The value of superb micro-vascular imaging technique in diagnosis of Takayasu arteritis and its relationship with serum MMP-3 and MMP-9
-
摘要: 目的 探究超微细血管成像技术(SMI)诊断多发性大动脉炎(TA)的价值及与血清基质金属蛋白酶(MMP)-3、MMP-9的关系。方法 选取2020年4月—2022年1月我院30例TA患者，根据疾病活动性分为活动期组(18例)和非活动期组(12例)。两组均行颈动脉常规超声及SMI检查，比较两组管壁厚度、颈动脉内中膜厚度(IMT)、SMI分级及血清MMP-3、MMP-9水平，分析TA患者IMT、SMI分级与血清MMP-3、MMP-9水平的相关性，探讨IMT、SMI分级诊断TA活动性的价值。活动期组经治疗处于非活动期后复查超声及SMI，比较治疗前后IMT及SMI分级。结果 活动期组IMT、SMI分级及血清MMP-9水平较非活动期组高，血清MMP-3水平较非活动期组低(均P < 0.05)。TA患者IMT、SMI分级与血清MMP-3水平呈负相关，与MMP-9水平呈正相关(均P < 0.05)。以活动期组为阳性样本，IMT诊断活动性TA的ROC曲线下面积(AUC)为0.646；以≥Ⅱ级作为SMI诊断活动期TA的标准，灵敏度为66.67%(12/18)，特异度为100%(12/12)，准确度为80.00%(24/30)。活动期组18例患者治疗3个月后均转为非活动期，治疗后IMT及SMI分级均较治疗前降低(均P < 0.05)。结论 SMI分级及血清MMP-3、MMP-9水平与TA病情活动性密切相关，为临床早期评估TA活动性及疗效提供可靠依据，以针对性制定个体化治疗方案。Abstract: Objective To explore the value of superb micro-vascular imaging(SMI) in the diagnosis of Takayasu arteritis(TA) and its correlation with serum matrix metalloproteinase(MMP) -3 and MMP-9.Methods Thirty TA patients in our hospital from April 2020 to January 2022 were selected and divided into the active period group(n=18) and the inactive period group(n=12) according to disease activity. Carotid artery conventional ultrasound and SMI examination were performed in both groups, and the wall thickness, carotid artery intima-media thickness(IMT), SMI grade, and serum MMP-3 and MMP-9 levels were compared between the two groups. The correlation of IMT and SMI grades with serum MMP-3 and MMP-9 levels, and the value of IMT and SMI grades in diagnosing TA activity were analyzed. Ultrasound and SMI were rechecked after treatment in the inactive period group, and IMT and SMI grades were compared before and after treatment.Results IMT, SMI grade, and serum MMP-9 levels in the active period group were higher than those in the inactive period group, and serum MMP-3 level was lower than that in the inactive period group(all P < 0.05). IMT and SMI grades were negatively correlated with MMP-3 level, while positively correlated with MMP-9(all P < 0.05). Taking the active period group as the positive sample, the area under the ROC curve(AUC) of IMT for the diagnosis of active TA was 0.646; Taking SMI≥grade II as the standard for diagnosing active TA, the sensitivity was 66.67%(12/18), the specificity was 100%(12/12), and the accuracy was 80.00%(24/30). All patients in the active period group turned into the inactive stage, and the IMT and SMI grades after treatment were lower than those before treatment(both P < 0.05).Conclusion SMI grade, serum MMP-3 and MMP-9 levels are closely related to TA activity, which can provide a reliable basis for early clinical assessment and curative effect, so as to formulate individualized treatment plans.
