基质金属蛋白酶3联合抗突变型瓜氨酸波形蛋白抗体、类风湿因子辅助诊断类风湿关节炎的临床价值  

The clinical value of matrix metalloproteinase-3 combined with anti-mutant citrulline vimentin antibody and rheumatoid factor in the diagnosis of rheumatoid arthritis

作　　者：张楠 李曼[2] 夏挺[2] 徐志晔[2] 李智洋 Zhang Nan;Li Man;Xia Ting;Xu Zhiye;Li Zhiyang(Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Clinical Laboratory,The Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,南京210008 [2]南京大学医学院附属鼓楼医院检验科,南京210008

出　　处：《中国医师杂志》2024年第11期1681-1686,共6页Journal of Chinese Physician

基　　金：南京鼓楼医院临床研究面上项目(2023-LCYJ-MS-13)

摘　　要：目的探讨血清基质金属蛋白酶3(MMP-3)联合抗突变型瓜氨酸波形蛋白抗体(anti-MCV)、类风湿因子(RF)在类风湿关节炎(RA)中的诊断及鉴别诊断价值。方法采用回顾性研究, 选取南京医科大学鼓楼临床医学院2022年8月至2024年4月期间确诊为RA的患者78例, 干燥综合征(SS)患者30例, 结缔组织病(CTD)患者25例, 抗磷脂综合征(APS)患者38例;另同期选取本院体检中心健康对照组50例。检测RA患者和健康体检者空腹外周血RF、抗链球菌溶血素O(ASO)、C-反应蛋白(CRP)、红细胞沉降率(ESR)、白介素-6(IL-6)、降钙素原(PCT)、抗角蛋白抗体(AKA)、anti-MCV、MMP-3、抗环瓜氨酸肽抗体(anti-CCP)水平。比较SS、CTD、APS患者及健康对照组的空腹外周血MMP-3水平, 采用Spearman相关分析法评估MMP-3水平与各指标的相关性, 采用logistic回归分析筛选RA发生的相关影响因素, 采用受试者工作特征(ROC)曲线评价血清MMP-3、anti-MCV、RF单独及联合检测对RA的诊断价值。结果 RA组的RF、CRP、ESR、IL-6、anti-MCV、MMP-3、anti-CCP水平与AKA阳性占比与健康对照组差异均有统计学意义(均P<0.001), 而PCT和ASO与健康对照组差异均无统计学意义(均P>0.05)。RA组血清MMP-3水平明显高于SS、CTD、APS患者及健康对照组, 差异有统计学意义(均P<0.05)。RA患者MMP-3与anti-CCP、CRP、ESR、anti-MCV、RF和AKA呈正相关(r=0.403、0.532、0.530、0.431、0.427、0.391, 均P<0.05)。多因素logistic回归分析结果显示, MMP-3(OR=1.082, P=0.02)、anti-MCV(OR=1.015, P=0.049)、RF(OR=1.046, P=0.036)是RA发生的独立危险因素。ROC曲线显示, MMP-3截断值为53.10 ng/ml时, 诊断RA的曲线下面积为0.889, 灵敏度为74.5%, 特异度为96.0%;MMP-3联合anti-MCV、RF诊断RA的ROC曲线下面积为0.975, 灵敏度为88.2%, 特异度为99.7%。结论 MMP-3对RA有一定的鉴别诊断价值, MMP-3联合anti-MCV、RF对RA的辅助诊断有较大意义。Objective To investigate the diagnostic value of serum matrix metalloproteinase 3(MMP-3)combined with anti-mutant citrulline vimentin antibody(anti-MCV)and rheumatoid factor(RF)in rheumatoid arthritis(RA).Methods A retrospective study was conducted to select 78 patients diagnosed with RA,30 with Sjogren's syndrome(SS),25 with connective tissue disease(CTD),and 38 with antiphospholipid syndrome(APS)from the Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University from August 2022 to April 2024.In the same period,50 healthy controls were selected from the physical examination center of our hospital.Fasting peripheral blood RF,anti-streptolysin O(ASO),C-reactive protein(CRP),erythrocyte deposition rate(ESR),interleukin-6(IL-6),procalcitonin(PCT),anti-keratin antibody(AKA),anti-MCV,MMP-3,anti-cyclic citrullinated peptide(anti-CCP)level.Fasting peripheral blood MMP-3 levels in SS,CTD,APS patients and healthy control group were compared,Spearman correlation analysis was used to evaluate the correlation between MMP-3 levels and various indicators,and logistic regression analysis was used to screen the related influencing factors of RA occurrence.The diagnostic value of serum MMP-3,anti-MCV,RF and combined detection for RA was evaluated by receiver operating characteristic(ROC)curve.Results There were statistically significant differences in RF,CRP,ESR,IL6,AKA,antiMCV,MMP-3 and anti-CCP between RA group and healthy control group(all P<0.001),while there were no statistically significant differences in PCT and ASO between the RA group and the healthy control group(all P>0.05).Serum MMP-3 level in the RA group was significantly higher than that in SS,CTD,APS and healthy control group,and the difference was statistically significant(all P<0.05).MMP-3 was positively correlated with anti-CCP,CRP,ESR,anti-MCV,RF and AKA(r=0.403,0.532,0.530,0.431,0.427,0.391,all P<0.05).Multivariate logistic regression analysis showed that MMP-3(OR=1.082,P=0.02),anti-MCV(OR=1.015,P=0.049)and RF(OR=1.046,P=0.036)were independen

关 键 词：关节炎 类风湿 基质金属蛋白酶3 类风湿因子 抗突变型瓜氨酸波形蛋白抗体 

分 类 号：R593.22[医药卫生—内科学]