基质金属蛋白酶3联合C反应蛋白检测评估女性类风湿关节炎病情活动性  

Combined detection of serum matrix metalloproteinase-3 and C-reactive protien in disease activity measurement in female patients with rheumatoid arthritis

作　　者：马剑达[1] 欧阳霞 郑东辉[1] 莫颖倩[1] 邹婵娟[1] 朱浪静[1] 李艳华[1] 戴冽[1] 

机构地区：[1]中山大学孙逸仙纪念医院风湿免疫科,广州510120 [2]广州市番禺区中心医院肾病风湿科

出　　处：《中华临床医师杂志（电子版）》2013年第8期55-58,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：教育部留学回国人员科研启动基金资助项目(外教司留[2008]101号);国家自然科学青年基金(30901333)

摘　　要：目的探讨血清基质金属蛋白酶3(MMP-3)联合C反应蛋白(CRP)检测在女性类风湿关节炎(RA)病情活动性评估中的价值。方法酶联免疫吸附法分别检测100例女性RA患者及31例正常女性血清MMP-3水平并收集临床资料,应用受试者工作特征曲线(ROC)进行诊断价值分析。结果 (1)女性RA患者血清MMP-3水平显著高于正常对照组(P<0.001),活动期(DAS28≥2.6,n=75)显著高于缓解期(DAS28<2.6,n=25,P<0.001),并与CRP(r=0.544,P<0.001)、ESR(r=0.449,P<0.001)、DAS28(r=0.414,P<0.001)等呈显著正相关;(2)根据试剂盒提供的女性正常参考值范围上限60ng/ml,血清MMP-3诊断女性RA病情活动的敏感度为92%,特异度为48%;(3)血清MMP-3诊断女性RA病情活动的ROC曲线下面积为0.81(P<0.001),最佳诊断界限值为216ng/ml,相应的敏感度为56%,特异度为92%;(4)血清MMP-3与CRP联合检测诊断女性RA病情活动的敏感度(97%)较单独检测CRP(84%)显著升高(χ2=7.878,P=0.005),特异度(96%)较单独检测血清MMP-3显著升高(χ2=14.86,P<0.001)。结论血清MMP-3可用于评估女性RA患者病情活动性,MMP-3联合CRP检测可提高诊断的敏感度和特异度,是最佳的联合检测方案。Objective To explore the value of combined detection of serum matrix metalloproteinase-3 （ MMP-3）and C-reactive protein（CRP） in disease activity measurement in female patients with rheumatoid arthritis （RA）. Methods Serum MMP-3 level of 100 female RA patients and 31 normal women was tested by enzyme-linked lmmunosorbent assay, while clinical data was collected simultaneously. Receiver operating characteristic（ROC） curve was used for the analysis of diagnostic value. Results （ 1 ） Serum MMP-3 level was significantly higher in female RA patients than that in normal women（P 〈 0. 001 ）. Among female RA patients, serum MMP-3 level was significantly higher in active group（DAS28 ≥2. 6,n =75）than that in remission group（DAS28 〈2. 6,P 〈0. 001 ,n =25）. Serum MMP-3 level positively correlated with CRP（ r = 0. 544, P 〈 0. 001 ）, erythrocyte sedimentation rate （ r = 0. 449, P 〈 0. 001 ） and DAS28 （ r = 0. 414, P 〈 0. 001 ） ; （ 2 ） According to the upper limit of normal reference （ 60 ng/ml）, the sensitivity and specificity of serum MMP-3 for diagnosing active female RA were 92% and 48% ; （ 3 ） ROC curve analysis showed that the optimal cut-off point for diagnosing active female RA was 216 ng/ml with AUC 0. 81 （P 〈 0. 001 ）, sensitivity was 56% and specificity was 92% ; （4） The sensitivity and specificity of serum MMP-3 ＋ CRP combined detection were 97%, and 96% for diagnosing active female RA, which were significantly higher than the sensitivity of CRP（84% ,P = 0. 005 ） and the specificity of serum MMP-3 （ P 〈 0. 001 ）. Conclusion Serum MMP-3 is a helpful indicator for disease activity measurement in female RA patients. Combined detection of serum MMP-3 and CRP can improve the sensitivity and specificity for diagnosing active female RA.

关 键 词：关节炎 类风湿 基质金属蛋白酶3 联合检测 病情评估 

分 类 号：R446.6[医药卫生—诊断学] R593.22[医药卫生—临床医学]