Department of Rheumatology, PLA General Hospital, 28# Fuxing Road, Beijing, China.
Clin Rheumatol. 2019 Feb;38(2):465-475. doi: 10.1007/s10067-018-4284-y. Epub 2018 Sep 11.
In recent years, MRI has been regarded as a major diagnostic tool for spondyloarthritis (SpA), and anti-TNF therapy has been widely confirmed as an effective treatment strategy. This study was designed to investigate the correlation between the secreted protein dickkopf-1 (Dkk-1) and abnormal findings on magnetic resonance imaging (MRI) through a prospective study of 30 cases of SpA. Thirty patients with active SpA were included, all treated with recombinant human tumor necrosis factor (TNF) receptor-antibody fusion protein (YiSaiPu) injection at 50 mg/week for 6 months. All patients were also examined for their clinical, serological, and imaging manifestations of the condition before and after treatment. In patients receiving TNF inhibitor treatment, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and clinical activity indices BASDAI, BASFI, BASMI, ASDAS-CRP were significantly decreased (p < 0.01). Serum Dkk-1 concentration was also significantly decreased (p < 0.05), as were the scores of bone marrow edema of the sacroiliac joints and the spine (p < 0.05). The score of sacroiliac joint backfill was significantly increased (p < 0.05), and the baseline and changes in the serum Dkk-1 concentration were significantly correlated with the baseline and changes in spinal bone marrow edema levels. Inhibition of the level of serum Dkk-1 by TNF inhibitors may be the molecular basis for inhibiting the formation of new bone in SpA patients. In addition, spinal marrow edema may have significance for predicting new bone formation.
近年来,磁共振成像(MRI)已被视为脊柱关节炎(SpA)的主要诊断工具,而抗 TNF 治疗已被广泛证实为一种有效的治疗策略。本研究旨在通过对 30 例 SpA 患者的前瞻性研究,探讨分泌蛋白 dickkopf-1(Dkk-1)与 MRI 异常表现之间的相关性。30 例活动期 SpA 患者纳入本研究,所有患者均接受重组人肿瘤坏死因子(TNF)受体-抗体融合蛋白(依那西普)50mg/周,治疗 6 个月。所有患者在治疗前后均进行临床、血清学和影像学表现检查。在接受 TNF 抑制剂治疗的患者中,红细胞沉降率(ESR)、C 反应蛋白(CRP)和临床活动指数 BASDAI、BASFI、BASMI、ASDAS-CRP 均显著降低(p<0.01)。血清 Dkk-1 浓度也显著降低(p<0.05),骶髂关节和脊柱骨髓水肿评分降低(p<0.05)。骶髂关节填充评分显著升高(p<0.05),血清 Dkk-1 浓度的基线值及其变化与脊柱骨髓水肿水平的基线值及其变化显著相关。TNF 抑制剂抑制血清 Dkk-1 水平可能是抑制 SpA 患者新骨形成的分子基础。此外,脊柱骨髓水肿可能对预测新骨形成具有重要意义。