1,25(OH)_2D_3治疗强直性脊柱炎的临床研究

Clinical Study on the Treatment of Ankylosing Spondylitis with 1,25(OH)_2D_3

目的:观察初诊强直性脊柱炎患者25(OH)D_3水平,并探讨1,25(OH)_2D_3是否对强直性脊柱炎有潜在治疗作用。方法:收集60例初诊强直性脊柱炎患者和40例健康对照组血清标本,采用酶联免疫法测定血清25(OH)D_3水平。将强直性脊柱炎组患者按1∶1比例随机分为1,25(OH)_2D_3治疗组和常规治疗组,每组30例。常规治疗组采用洛索洛芬钠+沙利度胺治疗,1,25(OH)_2D_3治疗组在常规治疗组基础上加维生素D治疗。观察2组患者在0,4,12周的25(OH)D_3水平、BASDAI评分、ESR、CRP变化,评判治疗效果。结果:(1)初诊强直性脊柱炎患者血清25(OH)D_3水平显著低于健康对照组(t=7.19,P<0.01),且与BASDAI评分、CRP呈显著负相关(r=-0.57,P<0.05;r=-0.53,P<0.05),与ESR无明显相关性(r=-0.48,P>0.05)。(2)治疗4周后,1,25(OH)_2D_3治疗组BASDAI评分、CRP及25(OH)D_3显著低于常规治疗组,差异均有统计学意义(t=2.23,P<0.05;t=2.16,P<0.05;t=2.38,P<0.01);治疗12周后,1,25(OH)_2D_3治疗组BASDAI评分、CRP及25(OH)D_3显著低于常规治疗组,差异均有统计学意义(t=3.15,P<0.01;t=2.38,P<0.05;t=6.32,P<0.01);在第4,12周,1,25(OH)_2D_3治疗组ESR低于常规治疗组,但差异无统计学意义(t=0.92,t=1.96,P>0.0 5)。结论:25(OH)D_3在强直性脊柱炎的发生、发展中有重要作用,1,25(OH)_2D_3添加治疗能有效改善强直性脊柱炎患者的BASDAI评分及临床症状,具有较高治疗前景。

Objective：To observe the level of 25 （OH） D3 in patients with newly diagnosed ankylosing spondylitis and to investigate whether 1,25 （ OH ） 2D3 has a potential therapeutic effect on ankylosing spondylitis.Metbods：Serum samples were collected from sixty patients with newly diagnosed ankylosing spondylitis and 40 healthy people,and the enzyme-linked immunosorbent assay was used to detect the level of serum 25 （ OH ） D3.The patients of ankylosing spondylitis were randomly divided into a 1,25 （ OH ） 2D3 treatment group and a conventional treatment group according to the ratio of 1 to 1,with 30 cases in each group. The conventional treatment group was treated with Lo Solo Finn sodium and thalidomide,and the patients in the 1,25 （ OH ） 2D3 treatment group were treated with vitamin D based on the treatment for the conventional treatment group.The levels of 25 （ OH ） D3,BASDAI scores,and changes ESR and CRP in the two groups were observed respectively before treatment,after four and twelve weeks of treatment to evaluate the results.Results： （1） The level of 25 （ OH ） D3 in the serum of patients with ankylosing spondylitis was significantly lower than that of the healthy control group （ t = 7.19,P 〈 0.01 ） .It was negatively correlated with the scores of BASDAI and CRP （ r = -0.57,P 〈 0.05;r = -0.53,P 〈 0.05 ）,and had no significant correlation with ESR（ r = -0.48,P 〉 0.05 ）. （2）After four weeks of treatment,the BASDAI score, CRP and 25 （ OH ） D3 of the 1,25 （ OH ） 2D3 treatment group were significantly lower than those of the conventional treatment group,and the differences were statistically significant （ t = 2.23,P 〈 0.05; t = 2.16,P 〈 0.05;t = 2.38,P 〈 0.01 ） .After 12 weeks of treatment,the BASDAI score,CRP and 25 （ OH ） D3 of the 1,25 （ OH ） 2D3 treatment group were significantly lower than those of the conventional treatment group,and the differences were statistically significant （ t = 3.15,P 〈 0.01;t = 2.38,P 〈 0.05;t = 6.32,P 〈 0.01 ） .In the fourth and twelfth weeks,the ESR of the 1,25 （ OH ） 2D3 treatment group was lower than that of the conventional treatment group,but the difference was not statistically significant （ t = 0.92,t = 1.96,P 〉 0.05 ） .Conclusion：25 （ OH ） D3 plays an important role in the occurrence and development of ankylosing spondylitis and therapy with 1,25 （ OH ） 2D3 can effectively improve the BASDAI score and clinical symptoms of patients,with high therapeutic potential.