强直性脊柱炎患者血清TNF-α、RANKL、OPG和IL-34水平与附着点病变的相关性研究  

Correlation of serum TNF-α, RANKL, OPG and IL-34 levels with enthesitis in patients with ankylosing spondylitis

作　　者：黄娴倩[1] 陈勇[1] 应银燕 彭勇[1] 干敏芝[1] 耿保庆 朱梦雅[1] 应颖[1] HUANG Xianqian;CHEN Yong;YING Yinyan(Department of Rheumatology,the Ningbo Second Hospital,Ningbo 315010,China)

机构地区：[1]宁波市第二医院风湿免疫科,315010

出　　处：《浙江医学》2018年第22期2454-2458,共5页Zhejiang Medical Journal

基　　金：宁波市第二医院华美研究基金(2017HMKY31)

摘　　要：目的探讨强直性脊柱炎(AS)患者TNF-α、细胞核因子-κB受体活化因子配体(RANKL)、骨保护素(OPG)和IL-34水平与超声评估附着点病变、实验室指标和临床指标的相关性。方法选取AS患者21例(AS组),类风湿关节炎(RA)患者21例(RA组),健康者41例(健康对照组)。采用ELISA法检测各组血清TNF-α、RANKL、OPG和IL-34水平。分析AS患者TNF-α、RANKL、OPG和IL-34与超声评估附着点病变、实验室指标和临床指标的相关性,并分析4项血清指标之间的相关性。结果 AS组患者血清TNF-α、RANKL和IL-34水平均高于RA组患者及健康对照组,血清OPG均低于RA组患者及健康对照组,差异均有统计学意义(均P<0.05)。AS患者血清RANKL和IL-34水平与超声评估附着点骨侵蚀关节个数(r=0.564和0.482,均P<0.05)及附着点炎关节个数(r=0.634和0.545,均P<0.05)均呈正相关。AS患者血清IL-34水平与Bath强直性脊柱炎病情活动指数呈负相关(r=-0.454,P<0.05)。AS患者血清RANKL水平与血清OPG水平呈负相关(r=-0.461,P<0.05)。ROC曲线显示血清RANKL和IL-34水平诊断AS的AUC分别为0.994和0.941,均P<0.05。当血清RANKL水平≥125.85pg/ml,灵敏度为0.95,特异度为0.95;当血清IL-34水平≥728.15pg/ml,灵敏度为0.95,特异度为0.73。结论 AS患者外周血中存在较高水平的RANKL和IL-34,其与超声评估附着点病变骨侵蚀关节个数及附着点炎关节个数均呈正相关,提示两者可作为预测AS患者存在附着点病变的尤其是存在骨侵蚀的可靠指标。Objective To evaluate the correlation of serum levels of TNF-α, RANKL, OPG and IL-34 with enthesitis in ankylosing spondylitis （AS） patients. Methods Serum levels of TNF-α, RANKL, OPG and IL-34, were measured with ELISA in 21 AS patients, 21 rheumatoid arthritis （RA） patients and 41 healthy subjects. The correlation of serum level of TNF-α, RANKL, OPG and IL-34 with clinical index and ultrasonographic assessment of enthesitis was analyzed; and the correlation among these 4 cytokines was also analyzed. Results The serum levels of TNF-α, RANKL and IL-34 in AS patients were significantly higher, and the serum OPG level was significantly lower than those in RA patients and healthy subjects（all P〈0.05）. The serum levels of RANKL and IL-34 in AS patients were positively correlated with the number of bone erosion（r=0.564 and 0.482, both P〈0.05） and the number of enthesitis （r=0.634 and 0.545, both P〈0.05）. The serum levels of IL-34 in AS patients was negatively correlated with BASDAI （r=-0.454, P〈0.05）. The serum level of RANKL in AS patients was negatively correlated with OPG （r=-0.461, P〈0.05）. The area under the ROC curve （AUC） of serum RANKL and IL-34 was 0.994 and 0.941, respectively. When 125.85pg/ml was taken as cut-off value, the sensitivity （SE） and specificity （SP） of RANKL were 0.95 and 0.95, respectively. When 728.15pg/ml was taken as cut-off value, the SE and SP of IL-34 were 0.95 and 0.73, respectively. Conclusion AS patients have high serum levels of RANKL and IL-34, which are positively correlated with the number of bone erosion and the number of enthesitis, indicating that RANKL and IL-34 may be used as indicators of enthesitis especially bone erosion in AS patients.

关 键 词：强直性脊柱炎 IL-34 细胞核因子-κB受体活化因子配体 附着点炎 超声 

分 类 号：R593.23[医药卫生—内科学]