类风湿关节炎患者白细胞介素-6与皮质醇节律的研究

目的：研究类风湿关节炎（RA）患者血清白细胞介素（IL）－6、皮质醇节律及其临床意义。方法：36例RA患者分别为8：00，12：00，16：00，20：00，0：00，4：00用双抗体夹心酶联免疫吸附试验（ELISA）检测其血清IL－6水平，用放射免疫法（RIA）测定皮质醇。结果：36例RA患者皮质醇分泌有明显节律，但与正常对照组相比，其峰值提前，出现于凌晨4点，血清IL－6水平高于对照组（P＜0．01），也存在昼夜节律，IL－6峰值出现在皮质醇峰值之前，经治疗病情稳定后，RA患者血清IL－6水平恢复或接近正常，IL－6与皮质醇节律紊乱得以纠正，相关性分析显示，RA患者血清IL－6水平与血沉（ESR）（P＜0．01，r=0.66)，C反应蛋白（CRP）（P＜0．01，r＝0.71)皮质醇（P＜0．05，r=0.58)呈正相关，结论：RA患者血清IL－6增高，IL－6与皮质醇存在昼夜节律紊乱，这些变化在RA的发病机制中可能具有重要意义。

Circadian variation of interleukin-6 and cortisol in rheumatoid arthritis

Objective To investigate the circadian variation of serum interleukin 6 (IL 6) and cortisol and their clinical value in rheumatoid arthritis (RA) patients.Methods Serum IL 6 levels were detected in 36 untreated RA patients at 8:00,12:00,16:00,20:00,0:00 and 4:00 with ELISA,and serum cortisol levels were measured by radioimmunoassay (RIA).Results There was pronounced circadian variation of serum cortisol levels in 36 untreated RA patients,but the peak was at 4:00 and earlier than that of controls.The level of IL 6 was signficantly higher in patients than in healthy people ( P <0 01).There was also pronounced circadian variation of serum IL 6 levels.The peak of serum IL 6 appeared before that of cortisol.Treated RA patients had significantly reduced serum IL 6 compared with untreated RA patients, and it recovered or neared to the normal.Pronounced circadian disorder of serum IL 6 and cortisol levels recovered there was a positive correlation between serum levels of IL 6 and ESR ( P <0 01, r =0 66),CRP ( P <0 01, r =0 71) and cortisol( P <0 05, =0 58) Conclusion Serum IL 6 levels are significantly increased in the RA patients,compared to control subjects.Serum IL 6 and cortisol levels show a pronounced circadian variation.These findings have an important implication in the pathogensis and development of RA.It is important to further study the pathophysiologic significance of IL 6 and cortisol in RA.