Pruzanski W, Keystone E C, Sternby B, Bombardier C, Snow K M, Vadas P
Immunology Diagnostic and Research Centre, Wellesley Hospital, University of Toronto, Canada.
J Rheumatol. 1988 Sep;15(9):1351-5.
We previously demonstrated a marked elevation of the proinflammatory enzyme phospholipase A2 (PLA2) in all synovial fluids and some sera of patients with rheumatoid arthritis (RA). Since PLA2 was found to induce inflammatory changes in the skin and joints of experimental animals, we tested whether the serum level of PLA2 correlates with the clinical activity of RA. In the group of 51 patients with classical or definite RA, 13 (25%) had high serum levels of PLA2 (over 2 standard deviations above the normal mean). Comparison of clinical disease activity in patients with high levels of PLA2 with those with normal PLA2 levels showed that patients with high PLA2 levels had a significantly higher joint count, more swollen joints, much higher Landsbury index, lower functional class, lower hemoglobin, lymphopenia and higher erythrocyte sedimentation rate (ESR). To more accurately assess the relationship between the PLA2 level and disease activity in RA, we formulated 2 indices. Clinical index consisted of the Landsbury index, number of swollen joints and duration of morning stiffness. Laboratory index consisted of hemoglobin, absolute number of peripheral blood lymphocytes, platelet count and ESR. Our results showed that both indices correlated strongly with PLA2 activity (p less than 0.0001). The results support the hypothesis that PLA2 plays a pathogenetic role in RA and suggest that serum PLA2 levels may serve as an additional measure of disease activity.
我们先前证明，在类风湿性关节炎（RA）患者的所有滑液和部分血清中，促炎酶磷脂酶A2（PLA2）显著升高。由于发现PLA2可在实验动物的皮肤和关节中诱导炎症变化，我们检测了PLA2的血清水平是否与RA的临床活动相关。在51例典型或确诊RA患者组中，13例（25%）血清PLA2水平较高（高于正常均值2个标准差以上）。比较PLA2水平高的患者与PLA2水平正常的患者的临床疾病活动情况，结果显示，PLA2水平高的患者关节计数显著更高、肿胀关节更多、Landsbury指数更高、功能分级更低、血红蛋白水平更低、淋巴细胞减少且红细胞沉降率（ESR）更高。为了更准确地评估PLA2水平与RA疾病活动之间的关系，我们制定了2个指数。临床指数包括Landsbury指数、肿胀关节数和晨僵持续时间。实验室指数包括血红蛋白、外周血淋巴细胞绝对数、血小板计数和ESR。我们的结果显示，这两个指数均与PLA2活性密切相关（p小于0.0001）。这些结果支持了PLA2在RA发病机制中起作用的假说，并表明血清PLA2水平可作为疾病活动的一项额外指标。
