幼年特发性关节炎血清维生素D水平与疾病活动度及骨密度相关性分析

Correlation analysis between serum vitamin D levels and disease activity as well as bone mineral density in children with juvenile idiopathic arthritis

目的检测幼年特发性关节炎(JIA)患儿血清25羟维生素D_3[25(OH)D_3]水平,研究维生素D与JIA疾病活动度及骨密度的关系。方法按照2001年国际风湿病学联盟(ILAR)诊断标准,于2015年1月至2017年1月纳入重庆医科大学附属儿童医院风湿免疫科110例JIA患儿,其中女58例、男52例,年龄(9.04±3.37)岁。检测JIA患儿血清25(OH)D_3、血浆PTH水平,双能X线检查评估骨密度。评价患儿疾病活动状态,并通过JADAS27评分衡量疾病活动度。比较JIA患儿血清25(OH)D3水平与其他指标之间的关系。结果 110例JIA患儿血清中25(OH)D_3水平为(49.8±15.3)μmol/L,其中59例(53.6%)为维生素D缺乏状态,43例(39.1%)表现为维生素D不足。活动期JIA 25(OH)D_3水平低于缓解期(t=5.162,P<0.001),与JADAS27评分无相关性(r=-0.72,P>0.05)。维生素D缺乏状态下JIA患儿骨密度(Z值)低于维生素D充足状态(t=3.791,P<0.05)。未使用皮质激素(GC)治疗的JIA患儿25(OH)D_3水平显著高于使用GC治疗者(t=2.823,P<0.01)。结论 JIA患儿普遍存在血清维生素D水平低下。处于疾病活动期、使用激素治疗的患儿血清25(OH)D_3水平低下尤为显著,维生素D缺乏状态下JIA患儿骨密度降低。

Objective To assessed serum level of 25 （OH）D3 in children with juvenile idiopathic arthritis, in order to find the association between the vitamin D and disease activity as well as bone mineral density. Methods We evaluated 110 patients （58 females and 52 males, mean age being 9.04±3.37 years） that fulfilled the 2011 ILAR criteria for juve- nile idiopathic arthritis. Patients underwent laboratory tests of serum25 （OH） D3, plasma parathyroidhormone and dual- energyx-ray absorptiometry examination. JIA patients were categorized by ACR standard of disease status in 2011, and the disease activity was measured by using JADAS-27. We analyzed the relationship between serum 25 （OH）D3 level and other indexes. Results The mean serum 25（OH）D level of 110 JIA patients was（49.8±15.3）μ mol/L. Vitamin D deficiency was detected in 59 patients （53.6%） and insufficiency in 43 patients （39.1%）. Patients with active disease had significantly reduced serum 25 （OH）D3 levels compared to patients with inactive disease （t = 5.162, P 〈 0.001 ）, but there was no significant association between serum 25 （OH）D3 level and JADAS-27 （r= -0.72, P 〉 0.05）. JIA patients with vitamin D deficiency showed a significantly lower bone mineral density than those with normal 25 （OH）D3 level （t = 3.791, P 〈 0.05）. Patients using glucocortieoid showed significantly lower 25 （OH）D3 level than those who never used glueoeortieoid （t = 2.823, P 〈 0.01 ）. Conclusion JIA patients have reduced serum 25 （OH） D3, particularly those withactive disease or/and using glucocorticoid. JIA patients with vitamin D deficiency showed a significantly lower bone mineral density.