ICTP、MMP-3、抗CCP抗体和RF检测对早期RA患者的诊断应用

目的:探讨Ⅰ型胶原吡啶交联终肽(ICTP)、基质金属酶-3(MMP-3)、抗环瓜氨酸肽抗体(抗CCP抗体)、类风湿因子(RF)检测对于早期类风湿关节炎(RA)患者疾病进程的预测价值。方法:2010年1月～2012年6月对我院风湿免疫科门诊及住院RA患者249例(RA组,其中早期RA112例)、非RA的其他免疫系统疾病患者41例(非RA对照组)及健康对照(正常对照组)60例,采用ELISA定量检测血清ICTP、MMP-3、抗CCP抗体,采用免疫比浊法测定血清RF。结果:①抗CCP抗体、RF在RA各组血清水平均高于非RA及正常对照组(P<0.01),ICTP、MMP-3、RF在非RA组中水平与正常对照组比较(P<0.01),差别有统计学意义。ICTP在早期RA与非RA组差别无统计学意义(P>0.05);MMP-3在中晚期具有较高含量,显著高于其它各组(P<0.01),在早期RA组与长期RA组中水平比较无差异(P>0.05),但与正常对照组比较,均有统计学意义(P<0.01)。②在抗CCP抗体与ICTP、MMP-3、RF间无统计学意义(P>0.05),但可同时作为RA早期诊断指标。③ICTP、MMP-3、抗CCP抗体与RF表明,四种血清标志物联检对早期RA诊断灵敏度为43.8%,特异性99.0%,诊断早期RA的敏感性有所下降,但特异性有所提高。结论:联检四种血清标志物可降低RA的漏诊率。动态联检ICTP、抗CCP抗体、RF、MMP-3能更有效地及时监测RA的疾病进展,对指导临床诊治及干预有积极意义。

Efficacy of knee-balancing manipulation plus heat-sensitive moxibustion for knee osteoarthritis and its influence on CTX-Ⅰ,TRACP-5b,ADAMTS-4,and MMP-3

Objective To observe the efficacy of knee-balancing manipulation plus heat-sensitive moxibustion in treating knee osteoarthritis(KOA)and its impact on the expression of C-telopeptide of type I collagen(CTX-Ⅰ),tartrate-resistant acid phosphatase 5b(TRACP-5b),A disintegrin and metalloproteinase with thrombospondin motifs 4(ADAMTS-4),and matrix metalloproteinase 3(MMP-3).Methods A total of 134 unilateral KOA patients were randomized into a knee-balancing group,a heat-sensitive moxibustion group,and a joint intervention group.The knee-balancing group received knee-balancing Tuina(Chinese therapeutic massage)manipulation for treatment.The heat-sensitive moxibustion group received heat-sensitive moxibustion treatment.The joint intervention group received the heat-sensitive moxibustion in addition to the knee-balancing manipulation.The intervention period lasted for four weeks.After the treatment,and at the 2-week and 6-week follow-ups,the three groups were assessed using the visual analog scale(VAS)for knee joint pain and Western Ontario and McMaster Universities arthritis index(WOMAC),and clinical efficacy was also evaluated.The enzyme-linked immunosorbent assay was adopted to detect the expression levels of serum CTX-Ⅰ,TRACP-5b,ADAMTS-4,and MMP-3.Results The knee-balancing group had 44 participants,but one dropped out;there was no dropout case among the 44 participants in the heat-sensitive moxibustion group;among the 46 participants in the joint intervention group,two cases dropped out.After the treatment,and at the 2-week and 6-week follow-ups,the total effective rate was found higher in the joint intervention group than in the knee-balancing and heat-sensitive moxibustion groups(P<0.05).Compared with the baseline,the VAS and WOMAC scores and the serum levels of CTX-Ⅰ,TRACP-5b,ADAMTS-4,and MMP-3 decreased significantly in all three groups after treatment and at the 2-week and 6-week follow-ups(P<0.05).At the same three time points,the VAS and WOMAC scores and serum levels of CTX-Ⅰ,TRACP-5b,ADAMTS-4,and MMP-3 were lower in the joint intervention group than in the knee-balancing and heat-sensitive moxibustion groups(P<0.001).Conclusion Either used alone or combined,the knee-balancing manipulation and heat-sensitive moxibustion therapy can improve the symptoms and down-regulate the serum levels of CTX-Ⅰ,TRACP-5b,ADAMTS-4,and MMP-3 in KOA patients,producing durable efficacy;nevertheless,a more significant efficacy can be achieved by combining the two methods.

