Graves眼病患者血清骨代谢相关细胞因子变化及与骨密度的相关性

The change of serum bone metabolism related cytokines in patients with Graves ophthalmopathy and its correlation with bone mineral density

目的探讨Graves眼病(GO)患者血清骨代谢相关细胞因子变化及与骨密度的相关性。方法选取2014年5月至2016年10月收治的60例GO患者为GO组,其中分为轻度GO组18例,重度GO组42例。另设同期进行健康体检的正常人为对照组(40例)。测定3组血清骨代谢相关细胞因子[护骨素(OPG)、细胞核因子κB受体活化因子配基(RANKL)、白介素6(IL-6)、白介素10(IL-10)、肿瘤坏死因子α(TNF-α)、胰岛素样生长因子Ⅰ(IGF-Ⅰ)]及第2~4腰椎(L2~4)、股骨颈、Ward三角和大转子区骨密度(BMD)。结果 (1)GO组血清OPG、RANKL、IL-6、TNF-α较对照组明显升高,OPG/RANKL、IL-10、IGF-Ⅰ较对照组明显降低,且重度GO组血清OPG、RANKL、IL-6、TNF-α较轻度GO组明显升高,OPG/RANKL、IL-10、IGF-Ⅰ较轻度GO组明显降低,差异有统计学意义(P<0.05)。(2)GO组L2~4、股骨颈、Ward三角和大转子区BMD较对照组明显降低,且重度GO组L2~4、股骨颈、Ward三角和大转子区BMD较轻度GO组明显降低,差异有统计学意义(P<0.05)。(3)对照组血清OPG、RANKL、OPG/RANKL、IL-6、IL-10、TNF-α、IGF-Ⅰ与各部位BMD均无相关性(P>0.05)。GO组血清OPG、RANKL、IL-6、TNF-α与各部位BMD均具有负相关性(r值分别为-0.685、-0.722、-0.775、-0.798,P<0.05),OPG/RANKL、IL-10、IGF-Ⅰ与各部位BMD均具有正相关性(r值分别为0.712、0.689、0.803,P<0.05)。结论 GO患者血清OPG、RANKL、IL-6、TNF-α水平升高,OPG/RANKL、IL-10、IGF-Ⅰ水平降低,且其变化与骨代谢异常和骨密度降低有关。

Objective To investigate the change of serum bone metabolism related cytokines in patients with Graves ophthalmopathy （ GO） and its correlation with bone mineral density. Methods Sixty patients with GO who were admitted and treated in our hospital from May 2014 to October 2016 were enrolled as GO group,who were redivided into two subgroups：mild GO group （ n =18） and severe GO group （ n = 4 2 ） ,meanwhile, 40 healthy subjects were served as control group. The serum bone metabolism related cytokines including osteoprotegerin （ OPG）,nuclear factor-k beta receptor activator ligand （RANKL） , interleukin-6 （IL-6） , interleukin-10 （ IL-10） , tumor necrosis factor a （ TNF-α） , insulin-like growth factor I （IGF- I ） and bone mineral density （BMD） in lumbar vertebrae （ L2 -4） , femoral neck,ward triangle and trochanter major were detected for the three groups. Results The serum levels of OPG, RANKL, IL-6 and TNF-α in GO group were significantly increased, however, the levels of OPG/RANKL, IL-10 and IGF- I were obviously decreased, as compared with those in control group. Moreover the serum levels of OPG, RANKL, IL-6 and TNF-α in severe GO group were significantly higher than those in mild GO group, however, the levels of OPG/RANKL, IL-10 and IGF- I in severe GO group were significantly lower than those in mild GO group （ P 〈 0.05） . The levels of BMD in lumbar 2 -4 （ L2-4） , femoral neck, Ward＇s triangle and trochanter region in GO group were obviosuly decreased, as compared with those in control group, furthermore, which in severe GO group were significantly lower than those in mild GO group （ P 〈0.05） . The correlation analysis showed that the serm levels of OPG,RANKL,OPG/RANKL,IL-6,IL-10,TNF-α and IGF- I in control group were not correlated to the levels of BMD in different sites （ P 〉 0 .0 5 ） . However the levels of OPG,RANKL,IL-6 and TNF-α in GO group were negatively correlated with the levels of BMD in different sites （ r = - 0. 685, - 0. 722, - 0. 775, - 0. 798, respectively, P 〈0.05） ,however, the levels of OPG/RANKL,IL-10 and IGF- I in GO group were positively correlated with the levels of BMD in different sites （r = 0. 712,0. 689,0. 803 , respectively, P 〈 0. 05 ）. Conclusion The serum levels of OPG,RANKL,IL-6 and TNF-α in patients with GO are increased, but the levels of OPG/RANKL, IL-10 and IGF- I are decreased,moreover,the changes are closely related with bone metabolism abnormality and BMD decrease.