【摘要】 目的探讨血清基质金属蛋白酶-3(MMP-3)与在类风湿关节炎(RA)的临床关系。方法 (1)用酶联免疫吸附法(ELISA)检测40例活动期RA患者(RA组)及20例健康人(对照组)血清MMP-3水平;(2)40例活动期RA患者经来氟米特(LEF)治疗2周4、周8、周、12周、24周,分析MMP-3水平变化及其与临床指标的关系。结果 (1)RA组血清MMP-3浓度为(158.63±36.91)ng/ml,高于对照组的(30.97±14.26)ng/ml,差异有统计学意义(P<0.01);(2)RA组血清MMP-3水平与肿胀指数、压痛指数、C反应蛋白(CRP)、红细胞沉降率(ESR)、类风湿因子(RF)、X线分期评分、疾病活动度积分(DAS28)成正相关(r分别为:0.334、0.363、0.512、0.436、0.509、0.493,P均<0.05),与晨僵时间无相关关系(r=0.212,P>0.05);(3)RA组不同X线分期:Ⅰ期(118.72±37.29)ng/ml与Ⅱ期(154.62±26.59)ng/ml、Ⅱ期与Ⅲ期(174.55±21.70)ng/ml、Ⅲ期与Ⅳ期(200.78±20.56)ng/ml,MMP-3水平比较差异均有统计学意义(P<0.001);(4)RA组治疗2周4、周、8周1、2周2、4周血清MMP-3水平分别为(156.48±40)ng/ml、(132.23±35.91)ng/ml(、114.75±22.57)ng/ml(、102.26±20.49)ng/ml(、108.14±47.62)ng/ml,MMP-3水平下降差异有统计学意义(除治疗后2周外,P均<0.05);(5)RA组晨僵时间、肿胀指数、压痛指数、ESR、CRP、RF、DAS28等治疗后24周较治疗前均改善(P均<0.05);(6)治疗终点病情缓解9例,血清MMP-3浓度(71.26±24.39)ng/ml仍高于对照组(P<0.01);(7)经有序多分类Logistic回归分析基线水平的疗效影响因素有MMP-3、RF、压痛关节数。结论活动期RA患者血清MMP-3的水平比正常人升高,MMP-3在RA的病情发展中扮演重要角色;MMP-3与骨侵蚀关系密切,是RA关节破坏的重要因素,其水平影响RA的预后,可能是预测关节破坏的指标。更多还原

【Abstract】 Objective To investigate the serum concentration of Matrix metalloproteinase 3 in patients with rheumatoid arthritis(RA)and its clinical significance.Methods(1)40 active RA patients and 20 normal controls were assessed by enzyme-linked immunosorbent assay(ELISA)to investigate the relation between serum levels of MMP-3 in active RA patients(RA group)and 20 healthy controls(control group).(2)40 RA patients(treatment group)were treated by leflunomide,and MMP-3 was detected in 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks.Concurrently,changes of MMP-3 at baseline and after therapy and the clinic indexes were analyzed.Results(1)Serum MMP-3 levels in the active RA patients[(158.63±36.91)ng/ml]was higher than that in normal controls[(30.97±14.26)ng/ml],the difference was significant(P<0.01).(2)Serum MMP-3 levels in active RA had positive correlations with C reaction protein(CRP),erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),swelling index,Ritchie index,X-ray score,DAS28 score(P<0.05),and had no relation with stiff time(P>0.05).(3)The levels of MMP-3 between phase Ⅰ[(118.72±37.29)ng/ml]and phase Ⅱ[(154.62±26.59) ng/ml],phase Ⅱ and phase Ⅲ[(174.55±21.70) ng/ml],phase Ⅲ and phase Ⅳ[(200.78±20.56) ng/ml]in RA group were statistically significant(P<0.05).(4)2 weeks,4 weeks,8 weeks,12 weeks,24 weeks after therapy,the levels of MMP-3 in RA treatment group were(156.48±40) ng/ml,(132.23±35.91)ng/ml,(114.75±22.57)ng/ml,(102.26±20.49) ng/ml,(108.14±47.62) ng/ml,respectively.The decrease of the serum concentration of MMP-3 were statistically significant(except for 2 weeks after therapy P<0.05).(5)Stiff time,swelling index,Ritchie index,ESR,CRP,RF,DAS28 scores of RA group in 24 weeks after therapy improved(P<0.05)in comparison with the cases at baseline.(6)The symptoms of 9 patients relieved 24 weeks after therapy,though the concentration of MMP-3 in this group was still higher [(71.26 ±24.39)ng/ml] than that in normal controls(P<0.01).(7)The factors that had affected curative effect including MMP-3,RF and Ritchie index by the means of the order in all Logistic regression analysis.Conclusion The levels of the MMP-3 in active RA patients are higher than that in the normal people,and MMP-3 plays an important role in the development of RA;MMP-3 is closely related to bony erosion,which is an important factor of articular destruction,the level would affect the prognosis of RA patients and it probably be an indicator of predicting articular destruction.更多还原