Expression Of Cytokines And Their Correlation With Endoscopic Disease Activity In Patients With Ulcerative Colitis

Objectives:To observe the expression of cytokines including tumor necrosis factor-?,interleukin-1?,interleukin-6,interleukin-8,interleukin-10,and to explore the relationship between these inflammatory factors and endoscopic disease activity.Methods:From February 2016 to December 2016,71 patients of ulcerative colitis(UC)were enrolled in the Department of Gastroenterology,First Affiliated Hospital of DaLian Medical University,whose diagnosis is in line with "inflammatory bowel disease diagnosis and treatment of consensus"(2012 Guangzhou).And 46 healthy persons were also enrolled as control.The level of serum cytokines including TNF-a,IL-1?,IL-6,IL-8,IL-10 was measured by chemiluminescence immunoassay(CLIA)method.Simultaneously,all these subjects received erythrocyte sedimentation rate,c-reactive protein,hemoglobin,platelets,albumin and colonoscopy examination,so as to explore the relationship between these inflammatory factors and endoscopic disease activity.Spss 13.0 software was used for the statistical analysis,p<0.05 was considered statistically significant.Results:1.General data:71 patients of UC(40 male,31 female)whose average age was 48.66 ± 16.34 years(19-77years),46 healthy persons whose average age was 56.76± 14.76 years(23-78years).There was no significantly statistical difference between the two groups of the average age(F=2.241 p=0.137,p>0.05).According to the modified Mayo score and the Truelove&Witts(when the results were inconsistent,a higher degree was recorded as the result),31 patients(44%)were mild,23(32%)were moderate,and 17(24%)were severe.The location of lesions was assessed by the Montreal classification,with rectal type(E1)35 patients(49%),left colon type(E2)24 patients(34%)and extensive colon type(E3)12 patients(17%).There were 8 patients(11%)with varying degrees of fever,and 5 patients(7%)with extraintestinal manifestations of joint pain.One patient(1%)with extraintestinal manifestations of iritis.2.Results of hemoglobin,albumin and platelets2.1 In UC group:the average HB level was(121.0±26.58)g/L,the average PLT level was(276.39±97.99)109/L,and average ALB level was(38.06±6.61)g/L.The level of HB was significantly lower in severe(100.11±25.32g/L)UC patients than in moderate(120.91±29.58g/L)UC patients(t=2.377,p=0.023);and the level of HB in moderate UC patients was significantly lower than in mild(134.06±15.07g/L)UC patients(t=2.110,p=0.040).The comparison of the levels of PLT(246.74±75.34g/L)and ALB(41.12±3.73g/L)in patients with mild UC and the levels of PLT(264.95±89.60g/L)and ALB(38.65±7.59g/L)in patients with moderate UC showed no significantly difference(t=-0.292,p=0.433;t=1.560,p=0.125).The level of PLT(337.42±115.60g/L)in patients with severe UC was significantly higher than that in mild to moderate UC patients(t=-2.228,p=0.032)and the levels of ALB(32.42±5.72 g/L)was significantly lower than its of mild to moderate UC(t=2.908,p=0.006).2.2 The level of serum hemoglobin and albumin in patients with UC decreased as the severity of the disease worsened(r=-0.495,p=0.000,p<0.05;r=-0.529,p=0.000,p<0.05);the level of serum platelet increased with severity of disease worsened(r=0.344,p=0.003,p<0.05).3.Results of cytokines3.1 The level of serum TNF-?(z=-3.725,p=0.000,p<0.05),IL-6(z=-2.714,p=0.007,p<0.05),IL-8(z=-1.967,p=0.049,p<0.05),IL-10(z=-2.365,p=0.018,p<0.05)and CRP(z=-4.751,p=0.000,p<0.05)in UC group was significantly higher than that in healthy group.There is no significant statistical difference in IL-1?(z=-1.134,p=0.257,p>0.05),erythrocyte sedimentation rate(z=-1.109,p=0.267,p>0.05)in the two groups of patient.3.2 According to the criteria of Truelove endoscopic activity classification,24 UC patients(34%),31 UC patients(43%)and 16 UC patients(23%)were classified into grade ?,grade ?,grade ?.The levels of serum TNF-a(r=0.567,p=0.000,p<0.05),IL-1?(r=0.256,p=0.031,p<0.05),IL-6(r=0.246,p=0.039,p<0.05)and IL-8(r=0.240,p=0.043,p<0.05)increased with endoscopic disease activity increased.The level of IL-10(r=0.125,p=0.301,p>0.05)has no relationship with endoscopic disease activity in UC patients.Conclusions:1.Severe UC patients are more liable to anemia,hypoproteinemia and hypercoagulable state.This high coagulation risk should be managed as early as possible.2.Proinflammatory cytokines,TNF-a,IL-6 and IL-8 can promote the intestinal mucosal injury in UC patients.A higher serum level of these cytokines indicates more severe endoscopic mucosal injury and these cytokines can be used as evaluation of serological indicator of mucosal injury.