早期类风湿关节炎患者甲襞微循环积分与病情活动度及骨质疏松的相关性分析

The correlation analysis between nail fold capillaroscopy score and disease activity and osteoporosis in patients with early rheumatoid arthritis

目的探讨早期类风湿关节炎患者甲襞微循环异常与病情活动性及骨质疏松的相关性。方法收集60例早期RA患者及60名健康对照者的血清,测定甲襞微循环积分,酶联免疫法测定其25(OH)D浓度,运用双能X线吸收仪测定RA患者骨密度,详细记录RA患者临床、实验室及影像学资料,计算疾病活动性。影响因素分析采用多元线性回归分析和Logistic回归分析进行统计学分析。结果 (1)RA患者甲襞微循环水平高于健康对照组,差异有统计学意义[(6.13±1.92)与(4.70±1.54),t=3.174,P=0.018];(2)甲襞微循环积分分别与RA患者DAS28积分、ESR、CRP、抗CCP抗体滴度相关(r=0.515、0.579、0.422、0.473,P均<0.05)同时,甲襞微循环积分在不同疾病活动度的RA患者中表达差异有统计学意义;(3)线性回归分析提示RA患者血清甲襞微循环积分增高是疾病活动性的危险因素(β=0.376,P=0.013);(4)VEGF水平随25(OH)D减低表现出增高的趋势,但差异无统计学意义(P=0.702);Pearson相关分析显示甲襞微循环积分与25(OH)D水平呈负相关(r=-0.593,P<0.001);(5)34例维生素D缺乏的患者均给予2周的阿法骨化醇补充治疗,血清25(OH)D水平从(14.0±3.4)ng/m L增加到(18.0±4.2)ng/m L,同时甲襞微循环评分由(6.68±2.06)下降到(4.62±1.69)。两者治疗前后比较均有统计学意义(t=-11.913,P<0.001和t=14.742,P<0.001);(6)Logistic回归分析发现甲襞微循环、年龄和DAS28是骨质疏松的危险因素(OR分别为1.632、1.257和1.506;P分别为0.003、0.015、0.047),而25(OH)D是RA患者骨质疏松的保护因素(OR=0.65,95%CI 0.44~0.96,P=0.032)。结论早期RA患者甲襞微循环异常与病情活动度相关;甲襞微循环积分增高是骨质疏松发生的危险因素。对于合并维生素D不足的RA患者,补充维生素D或许有助于微循环功能的改善。

Objective To explore the correlation between nailfold microcirculation and osteoporosis in early rheumatoid arthritis（RA）. Methods Nailfold capillaroscopies were performed and serum 25（OH） D levels were detected with enzyme-1 inked immunosorbent assay（ELISA） in 60 RA patients and 80 healthy controls. The detailed clinical data of the RA patients were recorded and bone mineral density（BMD） was measured using dua1-energy X-ray absorptiometry. Pearson＇s test was adopted for correlation analysis. Multi-variate analysis and logistic analysis were carried out for the identification of risk factors. Results（1）The scores of nailfold capillaroscopy were markedly higher in RA group（6. 13 ± 1. 92） than in the control group（4. 70 ± 1. 54,t = 3. 174,P =0. 018）.（2）Positive correlation was detected between nailfold capillaroscopy score and the DAS28 score,ESR,CRP,and anti CCP antibody titers in RA patients（r = 0. 515,0. 579,0. 422,0. 473,respectively,P〈0. 05）. At the same time,there was significant difference in the scores of nailfold capillaroscopy in the RA patients with different disease degrees.（3）Nailfold capillaroscopy scores were the risk factor for disease activity in multiple regression analysis（β = 0. 376,P = 0. 013）.（4）The level of VEGF increased with the decrease of 25（OH） D levels,but the difference was not statistically significant. Pearson correlation analysis showed that therewas a negative correlation between nailfold capillaroscopy score and 25（OH） D level（r =-0. 593,P〈0. 001）.（5）After supplement of alfa calcidol for 2 weeks in 34 patients with vitamin D deficiency,the level of serum 25（OH） D increased from（14± 3. 4） ng/mL to（18 ± 4. 2） ng/mL,and nailfold capillaroscopy score decreased from（6. 68 ± 2. 06） to（4. 62 ± 1. 69）. There was statistical significance between the two groups before and after the treatment（t =-11. 913,P〈0. 001 and t = 14. 742,P〈0. 001）.（6）The age and nailfold capillaroscopy were the risk factors of osteoporosis. Normal serum 25（OH） D level was a protective factor for RA-induced osteoporosis in logistic regression analysis（OR = 1. 632,1. 257,and 1. 506,respectively,and P = 0. 003,0. 015,and 0. 047,respectively）. Conclusion Nailfold capillaroscopy abnormalities in early RA is associated with the disease activity.The increase of nailfold capillaroscopy score is a risk factor of osteoporosis. Vitamin D supplementation may help to improve the function of microcirculation for patients with RA and vitamin D deficiency.