血清软骨寡聚基质蛋白检测在关节炎患者中的意义研究

目的 探讨血清软骨寡聚基质蛋白(COMP)在各类关节炎患者中的差别及对类风湿关节炎(RA)软骨破坏放射学改变的早期预测价值.方法 采用酶联免疫吸附试验(ELISA)方法测定并对比分析154例各类关节炎患者血清COMP水平的差异,RA患者各项临床指标及2年后关节放射学改良SHARP(vdH-Sharp)指数评分与COMP行相关性分析.结果 与仅有滑膜损害的其他关节炎患者及正常人群比较,RA患者血清COMP显著升高(P＜0.05).骨关节炎(OA)、银屑病关节炎(PSA)患者与正常人群比较血清COMP亦有差异,而与其他滑膜关节炎患者比较差异不大.RA、OA、PSA患者间血清COMP值比较差异无统计学意义.RA患者2年随访发现COMP与患者关节X线的改良SHARP评分前后差值呈正相关(P＜0.01,r=0.848).但与初诊时的抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)、关节功能、改良SHARP评分均无相关性,与初诊时的红细胞沉降率(ESR)、C反应蛋白(CRP)、晨僵时间、关节肿胀、压痛指数相关(P＜0.05).结论 COMP在各类软骨受侵犯关节炎尤其是RA患者血清中异常增高,提示其可为RA软骨病变早期诊断及判断软骨病变进展、预后和治疗效果的一项理想指标.

Serum cartilage oligomeric matrix protein levels in patients with inflammatory arthritis

Objective To explore the association between serum cartilage oligomeric matrix protein (COMe) levels and joint destruction in rheumatoid arthritis (RA) and inflammatory arthritis patients. Methods Serum level of COMP was measured with ELISA in 154 arthritis patients.The results of serum COMe were compared with clinical parameters and the modified SHARe scores after 2 years in RA patients. Results Serum COMP level of RA patients was higher than that of normal controls and patients with other forms of arthritis in which only synovial membrane was involved (P＜0.05).We found a significant difference between sCOMP in osteoarthritis (OA) and psoriatic arthritis (PSA) patients with normal controls ,but not with other forms of arthritis.There was no difference of sCOMP between RA,OA or PSA patients.We found a positive correlation between baseline sCOMP and deterioration of modified SHARP scores after 2 years (P＜ 0.001,r=0.848),but did not find correlation between the baseline sCOMP and the titer of anti-CCP,RF, grade of joint function and modified SHARP scores at baseline.We also found a significant correlation between sCOMP and ESR or CRP levels,duration of morning stiffness,joint swelling scores and tenderness scores re spoctively (P＜0.05).Conclusion Serum COMP level is elevated in arthritis patients whose joint cartilage is also involved,particularly in patients with RA.The results of this study indicate that serum COMe may be used as a diagnostic and prognostic marker for cartilage destruction in established RA patients.