Matrix metalloproteinases in the restorative proctocolectomy pouch of pediatric ulcerative colitis

AIM:To investigate matrix metalloproteinases(MMPs) and their tissue inhibitors(TIMPs) in pouch mucosa of pediatric onset ulcerative colitis(UC).METHODS:In this cross-sectional study,28 patients with pediatric onset UC underwent ileal pouch biopsy 13 years(median) after proctocolectomy.Expression of MMPs-3,-7,-8,-9,-12 and-26 and TIMPs-1,-2 and-3 in samples was examined using immunohistochemichal methods,and another biopsy was used to evaluate the grade of histological inflammation.Two investigators independently graded the immunohistochemical specimens in a semiquantitative fashion,using a scale marking staining intensity as follows:0 = less than 20 positive cells;1 = 20-50 positive cells;2 = 50-200 positive cells;3 = over 20 positive cells.Fecal calprotectin and blood inflammatory markers [serum C-reactive protein(CRP) and erythrocyte sedimentation rate] were determined during a follow-up visit to examine correlations between these markers and the expression of MMPs and TIMPs.RESULTS:Of the 28 patients with pediatric onset UC,nine had not experienced pouchitis,whereas thirteen reported a single episode,and six had recurrent pouchitis(≥ 4 episodes).At the time of the study,six patients required metronidazole.In all of the others,the most recent episode of pouchitis had occurred over one month earlier,and none were on antibiotics.Only four samples depicted no sign of inflammation,and these were all from patients who had not had pouchitis.Two samples were too small to determine the grade of inflammation,but both had suffered pouchitis,the other recurrent.No sample depicted signs of colonic metaplasia.Most pouch samples showed expression of epithelial(e) and stromal(s) MMP-3(e,n = 22;s,n = 20),MMP-7(e,n = 28;s,n = 27),MMP-12(e,n = 20;s,n =24),TIMP-2(e,n = 23;s,n = 23) and MMP-3(e,n = 23;s,n = 28) but MMP-8(e,n = 0;s,n = 1),MMP-9(e,n = 0;s,n = 9) and MMP-26(e,n = 0;s,n = 3) and TIMP-1(n = 0,both) were lacking.In samples with low grade of inflammatory activity,the epithelial MMP-3 and MMP-7 expression was increased(r =-0.614 and r =-0.472,respectively,P < 0.05 in both).MMPs and TIMPs did not correlate with the markers of inflammation,fecal calprotectin,erythrocyte sedimentation rate,or CRP,with the exception of patients with low fecal calprotectin(< 100 μg/g) in whom a higher expression of epithelial MMP-7 was found no differences in MMPor TIMP-profiles were seen in patients with a history of pouchitis compared to ones with no such episodes.Anastomosis with either straight ileoanal anastomosis or ileoanal anastomosis with J-pouch did depict differences in MMP-or TIMP-expression.CONCLUSION:The expression of MMPs pediatric UC pouch in the long-term shares characteristics with inflammatory bowel disease,but inflammation cannot be classified as a reactivation of the disease.

Ⅰ型胶原吡啶交联终肽等项目对于早期类风湿关节炎患者的预测价值

目的:探讨I型胶原吡啶交联终肽等项目对于早期类风湿关节炎(RA)患者疾病诊断的预测价值。方法:2010年1月-2012年6月对我院风湿免疫科门诊及住院RA患者249例,采用ELISA定量检测血清ICTP、MMP-3、抗CCP抗体,采用免疫比浊法测定血清RF。结果:(1)ICTP、MMP-3、抗CCP抗体及RF在早期RA中的水平与对照组相比,差异均有统计学意义(P<0.01)。(2)早期RA组的ICTP、MMP-3的水平与CRP、关节肿胀指数、压痛指数、ESR、X现分期评分及疾病活动度积分(DAS28)评分成正相关。结论:对于新近发生的诊断不明的关节炎患者、症状不典型或症状典型RF阴性者可以联合检测这四种抗体,可降低RA的漏诊率。动态测定ICTP、抗CCP抗体、RF、MMP-3能更有效地及时监测RA的疾病进展。