摘要
目的 探讨血清抗环瓜氨酸肽(CCP)抗体、25-羟维生素D[25-(OH)D]、基质金属蛋白酶(MMP)-2、MMP-9水平对类风湿性关节炎(RA)患者骨侵蚀的预测价值。方法 选择2019年1月至2022年1月通许第一医院收治的83例RA患者为研究对象。所有患者入组后给予非甾体抗炎药双氯芬酸钠缓释胶囊(每粒25 mg),口服,每日3次,每次1粒,连续用药4周。于治疗前,设计基线资料调查表,记录患者的性别、年龄、病程、疾病类型、晨僵时间、受累关节数目等一般资料。所有患者完成4周药物治疗后接受X线检查评估骨侵蚀情况,根据X线检查结果将患者分为骨侵蚀组(n=44)和非骨侵蚀组(n=39)。治疗前采用酶联免疫吸附法检测患者血清中MMP-2、MMP-9、抗CCP抗体、25-(OH)D水平,采用流式细胞术检测患者外周血中辅助性T细胞17(Th17)水平。采用logistic回归分析RA患者治疗后骨侵蚀发生的危险因素;绘制受试者操作特征(ROC)曲线分析血清MMP-2、MMP-9、抗CCP抗体、25-(OH)D水平对RA患者治疗后骨侵蚀发生的预测价值。结果 骨侵蚀组患者的血清MMP-2、MMP-9、抗CCP抗体水平显著高于非骨侵蚀组,25-(OH)D水平显著低于非骨侵蚀组(P<0.05)。骨侵蚀组与非骨侵蚀组患者的年龄、性别、病程、疾病类型、晨僵时间、受累关节数目及Th17水平比较差异无统计学意义(P>0.05)。Logistic回归分析结果显示,血清MMP-2、MMP-9、抗CCP抗体过表达和25-(OH)D低表达是RA患者治疗后发生骨侵蚀的危险因素(P<0.05)。ROC曲线分析显示,血清MMP-2、MMP-9、抗CCP抗体、25-(OH)D水平预测RA患者治疗后发生骨侵蚀的截断值分别为493.979 ng·L^(-1)、400.554 ng·L^(-1)、0.18 Ru·L^(-1)、28.885μg·L^(-1),曲线下面积分别为0.813、0.809、0.852、0.867。结论 血清MMP-2、MMP-9、抗CCP抗体过表达及25-(OH)D低表达是RA患者非甾体抗炎药治疗后发生骨侵蚀的危险因素,血清抗CCP抗体、25-(OH)D、MMP-2、MMP-9水平对RA患者非甾体抗炎药治疗后骨侵蚀的发生有一定预测价值。
Objective To investigate the predictive value of serum anti-cyclic citrullinated peptide(CCP)antibody,25-hydroxyvitamin D[25-(OH)D],matrix metalloproteinase(MMP)-2 and MMP-9 for bone erosion in patients with rheumatoid arthritis(RA).Methods A total of 83 RA patients admitted to Tongxu First Hospital from January 2019 to January 2022 were selected as the research subjects.After enrollment,all patients were given the non-steroidal anti-inflammatory drug diclofenac sodium sustained-release capsules(25 mg per capsule)orally,three times a day,one capsule each time,for four consecutive weeks.Before treatment,a baseline data questionnaire was designed to record general information such as the patient′s gender,age,course of disease,disease type,time of morning stiffness and number of affected joints.After completing 4 weeks of medication treatment,all patients underwent X-ray examination to evaluate their bone erosion status.Based on the X-ray examination results,the patients were divided into bone erosion group(n=44)and non-bone erosion group(n=39).Before treatment,serum levels of MMP-2,MMP-9,anti-CCP antibody and 25-(OH)D were measured by enzyme-linked immunosorbent assay,and peripheral blood helper T cell 17(Th17)level was measured by flow cytometry.The risk factors for bone erosion in RA patients after treatment were analyzed by logistic regression analysis;the predictive value of serum MMP-2,MMP-9,anti-CCP antibody and 25-(OH)D levels on the occurrence of bone erosion in RA patients after treatment was analyzed by receiver operating characteristic(ROC)curve.Results The serum levels of MMP-2,MMP-9 and anti CCP antibody of patients in the bone erosion group were significantly higher than those in the non-bone erosion group(P<0.05),and the level of 25-(OH)D was significantly lower than that in the non-bone erosion group(P<0.05).There was no significant difference in age,gender,course of disease,disease type,morning stiffness time,number of affected joints and Th17 level of patients between the bone erosion group and the non-bone erosion group(P>0.05).The results of logistic regression analysis showed that overexpression of serum MMP-2,MMP-9,anti-CCP antibody and low expression of 25-(OH)D were risk factors for bone erosion in RA patients after treatment(P<0.05).ROC curve analysis showed that the cutoff values of serum MMP-2,MMP-9,anti-CCP antibody and 25-(OH)D levels predicting bone erosion in RA patients after treatment were 493.979 ng·L^(-1),400.554 ng·L^(-1),0.18 Ru·L^(-1) and 28.885μg·L^(-1),respectively;the area under the curve were 0.813,0.809,0.852 and 0.867,respectively.Conclusion Overexpression of serum MMP-2,MMP-9,anti-CCP antibody,and low expression of 25-(OH)D are risk factors for bone erosion in RA patients after non-steroidal anti-inflammatory drug treatment;serum anti-CCP antibody,25-(OH)D,MMP-2 and MMP-9 levels have certain predictive value for the occurrence of bone erosion in RA patients after non-steroidal anti-inflammatory drug treatment.
作者
贾自晓
JIA Zixiao(Department of Clinical Laboratory,Tongxu First Hospital,Tongxu 475400,Henan Province,China)
出处
《新乡医学院学报》
CAS
2023年第10期932-936,944,共6页
Journal of Xinxiang Medical University
