目的:探讨缓解性血清阴性对称性滑膜炎伴凹陷性水肿(Remissive seronegative symmetric synovitis with depressed edema,RS3PE)患者血清中基质金属蛋白酶3(matrix metallopro-teinase-3,MMP-3)、基质金属蛋白酶抑制剂1(tissue inhibitor of metalloproteinases-1,TIMP1)、基质金属蛋白酶抑制剂2(tissue inhibitor of metalloproteinases-2,TIMP2)、血清骨桥素1(serum bone bridging protein 1,SPP1)及纤溶酶原(plasminogen,PLG)与疾病活动程度的相关性。方法:收集2020年5月~2021年7月包头医学院第二附属医院风湿免疫科诊治的RS3PE综合征患者21例(RS3PE组),正常健康体检者30例为对照组(CON组),两组均采用实时荧光定量PCR(qRT-PCR)和酶联免疫吸附试验(ELISA)法检测血清中MMP-3、TIMP1、TIMP2、SPP1及PLG基因和蛋白的表达水平。并对两组受试者类风湿因子(rheumatoid factor,RF)、血沉(erythrocyte sedimentation rate,ESR)和C-反应蛋白(C-reactive protein,CRP)、X线表现、磁共振成像(MRI)表现进行总结归纳。结果:与CON组相比,RS3PE组ESR、CRP、MMP-3、TIMP1、TIMP2、SPP1表达水平明显升高(P<0.01),PLG表达水平无明显变化(P>0.05);MMP-3、TIMP1、TIMP2、SPP1表达水平与ESR、CRP均呈明显正相关。结论:在RS3PE患者血清中MMP-3、TIMP1、TIMP2、SPP1表达水平明显增加,其表达水平与ESR和CRP水平呈明显正相关,提示MMP-3、TIMP1、TIMP2、SPP1可能参与了RS3PE的发生发展,与疾病活动程度密切相关。
Objective:To explore a possible association between systemic immunoglobulin A(IgA)vasculitis and RS3PE syndrome and to investigate specific treatment regimens for adults who present with IgA vasculitis with renal involvement.Methods:The patient was treated with plasmapheresis and fresh frozen plasma(FFP)every other day with 1g methylprednisolone daily for three days followed by oral prednisone taper.Mycophenolate mofetil twice daily and trimethoprim‐sulfamethoxazole for Pneumocystis jirovecii prophylaxis was started.In total the patient received two cycles of plasmapheresis and fresh frozen plasma.Results:The patient's renal function drastically improved with resolution of both abdominal pain and nausea.Conclusion:We illustrate a possible association between systemic IgA vasculitis and RS3PE syndrome,and this case demonstrates IgA vasculitis with renal involvement that acutely resolved with high‐dose glucocorticoids and plasmapheresis.Additionally,our specific treatment regimen can be a potential standard of care for adults who present with IgA vasculitis with renal involvement.
