Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Arthritis Care Res (Hoboken). 2010 Jun;62(6):835-41. doi: 10.1002/acr.20043.
To assess the clinical relevance of increased circulating cytokines in patients with giant cell arteritis (GCA) after long-term followup.
We performed a cross-sectional evaluation of 54 patients with biopsy-proven GCA prospectively followed for a median of 5.4 years (range 4-10.5 years). GCA-related complications, vascular events, relapses, current prednisone dose, time required to achieve a maintenance prednisone dosage <10 mg/day, cumulated prednisone at that point, and adverse effects during followup were recorded. Serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFalpha) were determined by immunoassay.
All patients were in clinical remission. Both cytokines were significantly higher in patients than in controls (mean +/- SD 21 +/- 35 versus 5 +/- 11 pg/ml; P < 0.001 for IL-6 and mean +/- SD 32 +/- 14 versus 16 +/- 9 pg/ml; P < 0.001 for TNFalpha). No differences were found in patients with or without GCA-related complications or vascular events during followup. Circulating cytokines were significantly higher in patients who had experienced relapses (mean +/- SD 25 +/- 39 versus 10 +/- 11 pg/ml; P = 0.04 for IL-6 and mean +/- SD 34 +/- 15 versus 25 +/- 11 pg/ml; P = 0.042 for TNFalpha). IL-6 was significantly higher in patients still requiring prednisone (mean +/- SD 29 +/- 45 versus 13 +/- 17 pg/ml; P = 0.008), and TNFalpha correlated with cumulated prednisone dose (r = 0.292, P = 0.04). No significant relationship was found between elevated cytokines and prednisone adverse effects or patients' quality of life.
Circulating TNFalpha and IL-6 may persist elevated in GCA patients after long-term followup and remain higher in patients who have experienced more relapsing disease. However, in this patient cohort, elevated circulating cytokines were not associated with increased frequency of GCA complications, vascular events, or treatment-related side effects.
评估巨细胞动脉炎（GCA）患者长期随访后循环细胞因子升高的临床相关性。
我们前瞻性评估了 54 例经活检证实的 GCA 患者，中位随访时间为 5.4 年（范围 4-10.5 年）。记录 GCA 相关并发症、血管事件、复发、当前泼尼松剂量、达到维持剂量<10mg/天所需的时间、累积泼尼松剂量以及随访期间的不良反应。通过免疫测定法测定血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNFalpha）。
所有患者均处于临床缓解期。患者的两种细胞因子均明显高于对照组（均值±SD 21±35 与 5±11pg/ml；P<0.001 用于 IL-6，均值±SD 32±14 与 16±9pg/ml；P<0.001 用于 TNFalpha）。在随访期间有或没有 GCA 相关并发症或血管事件的患者之间未发现差异。复发患者的循环细胞因子明显更高（均值±SD 25±39 与 10±11pg/ml；P=0.04 用于 IL-6，均值±SD 34±15 与 25±11pg/ml；P=0.042 用于 TNFalpha）。仍需泼尼松治疗的患者的 IL-6 明显更高（均值±SD 29±45 与 13±17pg/ml；P=0.008），TNFalpha 与累积泼尼松剂量相关（r=0.292，P=0.04）。升高的细胞因子与泼尼松不良反应或患者生活质量之间未发现显著关系。
在长期随访后，GCA 患者的循环 TNFalpha 和 IL-6 可能持续升高，且在经历更多复发疾病的患者中更高。然而，在该患者队列中，升高的循环细胞因子与 GCA 并发症、血管事件或治疗相关副作用的发生频率增加无关。
