原发性骨质疏松症患者血清TNF-α、IL-6、PCT与唑来膦酸急性期发热反应的相关性

Correlation between the expression of serum TNF-α,IL-6,PCT and acute phase febrile reaction induced by zoledronic acid in patients with primary osteoporosis

目的探讨原发性骨质疏松症患者唑来膦酸急性期发热反应与肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、降钙素原(PCT)等炎性细胞因子的相关性。方法以佛山市顺德区伦教医院接受唑来膦酸治疗的100例原发性骨质疏松症患者为研究对象,根据使用唑来膦酸后有无出现发热反应,分为发热组(n=42)与非发热组(n=58),检测两组患者治疗前后血清TNF-α、IL-6、PCT水平,分析其与唑来膦酸急性期发热反应的相关性。结果发热组患者给药前一天血清TNF-α和IL-6,给药1 d时血清TNF-α、IL-6、PCT,以及给药3 d和7 d时血清IL-6表达均高于非发热组,两组比较,差异具有统计学意义(P<0.05)。与用药前相比,发热组在用药1 d时TNF-α,1、3 d时IL-6,以及1、3、7 d时PCT表达均升高;非发热组则在用药1、3 d时TNF-α,以及3、7 d时PCT表达均升高,用药前后比较,差异具有统计学意义(P<0.05)。结论首次使用唑来膦酸治疗原发性骨质疏松症,用药前一天监测患者血清TNF-α、IL-6水平可能预测唑来膦酸急性期发热反应的发生,用药后7 d内TNF-α、PCT等炎性因子呈不同程度的高表达,可用来作为唑来膦酸急性期发热反应的诊断指标。

Objective To investigate the correlation between zoledronic acid induced acute phase fever reaction and expression of serum tumor necrosis factor(TNF)-α,interleukin(IL)-6,procalcitonin(PCT)in patients with primary osteoporosis.Methods A total of 100 patients with primary osteoporosis treated with zoledronic acid in Lunjiao Hospital of Shunde District of Foshan City were divided into fever group(n=42)and non-fever group(n=58)according to whether there was fever reaction after injection of zoledronic acid.The expression levels of serum TNF-α,IL-6,PCT in two groups were measured,and then their correlations to zoledronic acid induced acute phase fever reaction were analyzed.Results The serum levels of TNF-α,IL-6 at the day before treatment,TNF-α,IL-6,PCT at 1 d after treatment,IL-6 at 3,7 d after treatment in fever group were all higher than those in non-fever group,which showed statistical differences between two groups(P<0.05).Compared with the day before treatment,the expression of TNF-αincreased at 1 d,IL-6 increased at 1,3 d and PCT increased at 1,3,7 d after treatment in fever group,and the expression of TNF-αincreased at 1,3 d,PCT increased at 3,7 d in non-fever group,there were statistical differences between pre-treatment and post-treatment(P<0.05).Conclusion Monitoring of TNF-α,IL-6 levels at the day before treatment may be used to predict the occurrence of acute febrile reaction induced by zoledronic acid,which is the first time treatment in these patients with primary osteoporosis.Cytokines such as TNF-α,PCT were highly expressed in varying degrees within 7 days after treatment,which could be used as diagnostic indicators of acute febrile response to zoledronic acid.