维生素D与类风湿关节炎疾病活动度的关系分析

Association of vitamin D with disease activity of rheumatoid arthritis

目的探讨血清25-羟-维生素D[25(OH)D]与类风湿关节炎(RA)疾病活动度的关系及补充活性维生素D对RA疾病活动度的影响。方法检测118例RA患者血清25(OH)D水平,将25(OH)D低下的89例RA患者按随机数字表法分为研究组45例和对照组44例,均进行标准治疗,其中研究组在此基础上口服阿法骨化醇胶丸(每次0.25μg×2粒,1次/d),观察期为12个月。在入组前(基线)、3、6及12个月时均测定患者血清25(OH)D、血沉(ESR)、C反应蛋白(CRP)及进行28关节疾病活动度(DAS28)评估。分析血清25(OH)D与DAS28、ESR、CRP的相关性,比较两组25(OH)D水平、DAS28评分的差异。结果与基线比较,两组患者12个月时血清25(OH)D水平均上升、DAS28评分均下降(均P<0.05)。研究组6、12个月时血清25(OH)D水平高于对照组,差异均有统计学意义(P<0.05或0.01),但DAS28评分比较差异无统计学意义。在RA疾病本身基础状态下血清25(OH)D与DAS28评分呈负相关(r=-0.403,P<0.05)。将各观察点的血清25(OH)D水平与DAS28评分进行总体相关分析,均呈负相关(r=-0.534、-0.691、-0.639,均P<0.001)。结论 RA患者中有75.42%(89/118)血清25(OH)D降低;血清25(OH)D与DAS28评分、ESR、CRP值呈负相关;补充活性维生素D对降低DAS28评分有一定的作用,但不显著。

Objective To investigate the association between vitamin D and disease activity of rheumatoid arthritis（RA）.Methods Eighty-nine RA patients with vitamin D deficiency were divided into trial group （n=45） and control group （n=44） randomly.Two groups received standardized treatment while the trial group received additional α-calcidol （0.5μg q.d.） treatment for 12 months.Patients were evaluated by the Disease Activity Score （DAS28） at baseline and 3,6 and12 months of treatment;blood 25-hydroxyvitamin D,ESR,CRP levels were also measured.Results Compared with baseline level,DAS28 scores were decreased and 25-hydroxyvitamin D levels were increased at 12 month of treatment in both groups （P 〈0.05）.The 25-hydroxyvitamin D levels in trial group was significant higher than those in control group at 6 month and 12 month of treatment （P〈0.05,P〈0.01）.The scores of DAS28 was not significantly different between two groups （P 〉0.05）.The 25-hydroxyvitamin D levels were negatively correlated with DAS28 at all time points （r=-0.403,-0.534,-0.691 and-0.639,P〈0.05 or P〈0.001）.Conclusion The 25-hydroxyvitamin D level is negatively correlated with the disease activity of rheumatoid arthritis,but the effect of 25-hydroxyvitamin D administration is uncertain in improving disease activety of RA patients.