-
Key words:
- Takayasu arteritis /
- ultrafine angiography /
- matrix metalloproteinases /
- diagnosis
-
-
图 4 TA患者治疗前后血管壁厚度
Figure 4. Vascular wall thickness before and after treatment in TA patients
表 1 一般资料
Table 1. General data
例(%), X±S 项目 非活动期组(12例) 活动期组(18例) t/χ2 P 年龄/岁 34.28±2.25 33.62±2.08 0.392 0.697 男/女/例 4/8 5/13 0.569 0.451 体重指数/(kg·m-2) 23.28±1.12 23.38±1.25 0.224 0.825 临床症状 乏力、黑矇 7(58.33) 10(55.56) 0.023 0.880 胸闷、胸痛 5(41.67) 7(38.89) 0.023 0.879 头晕、头痛 7(58.33) 9(50.00) 0.201 0.654 脉搏减弱/无脉 左侧桡动脉 5(41.67) 6(33.33) 0.215 0.643 右侧桡动脉 4(33.33) 5(27.78) 0.106 0.745 左侧足背动脉 2(16.67) 3(16.67) 0.250 0.617 右侧足背动脉 2(16.67) 4(22.22) 0.139 0.709 血管杂音 左颈部 7(58.33) 8(44.44) 0.556 0.456 右颈部 6(50.00) 8(44.44) 0.089 0.765 左锁骨上下区 2(16.67) 2(11.11) 0.192 0.661 右锁骨上下区 2(16.67) 2(11.11) 0.192 0.661 腹部 3(25.00) 3(16.67) 0.313 0.576 心瓣膜区 1(8.33) 4(22.22) 0.250 0.617 
下载: 导出CSV
表 2 血管壁厚度、IMT与SMI分级及血清MMP-3与MMP-9水平
Table 2. Vascular wall thickness, IMT, SMI grade, serum MMP-3 and MMP-9 levels
例(%), X±S 组别 管壁厚度/mm IMT/mm SMI分级 MMP-3/(ng·mL-1) MMP-9/(ng·mL-1) 0级 Ⅰ级 Ⅱ级 非活动期组(12例) 0.25±0.08 1.43±0.42 7(58.33) 5(41.67) 0(0.00) 45.77±12.75 214.38±69.27 活动期组(18例) 0.28±0.09 1.86±0.52 2(11.11) 4(22.22) 12(66.67) 27.59±8.26 495.61±126.84 t/χ2 0.934 2.388 3.486 4.754 6.991 P 0.358 0.024 0.001 < 0.001 < 0.001
下载: 导出CSV
表 3 IMT、SMI分级与血清MMP-3、MMP-9水平的相关性
Table 3. Correlation between IMT, SMI grade and MMP-3, MMP-9 levels
指标 MMP-3 MMP-9 r P r P IMT -0.374 0.005 0.412 < 0.001 SMI分级 -0.508 < 0.001 0.539 < 0.001
下载: 导出CSV
表 4 活动期组治疗前后IMT及SMI分级
Table 4. IMT and SMI grade before and after treatment in the active period group
例(%), X±S 时间 IMT/mm SMI分级 0级 Ⅰ级 Ⅱ级 治疗前(18例) 1.86±0.52 2(11.11) 4(22.22) 12(66.67) 治疗后(18例) 1.50±0.45 8(44.44) 10(55.56) 0(0.00) t/χ2 1.957 3.657 P 0.060 < 0.001
下载: 导出CSV
-
[1] Tombetti E, Mason JC. Takayasu arteritis: advanced understanding is leading to new horizons[J]. Rheumatology(Oxford), 2019, 58(2): 206-219. doi: 10.1093/rheumatology/key040
[2] Podgorska D, Podgorski R, Aebisher D, et al. Takayasu arteritis-epidemiology, pathogenesis, diagnosis and treatment[J]. J Appl Biomed, 2019, 17(1): 20. doi: 10.32725/jab.2018.005
[3] 欧艳梅, 姜双全, 于丹丹, 等. 超声造影评估累及颈总动脉的多发性大动脉炎的活动性[J]. 中国医学影像技术, 2021, 37(12): 1770-1774. doi: 10.13929/j.issn.1003-3289.2021.12.003
[4] 张春燕, 李文胜. 多发性大动脉炎颈动脉病变的超声诊断价值探讨[J]. 影像研究与医学应用, 2019, 3(9): 103-104. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY201909072.htm
[5] García-Jiménez R, Arroyo E, Borrero C, et al. Evaluation of placental micro-vascularization by superb micro-vascular imaging doppler in cases of intra-uterine growth restriction: a first step[J]. Ultrasound Med Biol, 2021, 47(6): 1631-1636. doi: 10.1016/j.ultrasmedbio.2021.01.029
[6] 陈敏, 高洁, 牛慧敏, 等. SMI评估多发性大动脉炎颈动脉增厚管壁内新生血管治疗前后的变化[J]. 临床心血管病杂志, 2021, 37(2): 161-166. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202102015.htm
[7] Arend WP, Michel BA, Bloch DA, et al. The american college of rheumatology 1990 criteria for the classification of Takayasu arteritis[J]. Arthritis Rheum, 1990, 33(8): 1129-1134.
