核心蛋白聚糖 硫酸软骨素C末端Ⅱ型胶原在关节炎患者血清中的表达及与临床特征的关系

Correlation be tween serum expression levels of decorin, chondroitin sulfate and C-terminal crosslinking telopeptide of type Ⅱ collagen and clinical features in arthritis patients

目的探讨关节炎患者血清中核心蛋白聚糖（DCN）、硫酸软骨素（CS）、C末端Ⅱ型胶原（CTX-Ⅱ）表达变化，并分析其与临床特征的相关关系，为临床诊治提供依据。方法研究对象分为OA组、RA组、对照组，每组30例，OA组、RA组选取山西大医院风湿免疫科已确诊的初治患者，对照组选择在山西大医院体检中心体检的健康志愿者。采用疼痛视觉模拟评分（VAS）法评估患者的疼痛程度，采用X线评估关节病变程度，采用ELISA检测血清中DCN、CS、CTX-Ⅱ水平，并分析上述指标的相关性。计量资料采用x±s表示，多组间比较采用单因素方差分析，两两比较采用Tambane’s T2法，两因素间相关分析采用Spearman相关分析。结果OA组、RA组、对照组的DCN含量为（3．19±1．38）ng／ml，（1．90±0．62）ng／ml，（1．33±0．33）ng／ml，3组间的差异有统计学意义，OA组高于对照组（P〈0．01），RA组高于对照组（P〈0．01），OA组高于RA组（P〈0．D1）；OA组、RA组、对照组的CS含量是（0．57±0．12）ng／ml，（0．95±0．47）．g／ml，（0．36±0．09）ng／ml，3组问的差异有统计学意义，OA组高于对照组（P〈0．01），RA组高于对照组（P〈0．01），OA组低于RA组（P〈0．01）；OA组、RA组、对照组的CTX-Ⅱ含量是（3．1±0．9）ng／ml，（3．0±1．1）ng／ml，（2．2±0．8）ng／ml]，OA组、RA组的CTX-Ⅱ水平高于对照组，OA组高于对照组（P〈0．01），RA组高于对照组（P=0．005），OA组与RA组CTX-Ⅱ水平差异无统计学意义（P=0．996）。OA、RA患者血清DCN、CS、CTX-Ⅱ与x线、VAS评分均呈正相关，DCN的相关性最高，OA组DCN与x线、VAS评分（r=0．777，P〈O．01；r=0．622，P〈0．01），RA组DCN与x线、VAS评分（r=0．640，P〈0．01；r=0．493，P=0．006）。结论关节炎患者血清中DCN、CS、CTX—Ⅱ水平较健康人群明显增高，且与疼痛程度、软骨、骨损伤程度呈正相关，DCN在OA、RA的早期鉴别诊断中可能有一定的价值，但临床应用还需要有更确切的循证医学证据。

Objective To investigate changes in the serum expression levels of decorin （DCN）, chondroitin sulfate （CS） and C-terminal crosslinking telopeptide of type Ⅱ collagen （CTX- Ⅱ ） and analyze the relationship between the expression levels and clinical characteristics, aiming to provide evidence for clinical diagnosis and treatment of arthritis. Methods Ninety subjects were divided into the osteoarthritis （OA）, rheumatoid arthritis （RA） and control groups （n=30 for each group）. The OA and RA patients were diagnosed in Department of Rheumatism Inmmnity of Shanxi Dayi Hospital, and the healthy volunteers who were doing physical check-up in the Physical Check-up Center of Shanxi Dayi Hospital were recruited as the controlsubjects. Visual analogue scale （VAS） was utilized to evaluate the degree of pain. X-ray was performed to assess the severity of joint lesions. Enzyme linked immunosorbent assay （ELISA） was adopted to quantitatively measure the serum expression levels of DCN, CS and CTX-Ⅱ. The correlation among these parameters was statistically analyzed. Measurement data among different groups were statistically compared by one-way an- alysis of variance （ANOVA）and comparison between two groups was conducted by Tambane＇s T2. The cor- relation between two factors was analyzed by using Spearman correlation analysis. Results The difference of the serum expression levels of DCN in the OA, RA and control groups [（3.19±1.38） ng/ml,（1.90±0.62） ng/ml, （1.33±0.33） ng/ml] was statistically significant, which of the OA group was higher than the control group （P〈0.01）, which of the RA group was higher than control group （P〈0.01）, which of the OA group was higher than the RA group （P〈0.001）. The difference of the serum expression levels of CS in the OA, RA and control groups [（0.57±0.12） ng/ml, （0.95±0.47） ng/ml, （0.36±0.09） ng/ml] was statistically significant, in which, the OA group was higher than the control group （P〈0.01）, RA group was higher than control group （P〈0.01）, OA group was lower than RA group （P〈0.01）. The serum expression levels of CTX- Ⅱ in the OA and RA groups [（3.08± 0.86） ng/ml, （3.03±1.14） ng/ml] were significantly up-regulated compared with those in the control group [（2.17±0.82） ng/ml]（P〈0.001, P=0.005）. The expression level of CTX-Ⅱ did not significantly different between the OA and RA groups （P=0.996）. In the OA and RA groups, the sermn levels of DCN, CS, CTX-Ⅱ were po-sitively related to X-ray and VAS, the correlation of DCN was the highest, the correlation was high in both OA （r=0.777, P〈0.01; r=0.622, P〈0.01） and RA （r=0.640, P〈0.01; r=0.493, P=0.006）. Conclusion The serum levels of DCN, CS and CTX-Ⅱ in arthritis patients are significantly up-regulated compared with those in healthy controls, which are positively correlated with the degree of pain, and the severity of cartilage and bone dethcts. DCN is probably valuablein the differential diagnosis of early OA and RA. However, the clinical application remains to be further validated by evidence-based studies.