DKK-1在类风湿关节炎患者疾病活动性和骨关节破坏中的临床意义

发布时间：2018-04-12 21:22

本文选题：类风湿关节炎 + DKK-1　；参考：《川北医学院》2017年硕士论文

【摘要】：目的:探讨类风湿关节炎(Rheumatoid arthritis,RA)患者血清及关节液Dickkopf-1(DKK-1)水平的变化及其与RA疾病活动性、骨关节破坏之间的相关性。方法:采用酶联免疫吸附试验(Enzyme Linked ImmunosorbentAssay,ELISA)检测35例RA患者、27例骨关节炎(Osteoarthritis,OA)患者及25例健康对照者的血清DKK-1水平。同时留取与血清配对的17例RA患者和10例OA患者的关节液,采用ELISA检测关节液DKK-1水平。详细记录RA患者各临床及实验室指标,包括:性别、年龄、病程、体重指数、肿胀关节数、压痛关节数、血沉(Erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、类风湿因子(Rheumatoid factor,RF)、抗环瓜氨酸肽抗体(anti-citrullinated peptide antibody,ACPA)、VAS评分、28个关节的疾病活动度评分(Disease activity score in 28joints,DAS28评分);所有RA患者摄双手X片进行Sharp评分。结果:1.RA组血清DKK-1水平(4251.45±3139.04pg/ml)高于OA组(2700.15±1793.04pg/ml),P=0.024,差异有统计学意义(P0.05)。RA组血清DKK-1水平与健康对照组相比有增高趋势(4251.45±3139.04 vs2875.76.±2522.47pg/ml,P=0.055),但无统计学意义(P0.05)。2.RA活动组血清DKK-1水平(6025.31±3721.20pg/ml)明显高于RA缓解组(2731.63±943.59pg/ml),P=0.005,差异具有统计学意义。RA活动组血清DKK-1水平显著高于OA组及健康对照组(6025.31±3721.20 vs2700.15±1793.04vs2875.76.±2522.47pg/ml),差异具有显著统计学意义(p0.001)。3.ra缓解组血清dkk-1水平与oa组及健康对照组相比(2731.63±943.59vs2700.15±1793.04vs2875.76±2522.47pg/ml,p=0.971,p=0.828),无统计学差异(p0.05)。4.ra组关节液dkk-1水平与oa组相比(113.59±112.55vs61.60±40.67pg/ml,p=0.106),虽然有增高,但无统计学意义(p0.05)。5.ra组血清dkk-1水平明显高于配对的关节液(5464.89±3849.50vs113.59±112.55pg/ml),差异具有显著统计学意义(p0.001)。17例配对的ra患者血清和关节液dkk-1水平不相关(r=0.428,p=0.087)。6.ra组血清dkk-1水平与压痛关节数(r=0.474,p=0.008)、肿胀关节数(r=0.566,p=0.001)、esr(r=0.739,p=0.000)、crp(r=0.538,p=0.032)、rf(r=0.424,p=0.025)、das28评分(r=0.596,p=0.001)呈正相关;与年龄、病程、bmi、acpa、vas评分均无相关性。7.ra组血清dkk-1水平与双手x片关节间隙狭窄评分(r=0.416,p=0.031)、双手x片关节骨侵蚀评分(r=0.454,p=0.017)和双手x片sharp评分(r=0.409,p=0.034)均呈正相关。结论:1.ra组血清中dkk-1水平高于oa组,具有统计学意义,与健康对照组相比有增高趋势;ra活动组血清dkk-1水平明显高于ra缓解组、oa组及健康对照组,具有统计学意义,ra缓解组与oa组及健康对照组之间血清dkk-1水平无差异,提示dkk-1可能可作为类风湿关节炎的生物学标志物,且与ra炎症相关。2.ra组血清dkk-1水平明显高于配对的关节液,ra组关节液dkk-1水平与oa组相比有增高趋势,ra组血清和配对的关节液dkk-1水平不相关,提示ra血清和关节液dkk-1表达可能存在相对独立。3.RA患者血清DKK-1水平与压痛关节数、肿胀关节数、ESR、CRP、DAS28评分呈正相关;与年龄、病程、BMI、ACPA、VAS评分均无相关性,提示血清DKK-1水平与RA疾病活动相关。4.RA患者血清DKK-1水平与双手X片关节间隙狭窄评分、双手X片关节骨侵蚀评分和双手X片Sharp评分均呈正相关,提示血清DKK-1水平与RA骨关节侵蚀破坏相关。
[Abstract]:Objective: To investigate the rheumatoid arthritis (Rheumatoid arthritis, RA) in serum and synovial fluid of Dickkopf-1 (DKK-1) levels and RA disease activity, the correlation between bone and joint destruction. Methods: using enzyme-linked immunosorbent assay (Enzyme Linked, ImmunosorbentAssay, ELISA) were detected in 35 RA patients, 27 cases of osteoarthritis (Osteoarthritis, OA) the serum level of DKK-1 patients and 25 healthy controls. At the same time with synovial fluid from 17 patients with RA and serum matched and 10 cases of OA patients, ELISA was used to detect the DKK-1 level in synovial fluid. Including the detailed records of RA patients of various clinical and laboratory indexes: gender, age, duration, body weight index, swollen joint counts, tender joint count, erythrocyte sedimentation rate (Erythrocyte sedimentation, rate, ESR), C- reactive protein (C-reactive protein, CRP), rheumatoid factor (Rheumatoid, factor, RF) and anti cyclic citrullinated peptide antibody (anti-citrullinate D peptide antibody, ACPA), VAS score, 28 joint disease activity score (Disease activity score in 28joints, DAS28 score); all patients with RA X Sharp camera hands score. Results: the DKK-1 levels of serum 1.RA (4251.45 + 3139.04pg/ml) higher than that of group OA (2700.15 + 1793.04pg/ml), P=0.024, a statistically significant difference (P0.05).RA