血清基质金属蛋白酶-3、天冬氨酸特异性半胱氨酸蛋白酶-3水平与腰椎椎间盘退行性变程度的相关性

关键词：腰椎  椎间盘退行性变  基质金属蛋白酶3  半胱氨酸天冬氨酸蛋白酶3

Keywords:Lumbar vertebrae  Intervertebral disc degeneration  Matrix metalloproteinase 3  Caspase 3

摘要：

      目的 探究血清基质金属蛋白酶-3（MMP-3）、天冬氨酸特异性半胱氨酸蛋白酶-3（caspase-3）水平与腰椎椎间盘退行性变（IDD）程度的相关性。方法 回顾性分析2021年12月—2023年12月收治的116例腰椎IDD患者临床资料（观察组），并选取同时期的健康体检志愿者116名作为对照组。收集2组年龄、性别、体质量指数（BMI）、吸烟史、饮酒史、血钙水平、血磷水平、C反应蛋白（CRP）水平、红细胞沉降率（ESR）、骨钙素水平、血清MMP-3水平、血清caspase-3水平及日本骨科学会（JOA）评分。根据Pdfirrmann分级将观察组患者分为轻、中、重3个亚组。采用多元logistic回归法分析腰椎IDD病变程度的影响因素。采用Spearman秩相关系数分析不同腰椎IDD病变程度患者JOA评分与血清MMP-3、caspase-3水平的相关性。绘制受试者工作特征（ROC）曲线分析血清MMP-3、caspase-3水平对腰椎IDD病变程度的诊断价值。绘制决策曲线评估诊断模型在临床决策中的实际应用价值。结果 观察组CRP、ESR、骨钙素、MMP-3、caspase-3水平较对照组明显升高，差异均有统计学意义（P<0.05）。随着IDD严重程度的加重，血清MMP-3、caspase-3水平逐渐升高，JOA评分逐渐降低，亚组间差异均有统计学意义（P<0.05）。Logistic回归分析结果表明，血清MMP-3、caspase-3水平为腰椎IDD病变程度的影响因素。JOA评分与血清MMP-3、caspase-3水平均呈负相关（r=-0.626、r=-0.630）。ROC曲线显示血清MMP-3、caspase-3水平联合检测较单一指标预测腰椎IDD病变程度更有价值。决策曲线显示，高风险概率阈值为0.06~0.93时采用血清MMP-3、caspase-3水平联合预测腰椎IDD病变程度的临床应用价值较高。结论 血清MMP-3、caspase-3水平与腰椎IDD病变程度密切相关，二者联合应用具有更高的诊断效能，提示二者可作为诊断IDD病变程度的潜在生物标志物。

Abstract:

      Objective To investigate the correlation of serum matrix metalloproteinase-3（MMP-3） and caspase-3 levels and the severity of lumbar intervertebral disc degeneration（IDD）. Methods The clinical data of 116 patients with lumbar IDD admitted from December 2021 to December 2023（the observation group） were retrospectively analyzed，and 116 healthy volunteers during the same period were selected as the control group. The age，gender，body mass index（BMI），smoking history，drinking history，blood calcium level，blood phosphorus level，C-reactive protein（CRP） level，erythrocyte sedimentation rate（ESR），osteocalcin level，serum MMP-3 level and caspase-3 level，and Japanese Orthopedic Association（JOA） score of the 2 groups were collected. The patients in the observation group were divided into 3 subgroups（mild，moderate and severe） according to the Pfirrmann classification. The influencing factors of lumbar IDD severity were analyzed using multivariate logistic regression. Spearman rank correlation coefficients were employed to assess the correlation between JOA scores and MMP-3/caspase-3 levels in patients with varying lumbar IDD severity. The receiver operating characteristic（ROC） curves were plotted to evaluate the diagnostic value of serum MMP-3/caspase-3 levels for lumbar IDD severity. The decision curve was constructed to assess the practical clinical utility of the diagnostic model. Results The levels of CRP，ESR，osteocalcin，MMP-3，and caspase-3 in the observation group were significantly higher than those in the control group，and the differences were statistically significant（P<0.05）. With the increasing severity of IDD，serum levels of MMP-3 and caspase-3 gradually rose，while JOA scores progressively declined，with statistically significant differences observed among subgroups（P<0.05）. The results of logistic regression analysis showed that serum MMP-3 and caspase-3 levels were the influencing factors of lumbar IDD severity. The JOA score was negatively correlated with the levels of serum MMP-3 and caspase-3（r=-0.626，r=-0.630）. The ROC curve showed that the combined detection of serum MMP-3 and caspase-3 levels was more valuable than a single indicator in predicting the severity of lumbar IDD. The decision curve showed that the high-risk probability threshold was 0.06-0.93，and the clinical application value of using serum MMP-3 and caspase-3 levels for predicting the severity of lumbar IDD was relatively high. Conclusions The serum MMP-3 and caspase-3 levels are closely related to the severity of lumbar IDD. The combination of these 2 indicators has higher diagnostic efficacy，suggesting that they can serve as potential biomarkers for diagnosing the severity of the lumbar IDD.