类风湿关节炎患者血清血管生成素样蛋白3血管生成素样蛋白4水平及临床意义

The serum level and significance of angiopoietin-like protein 3 and angiopoietin-like protein 4 in patients with rheumatoid arthritis

目的了解血管生成素样蛋白（ANGPTL）3及ANGPTIA在RA患者血清中的表达情况，初步探讨ANGFTL3、ANGPTL4与RA临床表现及实验室指标的相关性。方法收集72例RA患者及28例健康体检者血清及临床资料，应用ELISA检测血清ANGVFL3、ANGPTL4、NF—κB受体活化因子配体（RANKL）水平，组间数据比较采用非参数秩和检验，两因素问关系采用Spearman相关分析。结果①RA患者血清ANGPTL3水平较对照升高[800．325（577．477，1750．636）pg／ml和487．900（382．340，565．499）pg／ml，z=-6．082，P〈0．05]；RA患者血清ANGPTL4水平较对照升高[1036．199（853．347，1746．677）pg／ml和706．095（558．571，807．302）pg／ml，Z=-5．962，P〈O．05]；②RA患者血清ANGPTL3、ANGPTL4水平随疾病活动加重而升高[ANGPTL3：低活动组457．265（373．709，605．296）pg／ml，中活动组785．815（679．156，1308．785）pg／ml，高活动组1502．038（817．713，1960．493）pg／ml，P〈0．05；ANGPTL4：低活动组737．604（467．040，918．222）pg／ml，中活动组991．227（819．456，1699．972）pg／ml，高活动组1842.310（1252．023，2669．902）pg／ml，P〈0．05）；③RA患者血清ANGPTL3、ANGPTIA与RANKL呈正相关（r分别为0．554、0．619，P〈0．05）；④RA患者双手加腕关节x线片提示无骨破坏者血清ANGPTIA水平低于有骨破坏者[927．590（737．604，1409．798）pg／ml和1624．071（949．432，2622．371）pg／ml，Z=-2．483，P〈0．053o结论RA患者血清ANGPTL3、ANGPTL4水平显著升高，二者与疾病活动性相关，后者还与骨破坏相关，可能成为判断疾病活动及骨破坏的新指标。

Objective To measure the serum levels of angiopoietin-like protein （ANGPTL） 3, ANGPTL4 and RANKL in patients with rheumatoid arthritis （RA）, and the relationship between ANGPTL3/ANGPTL4 and clinical manifestations were analyzed. Methods Blood samples were drawn from 72 patients with RA and 28 healthy subjects. Serum levels of ANGPTL3, ANGPTL4 and RANKL were tested by enzyme linked immunosorbent assay （ELISA）. Nonparametric rank SUb test was used for the comparisons between groups and Spearman＇s correlation test was used for correlation analysis. Results （1） The serum level of ANGPTL3 was significantly increased in RA group compared to healthy group [800.325（577.477, 1 750.636） pg/ml vs 487.900 （382.340, 565.499） pg/ml, P〈0.05, Z=-6.082]. （2） The serum level of ANGPTL4 was significantly increased in RA group compared to healthy group [1 036.199（853.347, 1 746.677） pg/ml vs 706.095（558.571,807.302） pg/ml, Z=-5.962, P〈0.05].（3） The serum levels of ANGPTL3 and ANGPTL4 in RA patients were increased with the rise of disease activity （DAS 28） [ANGPTL3 in the low disease activity groupwas 457.265（373.709, 605.296） pg/ml, that of the moderate disease activity group was 785.815（679.156, 1 308.785） pg/ml, that of the high disease activity group was 1 502.038 （817.713, 1 960.493） pg/ml, P〈0.05; ANGPTL4 in the low disease activity group was 737.604 （467.040, 918.222） pg/ml, that of the moderate disease activity group was 991.227 （819.456, 1 699.972） pg/ml, and that of the high disease activity group was 1 842.310 （1 252.023, 2 669.902） pg/ml, P〈0.05]. （4） ANGPTL3 and ANGPTIA was positively correlated with RANKL （r=0.554, 0.619, P〈0.01）. （5） The serum level of ANGPTIA was significantly increased in patients with bone destruction, compared to those without bone destruction [1 624.071（949.432, 2 622.371） pg/ml vs 927.590（737.604, 1 409.798） pg/ml, Z=-2.483, P〈0.05]. Conclusion The serum levels of ANGPTL3 and ANGPTL4 are increased in RA, and are both positively correlated with diSease activity, moreover, ANGPTIA is associated with pathological bone destruction.