维生素D与强直性脊柱炎患者甲襞微循环形态的相关性研究

The relationship between vitamin D status and capillary morphology of the nailfold in patients with ankylosing spondylitis

目的探讨强直性脊柱炎(ankylosing spondylitis,AS)患者血清25(OH)D 3与甲襞微循环形态的相关性。方法选择在胜利油田中心医院风湿免疫科就诊的AS患者121例,包括113例男性和8例女性,同时选取年龄、性别相匹配的健康对照80名,所有受试者行甲襞微循环及血清25(OH)D 3检测,同时详细记录AS患者的临床资料,并依据血清25(OH)D 3水平分为VitD不足组和VitD缺乏组。数据间的相关性分析采用Pearson及线性回归分析。结果①AS患者25(OH)D 3水平低于健康对照组;②AS甲襞微循环形态存在异常。VitD缺乏组的毛细血管密度、动静脉支管径分别小于与VitD不足组和对照组(P均<0.01),管袢直径分别大于VitD不足组和对照组(P均<0.01);VitD不足组的毛细血管密度、动静脉支直径均小于对照组(P均<0.01),管袢直径大于对照组(P=0.001),毛细血管长度与对照组相比无显著差异(P=0.832);③AS患者25(OH)D 3水平与甲襞微循环积分呈显著负相关(r=-0.357,P<0.01);25(OH)D 3水平下降是甲襞微循环积分增高的风险因素(β=-0.099,P=0.001)。结论AS患者存在不同程度的维生素D缺乏,血清25(OH)D 3水平下降与甲襞微循环积分升高显著相关,是AS患者发生微循环障碍的危险因素,详细机制仍需进一步研究。

Objective To study the relationship between serum 25-hydroxyvitamin D[25(OH)D 3]and nailfold microcirculation morphology in patients with ankylosing spondylitis(AS).Methods One hundred and twenty-one AS patients were included in this study,including 113 males and 8 females.Eighty gender-and age-matched healthy subjects were in the healthy control group.Nailfold capillaroscopy scores and serum 25(OH)D 3 levels were measured in all the subjects.The detailed clinical data of the AS patients were recorded.The patients were divided into insufficiency group and deficiency group according to the level of serum 25(OH)D 3.Pearson’s test was adopted for correlation analysis.Linear regression analysis was used to determine the association between vitamin D and nailfold microcirculation morphology.Results(1)The level of serum 25(OH)D 3(18.73±5.99 ng/mL)in AS group was lower than that in the control group(22.53±5.56 ng/mL,t=-3.883,P<0.01).(2)The capillary density and diameter of arterial and venous branches in VitD deficiency group were smaller than those in VitD insufficiency group and control group(P<0.01,respectively),and the diameters of apical loop were larger than those in VitD insufficiency group and control group(P<0.01,respectively).The capillary density and diameter of arterial and venous branches in VitD insufficiency group were smaller than those in control group,and the diameters of apical loop were larger than that in control group(P=0.001).There was no significant difference in capillary length between the two groups(P=0.832).(3)There was a negative correlation between serum 25(OH)D 3 level and nailfold capillary scores.Multiple linear regression analysis showed that the decrease of serum 25(OH)D 3 level was a risk factor for the increase of nailfold capillary scores(β=-0.099,P=0.001).Conclusion There are different degrees of vitamin D deficiency in patients with AS.The decrease of serum 25(OH)D 3 level is significantly related to the increase of nailfold capillary scores,which is the risk factor of microcirculation disturbance in AS patients.The detailed mechanism still needs further study.