ANGPTL4、RANKL在类风湿关节炎患者血清及关节液中的表达水平及其相关性研究  

Expression and correlation of ANGPTL4 and RANKL in serum and synovial fluid of patients with rheumatoid arthritis

作　　者：王玉梅[1] 刘秀梅[2] 郑晓[1] 孙伟[3] 

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第一医院风湿免疫科,太原030001 [3]北方自动控制技术研究所,太原030001

出　　处：《中华临床医师杂志（电子版）》2017年第10期1691-1695,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的测定类风湿关节炎(RA)患者血清及关节液中血管生成素样蛋白4(ANGPTL4)4及核因子-κB受体活化因子配体(RANKL)的表达水平,探讨二者与RA患者疾病活动的关系以及在RA患者的发病中是否具有协同作用。方法选择山西医科大学第一医院2016年1至9月门诊及住院部RA患者67例、骨关节炎(OA)患者20例及健康体检者20例;同期收集本院住院部RA患者关节液17例及OA患者关节液10例,用酶联免疫吸附试验(ELISA)方法分别测定各组血清及关节液中ANGPTL4、RANKL的水平。采用t检验、Mann-Whitney U检验、单因素方差分析、Kruskal Wallis H检验、Person相关分析进行统计学分析。结果 (1)RA患者血清中ANGPTL4、RANKL的表达水平[(5.89±2.90)ng/ml,(198.14±132.3)pg/ml]显著高于OA组[(2.97±0.86)ng/ml,(82.32±19.40)pg/ml]及健康组[(2.87±0.99)ng/ml,(81.51±21.30)pg/ml](Z值分别为:-5.720,-5.801,-5.387,-5.125;P均<0.05);(2)ANGPTL4、RANKL在RA患者的高活动组[(8.18±3.81)ng/ml,(309.47±162.25)pg/ml]与中活动组[(5.62±1.39)ng/ml,(191.36±63.43)pg/ml]、高活动组与低缓组[(4.05±0.77)ng/ml,(102.03±34.22)pg/ml]、中活动组与低缓组之间差异有统计学意义(H值分别为:11.082,9.976;29.511,30.708;19.485,23.483;P均<0.05);(3)RA患者血清中ANGPTL4与RANKL的表达水平呈正相关(r=0.979,P<0.05);二者分别与RA患者年龄、病程、ESR、CRP、关节肿胀数、关节压痛数、DAS28评分呈正相关(r值分别为:0.315,0.300;0.465,0.444;0.624,0.634;0.288,0.295;0.722,0.740;0.683,0.726;0.682,0.727;P均<0.05);(4)RA患者关节液中ANGPTL4、RANKL的表达水平[(7.68±5.41)ng/ml,(296.93±254.48)pg/ml]显著高于OA组[(2.45±0.50)ng/m,(80.76±24.06)pg/ml](t=3.021,t=2.658;P均<0.05)。结论 ANGPTL4可能协同RANKL参与RA患者的免疫炎症及骨质破坏过程,其有可能作为除RANKL/RANK途径之外的RA患者病情活动及关节破坏的指标之一来评估及检测RA患者的病情。Objective To detect the expression of angiopoietin-like protein-4(ANGPTL4) and receptor activator of NF-κB ligand(RANKL) in serum and synovial fluid of patients with rheumatoid arthritis(RA), and to explore the relationship between them and disease activity of RA patients, and whether they have synergistic effects in the pathogenesis of RA. Methods Serum were collected from 67 RA patients from Shanxi Medical University First Hospital from January 2016 to September 2016, 20 patients with osteoarthritis(OA) and 20 healthy subjects; At the same time, we collected 17 cases of joint fluid in RA patients and 10 cases of OA patients. The levels of ANGPTL4 and RANKL in serum and synovial fluid were determined by ELISA. Mann-Whitney U test, t test, one-way ANOVA, Kruskal Wallis H test and Person correlation analysis were used for statistical analysis. Results(1) The levels of ANGPTL4 and RANKL in serum of RA patients [(5.89±2.90) ng/ml,(198.14±132.3) pg/ml] were significantly higher than those of OA patients [(2.97±0.86) ng/ml,(82.32±19.40) pg/ml] and healthy controls [(2.87±0.99) ng/ml,(81.51±21.30) pg/ml](Z values were-5.720,-5.801,-5.387,-5.125; all P<0.05).(2) The serum levels of ANGPTL4 and RANKL in RA patients was significantly different between high activity group [(8.18±3.81) ng/ml,(309.47±162.25) pg/ml] and moderate activity group [(5.62±1.39) ng/ml,(191.36±63.43) pg/ml], high activity group and low group [(4.05±0.77) ng/ml,(102.03±34.22) pg/ml], moderate activity group and low group(H values were 11.082, 9.976; 29.511, 30.708; 19.485, 23.483; all P<0.05).(3) There was a positive correlation between the serum levels of ANGPTL4 and RANKL in RA patients(r=0.979, P<0.05), and the two were positively correlated with age, course of disease, ESR, CRP, joint swelling number, joint tenderness, DAS28(r values were 0.315, 0.300; 0.465, 0.444; 0.624, 0.634; 0.288, 0.295; 0.722, 0.740; 0.683, 0.726; 0.682, 0.727; all P<0.05).(4) The expression of ANGPTL4 and RANKL in synovial fluid of RA patients [(7.68±5.41) n

关 键 词：关节炎 类风湿 血管生成素样蛋白4 核因子-ΚB受体活化因子配体 

分 类 号：R593.22[医药卫生—内科学]