类风湿关节炎血清1,25-二羟维生素D3水平与肺动脉压的关系

Correlation between the level of 1,25-dihydroxy vitamin D3 and pulmonary arterial pressure in rheumatoid arthritis

目的研究类风湿关节炎(rheumatoid arthritis,RA)患者血清1,25-二羟维生素D3[1,25(OH)_2D3]水平与肺动脉压的关系,并探讨其临床意义。方法收集山西医科大学第二医院风湿免疫科2015-09~2016-12收治的RA患者300例,其中单纯RA 213例,肺部受累RA 67例,心脏受累RA 20例。研究指标包括年龄、性别、病程、疾病活动度(DAS28)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、1,25(OH)_2D3水平及肺动脉压等临床资料。计量资料比较采用方差分析,进一步多重比较采用LSD-t检验,用线性回归分析研究1,25(OH)2D3与肺动脉压关系。结果肺部受累RA组肺动脉压明显高于单纯RA组[(29.09±11.35)mm Hg vs(23.48±8.84)mm Hg,t=-2.573,P=0.013],心脏受累RA组与单纯RA组肺动脉压相比差异无统计学意义[(28.75±9.09)mm Hg vs(23.48±8.84)mm Hg,t=-1.895,P=0.079]。单纯RA组、肺部受累RA组及心脏受累RA组1,25(OH)_2D3水平均缺乏,两两比较差异无统计学意义(P>0.05)。1,25(OH)_2D3与肺动脉压之间存在负相关(r=-0.217,P<0.05)。进一步根据是否肺部、心脏受累分组后,发现肺部受累RA组1,25(OH)_2D3与肺动脉存在明显负相关(r=-0.447,P<0.05),而心脏受累RA组和单纯RA组1,25(OH)_2D3与肺动脉尽管有数值上的负相关,但无统计学意义。结论 RA患者血清1,25(OH)_2D3水平与肺动脉压有一定的关系,尤其对于合并肺部受累患者。

Objective To investigate the correlation between the levels of 1,25-dihydroxy vitamin D3（ 1,25（ OH）_2 D3） and pulmonary arterial pressure in patients with rheumatoid arthritis（ RA）,and to explore its significance. Methods Three hundred patients with RA from September 2015 to December 2016 in Department of Rheumatology in the Second Hospital of Shanxi Medical University were enrolled in the study,and divided into simple RA group（ n = 213）,pulmonary involvement group（ n = 67） and cardiovascular involvement group（ n = 20）. Clinical and laboratory features such as age,gender,disease duration,disease activity（ DAS 28）,erythrocyte sedimentation rate,1,25（ OH）_2 D3 level and pulmonary arterial pressure were recorded in detail. Numerical data and categorical data were compared using ANOVA and the correlation of 1,25（ OH）2 D3 level and pulmonary arterial pressure was assessed using linear regression analysis. Results Pulmonary arterial pressure in RA patients with pulmonary involvement was significantly higher than that in simple RA[（ 29. 09 ± 11. 35） mm Hg vs（ 23. 48 ± 8. 84） mm Hg,t =-2. 573,P = 0. 013]. However,there was no significant difference in pulmonary arterial pressure between cardiovascular involvement group and simple RA group[（ 28. 75 ± 9. 09） mm Hg vs（ 23. 48± 8. 84） mm Hg,t =-1. 895,P = 0. 079]. The levels of 1,25（ OH）_2 D3 were all deficient in simple RA group,pulmonary involvement group and cardiovascular involvement group,but showed no difference among three groups. The levels of 1,25（ OH）_2 D3 was negatively correlated with pulmonary arterial pressure（ r =-0. 217,P〈0. 05）. Further grouping,significant inverse relationship was observed between the levels of 1,25（ OH）_2 D3 and pulmonary arterial pressure in pulmonary involvement group（ r =-0. 447,P〈0. 05）,but not in cardiovascular involvement group or simple RA group. Conclusion The level of 1,25（ OH）_2 D3 has a close relationship with pulmonary arterial pressure in patients with RA,especially patients combined with pulmonary involvement.