软骨寡聚基质蛋白在脊柱关节病患者血清中的水平及意义的研究

Research on serum level of cartilage oligomeric matrix protein and its clinical significance in spondyloarthropathies

目的探讨血清软骨寡聚基质蛋白(COMP)水平与脊柱关节病(SpA)患者病情活动及骨破坏的相关性。方法采用酶联免疫吸附试验(ELISA)方法,检测38例SpA患者、18例正常人及10例注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(商品名益赛普)治疗前后SpA患者血清COMP水平、血沉及C反应蛋白,并行骶髂关节CT分级,记录患者BAS、ASDAS评分及夜间脊柱痛视觉评分(VAS),分析其与COMP的相关性。结果 SpA患者组血清COMP水平为(30.835±8.539)ng/ml,明显高于正常对照组的(12.639±2.939)ng/ml(P<0.01);病情活动组血清COMP水平为(34.168±7.988)ng/ml,明显高于非活动组的(25.122±6.243)ng/ml(P=0.01);治疗后SpA患者血清COMP水平为(17.670±7.199)ng/ml,较治疗前的(35.645±7.381)ng/ml明显下降(P<0.01)。COMP水平与夜间脊柱痛VAS、ESR、CRP及骶髂关节CT分级正相关,与BSADAI、BSAFI、ASDAS-ESR、ASDAS-CRP正相关,与年龄、病程、BASMI及外周关节受累无显著相关。结论 SpA患者血清COMP高水平存在提示病情活动,可能预示明显骨质破坏,血清COMP有可能成为判断SpA疾病活动性和疗效的指标。

Objective To explore the relation of serum level of cartilage oligomeric matrix protein （COMP） with the disease activity and bone destruction. Methods The serum levels of COMP were measured by ELISA in 38 patients with SpA and 18 controls, and those of 10 patients with SpA before and after treatment with Enbrel. The score of BSADAI, BSAFI, BASMI, ASDAS-ESR, ASDAS-CRP and the Night spinal pain （VAS） were recorded and the serum levels of erythrocyte sedimentation rate（ESR）, C-reactive protein （CRP） and Sacroiliac joints CT classification were examined at the same time. And their correlation with COMP were analyzed. Results Significantly increased serum level of COMP was found in SpA patients （30.835 ＋8.539）ng/ml as compared to that in healthy controls （12.639±2.939）ng/ml, there was statistically significant differences （P 〈 0.01） between the two groups. The serum level of COMP was higher in 24 active patients （34.168±7.988）ng/ml than that in 14 inactive patients （25.122±6.243）ng/ml, there was statistically significant differences between these two groups（P = 0.01）. The serum level of COMP of ten cases after treatment（17.670±7.199）ng/ml with Enbrel was evidently decreased before treatment （35.645±7.381）ng/ml. The COMP level was positively correlated with ESR ,CRP, BSADAI,BSAFI, ASDAS-ESR,ASDAS-CRP and the Night spinal pain （VAS） and the grade of sacroiliac joint CT changes（P 〈 0.05）, and has no significant correlation with age, duration, BASMI and Peripheral joint injury （P 〉 0.05）. Conclusion High serum levels of COMP indicat high disease activity and may indicate severe bone destruction. Serum level of COMP can be used for evaluation of disease activity and therapeutic effect of SpA.