基质金属蛋白酶3联合C反应蛋白检测评估女性类风湿关节炎病情活动性

目的 探讨血清基质金属蛋白酶3 （MMP-3）联合C反应蛋白（CRP）检测在女性类风湿关节炎（RA）病情活动性评估中的价值.方法 酶联免疫吸附法分别检测100例女性RA患者及31例正常女性血清MMP-3水平并收集临床资料,应用受试者工作特征曲线（ROC）进行诊断价值分析.结果 （1）女性RA患者血清MMP-3水平显著高于正常对照组（P＜0.001）,活动期（DAS28≥2.6,n=75）显著高于缓解期（DAS28 ＜2.6,n=25,P ＜0.001）,并与CRP（r =0.544,P＜0.001）、ESR（r=0.449,P ＜0.001）、DAS28（r=0.414,P＜0.001）等呈显著正相关；（2）根据试剂盒提供的女性正常参考值范围上限60 ng/ml,血清MMP-3诊断女性RA病情活动的敏感度为92％,特异度为48％；（3）血清MMP-3诊断女性RA病情活动的ROC曲线下面积为0.81（P ＜0.001）,最佳诊断界限值为216 ng/ml,相应的敏感度为56％,特异度为92％；（4）血清MMP-3与CRP联合检测诊断女性RA病情活动的敏感度（97％）较单独检测CRP（84％）显著升高（x2=7.878,P=0.005）,特异度（96％）较单独检测血清MMP-3显著升高（x2=14.86,P＜0.001）.结论 血清MMP-3可用于评估女性RA患者病情活动性,MMP-3联合CRP检测可提高诊断的敏感度和特异度,是最佳的联合检测方案.

Combined detection of serum matrix metalloproteinase-3 and C-reactive protien in disease activity measurement in female patients with rheumatoid arthritis

Objective To explore the value of combined detection of serum matrix metalloproteinase-3 （ MMP-3）and C-reactive protein（CRP） in disease activity measurement in female patients with rheumatoid arthritis （RA）. Methods Serum MMP-3 level of 100 female RA patients and 31 normal women was tested by enzyme-linked lmmunosorbent assay, while clinical data was collected simultaneously. Receiver operating characteristic（ROC） curve was used for the analysis of diagnostic value. Results （ 1 ） Serum MMP-3 level was significantly higher in female RA patients than that in normal women（P 〈 0. 001 ）. Among female RA patients, serum MMP-3 level was significantly higher in active group（DAS28 ≥2. 6,n =75）than that in remission group（DAS28 〈2. 6,P 〈0. 001 ,n =25）. Serum MMP-3 level positively correlated with CRP（ r = 0. 544, P 〈 0. 001 ）, erythrocyte sedimentation rate （ r = 0. 449, P 〈 0. 001 ） and DAS28 （ r = 0. 414, P 〈 0. 001 ） ; （ 2 ） According to the upper limit of normal reference （ 60 ng/ml）, the sensitivity and specificity of serum MMP-3 for diagnosing active female RA were 92% and 48% ; （ 3 ） ROC curve analysis showed that the optimal cut-off point for diagnosing active female RA was 216 ng/ml with AUC 0. 81 （P 〈 0. 001 ）, sensitivity was 56% and specificity was 92% ; （4） The sensitivity and specificity of serum MMP-3 ＋ CRP combined detection were 97%, and 96% for diagnosing active female RA, which were significantly higher than the sensitivity of CRP（84% ,P = 0. 005 ） and the specificity of serum MMP-3 （ P 〈 0. 001 ）. Conclusion Serum MMP-3 is a helpful indicator for disease activity measurement in female RA patients. Combined detection of serum MMP-3 and CRP can improve the sensitivity and specificity for diagnosing active female RA.