thirty-two patients with Class m malocclusion were randomly assigned into two groups（n = 16） ： control group（just wear into the expansion device without force） and experimental group （wear the expansion device and expansion arch 1 week）. Selecting the buccal surface of the right maxillary first molar and left maxillary canine teeth as the detection situs, gingival crevicular fluid was collected and periodontal clinical parameters were recorded before the expansion （baseline） and after expansion 24 h, 1 week, 2 weeks,1 month, 3 months, respectively. The levels of RANKL and osteoprotegerin in the gingival crevicular fluid were detected using the ELISA method. Results： The RANKL levels in gingival crevicular fluid of left and right maxillary first molar maxillary canine in the experimental group were markedly elevated at 24 h of expansion treatment, the peak level reached at 1 week and still maintained a relatively high level at 2 weeks of treatment. And then the RANKL levels declined gradually and fell approach to the baseline level （before the expansion） at 3 months. The osteoprotegerin levels were significantly reduced at 24 h of expansion and downed to nadir at 1 week,then maintained a low levels in 2 weeks. Then the osteoprotegerin levels were gradually increased at 3 months, approached to the level as that of before expansion. Groups comparison showed that there were no significantly differences in the periodontal clinical parameters between the two groups （P 〉 0.05）. From 24 h to 1 month of the expansion, there were statistically significant differences in the RANKL, osteoprotegerin levels between the experimental group and the control group （P 〈 0.05）. However, there was no statistically significant differences at 3 months of expansion between two groups （P 〉 0. 05 ）. Conclusion： The changes of RANKL and osteoprotegerin levels from gingival crevicular fluid in the rapid maxillary expansion process might be concerned with the alveolar bone remodeling with the orthopedic force.