肿瘤坏死因子-α在痛风性关节炎患者炎症反应中的作用

Tumor necrosis factor-α in the inflammatory reaction of patients with gouty arthritis

目的检测痛风性关节炎(GA)患者关节液、血清中肿瘤坏死因子-α(TNF-α)的表达水平并探究其在GA发生发展中作用。方法收集2016年4月至2017年10月在昆明医科大学第一附属医院诊治的急性发作期GA患者67例(AGA组)和缓解期GA患者26例(RGA组)为研究对象,将AGA患者按照主诉疼痛程度分级法评分(VAS)分为重度AGA(SAGA)组39例和轻度AGA(MAGA)组28例。选取同期健康体检者35例作为对照组。分别抽取GA患者及健康体检者关节液和静脉血,于生化实验室检测各受试者血沉、血尿酸、血常规指标,酶联免疫吸附法(ELISA)检测各受试者血清和关节液中TNF-α及血清中白细胞介素(IL)-1β、IL-8、IL-10、超敏C反应蛋白(hs-CRP)水平,分析TNF-α表达与其他实验指标的相关性。结果随患者病情逐步加重(对照组→RGA组→MAGA组→SAGA组),其血清、关节液中TNF-α、血尿酸、血沉、IL-1β、IL-8、hs-CRP水平递增,IL-10水平递降,相邻病情间两两比较差异均有统计学意义(P <0. 05)。GA患者血清中TNF-α水平与IL-1β、IL-8、hs-CRP水平呈正相关(r=5. 919、0. 607、0. 611,P <0. 01),与IL-10水平负相关(r=-0. 633,P <0. 01); GA患者关节液中TNF-α水平与血尿酸、IL-1β、hs-CRP水平正相关(r=0. 592、0. 618、0. 571,P <0. 01),与IL-10水平负相关(r=-0. 609,P <0. 01)。结论 GA患者血清及关节液中TNF-α高表达,可能促进IL-1β、hs-CRP等炎症相关因子的表达,促进炎症的发生。

Objective To detect the levels of tumor necrosis factor-α（TNF-α） in synovial fluid and blood serum of patients with gouty arthritis（GA） and explore its role in the development and progression of GA. Methods Sixty-seven GA patients in acute attack stage（AGA group） and 26 GA patients in remission period（RGA group） treated in the First Affiliated Hospital of Kunming Medical University from April 2016 to October 2017 were selected as the objects,another 35 healthy persons were served as control group at the same time. AGA patients were subdivided into severe AGA（SAGA）group（n = 39） and mild AGA（MAGA） group（n = 28） according to the degree of complaint pain scale of verbal rating scale（VAS） for AGA. The joint fluid and venous blood were extracted from GA patients and health persons respectively for the detections of erythrocyte sedimentation rate,blood uric acid and blood routine indexes,and enzyme linked immunosorbent assay（ELISA） was used to detect the levels of TNF-α,interleukin-1（IL-1）,IL-1β,IL-8,IL-10 and highsensitivity C-reactive protein（hs-CRP）. The correlations between TNF-α level and other experimental indexes were analyzed. Results The levels of TNF-α,blood uric acid,erythrocyte sedimentation rate,IL-1β,IL-8 and hs-CRP in serum and joint fluid significantly increased with the aggravation of the disease,but the level of IL-10 decreased with the aggravation of the disease（all P〈0. 05）. Serum TNF-α level in GA patients was positively correlated with the levels of IL-1β,IL-8 and hs-CRP（r = 5. 919,0. 607,0. 611 respectively,P〈0. 05） and was negatively correlated with IL-10 level（r =-0. 633,P〈0. 05）. TNF-α level in joint fluid of GA patients was positively correlated with the levels of blood uric acid,IL-1β,and hs-CRP（r = 0. 592,0. 618,0. 571,respectively,P〈0. 05） and was negatively correlated with the level of IL-10（r =-0. 609,P〈0. 05）. Conclusion High level of TNF-α in serum and synovial fluid of GA patients may boost the expressions of inflammatory factors such as IL-1β,hs-CRP and so on,and promote the occurrence of inflammation.