基质金属蛋白酶3在类风湿关节炎不同活动状态中的临床意义

Clinical significance of matrix metalloproteinase 3 in different active states of rheumatoid arthritis

目的:探讨血清基质金属蛋白酶3(matrix metalloproteinase 3,MMP-3)在类风湿关节炎(rheumatoid arthritis,RA)不同活动状态中的水平及临床意义。方法:病例对照研究。选取2017年至2018年苏州大学附属第二医院、苏州市中医医院以及苏州市第九人民医院风湿科确诊为RA的患者130例(男24例,女106例),年龄(52.98±13.24)岁,中位数51岁。同期来自苏州市第九人民医院体检中心的健康对照者100名(男28名,女72名),年龄(45.04±11.55)岁,中位数44岁。分析患者基本临床资料并用免疫比浊法对RA患者稳定期组、轻度活动期组、中度活动期组、重度活动期组和健康对照组进行MMP-3的测定,采用ROC曲线评判MMP-3对RA疾病活动评估的效能。结果:RA稳定期的血清MMP-3[28.8(21.9~38.7)ng/mL]与健康对照组[28.0(21.7~36.1)ng/mL]相比,差异无统计学意义(Z=1.09,P>0.05),而RA轻度活动期的血清MMP-3的值[51.8(41.8~73.1)ng/mL]明显高于健康对照组(Z=2.942,P<0.01)。MMP-3诊断RA患者的曲线下面积(AUC)为0.877,敏感度为73.1%,特异度为93%。其中对于RA轻度活动期患者的AUC为0.906,敏感度为77.8%,特异度为88%。另外,血清MMP-3与CRP、ESR相关(r分别为0.242和0.243),而与DAS 28相关性最强(r=0.361)。结论:MMP-3水平随着类风湿关节炎的病情严重程度而上升。临床上RA患者保持较低水平的MMP-3可用来提示病情处于相对稳定状态。另外,血清MMP-3与DAS28密切相关。

Objective To investigate the levels and the clinical signficance of matrix metalloproteinase 3(MMP-3)in different activities of rheumatoid arthritis(RA).Methods Case-control study.A total of 130 patients[24 cases of male,106 cases of female,age(52.98±13.24)years,the median age was 51 years]with RA diagnosed in the Department of Rheumatology from the Second Affiliated Hospital of Soochow University,Suzhou Hospital of Traditional Chinese Medicine and Suzhou Ninth People′s Hospital from 2017 to 2018,and 100 healthy controls[28 cases of male,72 cases of female,age(45.04±11.55)years,the median age was 44 years]from the physical examination center of the Suzhou Ninth People′s Hospital.The basic clinical data was used to determine the MMP-3 on groups of RA patients and healthy controls by immunoturbidimetry.The discriminating validity of MMP-3 in disease was evaluated using receiver operating characteristic(ROC)curve analysis.Results Compared with that in healthy controls[28.0(21.7-36.1)ng/mL],the MMP-3 in the low groups[51.8(41.8-73.1)ng/mL]increased dramatically(Z=2.942,P<0.01).However,there was no significant difference between the MMP-3 in remission patients[28.8(21.9-38.7)ng/mL]compared with the healthy controls(Z=1.09,P>0.05).The area under the curve(AUC)of MMP-3 for diagnosis of RA was 0.877.the sensitivity was 73.1%,and the specificity was 93%.The AUC of MMP-3 diagnosis of low groups was 0.906,the sensitivity was 77.8%,and the specificity was 88%.In addition,the MMP-3 level was correlated with CRP and ESR(r=0.242,r=0.243),and it was significantly correlated with DAS 28(r=0.361).Conclusions It was indicated that the level of MMP-3 increased with the severity of rheumatoid arthritis.And the clinically low level of MMP-3 in RA patients could be used to indicate the remission condition.Meanwhile,the serum MMP-3 was closely related to DAS28.