类风湿关节炎患者治疗前后血清分泌型磷脂酶A2变化

Changes of Serum Secreted Phospholipase A2 Levels before and after Treatment in Patients with Rheumatoid Arthritis

目的检测类风湿关节炎患者(rheumatoid arthritis,RA)治疗前后血清分泌型磷脂酶A2(secreted phospholipase A2,s PLA2)的变化,探讨s PLA2在RA发病机制中的作用及治疗意义。方法采用酶联免疫吸附法检测RA患者血清s PLA2水平,并对治疗前后血清s PLA2的变化进行比较,分析其与疾病活动性评分(disease activity score,DAS28)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactin protein,CRP)、血小板、年龄等指标的相关性,以及小剂量糖皮质激素治疗的影响。结果纳入91例RA患者,其中54例有治疗3个月前后资料。RA患者治疗前,与正常对照比较,s PLA2浓度升高[分别为(224.10±30.17)和(110.05±24.02)pgml],差异有统计学意义(P<0.05);治疗前和治疗后、治疗后和正常对照比较差异均无统计学意义(P>0.05)。RA组治疗前血清s PLA2与DAS28、ESR、CRP、血小板呈正相关(r=0.315,P=0.023;r=0.359,P=0.001;r=0.625,P=0.000;r=0.211,P=0.050),治疗后血清s PLA2降低且与DAS28、ESR、CRP、血小板无相关性(r=0.190,P=0.215;r=0.210,P=0.123;r=0.220,P=0.148;r=0.070,P=0.614);治疗前后均与年龄无相关性(治疗前:r=0.015,P=0.887;治疗后:r=0.262,P=0.058)。小剂量糖皮质激素使RA患者血清s PLA2浓度明显降低(P<0.05)。结论高水平s PLA2可能在RA炎性病理过程中起重要作用;小剂量糖皮质激素使s PLA2降低,可能有助于RA及其合并动脉粥样硬化的防治。

Objective To detect the change of ecreted phospholipase A2 （sPLA2） levels in rheumatoid arthritis （RA） before and after treatment, and study its effect on the pathogenesis of RA. Methods Enzyme linked immunosorbent assay was used to detect the concentration of serum sPLA2 before and after the treatment, and disease activity score （DAS28）, erythrocyte sedimentation rate （ESR）, C-reactin protein （CRP）, platelet, age correlation index were analyzed. The changes were also analyzed for the effects of small dose glucocorticoid therapy. Results Ninety-one patients were enrolled and, of them, 54 patients＇ data before and after 3-month treatment was collected. RA patients had higher sPLA2 concentration [ （224. 10 ±30. 17） pg/ml] compared to healthy controls before treatment [ （ 110.05 ± 24.02） pg/ml] （P 〈 0.05 ）, but there was no statistical differences after treatment, and no difference could be detected between after treatment and healthy controls （P 〉 0.05 ）. Correlation was found between sPLA2 and DAS28, ESR, CRP, platelet in RA group before treatment （r=0.315, P =0.023; r =0.359, P = 0. 001 ; r = 0. 625, P = 0. 000 ; r = 0. 211, P = 0. 050 ） ; but no correlation was found after treatment （r=0.190, P=0.215; r=0.210, P=0.123; r=0.220, P=0.148; r=0.070, P=0.614）.In addition, there was no correlation between sPLA2 and age （ before treatment ： r = 0. 015, P = 0. 887 ; after treatment ： r = 0. 262, P = 0. 058 ）. Low dose glucocorticoids treated patients had significantly decreased serum sPLA2 concentration （P 〈 0. 05 ）. Conclusion Serum sPLA2 is significantly increased in RA patients. It may play an important role in the pathogenesis of RA. Low dose glucocorticoids could decrease serum sPLA2 concentration, which may help to prevent and treat RA complicated with atherosclerosis.