血清补体C1q/肿瘤坏死因子相关蛋白3水平变化在类风湿关节炎患者中的临床意义  

Clinical significance of changes in serum complement C1q/tumor necrosis factor-associated protein 3 levels in patients with rheumatoid arthritis

作　　者：曾婷 韦彩雯 陈卫香 顾立华 钱悦 赵新锋 申艳[2] Zeng Ting;Wei Caiwen;Chen Weixiang;Gu Lihua;Qian Yue;Zhao Xinfeng;Shen Yan(Department of General Medicine,Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences(Xinhua Hospital Chongming Branch),Shanghai 202150,China;Department of Rheumatology,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]上海健康医学院附属崇明医院(上海新华医院崇明分院)全科医学科,上海202150 [2]复旦大学附属华东医院风湿免疫科,上海200040

出　　处：《中华风湿病学杂志》2025年第3期197-203,共7页Chinese Journal of Rheumatology

基　　金：上海健康医学院校级科研基金(SSF-23-24-006)。

摘　　要：目的探讨类风湿关节炎(RA)患者血清补体C1q/肿瘤坏死因子相关蛋白3(CTRP3)水平变化及其临床意义。方法收集2023年1月至2024年2月就诊于上海健康医学院附属崇明医院(新华医院崇明分院)60例RA患者根据颈动脉超声检查颈动脉内膜中层厚度(cIMT)结果分为有斑块组38例和无斑块组22例,健康体检者60名作为对照,分别检测ESR、血脂、CRP、RF、抗CCP抗体以及胰岛素抵抗指数(HOMA-IR)和CTRP3水平,分析RA患者CTRP3水平与疾病活动度、动脉粥样硬化的关系。通过χ2分析、t检验、Pearson相关性以及Logistic回归等多种分析方法进行统计学分析。结果RA患者血清CTRP3水平低于健康对照组[(116±44)ng/ml与(184±63)ng/ml,t=-6.54,P=0.004],RA有斑块组的CTRP3水平低于无斑块组[(98±28)ng/ml与(123±38)ng/ml,t=-5.57,P=0.008],差异有统计学意义。RA患者血清CTRP3水平和低密度脂蛋白胆固醇(LDL-C)(r=-0.68,P=0.011)、HOMA-IR(r=-0.74,P=0.001)、RF(r=-0.46,P=0.042)、抗CCP抗体(r=-0.54,P=0.037)、疾病活动度评分表28(DAS28)(r=-0.66,P=0.024)和cIMT(r=-0.76,P=0.001)呈负相关,和DMARDs使用时长(r=0.51,P=0.040)、肱动脉血流介导舒张功能(FMD)(r=0.70,P=0.004)呈正相关。CTRP3水平[OR值(95%CI)=0.683(0.355,0.807),P=0.023]为影响cIMT的独立相关因素。结论就CTRP3水平而言,RA患者明显低于健康对照组,同时CTRP3水平和自身抗体水平、胰岛素抵抗以及疾病活动度表现出负相关关系,并对RA患者早发动脉粥样硬化起保护作用。ObjectiveTo investigate the changes of serum complement C1q/tumor necrosis factor-associated protein 3(CTRP3)in patients with rheumatoid arthritis(RA)and its clinical significance.MethodsA total of 60 RA patients admitted to Chongming Hospital affiliated to Shanghai University of Medicine&Health Sciences(Chongming Branch of Xinhua Hospital)from January 2023 to February 2024 were collected.They were divided into a plaque group(38 cases)and a plaque free group(22 cases)according to the results of carotid intima-media thickness(cIMT)by carotid artery ultrasonography.ESR,CRP,blood lipid,HOMA-IR,RF,CCP antibody and CTRP3 levels were detected,and the relationship between CTRP3 levels and disease activity and atherosclerosis in RA patients was analyzed.The statistical analysis was carried out with independent t-test,analysis of variance,Pearson correlation analysis and logistic regression.ResultsSerum CTRP3 level in RA patients was lower than that in healthy control group[(116±44)ng/ml and(184±63)ng/ml,t=-6.54,P=0.004].The CTRP3 level in RA group with plaque was lower than that in RA group without plaque[(98±28)ng/ml and(123±38)ng/ml,t=-5.57,P=0.008].Serum CTRP3 levels in RA patients were correlated with LDL-C(r=-0.68,P=0.011),HOMA-IR(r=-0.74,P=0.001),RF(r=-0.46,P=0.042),anti-CCP antibody(r=-0.54,P=0.037),DAS28(r=-0.66,P=0.024)were negatively correlated with cIMT(r=-0.76,P=0.001),and positively correlated with DMARDs duration(r=0.51,P=0.040)and flow-mediated di latatiton(r=0.70,P=0.004).The CTRP3 level[(OR(95%CI)=0.683(0.355,0.807),P=0.023]was an independent correlation factor affecting cIMT.ConclusionCTRP3 level in RA patients is significantly lower than that in healthy control group,and is negatively correlated with insulin resistance,autoantibody level and disease activity,and has a protective effect on early atherosclerosis in RA patients.

关 键 词：关节炎 类风湿 动脉粥样硬化 疾病活动度 补体C1q/肿瘤坏死因子相关蛋白3 

分 类 号：R593.22[医药卫生—内科学]