类风湿关节炎患者骨质疏松与免疫调节性细胞因子的关系

Relationship between osteoporosis and immunoregulatory cytokines in patients with rheumatoid arthritis

目的探讨类风湿关节炎(RA)患者骨质疏松与免疫调节性细胞因子的关系。方法收集2018年1月至2019年2月在包头医学院第一附属医院风湿免疫科住院确诊的115例RA患者的临床资料、实验室检查及血清标本。根据骨密度值将RA患者分为RA伴骨质疏松症(OP)组65例和RA不伴OP组50例。检测两组患者免疫调节性细胞因子[白细胞介素(IL)-17、IL-6、IL-10、肿瘤坏死因子(TNF)-α、转化生长因子(TGF)-β1]的表达水平及红细胞沉降率(ESR)、C反应蛋白(CRP)、免疫球蛋白(Ig)G、IgA、IgM水平。结果 (1) RA伴OP组年龄、病程、压痛关节数(TJC)、肿胀关节数(SJC)和骨折史、使用糖皮质激素病史发病率均显著高于RA不伴OP组(P<0. 01)。(2) RA伴OP组各部位骨密度值均显著低于RA不伴OP组(P<0. 01)。两组RA患者腰椎骨密度值均显著低于髋关节骨密度值(P<0. 01)。(3) RA伴OP组IL-17、ESR、CPR、DAS28水平显著高于RA不伴OP组,IL-10低于RA不伴OP组,差异有统计学意义(P<0. 01)。结论 RA患者腰椎更容易出现骨质疏松,使用过糖皮质激素的患者更容易出现骨质疏松且易于发生骨折。合并OP的RA患者年龄、病程、TJC、SJC、DAS28、IL-17和CRP水平普遍偏高,且IL-10的下降水平较明显,RA患者发生OP可能与年龄、病程、使用糖皮质激素有关;免疫调节性细胞因子在RA发生OP的过程中起到一定的作用,其中IL-17可能参与骨破坏的过程,IL-10可能起到骨保护的作用。

Objective To discuss the relationship between osteoporosis(OP) and immunoregulatory cytokines in patients with rheumatoid arthritis(RA). Methods The clinical data,laboratory tests and serum samples of 115 patients with confirmed RA from January 2018 to February 2019 were collected. According to bone mineral density(BMD) value,RA patients were divided into RA accompanied by OP(RA with OP group,n = 65) and RA without OP(RA without OP group,n = 50). The levels of interleukin-17(IL-17),IL-6,IL-10,tumor necrosis factor(TNF)-α,transforming growth factor-β1(TGF-β1),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),immunoglobulin(Ig)G,IgA,IgM were detected in two groups. Results The age,course of disease,tender joint count(TJC),swollen joints count(SJC),history of fracture and history of glucocorticoid use in RA with OP group were significantly longer than those in RA without OP group(P< 0. 01). BMD values of each part in RA with OP group were significantly lower than those in RA without group(P< 0. 01). The BMD of lumbar vertebrae was significantly lower than that of hip joint in both groups(P< 0. 01).The levels of IL-17,ESR,CPR and DAS28(Disease Activity Score including a 28-joint count) in RA with OP group were significantly higher,and IL-10 was significantly lower than those in RA without OP group(P< 0. 01). Conclusions RA patients are prone to lumbar osteoporosis,and those who have used glucocorticoids are more likely to have osteoporosis and fracture. In RA patients with OP,age,course of disease,TJC,SJC,DAS28,levels of IL-17 and CRP are generally high,and IL-10 level is obviously low. The occurrence of OP in RA patients may be related to age,course of disease and corticosteroids use. Immunoregulatory cytokines possibly participate in the process of OP in RA,in which IL-17 may be involved in the process of bone destruction,while IL-10 may play a role in bone protection.