CAJ | 학술논문

目的：探讨强直性脊柱炎（AS）患者血清 Dickkopf 相关蛋白（DKK1）与冠状动脉钙化和脊柱骨化之间的关系，分析影响 AS 患者心血管钙化的危险因素。方法75例 AS 患者和70例正常对照者作为研究对象。采用 ELISA 法测定2组受试者血清中 DKK1的含量。采用64排螺旋 CT 扫描心脏计算冠状动脉钙化积分（CACS），用无创性全自动动脉测量仪器测量患者的脉搏传导速度（PWV），以 X 线记录的 AS 患者改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）作为评价骨化进展的放射学指标。运用相关分析法分析 DKK1水平与 CACS、PWV、mSASSS 评分及临床活动指标之间的关系。结果AS 患者血中 DKK1水平明显低于对照组（P ＜0．01）；AS 组患者 CACS、PWV均明显高于对照组（P ＜0．01）；与非钙化组相比，钙化组 DKK1水平显著增高（P ＜0．01），而钙化组mSASSS 评分明显升高；其中 DKK1水平与 CACS、PWV、mSASSS 评分呈明显负相关（P ＜0．05），而CACS、PWV 与 mSASSS 评分明显正相关（P ＜0．05）。在受试者工作特征曲线下，冠状动脉钙化的最佳 DKK1界值为54．3（曲线下面积为0．82，95％CI：0．71～0．87，敏感性为60％，特异性为81％），多元回归分析显示血清 DKK1水平是 CACS 独立危险因素。结论AS 患者血中 DKK1水平的降低伴随动脉粥样硬化和脊柱骨化的发生，DKK1可能同时参与了 AS 患者心血管疾病及韧带骨赘的发生，可作为预测心血管钙化及骨化程度的生物学指标。
목적：탐토강직성척주염（AS）환자혈청 Dickkopf 상관단백（DKK1）여관상동맥개화화척주골화지간적관계，분석영향 AS 환자심혈관개화적위험인소。방법75례 AS 환자화70례정상대조자작위연구대상。채용 ELISA 법측정2조수시자혈청중 DKK1적함량。채용64배라선 CT 소묘심장계산관상동맥개화적분（CACS），용무창성전자동동맥측량의기측량환자적맥박전도속도（PWV），이 X 선기록적 AS 환자개량 Stoke 강직성척주염척주평분（mSASSS）작위평개골화진전적방사학지표。운용상관분석법분석 DKK1수평여 CACS、PWV、mSASSS 평분급림상활동지표지간적관계。결과AS 환자혈중 DKK1수평명현저우대조조（P ＜0．01）；AS 조환자 CACS、PWV균명현고우대조조（P ＜0．01）；여비개화조상비，개화조 DKK1수평현저증고（P ＜0．01），이개화조mSASSS 평분명현승고；기중 DKK1수평여 CACS、PWV、mSASSS 평분정명현부상관（P ＜0．05），이CACS、PWV 여 mSASSS 평분명현정상관（P ＜0．05）。재수시자공작특정곡선하，관상동맥개화적최가 DKK1계치위54．3（곡선하면적위0．82，95％CI：0．71～0．87，민감성위60％，특이성위81％），다원회귀분석현시혈청 DKK1수평시 CACS 독립위험인소。결론AS 환자혈중 DKK1수평적강저반수동맥죽양경화화척주골화적발생，DKK1가능동시삼여료 AS 환자심혈관질병급인대골췌적발생，가작위예측심혈관개화급골화정도적생물학지표。
Objective To investigate the relations between serum DKK1 and coronary artery calcification score(CACS)or ossification process in ankylosing spondylitis(AS),and to find the risk factors for coronary artery calcification in patients with AS.Methods Seventy-five AS patients(AS group)and seventy healthy persons(control group)were enrolled in this study.The serum DKK1 was measured by enzyme-linked immunosorbent assay method(ELISA).CACS was calculated by 64-slice spiral CT,PWV was measured by non-invasive vascular screening device.The modified Stoke AS Spine Score(mSASSS) was applied to evaluate ossification in the spine of patiente of AS.The clinical indices(age,gender,course of disease,disease activity)and indices of inflammation,including erythrocyte sedimentation rate(ESR), C-reactive protein(CRP)were evaluated or measured.The relationship between DKK1 and clinical indexes, radiographic scoring,indices in inflammation were estimated by SPSS software,and the diagnostic value of DKK1 was analyzed by receiver operator characteristic(ROC)curve.Results The levels of serum DKK1 in AS patients were significantly lower than those in healthy controls(P <0.01).There was no significant correlation between DKK1 and ESR,CRP and BASFI score(P >0.05).Spearman analysis showed that PWV、CACS or mSASSS were significant negatively correlated with serum DKK1(P <0.05)in AS Group. The mean CACS and PWV in AS group was significantly higher than that in control group.ROC curve revealed that the optimal DKK1 value of CAC was 54.3(AUC =0.82,95%CI:0.71-0.87)with a sensi-tivity of 60% and a specificity of 81%.Serum DKK1 remained as independent predictor of CACS and mSASSS in multivariate analysis(P <0.05).Conclusion Serum DKK1 is correlated with CAC and can thus be considered as an independent predictor for CAC.Serum DKK1 may serve as a diagnostic biomarker of AS.