本文選題：類(lèi)風(fēng)濕關(guān)節(jié)炎 + DKK-1��； 參考：《川北醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討類(lèi)風(fēng)濕關(guān)節(jié)炎(Rheumatoid arthritis,RA)患者血清及關(guān)節(jié)液Dickkopf-1(DKK-1)水平的變化及其與RA疾病活動(dòng)性、骨關(guān)節(jié)破壞之間的相關(guān)性。方法:采用酶聯(lián)免疫吸附試驗(yàn)(Enzyme Linked ImmunosorbentAssay,ELISA)檢測(cè)35例RA患者、27例骨關(guān)節(jié)炎(Osteoarthritis,OA)患者及25例健康對(duì)照者的血清DKK-1水平。同時(shí)留取與血清配對(duì)的17例RA患者和10例OA患者的關(guān)節(jié)液,采用ELISA檢測(cè)關(guān)節(jié)液DKK-1水平。詳細(xì)記錄RA患者各臨床及實(shí)驗(yàn)室指標(biāo),包括:性別、年齡、病程、體重指數(shù)、腫脹關(guān)節(jié)數(shù)、壓痛關(guān)節(jié)數(shù)、血沉(Erythrocyte sedimentation rate,ESR)、C-反應(yīng)蛋白(C-reactive protein,CRP)、類(lèi)風(fēng)濕因子(Rheumatoid factor,RF)、抗環(huán)瓜氨酸肽抗體(anti-citrullinated peptide antibody,ACPA)、VAS評(píng)分、28個(gè)關(guān)節(jié)的疾病活動(dòng)度評(píng)分(Disease activity score in 28joints,DAS28評(píng)分);所有RA患者攝雙手X片進(jìn)行Sharp評(píng)分。結(jié)果:1.RA組血清DKK-1水平(4251.45±3139.04pg/ml)高于OA組(2700.15±1793.04pg/ml),P=0.024,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。RA組血清DKK-1水平與健康對(duì)照組相比有增高趨勢(shì)(4251.45±3139.04 vs2875.76.±2522.47pg/ml,P=0.055),但無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.RA活動(dòng)組血清DKK-1水平(6025.31±3721.20pg/ml)明顯高于RA緩解組(2731.63±943.59pg/ml),P=0.005,差異具有統(tǒng)計(jì)學(xué)意義。RA活動(dòng)組血清DKK-1水平顯著高于OA組及健康對(duì)照組(6025.31±3721.20 vs2700.15±1793.04vs2875.76.±2522.47pg/ml),差異具有顯著統(tǒng)計(jì)學(xué)意義(p0.001)。3.ra緩解組血清dkk-1水平與oa組及健康對(duì)照組相比(2731.63±943.59vs2700.15±1793.04vs2875.76±2522.47pg/ml,p=0.971,p=0.828),無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。4.ra組關(guān)節(jié)液dkk-1水平與oa組相比(113.59±112.55vs61.60±40.67pg/ml,p=0.106),雖然有增高,但無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。5.ra組血清dkk-1水平明顯高于配對(duì)的關(guān)節(jié)液(5464.89±3849.50vs113.59±112.55pg/ml),差異具有顯著統(tǒng)計(jì)學(xué)意義(p0.001)。17例配對(duì)的ra患者血清和關(guān)節(jié)液dkk-1水平不相關(guān)(r=0.428,p=0.087)。6.ra組血清dkk-1水平與壓痛關(guān)節(jié)數(shù)(r=0.474,p=0.008)、腫脹關(guān)節(jié)數(shù)(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評(píng)分(r=0.596,p=0.001)呈正相關(guān);與年齡、病程、bmi、acpa、vas評(píng)分均無(wú)相關(guān)性。7.ra組血清dkk-1水平與雙手x片關(guān)節(jié)間隙狹窄評(píng)分(r=0.416,p=0.031)、雙手x片關(guān)節(jié)骨侵蝕評(píng)分(r=0.454,p=0.017)和雙手x片sharp評(píng)分(r=0.409,p=0.034)均呈正相關(guān)。結(jié)論:1.ra組血清中dkk-1水平高于oa組,具有統(tǒng)計(jì)學(xué)意義,與健康對(duì)照組相比有增高趨勢(shì);ra活動(dòng)組血清dkk-1水平明顯高于ra緩解組、oa組及健康對(duì)照組,具有統(tǒng)計(jì)學(xué)意義,ra緩解組與oa組及健康對(duì)照組之間血清dkk-1水平無(wú)差異,提示dkk-1可能可作為類(lèi)風(fēng)濕關(guān)節(jié)炎的生物學(xué)標(biāo)志物,且與ra炎癥相關(guān)。2.ra組血清dkk-1水平明顯高于配對(duì)的關(guān)節(jié)液,ra組關(guān)節(jié)液dkk-1水平與oa組相比有增高趨勢(shì),ra組血清和配對(duì)的關(guān)節(jié)液dkk-1水平不相關(guān),提示ra血清和關(guān)節(jié)液dkk-1表達(dá)可能存在相對(duì)獨(dú)立。3.RA患者血清DKK-1水平與壓痛關(guān)節(jié)數(shù)、腫脹關(guān)節(jié)數(shù)、ESR、CRP、DAS28評(píng)分呈正相關(guān);與年齡、病程、BMI、ACPA、VAS評(píng)分均無(wú)相關(guān)性,提示血清DKK-1水平與RA疾病活動(dòng)相關(guān)。4.RA患者血清DKK-1水平與雙手X片關(guān)節(jié)間隙狹窄評(píng)分、雙手X片關(guān)節(jié)骨侵蝕評(píng)分和雙手X片Sharp評(píng)分均呈正相關(guān),提示血清DKK-1水平與RA骨關(guān)節(jié)侵蝕破壞相關(guān)。
[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.

【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R593.22

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