系统性红斑狼疮女性患者血清25(OH)D_3水平测定及其与骨密度关系的研究

Serum vitamin D level in patients with systemic lupus erythematosus and its relationship with bone mineral density

目的横断面观察系统性红斑狼疮(SLE)女性患者血清25(OH)D3的水平,统计其不足和缺乏的发生率;分析SLE患者血清25(OH)D3水平不足和缺乏的相关影响因素;研究血清中维生素D水平与疾病活动度(SLEDAI)、骨密度(BMD)等之间的相关性。方法选取无锡市第二人民医院2009年09月～2011年03月风湿科门诊及住院SLE未孕女性患者106例作为病例组,搜集患者资料;选取73例健康体检者作为对照组,采用酶联免疫法测定外周血血清中25(OH)D3的浓度,采用双能X线测量SLE组人员的BMD,进行各因素间相关分析。结果 106例SLE患者血清25(OH)D3水平较73例健康对照组显著低下(t=-10.422,P<0.001),影响因素有使用糖皮质激素、糖皮质激素使用剂量、肾脏受累。血清25(OH)D3水平与疾病活动度评分间有负相关(r=-0.602,P=0.023)。未接受糖皮质激素治疗的SLE患者血清25(OH)D3水平与BMD间有统计学相关性(r=0.178,P=0.012),而接受糖皮质激素患者两者之间无统计学相关性。结论女性SLE患者血清25(OH)D3水平较健康对照组显著低下,使用糖皮质激素、激素剂量、肾脏受累是其显著的影响因素;血清25(OH)D3水平与疾病活动度相关;未接受糖皮质激素治疗SLE患者血清25(OH)D3水平与BMD间有相关性。血清25(OH)D3的测定可为预测疾病活动程度、早期干预提供依据。

Objective The objective of this study was To determine the serum level of vitamin D in patients with systemic lupus erythematosus（SLE）,to calculate the incidence of its deficiency and the influential factors,and to study the relationship among serum 25（OH）D3 level,SLE activity index（SLEDAI）,and bone mineral density（BMD）.Methods Datas were collected from 106 non-pregnant female SLE patients,who were in outdoor and indoor patient department in the Second People＇s Hospital of Wuxi,from September 2009 to March 2011.Seventy-three healthy people were chosen as control.Peripheral serum 25（OH）D3 level was determined using ELISA method.BMD of SLE patients was measured with DEXA.Results Factors were analyzed.Results The mean 25（OH）D3 level in 106 SLE patients（22.37±6.74ng/ml） was significantly lower than in 73 controls（33.90±8.08 ng/ml,t=-10.422,P0.001）.The related factors included the use of glucocorticoid,the dose of glucocorticoid,and the renal damage.Serum 25（OH）D3 level was negatively correlated with SLEDAI（r=-0.602,P=0.023）.Serum 25（OH）D3 level in SLE patients who were not treated with glucocorticoid was associated with BMD status（r=0.178,P=0.012）,but not in patients who were treated with glucocorticoid.Conclusion Vitamin D level is low in patients with SLE than in controls.The use and dose of glucocorticoid and the renal damage are significant influential factors.The vitamin D level was also associated with disease activity.25（OH）D3 in SLE patients without using glucocorticoid is correlated with BMD status.Serum 25（OH）D3 measurement can be use to predict the disease activity and to provide evidence for early intervention.