类风湿关节炎患者血清软骨寡聚基质蛋白水平及意义的研究

The role of serum cartilage oligomeric matrix protein in the early progression of bone destruction in rheumatoid arthritis

目的探讨检测软骨寡聚基质蛋白（COMP）水平对类风湿关节炎（RA）患者疾病活动性及早期软骨破坏的临床意义。方法采用酶联免疫吸附试验（ELISA）法，检测94例RA患者及40名健康人血清中COMP的水平。同时测定RA患者的其他实验室及临床指标：类风湿因子（RF）、红细胞沉降率（ESR）、C反应蛋白（CRP）、抗环瓜氨酸肽抗体（抗CCP抗体）、压痛关节数、疼痛关节数、肿胀关节数、晨僵时间及双手X线，分析它们与COMP的相关性。结果RA患者血清COMP水平（11．3±5．2）U／L明显高于正常对照组的（9．2±1．7）U／L；两组差异有统计学意义（P=0．017）。64例RA活动期患者血清COMP水平为（14±6）U/L，30例缓解期患者为（9±4）U／L，组问比较差异有统计学意义（P=0．005）。COMP水平与RA患者的ESR、CRP、晨僵时间、压痛关节数、疼痛关节数、肿胀关节数、X线分期呈正相关（P〈0．05），与年龄、病程、RF、抗CCP抗体水平、功能分级无明显关系（19〉0．05）。30例RA患者完成2年放射学随访，18例COMP值大于健康者，16例X线有递增现象，2例无递增现象；而12例COMP值正常“氐于健康者，有递增5例，无递增7例，两组间差异有统计学意义（P=0.013）。结论RA患者血清中COMP高水平存在提示RA疾病活动性和早期关节软骨破坏。COMP可以作为反映RA疾病急性活动程度与软骨破坏的血清学指标。

Objective To study the association of serum cartilage oligomeric matrix protein （COMP） with disease activity and early joint destruction of rheumatoid arthritis （RA）. Methods The serum levels of COMP were measured with ELISA in 94 patients with RA and 40 controls. The serum level of erythrocyte sedimentation rate （ESR）, rheumatoid factor （RF）, anti-cyclic citrullinated peptide antibodies （ACCP） and hand X-ray were examined at the same time. Results Significantly increased serum level of COMP was found in RA patients （11.3±5.2） U/L as compared to that in healthy controls （9.2±1.7） U/L （P=0.017）. Serum level of COMP was higher in 64 active patients （14±6） U/L than that in 30 inactive disease （9±4） U/L （P=0.005）. COMP level was positively correlated with the number of the affected joints, X-ray stage, CRP and ESR level （P〈0.05）; but had no correlation with age, disease course, grade of joint function, RF and ACCP levels. Thirty patients were followed for two years and their radiographic changes were evaluated at the baseline and the end of this study. Sixteen of 18 patients with high concentration serum COMP level had radi- ologic progression, but only 5 of 12 patients with no increase of serum COMP had radiologic progression. A significant difference （P=0.013） was founded in the two groups. Conclusion The present data suggests that the level of COMP is high in patients with RA.High serum levels of COMP indicate high disease activity and early progressive of bone destruction in RA patients. We can us COMP as a laboratory marker of RA.