老年骨质疏松症合并髋部骨折患者外周T淋巴细胞亚群炎性细胞因子水平与骨代谢生化指标的关系

Study on the correlation among peripheral T-lymphocyte subsets,inflammatory cytokines and bone metabolism biochemical indices in elderly osteoporotic patients complicated with hip fracture

目的探讨老年骨质疏松症(OP)合并髋部骨折患者外周T淋巴细胞亚群、炎性细胞因子水平与骨代谢生化指标的相关性。方法在骨伤科收治的老年患者中(年龄≥60岁),根据骨质疏松症的诊断标准及有无发生髋部骨折,选取OP合并骨折组(A组)30例OP无骨折组(B组)30例,并选择同一时期年龄、性别相匹配的体检者30例作为健康对照组(C组)。测定3组研究对象的T淋巴细胞亚群、炎性细胞因子与骨代谢生化指标,并分析各指标间的相关性。结果A组和B组患者血清中外周T淋巴细胞亚群CD4^(+)与CD8^(+)含量低于C组(F=8.545、9.201,P<0.05);A组和B组患者血清中炎性细胞因子IL-6、TNF-α与骨代谢生化指标Ⅰ型胶原羧基末端肽(typeⅠcollagen carboxy-terminal peptide,CTX)、Ⅰ型前胶原氨基端前肽(typeⅠprollagen amino-terminal peptide,P1NP)含量高于C组(F=18.291、4.906、7.077、14.411,P<0.05);3组患者血清中CD4^(+)/CD8^(+)、IFN-γ、Ca、P含量无明显差异(P>0.05);老年骨质疏松症合并髋部骨折患者血清中CD4^(+)与CD8^(+)含量与CTX、P1NP含量呈负相关(CD4^(+):r=-0.714、-0.667,P=0.003、0.007;CD8^(+):r=-0.647、-0.746,P=0.007、0.001),IL-6、TNF-α含量与CTX、P1NP含量呈正相关(IL-6:r=0.777、0.864,P=0.0010.000;TNF-α:r=0.611、0.554,P=0.016、0.032)。结论老年骨质疏松症合并髋.部骨折患者血清中T淋巴细胞亚群CD4^(+)、CD8^(+)和炎性细胞因子IL-6、TNF-α的含量变化影响了骨代谢的过程,下降的CD4^(+)、CD8^(+)与上升的IL-6、TNF-α指标存在加大老年骨质疏松症合并髋部骨折风险的可能性,其指标对预测该类骨折发生有较大意义。

Objective To investigate the correlations between peripheral T-lymphocyte subsets,inflammatory cytokines and bone metabolism biochemical indexes in elderly osteoporotic patient(OP)complicated with hip fracture.Methods Among the elderly patients(aged≥60 years)admitted to the orthopedics and traumatology department,using the diagnostic criteria of osteoporosis,30 cases of OP with hip fracture were enrolled as Group A,the same number of OP without hip fracture as Group B.Simultaneously,the same amount of gender-matched health examination population were selected as the control group.In order to analyze their correlation,T lymphocyte subsets,inflammatory cytokines and biochemical indices of bone metabolism from the three groups would be determined.Results The levels of CD4^(+) and CD8^(+) in peripheral T lymphocyte subsets in Group A and B were significantly lower than those in the healthy control group(F=8.545 and 9.201,P<0.05).The serum levels of inflammatory cytokines IL-6,TNF-α,TypeⅠcollagen carboxy-terminal peptide(CTX)and TypeⅠprocollagen amino-terminal peptide(P1NP)were significantly higher in Group A and Group B than them in the healthy control group(F=18.291,4.906,7.077,14.411,P<0.05).There was no significant differences in CD4^(+)/CD8^(+),IFN-γ,Ca or P in serum among the 3 groups(P>0.05).The contents of CD4^(+) and CD8^(+) were negatively correlated with the contents of CTX and P1NP in aged OPs who was complicated with hip fracture(CD4^(+):r=-0.714 and-0.667,P=0.003 and 0.007;CD8^(+):r=-0.647 and-0.746,P=0.007 and 0.001).The contents of IL-6 and TNF-αwere positively correlated with the contents of CTX,P1NP(IL-6:r=0.777 and 0.864,P=0.001 and 0.000;TNF-α:r=0.611 and 0.554,P=0.016 and 0.032).Conclusion Changes in CD4^(+),CD8^(+),the inflammatory cytokines IL-6 and TNF-αin serum of elderly OPs with hip fracture affect the process of bone metabolism.Reduced CD4^(+),CD8^(+) and increased IL-6,TNF-α may increase the risk of elderly OPs with hip fracture.