Continuously elevated serum matrix metalloproteinase-3 for 3 ~ 6 months predict one-year radiographic progression in rheumatoid arthritis: a prospective cohort study.
Continuously elevated serum matrix metalloproteinase-3 for 3 ~ 6 months predict one-year radiographic progression in rheumatoid arthritis: a prospective cohort study.
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血清基质金属蛋白酶-3 连续升高 3 个月（相当于 6 个月）可预测类风湿关节炎一年的放射学进展：一项前瞻性队列研究
DOI：
10.1186/s13075-015-0803-2
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发表时间：
2015-10-14
影响因子：
4.9
通讯作者：
Dai L
中科院分区：
文献类型：
--
作者：
Ma JD;Wei XN;Zheng DH;Mo YQ;Chen LF;Zhang X;Li JH;Dai L
已发现类风湿性关节炎（RA）的核心疾病活动指标在预测关节破坏进展方面有限。基质金属蛋白酶（MMP）3在关节破坏中起重要作用，并在一些缓解患者中升高。我们的目的是监测动态核心疾病活动指标和血清MMP-3一年，并评估其预测放射学进展的价值。活动性RA患者（简化疾病活动指数> 3.3）根据达标治疗策略进行治疗。采用酶联免疫吸附法（ELISA）检测血清MMP-3水平，同时收集患者0、1、3、6、12个月的临床资料。在基线和第12个月重复手部/腕部的X线评估，总Sharp评分变化> 0.5个单位被定义为放射学进展。五十六例患者完成了一年随访，29%的患者显示放射学进展。虽然在基线时没有显著差异，但在第12个月时，进展组的血清MMP-3和所有核心疾病活动指标（除血沉外）均显著高于非进展组。在16例进展患者中，69%达到治疗目标，56%的患者血清MMP-3持续升高，38%的患者血清MMP-3持续升高，C反应蛋白（CRP）正常。Log-rank检验和重复测量分析显示，进展和非进展患者的动态血清MMP-3差异有统计学意义。受试者操作特征曲线和单因素Logistic回归分析显示，与第1个月CRP相比，第0、1、3、6个月血清MMP-3升高是1年放射学进展的显著预测因素（MMP-3 OR：10.500 ~ 27.000，均P < 0.05; CRP：OR = 7.400，P = 0.011）。血清MMP-3持续升高3 ~ 6个月可预测1年的放射学进展，提示动态监测血清MMP-3与核心疾病活动性指标结合可能更有助于预测RA的放射学进展和治疗决策。
Core disease activity indicators of rheumatoid arthritis (RA) have been found to be limited in predicting joint destruction progression. Matrix metalloproteinase (MMP) 3 plays an essential role in joint destruction and was found elevated in some remission patients. We aimed to monitor dynamic core disease activity indicators and serum MMP-3 for one year and evaluate their value for predicting radiographic progression. Patients with active RA (Simplified disease activity index > 3.3) were treated according to the treat-to-target strategy. Serum MMP-3 was detected by enzyme-linked immunosorbent assay and clinical data were collected simultaneously at 0, 1st, 3rd, 6th and 12th month. X-ray assessment of hand/wrist was repeated at baseline and the 12th month and a change of total Sharp score > 0.5 units was defined as radiographic progression. Fifty-six patients completed one year follow-up and 29 % showed radiographic progression. Although not significantly different at baseline, serum MMP-3 and all core disease activity indicators, except for erythrocyte sedimentation rate, at the 12th month were significantly higher in the progressive group than in the non-progressive group. Among sixteen progressive patients, 69 % achieved the therapeutic target and 56 % had continuous elevated serum MMP-3, 38 % had continuous elevated serum MMP-3 and normal C-reactive protein (CRP) at the 6th month. Log-rank tests and repeated measures analysis revealed a significant difference in dynamic serum MMP-3 between progressive and non-progressive patients. Receiver operating characteristic curve and univariate logistic regression analysis showed that elevated serum MMP-3 at 0, 1st, 3rd and 6th months, compared with CRP at the 1st month, were significant predictors for one-year radiographic progression (MMP-3 odds ratio (OR):10.500 ~ 27.000, all P < 0.05; CRP: OR = 7.400, P = 0.011). Our data showed that continuously elevated serum MMP-3 for 3 ~ 6 months predicted one-year radiographic progression which implied that monitoring of dynamic serum MMP-3 combined with core disease activity indicators may be more helpful for predicting radiographic progression and treatment decision in RA.