The Significance And Changes Of Serum MMP-3 And DKK-1 Levels In Active As Patients With Etanercept Therapy

Objectives:To study the changes and significance of serum Matrix metalloproteinase enzyme 3 (MMP-3) and DKK-1 levels in patients with active ankylosing spondylitis with Recombinant Human Tumor Necrosis Factor-a Receptor Ⅱ:Igg Fc Fusion Protein for injection (rhTNFR:Fc, Etanercept(?)) treatment.Methods:Collected 20 patients with active AS treated at the First Affiliated Hospital of Guangxi Medical University, Division of Rheumatology, from February 2015 to December 2015.20 patients were followed up 12 weeks, when 12 patients completed 24 weeks. They were treated with Etanercept and traditional drug therapy in the first 12 weeks. In the following 12 weeks,12 patients were randomly divided into A, B group and followed up to 24 weeks, group A(n= 8) used the original regimen, group B (n= 4) deactivated Etanercept, maintain the traditional medication. The level of serum DKK-1 and MMP-3 were detected by enzyme-linked immunosorbent assay (ELISA) in 20 cases of AS patients at baseline (week 0),6,12,18,24 weeks after treatment. They got sacroiliac joint MRI scan, SPARCC and SSS score at 0,12th,24th week.Using SPSS statistical software to analyze serum MMP-3, DKK-1 levels, and the relevance with the clinical indicators.Results:1.serum MMP-3(ng/ml):①The baseline level of active AS patients and healthy controls were:47.42±22.60,34.86±10.11, the difference was statistically significant(P<0.05);②the level after treatment of 6 weeks,12 weeks, 18 weeks(A),18 weeks(B),24 weeks(A),24 weeks(B) respectively were:25.78± 13.32,25.43±13.83,30.23±25.65,40.20±21.18,30.03±16.94,81.10±13.86, compare to the previous point, the difference of 6 weeks was statistically significant (P<0.05),no statistically significant difference for the rest(P>0.05); ③compare group A to B:18th week(A) vs 18th week(B),showed no significant difference (P>0.05),24th week(A) vs 24th week(B),the difference was statistically significant(P<0.05);④The baseline level of serum MMP-3was positively correlated with ESR,BASDAI,ASDAS-CRP and SPARCC score, the age of onset, duration, BASFI,CRP and SSS score are not related (P>0.05);⑤The serum MMP-3 level at 12th week is irrelevant with ESR, BASDAI, ASDAS-CRP, BASFI,CRP, BASDAI,BASFI,ASDAS-CRP,SPARCC and SSS scores (P>0.05). 2.Serum DKK-1(pg/ml):The baseline level of active AS patients and healthy controls were:647.11±244.35,929.89±473.20,the difference was statistically significant (P<0.05);②the level after treatment of 6 weeks,12 weeks,18 weeks(A),18 weeks(B),24 weeks (A),24 weeks(B) respectively were:573.26± 318.95,510.41±303.94,890.40±545.72,863.07±644.51,732.66±363.20, 547.15±381.81, compare to the previous point,the difference of 18 weeks(A) was statistically significant (P<0.05), no statistically significant difference for the rest (P>0.05);③compare group A to B:18th week (A) vs 18th week (B),24th week(A) vs 24th week(B) showed no significant difference (P>0.05);④The baseline level of serum DKK-1 and the level at 12th week were irrelevant with ESR,BASDAI, ASDAS-CRP, BASFI,CRP,BASDAI,BASFI, ASDAS-CRP, SPARCC and SSS scores (P>0.05).3.MRI score:①SPARCC:group A at 0,12th,24th week were:25.00±14.30,9.75±10.91,9.63±9.84, group B at 0,12th,24th week were:10.00±4.40,2.00±1.41,3.50± 2.38,compared to the previous point,the differences of two group at 12th week were significantly different (P<0.05),the differences of two group at 24th week were not significant (P> 0.05);②SSS:group A at 0,12th,24th week were:28.13±14.10,29.75±14.09, 29.75±15.67, group B at 0,12th,24th week were:27.00±11.37,24.75±10.50,25.25± 8.62,compared to the previous point,the differences of two group at 12th,24th week were not significant (P>0.05);③The SPARCC and SSS scores between the two groups did not have statistically significant difference at 0,12th,24th week (P>0.05).Conclusion:1. The level of serum MMP-3 in patients with active AS is higher than the healthy controls, the serum DKK-1 is lower than the healthy controls.2. Serum MMP-3 level is drop in patients with active AS after etanercept therapy, which can be used as indicators to assess the efficacy of etanercept.3. Through reducing the level of serum MMP-3 and other ways, etanercept can reduce bone marrow edema, inhibit bone erosion in active AS patients.4. Etanercept has little effect on abnormal ossification in active AS patients.