血清基质金属蛋白酶-3检测在类风湿关节炎中的临床意义

目的探讨血清基质金属蛋白酶-3（MMP-3）与在类风湿关节炎（RA）的临床关系。方法 （1）用酶联免疫吸附法（ELISA）检测40例活动期RA患者（RA组）及20例健康人（对照组）血清MMP-3水平;（2）40例活动期RA患者经来氟米特（LEF）治疗2周4、周8、周、12周、24周,分析MMP-3水平变化及其与临床指标的关系。结果 （1）RA组血清MMP-3浓度为（158.63±36.91）ng/ml,高于对照组的（30.97±14.26）ng/ml,差异有统计学意义（P〈0.01）;（2）RA组血清MMP-3水平与肿胀指数、压痛指数、C反应蛋白（CRP）、红细胞沉降率（ESR）、类风湿因子（RF）、X线分期评分、疾病活动度积分（DAS28）成正相关（r分别为：0.334、0.363、0.512、0.436、0.509、0.493,P均〈0.05）,与晨僵时间无相关关系（r=0.212,P〉0.05）;（3）RA组不同X线分期：Ⅰ期（118.72±37.29）ng/ml与Ⅱ期（154.62±26.59）ng/ml、Ⅱ期与Ⅲ期（174.55±21.70）ng/ml、Ⅲ期与Ⅳ期（200.78±20.56）ng/ml,MMP-3水平比较差异均有统计学意义（P〈0.001）;（4）RA组治疗2周4、周、8周1、2周2、4周血清MMP-3水平分别为（156.48±40）ng/ml、（132.23±35.91）ng/ml（、114.75±22.57）ng/ml（、102.26±20.49）ng/ml（、108.14±47.62）ng/ml,MMP-3水平下降差异有统计学意义（除治疗后2周外,P均〈0.05）;（5）RA组晨僵时间、肿胀指数、压痛指数、ESR、CRP、RF、DAS28等治疗后24周较治疗前均改善（P均〈0.05）;（6）治疗终点病情缓解9例,血清MMP-3浓度（71.26±24.39）ng/ml仍高于对照组（P〈0.01）;（7）经有序多分类Logistic回归分析基线水平的疗效影响因素有MMP-3、RF、压痛关节数。结论活动期RA患者血清MMP-3的水平比正常人升高,MMP-3在RA的病情发展中扮演重要角色;MMP-3与骨侵蚀关系密切,是RA关节破坏的重要因素,其水平影响RA的预后,可能是预测关节破坏的指标。

Clinical Significance of Serum Matrix Metalloproteinase-3 in Rheumatoid Arthritis

Objective To investigate the serum concentration of Matrix metalloproteinase 3 in patients with rheumatoid arthritis（RA）and its clinical significance.Methods（1）40 active RA patients and 20 normal controls were assessed by enzyme-linked immunosorbent assay（ELISA）to investigate the relation between serum levels of MMP-3 in active RA patients（RA group）and 20 healthy controls（control group）.（2）40 RA patients（treatment group）were treated by leflunomide,and MMP-3 was detected in 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks.Concurrently,changes of MMP-3 at baseline and after therapy and the clinic indexes were analyzed.Results（1）Serum MMP-3 levels in the active RA patients[（158.63±36.91）ng/ml]was higher than that in normal controls[（30.97±14.26）ng/ml],the difference was significant（P0.01）.（2）Serum MMP-3 levels in active RA had positive correlations with C reaction protein（CRP）,erythrocyte sedimentation rate（ESR）,rheumatoid factor（RF）,swelling index,Ritchie index,X-ray score,DAS28 score（P0.05）,and had no relation with stiff time（P0.05）.（3）The levels of MMP-3 between phase Ⅰ[（118.72±37.29）ng/ml]and phase Ⅱ[（154.62±26.59） ng/ml],phase Ⅱ and phase Ⅲ[（174.55±21.70） ng/ml],phase Ⅲ and phase Ⅳ[（200.78±20.56） ng/ml]in RA group were statistically significant（P0.05）.（4）2 weeks,4 weeks,8 weeks,12 weeks,24 weeks after therapy,the levels of MMP-3 in RA treatment group were（156.48±40） ng/ml,（132.23±35.91）ng/ml,（114.75±22.57）ng/ml,（102.26±20.49） ng/ml,（108.14±47.62） ng/ml,respectively.The decrease of the serum concentration of MMP-3 were statistically significant（except for 2 weeks after therapy P0.05）.（5）Stiff time,swelling index,Ritchie index,ESR,CRP,RF,DAS28 scores of RA group in 24 weeks after therapy improved（P0.05）in comparison with the cases at baseline.（6）The symptoms of 9 patients relieved 24 weeks after therapy,though the concentration of MMP-3 in this group was still higher [（71.26 ±24.39）ng/ml] than that in normal controls（P0.01）.（7）The factors that had affected curative effect including MMP-3,RF and Ritchie index by the means of the order in all Logistic regression analysis.Conclusion The levels of the MMP-3 in active RA patients are higher than that in the normal people,and MMP-3 plays an important role in the development of RA;MMP-3 is closely related to bony erosion,which is an important factor of articular destruction,the level would affect the prognosis of RA patients and it probably be an indicator of predicting articular destruction.