小剂量糖皮质激素治疗对类风湿性关节炎患者基质金属蛋白酶3(MMP-3)水平的影响

Effect of low dose of glucocorticoid on matrix metalloproteinase-3 (MMP-3) of rheumatoid arthritis

目的通过检测治疗前后类风湿关节炎(Rheumatoid arthritis,RA)患者血基质金属蛋白酶3( MMP-3)水平变化,探讨小剂量糖皮质激素是否有抑制类风湿关节炎的骨破坏作用。方法将我院2016 年5月至2017 年10 月门诊及住院初诊初发类风湿关节炎患者200 例,按照性别、年龄平均随机分为小剂量糖皮质激素组100 例及对照组100 例,两组患者同时给予来氟米特20 mg,日一次口服,雷公藤20 mg,日3 次口服的基础上,对照组给予患者依托考昔片60 mg,日一次口服,激素组给予患者醋酸泼尼松10 mg,晨起一次顿服,全部患者在治疗前,治疗后2 周、4 周、12 周,检测MMP-3 的水平及临床指标、血清学指标。结果激素组治疗后与治疗前及同期对照组相比,DAS28 评分、ESR、CRP、MMP-3 的水平差异均有统计学意义( P < 0. 05)。结论小剂量糖皮质激素联合慢作用抗风湿药物可在短期内明显缓解临床症状,降低炎性指标,起到抑制骨破坏的作用。

Objective To explore whether low dose of glucocorticoid has the function of inhibiting bone destruction of rheumatoid arthritis( RA) by detecting the matrix metalloproteinase-3 ( MMP-3) before and after treatment. Methods Totally 200 cases of rheumatoid arthritis patients who were treated in the ward and the clinic of our hospital from May 2016 to October 2017 were divided into two groups;glucocorticoid group and control group ( 100 cases in each group), according to age and gender. Both of the two groups were given leflunomide and tripterygium glycosides, the control group was given etoricoxib once a day;the glucocorticoid group was additionally given prednisone 10 mg each morning. The matrix metalloproteinases-3( MMP-3), the VAS scores, the DAS scores, erythrocyte sedimentation rate ( ESR) and C-reactive proteins( CRP) were measured at baseline, two weeks,four weeks, and twelve weeks after treatment. Results Compared with before treatment and control group, the VAS scores,DAS 28 scores and the levels of ESR,CRP and MMP3 of glucocorticoid group were significantly improved ( P < 0. 05). Conclusion The treatment with low-dose glucocorticoid combined with DMARDS can relieve clinical symptoms,decrease the inflammatory indicators and inhibit the bone destructions in the short term.