Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2020; 8(7): 1213-1222
Published online Apr 6, 2020. doi: 10.12998/wjcc.v8.i7.1213
Clinical significance and prognostic value of tumor necrosis factor-α and dickkopf related protein-1 in ankylosing spondylitis
Jun-Hui Xiong, Jian Liu, Jian Chen
Jun-Hui Xiong, Jian Liu, Jian Chen, Department of Rheumatology, Lishui People’s Hospital, Lishui 323000, Zhejiang Province, China
Author contributions: Xiong JH contributed to the study design and reviewed the manuscript; Liu J analyzed the data and contributed to manuscript writing; Xiong JH and Chen J contributed to data collection, data interpretation and manuscript writing; All authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Lishui People’s Hospital Ethics Committee.
Informed consent statement: All patients in our study provided informed consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Chen, BSc, Attending Doctor, Department of Rheumatology, Lishui People’s Hospital, No. 15 Dazhong Street, Liandu District, Lishui 323000, Zhejiang Province, China. cairuke99@163.com
Received: December 25, 2019
Peer-review started: December 25, 2019
First decision: February 20, 2020
Revised: March 2, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: April 6, 2020
Processing time: 103 Days and 6.3 Hours
ARTICLE HIGHLIGHTS
Research background

Ankylosing spondylitis (AS) frequently occurs in people aged 30-45 years, and its prevalence is generally believed to be between 0.1% and 1.4% globally. At present, the “gold standard” for diagnosis of AS requires the provision of pelvic X-rays, which makes it more difficult to perform in population-based epidemiological studies. Therefore, the identification of serological indicators related to the diagnosis, treatment, and prognosis of AS patients is of great significance.

Research motivation

The “gold standard” for ankylosing spondylitis depends on X-rays, and the prognosis of patients with ankylosing spondylitis is variable and closely related to the patient’s extraspinal manifestations (such as uveitis, psoriasis, and IBD), age at diagnosis, and treatment. The identification of convenient serological indicators related to patient treatment, diagnosis and prognosis is of great significance.

Research objectives

This study aimed to analyze the therapeutic, diagnostic significance and prognostic value of Dickkopf-related protein-1 (DKK-1) and tumor necrosis factor-α (TNF-α) in AS.

Research methods

A total of 113 patients with active AS were selected as the research group, and 100 healthy subjects who underwent physical examination were selected as the control group. The levels of DKK-1 and TNF-α in peripheral blood in the two groups were compared. The diagnostic and predictive value of DKK-1 and TNF-α for AS were analyzed with ROC curves, and the factors influencing AS recurrence were analyzed with COX regression.

Research results

Before treatment, the research group showed lower DKK-1 levels but higher TNF-α levels than the control group (both aP < 0.05). In the research group, DKK-1 was up-regulated and TNF-α was down-regulated after 12 wk of treatment (aP < 0.05). The (area under the curve) AUC, sensitivity and specificity of DKK-1 combined with TNF-α for diagnosing AS were 0.934, 82.30% and 97.00%, respectively. Before treatment, the AUC, cutoff value, sensitivity and specificity of DKK-1 for predicting the curative effect were 0.825, 68.42 pg/mL, 73.68% and 80.00%, respectively, and those of TNF-α were 0.863, 32.79 ng/L, 92.11% and 77.33%, respectively. DKK-1 and TNF-α levels after treatment were closely related to the curative effect (aP < 0.05). C-reactive protein, the Bath Ankylosing Spondylitis Disease Activity Index, DKK-1, and TNF-α were risk factors for AS recurrence (aP < 0.05).

Research conclusions

DKK-1 and TNF-α are effective in the diagnosis and treatment of AS and are risk factors for its recurrence. In addition, DKK-1 may be a potential target for the diagnosis of AS.

Research perspectives

Further analysis of the differential diagnostic value of DKK-1 and TNF-α in AS and suspected AS (such as lumbosacral joint strain, tuberculous spondylitis, Forestier disease, etc.), and the provision of more evidence for the clinical diagnosis of AS are required.