维生素D在强直性脊柱炎骨代谢中的作用研究

The role of vitamin D in bone metabolism of ankylosing spondylitis

目的 研究强直性脊柱炎（AS）患者血清维生素D水平与骨代谢及病情活动的相关性,探讨维生素D在骨代谢中的作用.方法 采用酶联免疫吸附试验（ELISA）法检测80例患者及40名健康者血清中25-（OH）D3、骨特异性碱性磷酸酶（BALP）、抗酒石酸酸性磷酸酶异构体-5b（TRACP-5b）水平及血淋巴细胞中维生素D受体（VDR）水平,用双能X线吸收法（DEXA）测定AS患者骨密度值,并测定红细胞沉降率（ESR）、C反应蛋白（CRP）.分析25-（OH）D3与骨代谢指标、炎性指标及骨密度等相关性；并根据患者25-（OH）D3水平分为正常组、不足组及缺乏组,采用t检验,t＇检验及x2检验,比较组间骨代谢指标及炎性指标的差异.结果 病例组血清25-（OH）D3[（11.9±2.7）μg/L]明显低于健康对照组[（22.3±7.9）μg/L],BALP[（3.9±2.7） μg/L]、TRACP-5b[（46±25） ng/L]高于健康对照组[（2.4±1.0）μg/L].25-（OH）D3与CRP呈负相关（r =0.324,P=0.003）.维生素D缺乏组的ESR、BALP、TRACP-5b高于正常组及不足组（P＜0.05）.结论 AS患者维生素D水平降低可导致骨质疏松发病率的升高及骨代谢活跃,并与病情活动存在相关.

Objective The goal of this study was to investigate the correlation between the level of serum vitamin D and bone metabolism and disease activity in ankylosing spondylitis（AS） patients,and thus to explore the role of vitamin D in bone metabolism in AS patients.Methods The serum levels of BALP,TRACP-5b,25-（OH）D3 and blood lymphocytes VDR of 80 AS patients were measured by enzyme-linked immunosorbent assay （ELISA） and compared with those of the control group.Bone mineral density （BMD）was measured by dual-energy X-ray absorptiometry （DEXA）.The ESR and CRP level of AS patients were also measured.The correlation between those parameters was analyzed and evaluated.Patients were divided into normal,insufficient and deficient subgroups according to the serum 25-（OH）D3 levels for further comparison.Indepondent saimple t test,t＇test andx2 test were used for statistical analysis.Results The 25-（OH）D3 of AS patients [（11.9±2.7） μg/L] was significantly lower than that of the control groups [（22.3±7.9） μg/L] （P＜0.05）,while the serum levels of BALP [（3.9±2.7） μg/L] and TRACP-5b [（46±25） ng/L] of AS patients were significantly higher than those of the control group [（2.4±1.0） μg/L] （P＜0.05）.According to linear correlation analysis,25-（OH）D3 was negatively correlated with CRP （r=0.324,P=0.003）.The ESR,BALP,TRACP-5b in the deficient subgroup were higher than those in the normal and insufficient subgroups（P＜0.05）.Conclusion The plasma 25-（OH）D3 may decrease in AS patients,and this may activate bone metabolism,results in increased morbidity of osteoporo-sis,and negatively affect disease activity.