类风湿关节炎患者血清25-羟维生素D水平与血脂代谢和冠状动脉病变的相关性分析

Correlations of serum 25-hydroxyvitamin D with blood lipid metabolism and coronary artery disease in rheumatoid arthritis

目的分析类风湿关节炎（RA）患者血清25-羟维生素D[25-（OH）-D]水平与血脂代谢和冠状动脉病变的相关性。方法选取2014年1月至2016年3月于首都医科大学附属北京安贞医院确诊且行冠状动脉造影的RA患者132例（RA组），依据是否合并冠状动脉病变将RA组分为RA不合并冠状动脉病变组（A组，81例）与RA合并冠状动脉病变组（B组，51例）。另选取同期年龄、性别匹配的健康体检者作为对照组（62例）。比较RA组与对照组血清25-（OH）-D水平，分析各组血清25-（OH）-D水平与不同血脂成分的相关性及RA患者发生冠状动脉病变的危险因素。结果RA组患者血清25-（OH）-D水平明显低于对照组[（15±8）μg/L比（25±7）μg/L]，差异有统计学意义（P〈0．01）；B组患者血清25-（OH）-D水平明显低于A组[（13±7）μg/L比（16±9）μg/L]，差异有统计学意义（P〈0．05）。RA组血清25-（OH）-D水平与总胆固醇、低密度脂蛋白胆固醇呈负相关（r=-0．213，P=0．014；r=-0．215，P=0．013）。对照组血清25-（OH）-D水平与不同血脂成分均无相关性（均P〉0．05）。A组血清25-（OH）-D水平与总胆固醇、低密度脂蛋白胆固醇呈负相关（r=-0．229，P=0．039；r=-0．248，P=0．025）。B组血清25-（OH）-D水平与不同血脂成分均无相关性（均P〉0．05）。血清25-（OH）-D水平〈30μg／L是RA患者发生冠状动脉病变的独立危险因素（比值比=0．86，95％置信区间：0．75—1．00，P=0．043）。结论RA不合并冠状动脉病变者血清25-（OH）-D水平与总胆固醇和低密度脂蛋白胆固醇水平呈负相关，血清25-（OH）-D水平〈30μg／L是RA患者发生冠状动脉病变的独立危险因素。

Objective To investigate correlations of serum 25-hydroxyvitamin D[25-（OH） -D] with blood lipid metabolism and coronary artery disease（CAD） in patients with rheumatoid arthritis（RA）. Methods Totally 132 patients with RA who had coronary arteriongraphy from January 2014 to March 2016 in Beijing Anzhen Hospital, Capital Medical University were enrolled as RA group, which were further divided into 2 subgroups： group A （81 cases, complicated with CAD） and group B（51 cases, without CAD）. Other 25 healthy people matched in age and sex were selected as control group. Serum levels of 25-（OH）-D were analyzed. The correlation between 25-（OH） -D and blood lipid components and the risk factor of CAD were analyzed. Results The serum level of 25-（ OH ）-D in RA group was significantly lower than that in control group[ （15 ± 8 ）μg/L vs （25 ± 7 ） μg/L ] （P 〈 0.01 ） , the serum level of 25-（OH） -D in group B was significantly lower than that in group A[ （ 13±7） μg/L vs （16 ± 9）μg/L] （P 〈0.01 ）. In RA group and group A, serum 25-（OH）-D was negatively correlated with total cholesterol （ TC ） and low density lipoprotein cholesterol（LDL） （ RA group ： r = - 0. 213 and - 0.215, P = 0. 014 and 0.013 ; group A： r = -0. 229 and -0. 248, P =0. 039 and 0. 025） ; there was no correlation in control group and group B（P 〉 0.05）. Serum 25-（ OH）-D 〈 30 μg/L was an independent risk factor of CAD in RA group（odds ratio： 0.86, 95% confidence interval： 0. 75-1.00, P 〈 0.05）. Conclusions The serum level of 25-（ OH）-D is negatively correlated with TC and LDL in RA patients without CAD. The serum level of 25-（ OH）-D 〈 30 μg/L is an independent risk factor of CAD in RA patients.