摘要
目的探讨软骨细胞蛋白聚糖异常代谢与RA患者关节病变的相关性。方法本研究选取病程〈24个月的RA患者140例，对照组为健康人群100名及其他风湿病患者95例。采用竞争性ELISA法，通过针对蛋白聚糖代谢片段的单克隆抗体（5D4，7D4及BC-3）检测3组人群血清中的蛋白聚糖代谢片段并进行比较，同时记录RA患者人口学资料、临床及实验室指标；在入选及随诊1年时使用改良Sharp评分法评估患者的关节病变，以多元线性回归分析Sharp评分的影响因素，受试者工作特征曲线（ROC曲线）分析蛋白聚糖检测对关节病变进展的预测价值。结果RA患者蛋白聚糖5D4及BC-3代谢片段明显高于健康对照组[5D4：RA患者（5．8±2．1）ng／μl，健康对照组（2．2±1．3）ng／μl；BC-3：RA患者（11．1±3．4）ng/μl，健康对照组（5．0±2．1）ng／μl，F值分别为38．65，24．07，P值均〈0．01]；抗CCP抗体阳性的RA患者的2种代谢片段水平明显高于阴性患者[5D4：抗CCP抗体阳性组（5．6±1．3）ng／μl，阴性组（4．4±1．1）g／μl，F=21．23，P〈0．01；BC-3：抗CCP抗体阳性组（12．2±3．9）ng／μl，阴性组（9．3±2．8）g／μl，F=27．14，P〈0．01]；随访1年RA患者Sharp评分的多因素分析结果显示：5D4代谢片段、BC-3代谢片段及抗CCP抗体阳性为Sharp评分进展的危险因素。联合检测血清两种代谢片段，ROC曲线评估它们对关节病变Sharp评分的预测性，结果显示敏感性56．5％，特异性84．2％，阳性预测值74．3％，阴性预测值70．6％，ROC曲线下面积为0．798。结论RA患者血清蛋白聚糖5D4及BC-3两种代谢片段与关节早期病变有一定的相关性，可进一步研究确定它们作为RA关节进展的预测价值。
Objective To investigate the relationship between abnormal metabolism of aggrecan and joint destruction in patients with rheumatoid arthritis （RA）. Methods 140 RA patients with duration less than 24 months were enrolled into this study. The study also included 100 normal controls and 95 patients with other rheumatic diseases. Three monoclonal antibodies （5D4, 7D4 and BC-3） of aggrecan were used to detected aggrecan catabolic fragments in serum of RA patients and the other two groups of controls by enzyme linked immunosorbent assay （ELISA）, and the correlation of aggrecan catabolic fragments with joint damage were analyzed. Sharp evaluation of hand joints in RA patients were performed at baseline and after one year follow- up. Calculating the area under the receiver operating characteristic curve （ROC） was used to evaluate the sensitivity and specificity of aggrecan catabolic fragments detected in serum of RA patients. Results Both levels of 5D4 fragment and BC-3 fragment of RA group were higher than those of normal control [5D4 of RA： （5.8±2.1） ng/μl,normal control： （2.2±1.3） ng/μl; BC-3 of RA： （11.1±3.4） ng/μl, normal control： （5.0±2.1） ng/μl,F=38.65, 24.07, P〈0.001）. There was no difference in 7D4 fragment among three groups （F=0.589, P=0.478）. Both two fragment levels of RA patients with anti-CCP positive were greater than those patients with anti-CCP negative [5D4： （5.6±1.3） ng/μl vs （4.4±1.1） ng/μl, F=21.23, P〈0.01; BC-3： （12.2±3.9） ng/μl vs （9.3±2.8） ng/μl, F=27.14, P〈0.01]. Linear Regression showed that serum fragments detected by 5D4 and BC-3, and anti-CCP positive were risk factors for Sharp deterioration after one year follow-up. The sensitivity and specificity of combined detection of two aggrecan fragments in serum of RA patients for the prediction of joint Sharp were 56.5% and 84.2% respectively. Positive predictive value and negative predictive value are 74.3% and 70.6%. respectively. Application of areas of ROC
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2017年第3期172-177,共6页
Chinese Journal of Rheumatology
基金
北京市科技计划课题（Z121107001012019）
