正五聚体蛋白-3(PTX-3)评估多发性大动脉炎(TA)病情活动性的价值

 目的  探索正五聚体蛋白-3(pentraxin-3,PTX-3)在评估多发性大动脉炎(Takayasu′s arteritis,TA)病情活动性方面的价值。 方法  选取2010年10月至2012年3月就诊于复旦大学附属中山医院风湿科的TA患者45名、健康体检者25名及类风湿关节炎(rheumatoid arthritis,RA)患者10名,采用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISAs)检测血浆PTX-3水平,采用Kerr指标作为疾病活动性评定的金标准。结果   TA患者血浆PTX-3水平显著高于健康人［(18.5±13.9) ng/mL vs. (0.52±0.26) ng/mL,P<0.01］和RA患者［(18.5±13.9) ng/mL vs. (0.73±0.47) ng/mL,P<0.01］;且活动期患者PTX-3水平显著高于稳定期患者［(26.7±16.8) ng/mL vs. (6.2±4.7) ng/mL,P< 0.01］,并与疾病活动性评分呈正相关(Rho=0.78,P<0.01);而健康人与RA患者血浆PTX-3水平差异无统计学意义。结合其他实验室检查及影像学结果分析后发现,TA患者血浆PTX 3水平与血清基质金属蛋白酶(matrix metalloproteinase,MMP) 9水平(Rho=0.65,P<0.01)、全身血管磁共振(magnetic resonance imaging,MRI)上受累血管管腔狭窄程度(Rho=0.67,P=0.04)及管壁增厚程度(Rho=0.54,P=0.05)呈正相关。ROC曲线分析表明,PTX-3(≥10.71 ng/mL)在评估TA活动性方面的敏感性为88.89%,特异性为77.78%,准确性为84.44% ( ROC 曲线下面积=0.95,95% CI:0.89~1.00)。结论   PTX-3有望成为一种评估TA病情活动性的有效的血清学指标,且其血浆水平可能反映了患者血管损伤情况,用于监测疾病活动性。

The value of pentraxin- (PTX-) for evaluating disease status in Takayasu′s arteritis (TA)

Objective  To investigate the value of pentraxin-3 (PTX-3) for evaluating the disease status in Takayasu′s arteritis (TA).Methods   Circulating PTX-3 level was determined in 45 Chinese TA patients,25 healthy donors and 10 rheumatoid arthritis (RA) patients from October,2010 to March,2012.Enzyme linked immunosorbent assay (ELISA) was employed to detect the plasma PTX-3 level.Kerr′s index was used as the golden standard of disease activity.Results    PTX-3 plasma level in TA patients was significantly higher than those in healthy controls ［(18.5±13.9)  ng/mL vs. (0.52±0.26) ng/mL,P<0.01］ and RA patients ［(18.5±13.9) ng/mL vs. (0.73±0.47 ng/mL),P<0.01］;however,PTX-3 levels were similar in healthy donors and RA controls (P=0.49).Plasma level of PTX-3 was significantly higher in active TA than inactive TA patients ［(26.7±16.8) ng/mL vs. (6.2±4.7) ng/mL,P< 0.01］,and was positively related to TA disease activity score (Rho=0.78,P<0.01) and serum MMP-9 levels (Rho=0.65,P<0.01).Furthermore,plasma PTX-3 level was positively related to the serum matrix metalloproteinase 9 (MMP-9) level (Rho=0.65,P<0.01),severity of lumen stenosis (Rho=0.67,P=0.04) and wall thickness (Rho=0.54,P=0.05) on the delayed contrast enhanced magnetic resonance imaging (MRI) of TA patients.PTX-3 (≥10.71 ng/mL) had a sensitivity,specificity and accuracy of 88.89%,77.78% and 84.44% to identify TA disease activity (area under the ROC curve=0.95,95% CI:0.89 1.00).Conclusions   PTX-3 may be sensitive and specific for the evaluation of disease status in TA,and might also reflect prior vessel damage,and monitor disease progression.