白细胞介素-17在新诊断Graves病骨量异常女性患者中水平的变化

Changes of serum IL-17 concentration in newly diagnosed female Graves disease patients with abnormal bone mass

目的通过检测女性Graves病所致骨量异常患者血清白细胞介素17(IL-17)、Ⅰ型胶原氨基末端肽(t P1NP)、β-胶原特殊序列(β-Cross Laps)、N端中段骨钙素(N-MID OCN)、血雌二醇(E2)、促卵泡生成素(FSH)、促黄体生成素(LH)的变化,分析其与游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)水平及骨密度(BMD)的相关性,探讨IL-17在女性甲状腺功能亢进症所致骨量异常中表达水平的变化及作用机制。方法收集于2013年10月至2014年8月在我院内分泌科就诊的初发Graves病患者57例。对照组选择相匹配的我院健康体检者46例。根据WHO骨质疏松诊断标准,将Graves病患者分为骨质疏松组、骨量低下组、骨量正常组三个亚组,进行各项生化指标的测定,双能X线骨密度测定仪(DXA)测定腰椎(L总)、股骨颈(Neck)及前臂1/3的BMD。结果 (1)在Graves病患者中,血IL-17升高,血N-MID OCN、t P1NP、β-Cross Laps显著升高,差异有统计学意义(P<0.05);而股骨颈、前臂1/3 BMD降低,且以前臂1/3降低更明显,血FSH、LH、E2升高,差异有统计学意义(P<0.05)。(2)股骨颈、L总、前臂1/3的BMD下降,差异有统计学意义(P<0.05,P<0.01)。(3)Graves病患者中,骨质疏松组IL-17、N-MID OCN、t P1NP,β-Cross Laps水平高于骨量正常组及骨量低下组,骨量低下组IL-17、β-Cross Laps、N-MID OCN、t P1NP均高于骨量正常组,差异有统计学意义(P<0.05,P<0.01)。(4)Graves病患者中,IL-17与FT3、FT4及β-Cross Laps呈正相关(r=0.491,r=0.492,r=0.473,均P<0.05),而与TSH、桡骨1/3及股骨颈BMD呈负相关(r=-0.462,r=-0.501,r=-0.502,均P<0.05)。结论 (1)IL-17水平在女性Graves病患者血中明显升高,与甲状腺激素呈正相关,与TSH呈负相关。(2)女性Graves病患者中血IL-17水平与β-Cross Laps呈正相关。(3)绝经后女性血IL-17水平均较绝经前表达明显升高,并与BMD的降低有一定相关性,表明其可能参与了绝经后骨质疏松的发生和发展。

Objective To explore the change of the serum IL-17 concentration and its possible effect on bone metabolism in patients with Graves disease by detecting the levels of IL-17, t P1 NP, β-Cross Laps, N-MID, Ca, P, E2, FSH, LH, and analyzing the relationship between IL-17 and FT3, FT4, TSH levels, bone mineral density in newly diagnosed Graves disease patients with abnormal bone mass. Methods 57 female newly diagnosed and untreated GD patients were involved in the hyperthyroidism group, 46 cases as control group. According to WHO classification of osteoporosis of BMD, Graves patients were divided into osteoporosis group, osteopenia group, the normal bone mass group three subgroups. All cases were measured above-mentioned biochemical indicator. Bone mass of the patients were detected using duel-energy X-ray absorptiometry. Results(1) In Graves patients IL-17 increased(P<0.05), N-MID OCN, t P1 NP, β-Cross Laps was significantly increased(P<0.05, P<0.01); The BMD at femoral neck and distal radius 1/3 were lower than healthy women, especially at distal radius, the levels of FSH, LH, E2 increased(P<0.05).(2) The BMD at femoral neck, distal radius 1/3 and L1-4 deceased(P<0.05).(3) In Graves patients IL-17, t P1 NP, β-Cross Laps and N-MID OCN were significantly higher in osteoporosis group than in osteopenia group and normal BMD group. IL-17, t P1 NP, β-Cross Laps and N-MID OCN were higher in osteopenia group than normal BMD group(P<0.05, P<0.01).(4) The correlation analysis showed that IL-17 positively correlated with FT3, FT4 and β-Cross Laps(r=0.491, r=0.492, r=0.473; P<0.05), negatively correlated with TSH, 1/3 radial and femoral neck BMD(r=-0.462, r=-0.501, r=-0.502; P<0.05). Conclusions(1) The level of IL-17 increased significantly in patients with Graves disease in women, and positively related with thyroid hormone, and negatively correlated with TSH.(2) The level of serum IL-17 was positively related with β-Cross Laps.(3) The level of IL-17 was significantly increased in post-menopausal women, and has some correlation with lower bone mineral density, indicating that it may be involved in the occurrence and development of postmenopausal osteoporosis.