老年性類風濕性關節炎中基質金屬蛋白水解酶的研究

類風濕性關節炎是一種自體免疫性疾病，致病原因不明，以侵犯關節為主。此種進行性的關節軟骨的破壞，基本上是與基質金屬蛋白水解酶有很大的關係。而老年性類風濕性關節炎在臨床症狀、血清學、藥物療效及預後等皆與一般類風濕性關節炎不盡相同。本研究即針對老年性類風濕性關節炎病患，利用免疫酵素分析法，免疫散射法檢測其關節液與血清中基質金屬蛋白水解酶的濃度，分析其與一般類風濕性關節炎患者之關節液與血清中基質金屬蛋白水解酶之異同，並將基質金屬蛋白水解酶與C-反應蛋白、類風濕因子及精氨酸化環狀胜肽抗體作一對照分析，試求其相關性。結果顯示在關節液中，老年性類風濕性關節炎與一般類風濕性關節炎的患者之基質金屬蛋白水解酶-1、-2、-3、-9及-13的濃度相近，並無統計學上的差異。而老年性類風濕性關節炎患者之基質金屬蛋白水解酶抑制蛋白-1濃度則高於一般類風濕性關節炎患者，呈統計學上的差異(p=0.031)。在血清中，老年性類風濕性關節炎與一般類風濕性關節炎患者之基質金屬蛋白水解酶-1、-3、-9、-13和基質金屬蛋白水解酶抑制蛋白-1並無差異，而是在基質金屬蛋白水解酶-2的表現上，老年性類風濕性關節炎高於一般類風濕性關節炎且具有統計學上的意義(p=0.015)。老年性類風濕性關節炎患者血清中精氨酸化環狀胜肽抗體與基質金屬蛋白水解酶-2有相關性(r=0.511，p=0.021)，而一般類風濕性關節炎患者血清中精氨酸化環狀胜肽抗體則與基質金屬蛋白水解酶-1有相關聯(r=0.56，p=0.01)。結論：老年性類風濕性關節炎病患與一般類風濕性關節炎病患不論是關節液或血清中基質金屬蛋白水解酶的濃度表現並不相同。而這樣的不一致是否是造成老年性類風濕性關節炎與一般類風濕性關節炎的臨床症狀不一致，還需更進一步的探討。

Rheumatoid arthritis is an autoimmune disease of unknown etiology, which involves primarily the peripheral joints. It has been reported that the progressive damage of the articular cartilage is associated with the presence of matrix metalloproteinases (MMPs). The clinical symptoms, serologic findings, therapeutic response and prognosis in elderly onset rheumatoid arthritis (EORA) are different from those in younger onset rheumatoid arthritis (YORA). The aim of this study is to determine the differences of serum and synovial level of matrix metalloproteinases (MMPs) between EORA and YORA patients using enzyme link immunoassay and immunodiffusion. The levels of MMPs were also compared with those of C-reactive protein, rheumatoid factor and cyclic ctrullinated peptide (CCP) antibodies. We found that the synovial levels of MMP-1, -2, -3, -9 and -13 were similar between EORA and YORA, however, the level of tissue inhibitors of metalloproteinase-1 (TIMP-1) was significantly higher in EORA group (p=0.031). The serum levels of MMP-1, -3, -9, -13 and TIMP-1 showed no difference from the two groups but MMP-2 was drastically higher in EORA group (p=0.015). The serum level of CCP antibodies was slightly correlated with that of MMP-2 (r2= 0.511, p=0.021) in EORA group and correlated with MMP-1 (r2=0.56, p=0.01) in YORA group. We concluded that the expression of synovial and serum level of MMPs were different between EORA and YORA groups. Further studies are needed to elucidate whether it plays a role in mechanism with regard to the distinct clinical symptoms between the two groups of rheumatoid arthritis.