血清25-羟维生素D水平与类风湿性关节炎疾病活动度的相关性分析

Correlation analysis between serum 25-(OH)D level and disease activity of rheumatoid arthritis

目的探讨25-羟维生素D[25-(OH)D]与类风湿性关节炎(RA)患者疾病活动度的相关性。方法收集2015年1月-2018年12月嘉兴市第一医院收治的RA患者(456例)作为RA组及同期健康体检者作为健康对照组(270例),按照血中25-(OH)D浓度不同分为缺乏组(<20 ng/ml)、不足组(20~<30 ng/ml)及正常组(≥30 ng/ml),记录各组患者压痛关节计数(TJC28)、肿胀关节计数(SJC28),用28处疾病活动度评分(DAS28)评估RA疾病活动度,分析比较25-(OH)D水平与RA患者的抗环瓜氨酸肽抗体(ACPA)阳性率、类风湿因子(RF)阳性率、D-二聚体、Ca^2+、血沉(ESR)、TJC28、SJC28和DAS28的相关性。结果两组25-(OH)D水平比较,差异有统计学意义(P<0.05),RA组低于健康对照组;456例RA患者中,25-(OH)D正常组仅占11.4%(52/456);正常组、不足组和缺乏组在ACPA阳性率、DAS28≥2.6分的百分率、25-(OH)D、D-二聚体、Ca^2+、ESR、TJC28及SJC28值比较,差异均有统计学意义(P<0.05)。Pearson相关性分析显示:25-(OH)D水平与ESR、D-二聚体、ACPA阳性率、SJC28、TJC28和DAS28呈负相关(均P<0.05),与Ca^2+呈正相关(P<0.05)。结论RA患者的血清25-(OH)D水平普遍较低,与疾病的活动度相关,可作为RA患者疾病活动度的参考指标。

Objective To investigate the correlation between 25-hydroxyvitamin D[25-(OH)D]and disease activity in patients with rheumatoid arthritis(RA).Methods A retrospective study was carried out in the First Hospital of Jiaxing.From January 2015 to December 2018,456 patients diagnosed with RA and 270 healthy controls were collected.According to different concentrations of 25-(OH)D,they were divided into deficiency group[25-(OH)D<20 ng/ml],deficiency group[25-(OH)D:20 to 30 ng/ml]and normal group[25-(OH)D≥30 ng/ml].Tenderness joints count(TJC28),the number of swollen joints count(SJC28)and using DAS28(ESR)score to assess the RA disease activity were recorded,and then analysis the comparison between 25-(OH)D levels of RA patients with Anti CCP antibody(Anti-CCP antibody,ACPA)positive rate,rheumatoid factor(RF)positive rate,D-Dimer,Ca^2+,ESR,SJC28,TJC28 and DAS28(ESR).Results The 25-(OH)D level of RA patients was significantly lower than that of the healthy control group(P<0.05).Among the 456 RA patients,only 11.4%(52/456)were in the 25-(OH)D normal group.There were statistically significant differences among the components of ACPA positive rate,25-(OH)D,D-Dimer,Ca^2+,ESR,SJC28,TJC28 and DAS28≥2.6%in the normal,deficient and deficient groups(P<0.05).Pearson correlation analysis showed that 25-(OH)D level was negatively correlated with ESR,D-Dimer,ACPA positive rate,SJC28,TJC28 and DAS28 scores(P<0.05),and positively correlated with Ca^2+(P<0.05).Conclusion The average serum level of 25-(OH)D in RA patients is generally low,which is related to the activity of the disease,and may be used as a reference index for disease activity in RA patients.