类风湿关节炎患者血清VEGF与25-(OH)D 水平的影响因素及临床预防研究

Serum levels of VEGF and 25-(OH)D in patients with rheumatoid arthritis

目的研究类风湿关节炎患者的血清(vascularerdothelial growth factor,VEGF)与25羟基维生素D[25-(OH)D]的危险因素及预防措施。方法对2016年10月至2018年8月金华文莱医院收治的103例类风湿关节炎(rheumatoid arthritis,RA)患者作为RA组,按相关分期标准将RA组患者分为RA活动期组(43例)、RA缓解期组(60例),另选择同期进行健康体检的141例健康体检者作为对照组。对RA活动期组、RA缓解组、对照组受检者的血清VEGF、25-(OH)D水平以及相关炎性因子进行测定,并对RA组、对照组受检者的相关情况进行问卷调查。结果RA活动期组、RA缓解期组患者的血清VEGF水平以及超敏C反应蛋白(hypresensitive C-reactive protein,hs-CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(interleukin-6,IL-6)水平均高于对照组,RA活动期组患者的血清VEGF水平以及hs-CRP、TNF-α和IL-6水平均明显高于缓解期组,间组比较差异有统计学意义(F=1111.83、367.77、640.49、141.13,P均=0.000)。RA活动期组、RA缓解期组患者的25-(OH)D水平高于对照组,RA活动期组的25-(OH)D水平高于RA缓解期组(F=231.20,P=0.0000),三组的维生素D含量比较差异有统计学意义(χ~2=34.352、8.992、9.950,P=0.000、0.011、0.007)。两组在性别、年龄以及抽烟、喝酒所占比例上比较差异无统计学意义(P均>0.05);RA组患者中居住环境阴冷潮湿、有结核病史、有类风湿性关节炎家族史所占比例高于对照组,RA组女性患者的初潮年龄大于对照组,初孕年龄则低于对照组,差异有统计学意义(t=5.488、3.373、P均<0.05)。结论引起类风湿关节炎的发病因素较多,患者的血清VEGF偏高,25-(OH)D水平偏低,通过检测血清VEGF、25-(OH)D及相关炎性因子水平能够反映出类风湿关节炎的病情活动程度,对于其病情评估及预防治疗均具有重要意义。

Objective To understand the serum levels of vascular endothelial growth factor(VEGF)and 25-(OH)D in patients with rheumatoid arthritis(RA),and to discuss the risk factors.Methods 103 patients with RA treated in our hospital from October 2016 to August 2018 were enrolled and were divided into active RA group(43 cases)and remission RA group(60 cases)according to the relevant staging criteria.Meanwhile,141 healthy individuals who underwent physical examination during the study period were recruited as controls.Serum levels of VEGF,25-(OH)D and related inflammatory factors were determined and a questionnaire survey was conducted.Results The serum levels of VEGF,hs-CRP,TNF-alpha and IL-6 were higher in patients with RA than those in healthy controls,and were higher in RA active group compared to RA remission group,the differences were statistically significant(F=1111.83,367.77,640.49,141.13,P=0.000).There were significant differences in the serum level of 25-(OH)D among three groups,with the highest level in RA active group and the lowest in control group(χ~2=23.831,8.992,9.950,P<0.05).The differences in gender,age,smoking and drinking rates between the two groups were not significant(P>0.05),while the percentages of subjects living in cold and wet places,with tuberculosis history and family history of rheumatoid arthritis were higher in RA group than in control group(P<0.05).Compared to controls,female patients with RA were more likely to have their menarche at older age and their first pregnancy at younger age,the differences were significant(t=5.488,3.373,P<0.05).Conclusions There are many factors related to rheumatoid arthritis.The serum level of VEGF is higher while the level of 25-(OH)D is lower in patients with RA.Detection of serum levels of VEGF,25-(OH)D and related inflammatory factors may reflect the disease activity,which of great significance for the evaluation and prevention of RA.