脂联蛋白内脂素抵抗素在类风湿关节炎患者血清中的变化及临床意义

The serum level and significance of adiponectin, visfatin and resistin in patients with rheumatoid arthritis

目的检测RA患者血清脂联蛋白、内脂素、抵抗素表达水平，探讨其在RA发生发展中的作用及临床意义。方法ELISA法检测67例RA患者及65名健康对照血清脂联蛋白、内脂素、抵抗素表达水平。采用Mann-Whitney秩和检验比较2组研究对象血清脂肪因子表达水平有无差异，多因素逐步回归分析及Spearman检验分析其与临床及实验室指标（ESR、CRP、血小板、RF、抗CCP抗体、DAS28）的相关性。结果RA患者血清脂联蛋白、内脂素、抵抗素表达水平较健康对照组明显升高[8.17（4.51，28.53）μg/ml和6.83（4.48，25.32）μg/ml，U=1 663，P=0.019；6.56（5.34，8.40）ng/L和4.24（3.01，6.65）ng/L，U=762，P=0.001；10.65（5.99，20.70）ng/ml和6.12（4.49，9.98）ng/ml，U=1 406.5，P=0.000]。RA患者血清内脂素水平与RF呈正相关（r=0.186，P=0.013）；血清脂联蛋白、内脂素、抵抗素水平与DAS28评分成正相关（r=0.370，0.263，0.285，P均〈0.05）。RA患者病情高度活动组的内脂素表达水平高于低中度活动组[4.37（2.72，7.53）ng/L和4.11（3.11，6.44）ng/L，U=133.5，P=0.019]。2组RA患者血清脂联蛋白、抵抗素表达水平，差异均无统计学意义（P均〉0.05）。多因素相关分析结果显示ESR、血小板、DAS28是影响脂联蛋白表达水平显著因素，而CRP是影响抵抗素表达水平的显著因素。结论RA患者血清脂联蛋白、内脂素、抵抗素表达水平显著升高，且与DAS28呈正相关，提示其可能参与了RA的免疫炎症反应。

ObjectiveTo determinate the serum level of adiponectin, visfatin and resistin in patients with rheumatoid arthritis （RA） and to explore its role in the development of RA and its clinical significance.MethodsBlood samples were collected from 67 cases of RA patients and 65 healthy controls, the serum levels of adiponectin, visfatin and resistin were tested by enzyme linked immunosorbent assay （ELISA）. Adipokine levels in different groups were compared using the Mann-Whitney U test. Spearman test and multivariate analysis were used to evaluate the correlation with clinical and laboratory parameters [erythrocyte sedimentation rate（ESR）, C reactive protein（CRP）, blood platelet （PLT）, rheumatoid factor （RF）, anti-cyclic citrullinated peptide （CCP）, disease activity score （DAS）28].ResultsThe serum level of adiponectin, visfatin and resistin in RA patients were significantly higher than those in healthy controls[8.17（4.51, 28.53） μg/ml vs 6.83（4.48, 25.32） μg/ml, U=1 663, P=0.019]; [6.56（5.34, 8.40） ng/L vs 4.24 （3.01,6.65） ng/L, U=762, P=0.001]; [10.65（5.99,20.70） ng/ml vs 6.12（4.49, 9.98） ng/ml, U=1 406.5, P=0.000] .The serum level of visfatin was positively correlated with RF in patients with RA（r=0.186, P=0.013）, and serum levels of adiponectin, visfatin and resistin were positively correlated with DAS28 （r=0.370, 0.263, 0.285; P〈0.05）. The level of visfatin in RA patients with high activity group was higher than that in the low and moderate activity group [4.37（2.72, 7.53） ng/L vs 4.11 （3.11, 6.44） ng/L, U=133.5, P=0.019].ConclusionMultivariate analysis has showm that ESR, PLT and DAS28 can significantly affect adiponectin, and CRP can significantly influence resistin. Serum level of adiponectin, visfatin and resistin are elevated and correlate with DAS28, suggesting that they may be involved in the chronic inflammation of RA.