类风湿关节炎患者血清基质金属蛋白酶-9水平及意义的研究

The serum matrix metalloproteinase-9 level and it′s significance in rheumatoid arthritis

目的探讨类风湿关节炎(RA)患者血清基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)的水平及意义。方法采用双抗体夹心酶联免疫吸附试验(ELISA)测定50例RA患者(就诊前6个月内未用过慢作用药及糖皮质激素)和18名正常健康对照者的血清MMP-9水平,并选取20例患者进行治疗后的MMP-9测定,比较不同时期MMP-9的水平。同时测定其治疗前的其他实验室及临床指标:类风湿因子(RF)-IgM、血沉(ESR)、抗环瓜氨酸肽抗体(抗CCP抗体)、抗角蛋白抗体(AKA)、抗核周因子(APF)、压痛关节数、疼痛关节数、肿胀关节数及手X线片,分析它们与MMP-9变化的相关性。结果RA患者血清MMP-9水平[(566±175)ng/ml]明显高于正常对照组[(340±246)ng/ml],P<0.01;RA活动期血清MMP-9水平[(894±357)ng/ml]高于缓解期[(438±302)ng/ml],P<0.01;治疗后血清MMP-9水平[(489±359)ng/ml]与治疗前水平[(902±407)ng/ml]相比,差异有统计学意义(P<0.01)。MMP-9水平与RA患者的ESR(P<0.01)、疾病活动分数(DAS)评分(P<0.01)、压痛关节数(P<0.05)、疼痛关节数(P<0.01)、肿胀关节数(P<0.01)、X线分期(P<0.05)呈正相关;而与年龄、病程、晨僵时间、功能分级、AKA、APF、RF、抗CCP抗体水平无明显相关性(P>0.05)。结论MMP-9在RA患者血清中高水平存在提示RA关节骨质破坏和疾病活动程度,可作为除ESR、C反应蛋白(CRP)外提示RA疾病进展与改善的血清学指标。

Objective By investigating the serum matrix metalloproteinase-9 （MMP-9） level and it＇s significance in patients with rheumatoid arthritis to discover new method for diagnosis and therapy. Methods MMP-9 serum level was tested by ELISA in 50 patients with RA and 18 controls. The serum levels of antikeratin antibody （AKA）, antiperinuclear factor （APF）, erythrocyte sedimentation rate （ESR）, rheumatoid factor （RF）, anti-cyclic citrullinated peptide antibodies（ACCP） and hand X-ray were examined at the same time. Result Significantly increased serum level of MMP-9 was found in RA patients as compared to that in healthy controls （P〈0.01）. Serum level of MMP-9 was higher in active patients than that in inactive disease （P〈0.01）. Serum level of MMP-9 after treatment was lower than before treatment （P〈0.01）. MMP-9 level was positively correlated with the number of the affected joints, X-ray stage, DAS and ESR level; but had no obvious corelation with age, the disease course, length of morning stiffness, stage of finction and RF, AKA, APF, ACCP levels. Conclusion The present data suggests that the level of MMP-9 is high in patients with RA. The level of MMP-9 may be a better marker of disease activity than joint damage. We can use MMP-9 as a potential useful laboratory marker in RA.