CAJ | 학술논문

目的探讨类风湿关节炎(RA)继发间质性肺疾病(RA-ILD)患者血清基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶组织抑制因子(TIMP-1)和转化生长因子β,(TGF-β1)的变化及其意义.方法 RA组29例,RA-ILD组28例(其中早期RA-ILD组16例,中晚期RA-ILD组12例),对照组为健康体检人员29名.采用ELASA法检测血清中MMP-9、TIMP-1和TGF-β1水平.计量资料用-x±s表示,多组间比较采用方差分析,两组间比较采用t检验,关节分级资料采用卡方检验.结果 RA组和RA-ILD组血清TIMP-1水平[(645±220)和(536±188)μg/L]明显高于对照组[(392±92)μg/L],RA-ILD组血清TGF-β1.水平[(13.1±10.0)μg/L]明显高于RA组和对照组[(3.9±2.9)和(2.4±1.7)μg/L],RA组与RA-ILD组血清TIMP-1水平、RA组与对照组血清TGF-β1的水平无明显差别.各组血清MMP-9水平和MMP-9/TIMP-1均无明显差别.中晚期RA-ILD组血清TIMP-1水平[(690±110)μg/L]明显高于早期RA-ILD组[(420±147)μg/L],中晚期RA-ILD组血清TGF-β1水平[(17.9±8.2)μg/L]明显高于早期RA-ILD组[(9.5±9.9)μg/L].中晚期RA-ILD组血清MMP-9/TIMP-1(0.9±0.1)明显低于早期RA-ILD组(1.2±0.4).早期RA-ILD组血清MMP-9水平[(537±309)μg/L]与中晚期RA-ILD组[(595±110)μg/L]无明显差别.结论血清TGF-β1可以作为RA患者ILD的诊断标志,且在一定程度上可反映RA-ILD肺部病变的严重程度.MMP-9/TIMP-1下降能反映肺部病变的严重程度.血清MMP-9水平不能作为RA-ILD的诊断指标及ILD肺部病变严重程度的判定指标.
목적 탐토류풍습관절염(RA)계발간질성폐질병(RA-ILD)환자혈청기질금속단백매-9(MMP-9)、기질금속단백매조직억제인자(TIMP-1)화전화생장인자β,(TGF-β1)적변화급기의의.방법 RA조29례,RA-ILD조28례(기중조기RA-ILD조16례,중만기RA-ILD조12례),대조조위건강체검인원29명.채용ELASA법검측혈청중MMP-9、TIMP-1화TGF-β1수평.계량자료용-x±s표시,다조간비교채용방차분석,량조간비교채용t검험,관절분급자료채용잡방검험.결과 RA조화RA-ILD조혈청TIMP-1수평[(645±220)화(536±188)μg/L]명현고우대조조[(392±92)μg/L],RA-ILD조혈청TGF-β1.수평[(13.1±10.0)μg/L]명현고우RA조화대조조[(3.9±2.9)화(2.4±1.7)μg/L],RA조여RA-ILD조혈청TIMP-1수평、RA조여대조조혈청TGF-β1적수평무명현차별.각조혈청MMP-9수평화MMP-9/TIMP-1균무명현차별.중만기RA-ILD조혈청TIMP-1수평[(690±110)μg/L]명현고우조기RA-ILD조[(420±147)μg/L],중만기RA-ILD조혈청TGF-β1수평[(17.9±8.2)μg/L]명현고우조기RA-ILD조[(9.5±9.9)μg/L].중만기RA-ILD조혈청MMP-9/TIMP-1(0.9±0.1)명현저우조기RA-ILD조(1.2±0.4).조기RA-ILD조혈청MMP-9수평[(537±309)μg/L]여중만기RA-ILD조[(595±110)μg/L]무명현차별.결론 혈청TGF-β1가이작위RA환자ILD적진단표지,차재일정정도상가반영RA-ILD폐부병변적엄중정도.MMP-9/TIMP-1하강능반영폐부병변적엄중정도.혈청MMP-9수평불능작위RA-ILD적진단지표급ILD폐부병변엄중정도적판정지표.
Objective To study the clinical significance of matrix metalloproteinase-9(MMP-9),tissue inhibitor of metalloprotenases(TIMPs)and transforming growth factor beta 1(TGF-β1)in the serum of patients with rheumatoid arthritis(RA)associated interstitial lung disease(ILD). Methods Twenty-nine patients with RA only(the RA group)and 28 patients with RA associated ILD (the RA-ILD group)were included in the study.Patients in the RA-ILD group were divided into 2 subgroups,16 in the early RA-ILD group and 12 in the late RA-ILD group.Twenty-nine healthy volunteers senred as the control group.ELISA was used to detect the levels of MMP-9,TIMP-1,TGF-β1 in the serum of the three groups.Results The TIMP-1 levels of both the RA and the RA-ILD groups[(645±220)μg/L,(536±188) μg/L]were significantly higher than that of the control group[(392±92)μg/L,F=15.221,P＜0.01].The TGF-β1 level of the RA-ILD group[(13.1±10.0)μg/L]was significantly higher than those of the control group and the RA group[(3.9±2.9)μg/L,(2.4±1.7)μg/L,F=26.455,P＜0.01].There was no difierence in the TIMP-1 level between RA-ILD and RA groups,the TGF-β1 level between the control group and the RA group,the MMP-9 level and MMP-9/TIMP-1 ratio among the three groups.The TIMP-1 level in the late RA-ILD group[(690±110)μg/L]was higher than that of the early RA-ILD group[(420±147)μg/L,t=-5.347,P＜0.01].The TGF-β1 level in the late RA-ILD group[(17.9±8.2)μg/L]was higher than that of the early RA-ILD group[(9.5±9.9)μg/L,t=-2.39,P＜0.05].The MMP-9/TIMP-1 ratio of the late RA-ILD group(0.9±0.1)was lower than that of the early RA-ILD group (1.2±0.4,z=4.307,P＜0.01).There was no statistic significance in the MMP-9 level between the early and the late RA-ILD groups[(537±309)μg/L,(595±110)μg/L,t=-1.397,P=0.174].Conclusions TGF-β1 can be used as a diagnostic marker of ILD in RA patients and it also reflects the pathological change of the lung.The decrease of MMP-9/TIMP-1 ratio in RA patients with ILD can reflect the severity degree of lung pathological changes.