group serum DKK-1 levels compared with healthy control group, there was an increasing trend (4251.45 + 3139.04 vs2875.76. + 2522.47pg/ml, P=0.055), but no statistical significance (P0.05).2.RA activity group serum DKK-1 level (6025.31 + 3721.20pg/ml) was significantly higher than RA in remission (2731.63 + 943.59pg/ml), P=0.005, the difference is the level of serum DKK-1 significantly.RA activity group was significantly higher than that of OA group and healthy control group (6025.31 + 3721.20 vs2700.15 + 1793.04vs2875.76. + 2522.47pg/ml), the difference was statistically significant (p0.001).3.ra remission The serum level of DKK-1 group compared with OA group and healthy control group (2731.63 + 943.59vs2700.15 + 1793.04vs2875.76 + 2522.47pg/ml, p=0.971, p=0.828), there was no significant difference in group.4.ra (P0.05) DKK-1 level in synovial fluid compared with group OA (113.59 + 112.55vs61.60 + 40.67pg/ml, p=0.106), although there is increased, but the difference was not statistically significant (P0.05 DKK-1) the level of serum.5.ra was significantly higher than that of joint fluid pair (5464.89 + 3849.50vs113.59 + 112.55pg/ml), there was a statistically significant difference (p0.001) is not related to.17 paired with RA serum and synovial fluid levels of DKK-1 (r=0.428, p=0.087).6.ra serum level of DKK-1 group and tender joint count (r=0.474, p=0.008), swollen joint count (r=0.566, p=0.001, ESR) (r=0.739, p=0.000), CRP (r=0.538, p=0.032), RF (r=0.424, p=0.025), DAS28 score (r=0.596, p= 0.001) was positively correlated with age, course of disease,; BMI, ACPA, VAS scores were not correlated to.7.ra The serum level of DKK-1 group and hands radiographs of joint space stenosis score (r=0.416, p=0.031), hands X-ray bone erosion score (r=0.454, p=0.017) and hands sharp score (r=0.409, X p=0.034) were positively correlated. Conclusion: DKK-1 serum level of 1.ra was higher than OA group, there was statistical significance compared with the control, there was an increasing trend group and health; the level of serum DKK-1 activity of RA group was significantly higher than that in RA remission group, OA group and healthy control group, with statistical significance, the serum level of DKK-1 between RA remission group and OA group and healthy control group had no significant difference, indicating that DKK-1 can be used as a biological marker for rheumatoid arthritis, and inflammatory related serum RA the DKK-1 level of.2.ra group was significantly higher than that of synovial fluid paired RA group, DKK-1 level in synovial fluid compared with the OA group has increased, not related to joint fluid DKK-1 levels in serum of group RA and paired, suggesting that RA serum and synovial fluid of DKK-1 expression There is relatively independent of serum DKK-1 level in patients with.3.RA and the number of tender joints, swollen joint count, ESR, CRP, DAS28 score was positively correlated with age, course of disease,; BMI, ACPA, VAS scores were not correlated, suggesting that serum DKK-1 levels are associated with disease activity in RA patients with.4.RA serum DKK-1 level and X score of joint space narrowing hands X, hand joint bone erosion score and hands X Sharp score were positively correlated, suggesting that the level of serum DKK-1 and RA of bone erosion.

【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.22

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