绝经后妇女血清中IL-6、TNF-α、IL-27与骨质疏松的相关性

The correlation between serum IL-6,TNF-α,IL-27 and osteoporosis in postmenopausal women

目的探讨白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-27(interleukin-27,IL-27)水平与绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)相关性及其对PMOP的预测价值。方法选取2021年4月至2022年1月到广州中医药大学附属骨伤科医院住院和门诊治疗的84例符合纳入标准的绝经后女性患者为研究对象。根据骨密度T值将患者分为骨质疏松组(67例)和非骨质疏松组(17例)。收集并测定患者血清中IL-6、TNF-α、IL-27蛋白水平和β胶原降解产物(β-C-terminal telopeptide of type I collagen,β-CTX)、1型前胶原氨基端延长肽(propeptide of typeⅠprocollagen,PINP)、血清骨钙素(osteocalcin,OC)的水平。比较两组受试者的基线数据及IL-6、TNF-α、IL-27、β-CTX、TPINP、OC的表达水平;分析IL-6、TNF-α、IL-27与年龄、骨转换指标的相关性;同时采用Logistics回归进行PMOP危险因素分析,在其基础上通过受试者工作特征曲线评价IL-6、TNF-α对PMOP的预测效能。结果①两组受试者在身高、β-CTX、OC水平上的比较,差异无统计学意义(P>0.05);PMOP组在体重、BMI方面均低于非骨质疏松症组,而在年龄、IL-6、TNF-α、IL-27、TPINP水平均高于非骨质疏松症组,差异有统计学意义(P<0.05);②不同中医证型间IL-6、TNF-α、IL-27蛋白水平差异具有统计学意义(P<0.05);③受试者的年龄与IL-27蛋白水平呈正相关(r值:0.263 P<0.05),IL-6和TNF-α水平与年龄无相关性;④受试者IL-6水平与TPINP水平呈正相关(r值:0.244 P:0.025),TNF-α、IL-27水平与骨代谢指标无相关性;⑤Logistics回归分析显示体重、IL-6和TNF-α水平是PMOP的独立危险因素。进一步构建ROC曲线,显示IL-6与TNF-α对PMOP均具有良好的预测价值,IL-6的AUC值、临界值、灵敏度和特异性分别为0.884,5.038 pg/mL,88.2%和77.6%;TNF-α的AUC值、临界值、灵敏度和特异性分别为0.843,7.593 pg/mL,76.5%和76.1%。结论IL-27水平与年龄呈正相关,IL-6和TNF-α水平是PMOP的独立危险因素,若血清中IL-6含量大于5.038 pg/mL或TNF-α含量大于7.593 pg/mL,则需警惕PMOP的发生。

Objective To investigate the correlation of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-27(IL-27)with postmenopausal osteoporosis(PMOP)and its predictive value.Methods 84 postmenopausal women who met the inclusion criteria from April 2021 to January 2022 were selected for hospitalization and outpatient treatment in the Orthopaedic Hospital of Guangzhou University of traditional Chinese Medicine.According to the bone mineral density T value,the patients were divided into osteoporosis group(67 cases)and non-osteoporosis group(17 cases).The serum levels of IL-6,TNF-α,IL-27,βcollagen degradation products(β-CTX),N-terminal extension peptide of type 1 procollagen(TPINP)and serum osteocalcin(OC)were collected and measured.The baseline data and the expression levels of IL-6,TNFα,IL-27,β-CTX,TPINP and OC were compared between the two groups,and the correlation of IL-6,TNF-α,IL-27 with age and bone turnover was analyzed.At the same time,logistics regression was used to analyze the risk factors of PMOP,and the predictive efficiency of IL-6 and TNF-αon PMOP was evaluated by the working characteristic curve of the subjects.Results①There was no significant difference in height,β-CTX and OSTEOC level between the two groups(P>0.05),the body weight and BMI of PMOP group were lower than those of non-osteoporosis group,while the age,IL-6,TNF-α,IL-27 and TPNIP level of PMOP group were higher than those of non-osteoporosis group,and the differences were statistically significant(P<0.05).②There were statistically significant differences in IL-6,TNF-αand IL-27 protein levels among different TCM syndromes(P<0.05).③Age was positively correlated with IL-27 protein level(r value:0.263,P<0.05),and IL-6 and TNF-αlevels were not correlated with age.④IL-6 level was positively correlated with TPNIP level(r value:0.244,P:0.025),and TNF-αand IL-27 levels were not correlated with bone metabolism indexes.⑤Logistics regression analysis showed that body weight,IL-6 and TNF-αlevels were independent risk factors for PMOP.ROC curve showed that IL-6 and TNF-αhad good predictive value for PMOP.The AUC value,critical value,sensitivity and specificity of IL-6 were 0.884,5.038 pg/mL,88.2%and 77.6%,respectively.The AUC,cut-off value,sensitivity and specificity of TNF-αwere 0.843,7.593 pg/mL,76.5%and 76.1%,respectively.Conclusion The result suggest that IL-27 level is positively correlated with age.IL-6 and TNF-αlevels are independent risk factors for PMOP.If serum IL-6 content>5.038 pg/mL or TNF-αcontent>7.593 pg/mL,we should be alert to the occurrence of PMOP.