强直性脊柱炎患者英夫利昔单抗治疗后MMP-3、MMP-9的变化及临床意义  

Alteration of serum matrix metalloproteinase 3 and 9 levels in patients with ankylosing spondylitis during infliximab therapy

作　　者：刘伟丽[1] 张瑾[1] 李声东[1] 丁健[1] 应振华[2] 

机构地区：[1]宁波市医疗中心李惠利医院风湿免疫科,315040 [2]浙江省人民医院风湿免疫科

出　　处：《浙江医学》2015年第10期846-849,共4页Zhejiang Medical Journal

基　　金：宁波市社会发展科研项目(2012C50013)

摘　　要：目的探讨强直性背脊柱炎(AS)患者英夫利昔单抗治疗后血清基质金属蛋白酶(MMP)3、9的变化,以及其与患者临床疾病活动性的相关性。方法对44例AS患者分别于第0、2、6、12周给予静脉微泵滴注英夫利昔单抗针200mg或300mg,其中合并外周关节炎者25例;采用ELISA法检测英夫利昔单抗治疗前、治疗第12周血清MMP-3、MMP-9水平,同时采用血沉(ESR)、C反应蛋白(CRP)、强直性脊柱炎疾病活动指标(ASDAS)、Bath AS功能指数(BASFI)、Bath AS活动度衡量指数(BASMI)对患者进行临床疾病活动性评估。结果 44例AS患者治疗12周后,血清MMP-3、MMP-9水平以及ASDAS、BASFI、BASMI、ESR、CRP均有下降,差异均有统计学意义(均P<0.01),34例患者(77.3%)达临床重要改善,其中5例患者(11.4%)达临床显著改善。治疗前,血清MMP-3水平与ESR、CRP及ASDAS、BASFI有相关性(P<0.01),血清MMP-9水平与CRP及ASDAS、BASFI、BASMI有相关性(P<0.05)。治疗前后,血清MMP-3下降水平与ASDAS、BASFI、ESR、CRP的改善有相关性(P<0.05),而与BASMI的改善无关(P>0.05),血清MMP-9下降水平与BASMI、CRP的改善相关(P<0 05)。合并外周关节炎组的血清MMP-3、ESR、CRP水平均显著高于不合并外周关节炎组(P<0.05),而血清MMP-9水平低于不合并外周关节炎组(P<0.05)。结论血清MMP-3、MMP-9水平与AS患者的疾病活动指标高度相关,可以作为英夫利昔单抗治疗时的病情监测指标,其中MMP-3在合并外周关节炎时升高显著,MMP-9水平变化在不合并外周关节炎时升高。Objective To investigate serum levels of matrix metalloproteinase （MMP） 3 and 9 in patients with ankylosing spondylitis （AS） treated with infliximab. Methods Serum MMP-3 and 9 levels of 44 AS patients, including 25 cases complicated with peripheral arthritis, were measured by ELISA before and 12 weeks after infliximab treatment. Serum ESR and CRP were measured, Ankylosing Spondylitis Disease Activity Score（ASDAS）, Bath Ankylosing Spondylitis Functional Index （BASFI） and Bath Ankylosing Spondylitis Metrology Index（BASMI） were evaluated. The T-test and Spearman correlation analysis were used for statistic analysis. Results Serum MMP-3 and 9, ESR, CRP levels were decreased, and ASDAS, BASFI, BASMI scores were declined 12 weeks after infliximab treatment （P〈0.01）. Thirty four patients （77.3%） had clinically important improvement and 5 patients（11.4%）had major improvement after 12 weeks of infliximab treatment. Before treatment the MMP-3 level was correlated with ESR, CRP, and ASDAS, BASFI scores（P〈0.01）, MMP-9 was correlated with CRP, ASDAS, BASFI and BASMI （P〈0.05）. After 12 weeks of treatment the decline of MMP-3 was correlated with the changing of ASDAS, BASFI scores and ESR, CRP levels, but not with BASMI score. The decline of MMP-9 was correlated with the changing of BASMI and CRP. Patients with peripheral arthritis had higher MMP-3, ESR and CRP, while patients without peripheral arthritis had higher MMP-9. Conclusion High levels of MMP-3 and MMP-9 are associated with increased disease activity in AS patients and they declined during infliximab therapy. MMP-3 is associated with patients with peripheral arthritis, while MMP-9 is associated with patients without peripheral arthritis.

关 键 词：强直性脊柱 炎疾病活动性 基质金属蛋白酶3 基质金属蛋白酶9 

分 类 号：R593.23[医药卫生—内科学]