溃疡性结肠炎患者外周血及结肠黏膜TNF-a、IL-6和IL-2变化的临床意义

Changes of TNF-a, IL-6 and IL-2 in peripheral blood and colonic mucosa of ulcerative colitis patients

摘要:

目的  考察溃疡性结肠炎（UC）患者外周血及结肠黏膜肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）和白细胞介素2（IL-2）变化并探讨其意义。方法  收集2008年1月-2013年1月贵阳市第二人民医院门诊及住院的活动期UC患者85例。根据病情严重程度将患者分为3组：轻度31例、中度25例和重度29例，选肠镜检查正常的健康体检者25例为对照组。检测所有受试者，UC患者治疗前后外周血和结肠黏膜TNF-α、IL-6和IL-2水平，并进行比较。结果  治疗前，各个UC组外周血和结肠黏膜TNF-α和IL-6水平明显高于对照组（P <0.05），IL-2明显低于对照组（P <0.05），随着严重程度增加，TNF-α和IL-6增高，IL-2降低，治疗后，UC组外周血和结肠黏膜TNF-α、IL-6及IL-2水平和对照组差异无统计学意义（P > 0.05），外周血TNF-α分别与IL-6和IL-2呈正相关（r =0.733，P=0.009）和负相关（r =-0.674，P =0.017），IL-6和IL-2呈负相关（r =-0.615，P =0.032），结肠黏膜的TNF-α分别与IL-6和IL-2呈正相关（r = 0.755，P =0.005）和负相关（r =-0.584，P =0.042），IL-6和IL-2呈负相关（r =-0.533，P =0.049），外周血TNF-α和IL-6分别与Geboes呈正相关（r =0.684，P =0.012；r =0.722，P =0.0011），IL-2与Geboes呈负相关（r =-0.631，P =0.021）。所有患者随访3、6、12和24个月，UC复发者分别为1、3、3和4例，合计11例，失访者分别为1、2、1和2例，复发率分别为1.19%（1/84）、3.66%（3/82）、3.70%（3/81）和5.06%（4/79），合计复发率为13.90%。结论  UC患者外周血及结肠黏膜TNF-a、IL-6和IL-2与UC严重程度相关，评估TNF-α、IL-6和IL-2有助于判断UC治疗的“黏膜愈合”，对预后有较准确的指导价值。

Abstract:

Objective To investigate the changes of TNF-a, IL-6 and IL-2 in peripheral blood and colonic mucosa in ulcerative colitis(UC) patients and their significance. Methods Eighty-five UC patients in our hospital from January 2008 to January 2013 were collected and divided into 3 groups: mild group with 31 cases, moderate group with 25 cases and severe group with 29 cases. Twenty-five healthy people having  normal colonoscopic results were collected as control group. TNF-α, IL-6 and IL-2 in peripheral blood and colonic mucosa of all subjects were detected and compared before and after treatment. Results Before treatment, compared with the control group, TNF-α and IL-6 in peripheral blood and colonic mucosa were significantly increased (P < 0.05) while IL-2 significantly decreased by a severity-dependent manner in all the UC groups (P < 0.05). After treatment, there was no significant difference in TNF-α, IL-6 or IL-2 of peripheral blood and colonic mucosa between the UC groups and the control group (P > 0.05). Peripheral blood and colonic mucosa TNF-α and IL-6, TNF-α and Geboes, IL-6 and Geboes were in positive linear relationships (P < 0.05). TNF-α and IL-2, IL-6 and IL-2, IL-2 and Geboes were in negative linear relationships (P < 0.05). All patients accepted 3, 6, 12 and 24 months of follow-up;  but 1, 2, 1 and 2 cases failed to be followed up in the respective period; UC recurrence was found in 1, 3, 3 and 4 cases respectively with the relapse rate of 1.19% (1/84), 3.66% (3/82), 3.70% (3/81) and 2.53% (3/79) respectively. The total recurrence rate was of 10.59%. Conclusions Peripheral blood and colonic mucosa TNF-α, IL-6 and IL-2 are correlated with the severity of UC. Assessing TNF-a, IL-6 and IL-2 can help to determine mucosal healing of UC.