血清MMP-3、RANK、RANKL、OPG水平诊断早期类风湿关节炎及骨关节损伤的价值  

Clinical value of serum MMP-3,RANK,RANKL and OPG levels in the diagnosis of early rheumatoid arthritis and osteoarticular injuries

作　　者：李贺伟[1] 王勇 魏优秀[1] 郭朗 黄康[1] 孙飞 

机构地区：[1]华中科技大学同济医学院附属梨园医院骨科 [2]中国人民解放军海军91650部队卫生队

出　　处：《临床和实验医学杂志》2017年第20期2026-2030,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的探究血清MMP-3、胞核因子KB受体活化因子(RANK)、胞核因子KB受体活化因子配体(RANKL)、骨保护因子(OPG)水平用于早期类风湿关节炎及骨关节损伤的诊断价值。方法选取2014年5月至2016年5月间就诊的类风湿关节炎(RA)患者195例,其中116例为早期RA,79例为非早期RA,并选取同期体检的健康人群85例作为对照组。均于入院后空腹抽取静脉血测定血清MMP-3、RANK、RANKL、OPG水平,并对比分析上述血清学指标在早期RA骨关节损伤和未损伤患者中的表达情况。分析影像学指标与早期RA患者血清学指标相关性。结果入院时RA患者血清MMP-3、RANK、RANKL水平均显著高于对照组,组间差异显著(P<0.05),而早期RA患者OPG水平明显比非早期RA组及对照组低,组间统计差异显著(P<0.05)。早期RA骨关节损伤组患者MMP-3、RANK、RANKL水平显著较骨关节未损伤组患者高,而OPG水平明显低于骨关节未损伤组,差异有显著性(P<0.05)。早期RA患者不同部位BMD水平存在显著性差异(P<0.05),早期RA组(23.28%)和非早期RA组(36.71%)骨质疏松发生率存在统计学差异(P<0.05)。此外,早期RA患者骨侵蚀评分与大转子、总股骨区BMD呈现一定负相关性,r=-0.387、-0.358,P<0.05,而与Sharp评分评分呈较强正相关性(r=0.712,P<0.05);肌腱炎评分与关节肿胀数及关节压痛数均有正相关性(r=0.372、0.369,P<0.05);此外,OPG及MMP-3表达水平均与关节肿胀数、关节压痛数及Sharp评分存在一定正相关性(r=0.293、0.315、0.298、0.468、0.398、0.689,P<0.05)。结论血清MMP-3、RANK、RANKL、OPG水平检测用于RA早期诊断具有重要价值,且与骨关节损害有一定关系。Objective To investigate the clinical value of serum levels of MMP-3,RANK,RANKL and OPG in the diagnosis of early rheumatoid arthritis and osteoarticular injuries. Methods 195 cases of patients with rheumatoid arthritis（ RA） in our hospital from May 2014 to May 2016 were selected,including 116 cases of early RA and 79 cases of non early RA,and 85 cases of healthy people at the same period were selected as the control group,all patients had fasting venous blood extraction after admission to detect serum MMP-3,RANK,RANKL,OPG levels,and the comparative analysis of the expression of serological indexes in early RA osteoarticular injury and non injury patients was taken. Results In admission,serum MMP-3,RANK and RANKL levels of the RA patients were significantly higher than those of the control group,there was significant difference between groups（ P〈0. 05）,and OPG level of the early RA patients was significantly lower than that of the non early RA group and the control group,the difference between groups was statistically significant（ P〈0. 05）. MMP-3,RANK and RANKL level of the early RA patients with osteoarticular injuries were significantly higher than those of the early RA patients without osteoarticular injuries group,but the level of OPG was significantly lower than that of the osteoarticular no injury group,inter group data were analyzed statistically and showed significant difference（ P〈0. 05）. There were significant differences in BMD levels at different sites in early RA patients（ P〈0. 05）. There was statistical significance in the incidence of osteoporosis between the early RA group（ 23. 28%） and the non early RA group（ 36. 71%）（ P〈0. 05）.In addition,early RA patients＇ bone erosion score big rotor and total femur BMD showed a negative correlation（ r =-0. 387,r =-0. 358,P〈0. 05）,and showed a strong positive correlation with Sharp scores（ r = 0. 712,P〈0. 05）; Tendinitis score and joint swelling number and joint tenderness number had positive correlation�

关 键 词：早期类风湿关节炎 MMP-3 RANK RANKL OPG 骨关节损伤 

分 类 号：R593.22[医药卫生—内科学]