类风湿性关节炎患者血清25-羟维生素D水平及与疾病活动度的相关性研究

Study on correlation between serum 25-hydroxyvitamin d level and disease activity in patients with rheumatoid arthritis

目的研究类风湿性关节炎患者血清25-羟维生素D[25(OH)D]水平及与疾病活动度的相关性。方法使用病例对照的研究方法,选取2019年12月至2020年12月新疆医科大学第一附属医院及第二附属医院的类风湿性关节炎(RA)患者作为RA组(n=241),健康体检者作为对照组(n=240),测定其25(OH)D水平,并收集患者一般资料、C反应蛋白(CRP)、血沉(ESR)、体重指数(BMI)、类风湿因子(RF)、抗环瓜氨酸肽抗体(Anti-CCP)、红细胞分布宽度(RDW)、血清骨钙素、D-二聚体(D-D)、抗链球菌溶血素O(ASO),肿胀关节数(SJC28)、压痛关节数(TJC28)及疾病活动性评分(DAS28)评分等资料,比较两组患者25(OH)D水平高低以及25(OH)D与RA患者疾病活动度的相关性,并分析RA患者25(OH)D水平与各项临床指标的相关性。结果RA患者血清25(OH)D水平低于对照组,差异有统计学意义(P<0.05);RA组25(OH)D缺乏数高于对照组,差异有统计学意义(P<0.05)。不同疾病活动度的RA患者25(OH)D水平不同,DAS28评分越高,25(OH)D水平越低,25(OH)D水平与RA患者的疾病活动度呈负相关;25(OH)D浓度与ESR、Anti-CCP、SJC28、TJC28、DAS28>3.2呈负相关,与血清骨钙素及RDW呈正相关,与年龄、BMI、CRP、RF、ASO、D-D无关;高DAS28评分、高ESR、高Anti-CCP、SJC28、TJC28均为25(OH)D的抑制影响因素;RDW、血清骨钙素可作为RA患者25(OH)D水平的促进因素。结论RA患者25(OH)D水平明显降低,且与疾病的活动度相关;高ESR、高Anti-CCP、低血清骨钙素、高SJC28、高TJC28、高DAS28评分的RA患者均可能是评价25(OH)D水平与RA疾病活动度的重要因素。

Objective To study the correlation between serum 25-hydroxyvitamin D(25-OH Vitamin D,25[OH]D)level and disease activity in patients with rheumatoid arthritis(RA).Methods Using a case-control study method,collecting rheumatoid arthritis(RA)patients from the First Affiliated Hospital and Second Affiliated Hospital of Xinjiang Medical University from December 2019 to December 2020 were used as the RA group(n=241),and physical examination As the control group(n=240).The patients'general information,C-reactive protein(CRP),blood sedimentation(ESR),body mass index(BMI),rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(Anti-CCP),red blood cell distribution width(RDW),serum osteo-calcium,D-dimer(D-D),antistreptolysin O(ASO),number of swollen joints(SJC28),number of tender joints(TJC28)and disease activity score(DAS28),and other clinical data were also collected.Compare the levels of 25(OH)D in the two groups and the correlation between 25(OH)D and disease activity in RA patients,and to analyze the correlation between 25(OH)D levels and various clinical indicators in RA patients.Results The level of serum 25(OH)d in RA patients was significantly lower than that in the control group(P<0.05).The number of 25(OH)D deficiency in RA group was significantly higher than that in control group(P<0.05).The 25(OH)D levels in RA patients with different disease activity were also different.The higher the DAS28,the lower the 25(OH)D level,and the 25(OH)D level was negatively correlated with the disease activity of RA patients.The 25(OH)D concentration was inversely and significantly correlated with ESR,Anti-CCP,SJC28,TJC28,DAS28>3.2,and positively correlated with serum osteocalcin and RDW,and independent of age,BMI,CRP,RF,ASO,D-D.High DAS28,high ESR,high Anti-CCP,SJC28,TJC28 were inhibitory factors on 25(OH)D,and RDW,serum osteocalcin could be contributing factors to 25(OH)D level in RA patients.Conclusion The 25(OH)D levels were significantly lower in patients with rheumatoid arthritis and correlated with disease activity.RA patients with high ESR,high Anti-CCP,low serum osteocalcin,high SJC28,high TJC28,and high DAS28 may all be important factors in the evaluation of 25(OH)D level and RA dis ease activity.