中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
17期
1300-1304
,共5页
脊柱炎,强直性%骨化,异位性%硬骨素
脊柱炎,彊直性%骨化,異位性%硬骨素
척주염,강직성%골화,이위성%경골소
Spondylitis,ankylosing%Ossification,heterotopic%Sclerostin
目的 探讨强直性脊柱炎(AS)患者血清硬骨素水平与放射学变化的关系.方法 选择2012年5月至2013年12月南京医科大学第二附属医院风湿免疫科收治的65例AS患者(AS组),患者接受注射用重组人Ⅱ型肿瘤坏死因子受体—抗体融合蛋白(益赛普)治疗,随访1年.同期45例健康体检者作为对照组.分别在基线状态、治疗后12个月时评估AS患者各项临床指标(年龄、性别、病程、疾病活动度)、影像学进展以及炎症的指标[红细胞沉降率(ESR)、C反应蛋白(CRP)]、疾病功能指数依据BASFI评分标准,疾病活动指数依据BASDAI评分标准,活动度衡量指数依据BASMI评分标准,放射学指数依据BASRI评分标准,放射学进展以mSASSS评分标准为依据,采用酶联免疫法检测AS患者血清硬骨素浓度.运用相关分析法分析硬骨素与疾病活动度、影像进展及炎症生物标志的关系.结果 AS组在基线状态时ESR及血清CRP水平高于对照组,但硬骨素浓度(55.6±19.5) pmol/L低于对照组(78±27.6)pmol/L,P＜0.01;AS组在治疗12个月时,ESR及血清CRP水平较基线状态时明显下降(P＜0.01),治疗后12个月时,BASFI、BASMI和BASDI评分较基线状态时明显改善(P＜0.01),但在治疗后12个月时,硬骨素浓度(62±15.3) pmol/L较基线状态时稍有升高(P=0.25),仍低于对照组(78±27.6)pmoL/L,P＜0.01.ROC曲线分析显示,硬骨素水平62.75 pmol/L为截断点,该点诊断的敏感度为82.02％,特异度为91.50％,曲线下面积(AUC)为0.905;诊断效力高.相关分析显示,AS组患者在基线状态时和治疗后12个月时,血清硬骨素水平与ESR、CRP、BASFI、BASMI以及BASDAI评分无明显相关性.而放射学指数BASRI及影像学mSASSS评分在基线状态和治疗后差异无统计学意义,且mSASSS评分与硬骨素水平在基线状态和治疗12个月时呈显著负相关(r=-0.768,P＜0.01).结论 TNF拮抗剂对AS患者血清硬骨素水平无明显影响,且血清硬骨素水平与放射学评分具有明显相关性,提示血清硬骨素的产生可能与炎症状态无明显相关性,TNF拮抗剂可能对AS骨化进程无明显阻止作用.AS患者血清硬骨素可作为一种新的血清诊断骨化指标及反映影像学进展的生物标志.
目的 探討彊直性脊柱炎(AS)患者血清硬骨素水平與放射學變化的關繫.方法 選擇2012年5月至2013年12月南京醫科大學第二附屬醫院風濕免疫科收治的65例AS患者(AS組),患者接受註射用重組人Ⅱ型腫瘤壞死因子受體—抗體融閤蛋白(益賽普)治療,隨訪1年.同期45例健康體檢者作為對照組.分彆在基線狀態、治療後12箇月時評估AS患者各項臨床指標(年齡、性彆、病程、疾病活動度)、影像學進展以及炎癥的指標[紅細胞沉降率(ESR)、C反應蛋白(CRP)]、疾病功能指數依據BASFI評分標準,疾病活動指數依據BASDAI評分標準,活動度衡量指數依據BASMI評分標準,放射學指數依據BASRI評分標準,放射學進展以mSASSS評分標準為依據,採用酶聯免疫法檢測AS患者血清硬骨素濃度.運用相關分析法分析硬骨素與疾病活動度、影像進展及炎癥生物標誌的關繫.結果 AS組在基線狀態時ESR及血清CRP水平高于對照組,但硬骨素濃度(55.6±19.5) pmol/L低于對照組(78±27.6)pmol/L,P＜0.01;AS組在治療12箇月時,ESR及血清CRP水平較基線狀態時明顯下降(P＜0.01),治療後12箇月時,BASFI、BASMI和BASDI評分較基線狀態時明顯改善(P＜0.01),但在治療後12箇月時,硬骨素濃度(62±15.3) pmol/L較基線狀態時稍有升高(P=0.25),仍低于對照組(78±27.6)pmoL/L,P＜0.01.ROC麯線分析顯示,硬骨素水平62.75 pmol/L為截斷點,該點診斷的敏感度為82.02％,特異度為91.50％,麯線下麵積(AUC)為0.905;診斷效力高.相關分析顯示,AS組患者在基線狀態時和治療後12箇月時,血清硬骨素水平與ESR、CRP、BASFI、BASMI以及BASDAI評分無明顯相關性.而放射學指數BASRI及影像學mSASSS評分在基線狀態和治療後差異無統計學意義,且mSASSS評分與硬骨素水平在基線狀態和治療12箇月時呈顯著負相關(r=-0.768,P＜0.01).結論 TNF拮抗劑對AS患者血清硬骨素水平無明顯影響,且血清硬骨素水平與放射學評分具有明顯相關性,提示血清硬骨素的產生可能與炎癥狀態無明顯相關性,TNF拮抗劑可能對AS骨化進程無明顯阻止作用.AS患者血清硬骨素可作為一種新的血清診斷骨化指標及反映影像學進展的生物標誌.
