血清基质金属蛋白酶-3和7个关节超声评分在类风湿关节炎病情活动性评估中的应用  

The application of matrix metalloproteinase-3 and 7 joints ultrasonic score in assessment of disease activity in patients with rheumatoid arthritis

作　　者：周凌[1] 宋婧[1] 陈凌[1] 徐沪济[1] 

机构地区：[1]第二军医大学附属长征医院风湿免疫科,上海200003

出　　处：《中华内科杂志》2016年第7期531-534,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨血清基质金属蛋白酶-3（MMP-3）和7个关节超声评分（US7评分）在类风湿关节炎（RA）患者病情活动性评估中的应用。方法选2014年12月—2015年6月第二军医大学附属长征医院风湿免疫科确诊的RA患者133例，根据28个关节疾病活动指数（DAS28）分为稳定期（DAS28〈2．6）、轻度活动期（DAS28t〉2．6～〈3．2）、中度活动期（DAS28≥3．2～〈5．1）、重度活动期（DAS28i〉5．1）。另选同期健康体检者53例。免疫比浊法测所有受试者血清MMP-3水平。彩色多普勒超声观察RA患者7个关节，并进行US7评分。采用ROC曲线评判MMP-3、US7评分及MMP-3联合US7评分对RA疾病活动评估的效能。结果中度活动期RA患者血清MMP-3水平为105．1（61．70，172．70）μg／L，重度活动期RA患者血清MMP．3水平为363．1（161．50，475．90）μg/L，高于健康体检者[35．20（25．90，48．90）μg/L；P〈0．001]和稳定期RA患者[33，40（22．60，678，40）μg/L；P〈0．001]。重度活动期RA患者ES7评分高于稳定期RA患者[7．0（2．5，11．0）比0（0，2．0）；P〈0．001]。RA患者MMP-3水平与US7评分呈正相关（r=0．566，P〈0．001）。对RA病情活动评估，MMP-3联合US7评分（AUC为0．8632）与MMP-3（AUC为0．8543）比，差异无统计学意义（P〉0．05）；与US7评分（AUC为0．7643）比，差异有统计学意义（P〈0．01）。结论MMP-3和US7评分可以作为RA活动性的评价指标，特别是对中重度活动性RA患者。MMP-3与US7评分密切相关，但MMP-3和US7评分联合使用并未提高RA活动性的评价效能。Objective To evaluate the significance of serum matrix metalloproteinase-3 （MMP-3） and joint ultrasonography in assessing the activity of rheumatoid arthritis （RA） by comparing MMP-3 level and the ultrasonic 7 joints （ US7 ） score in RA patients. Methods Serum MMP-3 level and US7 score were measured in 133 RA patients by immune turbidity and Doppler ultrasound. Synchronous 53 healthy subjects were recruited as controls. Clinical data were collected. Erythrocyte sedimentation rate （ESR） , serum level of anti-cyclic eitrullinated peptide （CCP） antibody, health assessment questionnaire （HAQ） and disease activity score 28 （DAS28） were measured. The level of disease activity is interpreted as remission（ DAS28 〈 2.6）,low（DAS 28≥ 2.6 - 〈3.2）,moderate（DAS 28 ≥3.2 - 〈5.1）,high（DAS28〉15.1）. The discriminating validity of MMP-3 and US7 score in disease was evaluated using receiver operating characteristic （ROC） curve analysis with DAS28 as the reference standard. Results Compared with that in healthy controls [35. 20（25. 90,48.90） μg/L] and remission patients[33.40（22. 60,678.40） μg/L], the MMP-3 level in moderate [ 105.1 （61.70,172. 70）μg/L] and high [ 363.1 （161.50,475.90）μg/L] groups increased dramatically. US7 score in patients with high disease activity was significantly higher than that in other groups. The level of MMP-3 was significantly correlated with DAS28, HAQ, US7 score, yet did not have correlation with anti-CCP antibody. Serum level of MMP-3 was positively correlated with US＇？ score （ r = 0. 566, P 〈 0. 001 ）. In evaluating the disease activity, US7 score combined with MMP-3 （ AUC 0. 863 2） was not superior to MMP-3 alone （AUC 0. 854 3）, but significantly better than single US7 score（ AUC 0. 764 3, P 〈 0. 05 ）. Conclusions MMP-3 is an effective and simple index in evaluating RA disease activity. The combination of MMP-3 and US7 score does not further improve the efficacy to evaluate disease activity than MM

关 键 词：关节炎 类风湿 基质金属蛋白酶3 关节 超声检查 

分 类 号：R593.22[医药卫生—内科学]