[8] 闫加勇, 陈慧敏, 张亚茹, 等. 超声心动图在儿童多发性大动脉炎合并心脏瓣膜受累中的应用研究[J]. 中国超声医学杂志, 2022, 38(1): 41-44. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY202201011.htm
[9] 李涛涛, 赵扬, 何楠, 等. 阿达木单抗治疗难治性活动期多发性大动脉炎的疗效分析[J]. 中华风湿病学杂志, 2022, 26(4): 217-223.
[10] 韩亮, 张文君. 超声诊断多发性大动脉炎头臂动脉型非活动期1例[J]. 临床超声医学杂志, 2019, 21(3): 165. doi: 10.3969/j.issn.1008-6978.2019.03.002
[11] Kim H, Barra L. Ischemic complications in Takayasu's arteritis: A meta-analysis[J]. Semin Arthritis Rheum, 2018, 47(6): 900-906.
[12] Hasegawa J, Yamada H, Kawasaki E, et al. Application of superb micro-vascular imaging(SMI)in obstetrics[J]. J Matern Fetal Neonatal Med, 2018, 31(2): 261-263.
[13] 张晋源, 马薇, 崔海鸥, 等. 超微血管成像技术在颈部动脉夹层诊断中的价值[J]. 中风与神经疾病杂志, 2022, 39(2): 119-122. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ202202006.htm
[14] 王亚红, 田新平, 葛志通, 等. 超微血管成像和超声造影评估多发性大动脉炎活动性[J]. 中国医学影像技术, 2021, 37(12): 1765-1769. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202112002.htm
[15] 王立娟, 张蕾, 包晶晶, 等. 微细血管成像技术对多发性大动脉炎分期诊断的价值[J]. 中国超声医学杂志, 2017, 33(11): 1034-1036. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY201711024.htm
[16] Lech AM, Wiera G, Mozrzymas JW. Matrix metalloproteinase-3 in brain physiology and neurodegeneration[J]. Adv Clin Exp Med, 2019, 28(12): 1717-1722.
[17] 余惠珍, 郑熙, 卢荔红, 等. 组织激肽释放酶-1对心肌梗死大鼠心肌中巨噬细胞移动抑制因子和基质金属蛋白酶表达的影响[J]. 中华高血压杂志, 2021, 29(12): 1258-1265. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202112017.htm
[18] 诸海军, 孙杰, 陈嵩, 等. 托拉塞米联合阿托伐他汀对COPD伴急性心力衰竭患者血清hs-CRP、基质金属蛋白酶及尿酸水平的影响[J]. 临床和实验医学杂志, 2021, 20(20): 2171-2174. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC202120012.htm
[19] Guizani I, Zidi W, Zayani Y, et al. Matrix metalloproteinase-3 predicts clinical cardiovascular outcomes in patients with coronary artery disease: a 5 years cohort study[J]. Mol Biol Rep, 2019, 46(5): 4699-4707.
[20] 刘斌, 赵晓东, 舒建宇, 等. 血清NGAL、MMP-9水平与ST段抬高型心肌梗死患者病情严重程度的关系[J]. 解放军医药杂志, 2022, 34(3): 37-40, 68. https://www.cnki.com.cn/Article/CJFDTOTAL-HBGF202203010.htm
[21] 王青, 谢荣华, 王静, 等. 血清SAA水平变化与大动脉炎患者免疫炎症、疾病活动性的关系研究[J]. 解放军医药杂志, 2021, 33(11): 60-63. https://www.cnki.com.cn/Article/CJFDTOTAL-HBGF202111017.htm
[22] Rodriguez-Pla A, Warner RL, Cuthbertson D, et al. Evaluation of potential serum biomarkers of disease activity in diverse forms of vasculitis[J]. J Rheumatol, 2020, 47(7): 1001-1010.
-
图(6)
表(4)
计量
- 文章访问数: 1476
- PDF下载数: 193
- 施引文献: 0