血清正五聚素蛋白3和Wnt-3α及survivin对类风湿关节炎治疗反应性的预测价值  

Values of serum pentraxin 3,Wnt-3αand survivin to the therapeutic response in patients with rheumatoid arthritis

作　　者：郑戈[1] 袁一孟[2] 申利平[1] ZHENG Ge;YUAN Yi-meng;SHEN Li-ping(Department of Hematology and Immunology,the First People's Hospital of Zigong,Zigong,Sichuan 643000,China;Department of Nephrology,the First People's Hospital of Zigong,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第一人民医院血液免疫科,四川自贡643000 [2]自贡市第一人民医院肾内科,四川自贡643000

出　　处：《中华实用诊断与治疗杂志》2021年第12期1270-1274,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：四川省科技计划项目(2018JDR3389)。

摘　　要：目的观察类风湿关节炎患者血清正五聚素蛋白3(pentraxin 3,PTX3)、Wnt-3α、survivin表达变化,分析其与类风湿关节炎疾病活动性(DAS28评分)的关系,探讨其对治疗反应性的预测价值。方法类风湿关节炎患者167例均给予依那西普联合甲氨蝶呤治疗,根据治疗6个月的反应性分为反应良好组131例和无反应组36例。比较2组一般资料及治疗前、后DAS28评分,采用ELISA法检测血清PTX3、survivin水平,采用放射免疫法检测血清Wnt-3α水平,采用Pearson相关性分析血清PTX3、Wnt-3α、survivin水平与DAS28评分的相关性;采用多因素logistic回归分析类风湿关节炎患者治疗无反应的影响因素;绘制ROC曲线,评估血清PTX3、Wnt-3α、survivin水平对类风湿关节炎患者治疗无反应的预测效能。结果无反应组治疗前、治疗6个月后血清PTX3[(3.04±0.72)、(2.88±0.68)μg/L]、Wnt-3α[(2.25±0.44)、(2.17±0.41)μg/L]、survivin[(826.41±224.85)、(753.28±238.57)ng/L]水平均高于反应良好组[(2.21±0.57)、(1.29±0.37)μg/L,(1.91±0.23)、(1.08±0.20)μg/L,(602.37±138.29)、(372.44±104.36)ng/L](P<0.05),反应良好组治疗6个月后血清PTX3、Wnt-3α、survivin水平均低于治疗前(P<0.05),无反应组治疗6个月后血清PTX3、Wnt-3α、survivin水平与治疗前比较差异均无统计学意义(P>0.05)。治疗前、治疗6个月后血清PTX3(r=0.528,P<0.001;r=0.571,P<0.001)、Wnt-3α(r=0.606,P<0.001;r=0.664,P<0.001)、survivin(r=0.583,P<0.001;r=0.629,P<0.001)水平与DAS28评分均呈正相关。病程、关节压痛指数、关节肿胀指数、治疗前和治疗6个月后DAS28评分、治疗前和治疗6个月后血清PTX3、Wnt-3α、survivin水平是类风湿关节炎患者治疗无反应的影响因素(P<0.05)。治疗前血清PTX3、Wnt-3α、survivin水平最佳截断值分别为2.73μg/L、2.15μg/L、787.72 ng/L时,预测类风湿关节炎患者治疗无反应的AUC分别为0.825(95%CI:0.759~0.880,P<0.001)、0.803(95%CI:0.734~0.860,P<0.001)、0.Objective To observe the changes of serum pentaxin 3(PTX3),Wnt-3αand survivin in patients with rheumatoid arthritis,and to analyze their correlations with rheumatoid arthritis disease activity 28(DAS28)score and their predictive values to the therapeutic response.Methods Totally 167 patients with rheumatoid arthritis received etanercept plus methotrexate,and were divided into 131 patients in good response(good response group)and 36 patients with no response(no-response group)according to the response after 6-month treatment.The general data and DAS28 scores before and after treatment were compared between two groups.The serum PTX3 and survivin levels were detected by ELISA.The Wnt-3αlevel was detected by radioimmunoassey.Pearson correlation coefficient model was used to analyze the correlations of serum PTX3,Wnt-3αand survivin with DAS28 score.Multivariate logistic regression was used to analyze the influencing factors of no-response.ROC curve was drawn to evaluate the efficiencies of serum PTX3,Wnt-3αand survivin on predicting no-response.Results The levels of serum PTX3,Wnt-3αand survivin were higher in no-response group[(3.04±0.72),(2.88±0.68)μg/L;(2.25±0.44),(2.17±0.41)μg/L;(826.41±224.85),(753.28±238.57)ng/L]than those in good response group[(2.21±0.57),(1.29±0.37)μg/L;(1.91±0.23),(1.08±0.20)μg/L;(602.37±138.29),(372.44±104.36)ng/L]both before and after 6-month treatment(P<0.05),were higher after 6-month treatment than those before treatment in good response group(P<0.05),and showed no significant differences before treatment compared with those after 6-month treatment in no-response group(P>0.05).The levels of serum PTX3(r=0.528,P<0.001;r=0.571,P<0.001),Wnt-3α(r=0.606,P<0.001;r=0.664,P<0.001)and survivin(r=0.583,P<0.001;r=0.629,P<0.001)before and after 6-month treatment were positively correlated with DAS28 score.The course of disease,joint tenderness index,joint swelling index,DAS28 score before and after 6-month treatment,and the levels of serum PTX3,Wnt-3αand survivin before and af

关 键 词：类风湿关节炎 正五聚素蛋白3 Wnt-3α SURVIVIN 疾病活动性 

分 类 号：R593.22[医药卫生—内科学]