D-二聚体与sMMP-3联合检测对类风湿关节炎患者病情活动的评估价值  

Evaluation value of combined detection of D-dimer and sMMP-3 on the disease activity of patients with rheumatoid arthritis

作　　者：招湛静 丘创华[2] 陈锐锋 ZHAO Zhanjing;QIU Chuanghua;CHEN Ruifeng(Department of Clinical Laboratory,Maternal and Child Health Hospital of Dapeng New District,Shenzhen,Guangdong 518000,China;Department of Clinical Laboratory,Shenzhen Second People′s Hospital of Guangdong Province,Shenzhen,Guangdong 518000,China)

机构地区：[1]广东省深圳市大鹏新区妇幼保健院检验科,广东深圳518000 [2]广东省深圳市第二人民医院检验科,广东深圳518000

出　　处：《检验医学与临床》2020年第21期3102-3105,共4页Laboratory Medicine and Clinic

基　　金：广东省深圳市龙岗区科技局基金项目(20170403142337440)。

摘　　要：目的探讨D-二聚体与血清基质金属蛋白酶3(sMMP-3)联合检测对类风湿关节炎患者病情活动的评估价值。方法回顾性分析2017年4月至2019年3月深圳市第二人民医院收治的类风湿关节炎患者140例的临床资料。根据类风湿关节炎的28个关节疾病活动评分(DAS28评分)将患者分为病情缓解期组(32例)和病情活动期组(108例)。采用免疫比浊法检测血清D-二聚体水平,采用酶联免疫吸附试验法检测sMMP-3水平,比较2组患者的血清D-二聚体、sMMP-3水平差异。采用受试者工作者特征曲线(ROC曲线)评估血清D-二聚体、sMMP-3水平对类风湿关节炎患者病情活动的临床诊断价值。结果病情缓解期组患者血清D-二聚体、C反应蛋白、红细胞沉降率(ESR)、抗环瓜氨酸肽抗体(抗CCP抗体)、sMMP-3水平显著低于病情活动期组(P<0.05)。多因素Logistic回归分析结果显示,血清D-二聚体、ESR、抗CCP抗体、sMMP-3是类风湿关节炎患者病情活动的独立影响因素(P<0.05)。血清D-二聚体、ESR、抗CCP抗体、sMMP-3水平、D-二聚体联合sMMP-3检测的曲线下面积分别为0.936、0.832、0.804、0.897、0.940,最佳临界值分别为1.740μg/mL、58.904 mm/h、350.872 RU/mL、167.965μg/L、8.511,灵敏度分别为92.4%、55.1%、57.4%、90.3%、94.7%,特异度分别为82.8%、100.0%、93.4%、87.2%、81.8%。结论相较于血清抗CCP抗体、ESR检测,血清D-二聚体、sMMP-3检测能更好地评估类风湿关节炎患者的病情活动情况,血清D-二聚体联合sMMP-3检测能进一步提高对患者病情活动的评估价值。Objective To explore the evaluation value of combined detection of D-dimer and serum matrix metalloproteinase 3(sMMP-3)on the disease activity of patients with rheumatoid arthritis.Methods The clinical data of 140 patients with rheumatoid arthritis admitted to Shenzhen Second People′s Hospital from April 2017 to March 2019 were retrospectively analyzed.The patients were divided into remission group(32 cases)and active stage group(108 cases)according to the 28 joint disease activity score(DAS28)of rheumatoid arthritis.The serum D-dimer level was detected by immunoturbidimetric method,and the level of sMMP-3 was measured by enzyme-linked immunosorbent assay,the serum levels of D-dimer and sMMP-3 were compared between the two groups.Receiver operator characteristic curve(ROC curve)was used to evaluate the clinical diagnostic value of serum D-dimer and sMMP-3 levels in patients with rheumatoid arthritis.Results The levels of serum D-dimer,C-reactive protein,erythrocyte sedimentation rate(ESR),anti cyclic citrullinated peptide antibody(anti CCP antibody)and sMMP-3 in remission group were significantly lower than those in active stage group(P<0.05).Multivariate Logistic regression analysis showed that serum D-dimer,ESR,anti CCP antibody and sMMP-3 were the independent influencing factors of disease activity in patients with rheumatoid arthritis(P<0.05).The area under the ROC curve of serum D-dimer,ESR,anti CCP antibody,sMMP-3 level and D-dimer combined with sMMP-3 detection were 0.936,0.832,0.804,0.897 and 0.940,respectively,the optimal critical values were 1.740μg/mL,58.904 mm/h,350.872 RU/mL,167.965μg/L and 8.511,the sensitivity was 92.4%,55.1%,57.4%,90.3%,94.7%,and the specificity was 82.8%,100.0%,93.4%,87.2%and 81.8%,respectively.Conclusion Compared with anti CCP antibody and ESR detection,serum D-dimer and sMMP-3 detection can better evaluate the disease activity of patients with rheumatoid arthritis,and serum D-dimer combined with sMMP-3 detection can further improve the evaluation value of disease activity o

关 键 词：D-二聚体 血清基质金属蛋白酶3 类风湿关节炎 病情活动 

分 类 号：R446.11[医药卫生—诊断学] R593.22[医药卫生—临床医学]