목적 탐토강직성척주염(AS)환자혈청경골소수평여방사학변화적관계.방법 선택2012년5월지2013년12월남경의과대학제이부속의원풍습면역과수치적65례AS환자(AS조),환자접수주사용중조인Ⅱ형종류배사인자수체—항체융합단백(익새보)치료,수방1년.동기45례건강체검자작위대조조.분별재기선상태、치료후12개월시평고AS환자각항림상지표(년령、성별、병정、질병활동도)、영상학진전이급염증적지표[홍세포침강솔(ESR)、C반응단백(CRP)]、질병공능지수의거BASFI평분표준,질병활동지수의거BASDAI평분표준,활동도형량지수의거BASMI평분표준,방사학지수의거BASRI평분표준,방사학진전이mSASSS평분표준위의거,채용매련면역법검측AS환자혈청경골소농도.운용상관분석법분석경골소여질병활동도、영상진전급염증생물표지적관계.결과 AS조재기선상태시ESR급혈청CRP수평고우대조조,단경골소농도(55.6±19.5) pmol/L저우대조조(78±27.6)pmol/L,P＜0.01;AS조재치료12개월시,ESR급혈청CRP수평교기선상태시명현하강(P＜0.01),치료후12개월시,BASFI、BASMI화BASDI평분교기선상태시명현개선(P＜0.01),단재치료후12개월시,경골소농도(62±15.3) pmol/L교기선상태시초유승고(P=0.25),잉저우대조조(78±27.6)pmoL/L,P＜0.01.ROC곡선분석현시,경골소수평62.75 pmol/L위절단점,해점진단적민감도위82.02％,특이도위91.50％,곡선하면적(AUC)위0.905;진단효력고.상관분석현시,AS조환자재기선상태시화치료후12개월시,혈청경골소수평여ESR、CRP、BASFI、BASMI이급BASDAI평분무명현상관성.이방사학지수BASRI급영상학mSASSS평분재기선상태화치료후차이무통계학의의,차mSASSS평분여경골소수평재기선상태화치료12개월시정현저부상관(r=-0.768,P＜0.01).결론 TNF길항제대AS환자혈청경골소수평무명현영향,차혈청경골소수평여방사학평분구유명현상관성,제시혈청경골소적산생가능여염증상태무명현상관성,TNF길항제가능대AS골화진정무명현조지작용.AS환자혈청경골소가작위일충신적혈청진단골화지표급반영영상학진전적생물표지.
Objective To explore the serum level of sclerostin in ankylosing spondylitis (AS) patients and evaluate its diagnostic value and the relationship of sclerostin with inflammation and ossification process in AS.Methods A total of 75 AS patients and 45 healthy controls were enrolled into this randomized controlled study.The clinical indices (age,gender,course of disease and disease activity),changes in radiographic studies and indices of bone metabolism or inflammation,including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated or measured.The disease activity was assessed by Bath ankylosing spondylitis disease activity index (BASDAI),Bath ankylosing spondylitis functional index (BASFI),Bath ankylosing spondylitis metrology index (BASMI) and Bath arthritis spondylitis radiology index (BASRI).And radiographic changes were evaluated according to the modified Stoke AS spine score (mSASSS) and serum level of sclerostin was measured by enzyme-linked immunosorbent assay (ELISA).The relationship between sclerostin and clinical indices,radiographic scores and inflammatory indices was estimated by SPSS software and the diagnostic value of sclerostin analyzed by receiver operator characteristic (ROC) curve.Results The levels of ESR and CRP were higher in AS patients than those in healthy controls.However,serum sclerostin was lower (55.6 + 19.5 pmol/L) compared with healthy controls (78 ±+27.6 pmol/L,P ＜0.01).ROC analysis revealed that the diagnostic specificity and sensitivity of sclerostin were 91.5％ and 82.02％ respectively with a cut-off of 62.75 pmol/L (Youden index 0.735,AUC 0.905,95％ Cl 0.812-0.947).And the diagnostic validity was high.No significant correlation existed between sclerostin and ESR,CRP,BASDAI,BASMI and BASFI scores.ESR,CRP,BASDAI,BASMI and BASFI score were improved significantly in AS patients after anti-TNF treatment compared with baseline (P ＜ 0.01).There was little difference between BASRI and mSASSS score after anti-TNF treatment compared with baseline (P =0.19,0.67).A significant negative correlation existed between the radiographic progression in spine of patients with AS and sclerostin serum levels (r =0.768,P ＜ 0.01).This correlation became stronger when radiographic scores rose (mSASSS ＞ 10,r =0.768,P ＜ 0.01) and it diminished when radiographic scores dropped (0 ＜ mSASSS ＜ 10,r =-0.097,P =0.43).Conclusion Serum sclerostin may serve as a diagnostic biomarker of AS and progression index of ossification,especially in late stage of AS.A low serum level of sclerostin in the setting of AS is linked to greater structural damage.
