类风湿关节炎患者血清25-羟维生素D和白蛋白/纤维蛋白原比值的临床意义

Significance of detecting serum 25-hydroxy-vitamin D level and albumin/fibrinogen ratio in patients with rheumatoid arthritis

目的探讨血清25-羟维生素D[25(OH)D]、白蛋白/纤维蛋白原比值(AFR)水平在类风湿关节炎(RA)中的变化及意义。方法回顾性研究2017年5月至2020年1月亳州市人民医院诊断明确的131例患者,其中95例RA患者为RA组,36例排除自身免疫疾病的关节痛患者为疾病对照组,选取同期40名体检健康者为健康对照组。RA组以基于28个关节计数和C反应蛋白水平的疾病活动度(DAS28-CRP)评分分为高度(>5.1分,25例)、中度(3.2分<DAS28-CRP≤5.1分,40例)、低度(≤3.2分,30例)疾病活动亚组;以血清25(OH)D水平分为正常(≥30 ng/ml,17例)、不足(20 ng/ml≤25(OH)D<30 ng/ml,31例)和缺乏(<20 ng/ml,47例)3个亚组;以年龄分为≤44岁(21例)、45~59岁(43例)、60~74岁(21例)、≥75岁(10例)4个亚组;以性别分为女(79例)、男(16例)2个亚组。分析其血清25(OH)D、白蛋白(ALB)及纤维蛋白原(Fib)水平,同时计算AFR。采集患者一般临床资料及实验室指标进行统计分析。用Spearman相关分析RA患者DAS28-CRP评分与实验室指标间的相关性,Logistic回归模型评价RA独立危险因素。结果RA组25(OH)D和AFR水平低于疾病对照组和健康对照组(P均<0.001),RA组25(OH)D水平缺乏/不足率为82.11%(78/95);不同年龄亚组的25(OH)D水平差异有统计学意义(P<0.05),且女性明显低于男性(P<0.05);相关性分析显示AFR与DAS28-CRP评分呈显著负相关(r=-0.497,P<0.01);Logistic回归分析显示25(OH)D(OR=0.852,95%CI 0.768~0.944,P=0.002)、AFR(OR=0.626,95%CI 0.480~0.817,P=0.001)、类风湿因子免疫球蛋白M(OR=1.044,95%CI 1.019~1.069,P<0.001)、抗环瓜氨酸肽抗体(OR=1.017,95%CI 1.002~1.032,P=0.030)均是RA患者疾病活动度的独立危险因素。结论RA患者血清25(OH)D及AFR水平较低且普遍存在25(OH)D缺乏/不足的现象,低水平的25(OH)D和AFR可作为RA患者疾病活动度评估的危险因素。

Objective To investigate the clinical significance of detecting serum 25-hydroxyl-vitamin D[25(OH)D]level and albumin/fibrinogen ratio(AFR)in patients with rheumatoid arthritis(RA).Methods This retrospective study included 131 patients(95 patients with RA and 36 with arthralgia excluding autoimmune diseases),who were treated in Bozhou People′s Hospital from May 2017 to January 2020.Forty healthy controls underwent health checkups during the same period served as healthy control.RA group was divided into high(>5.1,25 cases),medium(3.2<DAS28-CRP≤5.1),40 cases and low(≤3.2,30 cases)subgroups by disease activity(DAS28-CRP)based on 28 joint counts and the level of C-reactive protein(CRP).RA patients were further divided into normal(≥30 ng/ml,17 cases),insufficient(20 ng/ml≤25(OH)D<30 ng/ml,31 cases)and deficient(<20 ng/ml,47 cases)subgroups according to the serum 25(OH)D concentration;4 age subgroups(≤44 years of 21 cases,45-59 years of 43 cases,60-74 years of 21 cases and≥75 years of 10 cases);2 sex subgroups(79 female and 16 male).Serum 25(OH)D,albumin and fibrinogen levels were measured in all patients and healthy controls.The general clinical and laboratory indexes were collected and analyzed.Multivariate logistic regression analyses were performed to determine the independent risk factors of RA.Results The serum 25(OH)D concentration and albumin/fibrinogen ratio were lower(P<0.05)in rheumatoid arthritis patients than those in other groups,and serum 25(OH)D insufficiency or deficiency was evidenced in 82.11%(78/95)rheumatoid arthritis patients.Among patients with rheumatoid arthritis,the levels of 25(OH)D were apparently different in various age groups(P<0.05)and significantly lower in female than those in male(P<0.05).In addition,a significant negative correlation was found between AFR and DAS28-CRP(r=-0.497,P<0.01).Logistic regression analysis showed that 25(OH)D(OR=0.852,95%CI:0.768-0.944,P=0.002)and AFR(OR=0.626,95%CI 0.480-0.817,P=0.001),RF-IgM(OR=1.044,95%CI 1.019-1.069,P<0.001)and anti-CCP antibodies(OR=1.017,95%CI 1.002-1.032,P=0.030)were independent risk factors for disease activity in RA patients.Conclusions The serum 25(OH)D and AFR levels are significantly reduced and 5(OH)D insufficiency or deficiency is common in RA patients,suggesting that low levels of 25(OH)D and AFR may be the risk factors reflecting the RA disease activity.