Plasma Inflammatory Cytokines as Predictor Markers for Severity of Histological Variations of Intestine among Celiac Patients

Background: Celiac is a chronic hereditary intestinal disorder caused by autoimmune stimulation and injury of intestinal mucosa and different studies have reported an increase of inflammatory cytokines production in these patients. This study aimed to investigate the serum level of inflammatory cytokines and their correlations with the severity of histological variations among celiac patients. Material and methods: By a cross sectional study all celiac patients attending to gastrointestinal clinics in Ilam city during Oct. 2011- MAR. 2013 were investigated. Demographic data was collected using a validate questionnaire and patient's interview and each patient was taken a blood sample for laboratory investigation of tTG-IgA antibody via ELISA test and the serum level of hs-CRP, IL-6 and TNF-a was measured. All patients underwent endoscopic evaluation and biopsy samples were evaluated according to Marsh classification and correlation between severity of histological variations and serum levels of inflammatory cytokines was measured. Results: Totally 274 patients including 90 male and 184 female with a mean age of 28.8±14.4 years were evaluated. The mean serum levels of hs-CRP, IL-6 and TNF-a were 7.8±3.1 mg/l, 2.6±0.9 pg/ml and 6.9±4.6 pg/ml respectively (p=0.599, p=0.629 and p= 0.651). Hs-CRP showed a significant relationship with the severity of mucosal damage upon class I of Marsh classification (p=0.01); however, IL-6 showed a significant level among patients with Marsh I, II and IIIC (p=0.000, p=0.02 and p=0.000) but not in those with Marsh class IIIA and IIIB. Conclusion: There was a positive relationship between mean serum levels of IL-6 and TNF-a with increasing the Marsh classification from class I to class IIIC and the highest rate of IL-6 and TNF-a was shown in Marsh IIIC but the serum level of hs-CRP was not increased with Marsh class increasing. It was concluded that as the Marsh classification increased from class I to class IIIC, and/or the severity of pathologic variations was increased, the mean serum levels of inflammatory markers were increased too.