血清14-3-3η蛋白水平在类风湿关节炎和脊柱关节病诊断中的临床意义  

Clinical significance of the serum 14-3-3η protein level in rheumatoid arthritis and spondyloarthropathy

作　　者：吴颖[1] 徐胜前[1] 肖会[1] 齐姗[1] 刘文[1] 彭丽萍[1] 徐建华[1] 

机构地区：[1]安徽医科大学第一附属医院风湿免疫科,合肥230022

出　　处：《医学研究生学报》2016年第6期605-609,共5页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81571572)

摘　　要：目的对于类风湿关节炎(rheumatoid arthritis,RA)与脊柱关节病(spondyloarthropathy,Sp A)的诊断标准中,实验室指标的敏感度及特异度均有限,易造成误诊。文中探讨血清14-3-3η蛋白水平在RA和Sp A中的临床意义。方法回顾性分析2012年11月至2014年8月期间安徽医科大学第一附属医院风湿科住院的84例RA患者(RA组)、93例Sp A患者(Sp A组)和体检中心按年龄、性别、身高、体重相匹配的80例正常人群(对照组)。采用ELISA法分别测定上述研究对象血清14-3-3η蛋白浓度。同时对67例RA患者均采用DEXA法测定其股骨和腰椎部位骨密度;53例Sp A患者行骶髂关节MRI扫描并进行SPARCC评分。结果 1血清14-3-3η蛋白在RA组[3.91(1.69,6.51)]和Sp A组[0.52(0.32,0.92)]中水平均明显高于正常对照组[0.20(0.14,0.29)],差异有统计学意义(P<0.01),且RA组中水平亦明显高于Sp A组(P<0.01)。2RA组中血清14-3-3η蛋白浓度阳性率高达91.7%,其次为Sp A组(33.3%),对照组血清14-3-3η蛋白阳性率最低(5%),3组阳性率比较,差异有统计学意义(P<0.01)。3相关性分析结果显示,RA组血清14-3-3η蛋白与患者疼痛积分(visual analogue scale,VAS)评分、健康评价问卷(health assessment questionnaire,HAQ)评分、血沉(erythrocyte sedimentation rate,ESR)、CRP均呈正相关(P<0.05),与腰椎及股骨区各骨密度值均呈负相关(P<0.05)。Sp A组患者血清14-3-3η蛋白仅与ESR呈正相关(P<0.05)。结论血清14-3-3η蛋白可作为RA及Sp A诊断及鉴别诊断的参考指标,且可能在RA中的临床意义更大;14-3-3η蛋白与RA患者临床症状、疾病活动性及骨质疏松的发生相关。Objective The aim of this study was to investigate the clinical significance of the serum 14-3-3η protein concentration in patients with rheurvatoid arthritis （RA） or spondyloarthropathy （SPA）. Methods We retrospectively analyzed the clinical data about 84 cases of RA and 93 cases of SpA, with 80 normal subjects matched with the patients in age, gender, height, and BMH as controls. We measured the concentration of the serum 14-3-3η protein by ELISA, determined the bone mineral density （BMD） of the femur and lumbar vertebrae in 67 RA patients by the DEXA, and obtained the scores of Spondyloarthritis Research Consortium of Canada （SPARCC） by MRI scanning of the sacroiliac joints of the 53 SpA patients. Results The concentration of the serum 14-3-3η protein was significantly increased in the RA and SpA patients as compared with that in the normal controls （ 3.91 [ 1.69 - 6.51 ] and 0.52 [0.32 -0.92] vs 0. 20 [0.14 -0.29], P 〈0.01 ）, even higher in the RA than in the SpA group （P 〈0.01）, and above the normal reference value in 91.7% （77/84） of the RA patients, 33.3% （31/93） of the SpA patients, and 5.0% （4/80） of the normal controls, with no statistically significant differences in the positive rate among the three groups （ P 〈 0. 01 ）. The level of the serum 14-3-3η protein was correlated positively with the Visual Analogue Scale （VAS） score, Health Assessment Questionnaire （HAQ） score, erythro- cyte sedimentation rate （ ESR）, and C reactive protein （CRP） level （ P 〈 0.05 ）, but negatively with BMD in the lumbar spine and femur in the RA patients （ P 〈 0. 05 ）, and it was only positively correlated with ESR in the SpA patients （ P 〈 0. 05 ）. Conclusion The level of the serum 14-3-3η protein can be used as a reference index in the diagnosis and differential diagnosis of RA and SpA, probably with a great clinical significance in RA, and it is associated with the clinical symptoms, disease activity and osteoporosis in RA patients.

关 键 词：14-3-3η蛋白 类风湿关节炎 脊柱关节病 

分 类 号：R363[医药卫生—病理学]