血清25-羟维生素D和IgG4水平与类风湿关节炎患者骨质侵蚀的关系

Relationships between serum 25-hydroxy vitamin D and IgG4 levels and bone erosion in patients with rheumatoid arthritis

目的探讨血清25-羟维生素D[25-(OH)D]和免疫球蛋白G4(IgG4)水平与类风湿关节炎(RA)患者骨质侵蚀的关系。方法收集2018年1月至2022年1月在汉中市中医医院确诊的203例RA患者为研究组,从同期健康体检者中选取60例作为对照组。依据X线检查结果是否存在骨质侵蚀将研究组又分为无侵蚀组和侵蚀组。检测研究对象血清25-(OH)D、抗环瓜氨酸肽(CCP)抗体和IgG4水平。比较研究组与对照组血清25-(OH)D、抗CCP抗体、IgG4水平;评估血清25-(OH)D、抗CCP抗体和IgG4对RA患者骨质侵蚀的预测效能;分析RA患者骨质侵蚀发生的影响因素。结果研究组血清25-(OH)D水平低于对照组,抗CCP抗体、IgG4水平高于对照组,差异有统计学意义(P<0.05)。侵蚀组年龄大于无侵蚀组与对照组,病程长于无侵蚀组,血清抗CCP抗体、IgG4水平高于无侵蚀组和对照组,血清25-(OH)D水平低于无侵蚀组与对照组,差异均有统计学意义(P<0.05)。血清25-(OH)D、抗CCP抗体和IgG4预测RA患者骨质侵蚀的最佳截断值分别为23.53 ng/mL、102.84 RU/mL和207.56 mg/dL,曲线下面积分别为0.801、0.886、0.914。多因素Logistic回归分析结果显示,RA患者病程≥23个月、抗CCP抗体≥102.84 RU/mL和IgG4≥207.56 mg/dL是RA患者发生骨质侵蚀的独立危险因素(P<0.05),25-(OH)D≥23.53 ng/mL是RA患者发生骨质侵蚀的独立保护因素(P<0.05)。结论血清25-(OH)D、IgG4水平与RA患者骨质侵蚀的发生密切相关,且对RA骨质侵蚀具有潜在预测价值。

Objective To investigate the relationships between serum levels of 25-hydroxy vitamin D[25-(OH)D],immunoglobulin G4(IgG4)and bone erosion in patients with rheumatoid arthritis(RA).Methods A total of 203 patients with RA diagnosed in Hanzhong Hospital of Traditional Chinese Medicine from January 2018 to January 2022 were selected as the study group,and 60 healthy people underwent physical examination during the same period were selected as the control group.The study group was divided into non-erosion group and erosion group according to the results of X-ray examination.Serum levels of 25-(OH)D,anti-cyclic citrullinated peptide(CCP)antibody and IgG4 were detected.The serum levels of 25-(OH)D,anti-CCP antibody and IgG4 were compared between the study group and the control group.The predictive efficacy of serum 25-(OH)D,anti-CCP antibody and IgG4 on bone erosion in patients with RA were evaluated.The influencing factors of bone erosion in RA patients were analyzed.Results The level of serum 25-(OH)D in the study group was lower than that in the control group,and the levels of anti-CCP antibody and IgG4 in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).The age in the erosion group was older than that in the non-erosion group and the control group,and the course of disease was longer than that in the non-erosion group,the levels of serum anti-CCP antibody and IgG4 were higher than those in the non-erosion group and the control group,and the level of serum 25-(OH)D was lower than that in the non-erosion group and the control group,the differences were statistically significant(P<0.05).The best cut-off values of serum 25-(OH)D,anti-CCP antibody and IgG4 for predicting RA bone erosion were 23.53 ng/mL,102.84 RU/mL and 207.56 mg/dL respectively,and the areas under the curve were 0.801,0.886 and 0.914 respectively.Multivariate Logistic regression analysis showed that the course of disease of RA patients≥23 months,anti-CCP antibody≥102.84 RU/mL and IgG4≥207.56 mg/dL were independent risk factors for bone erosion in RA patients(P<0.05),and 25-(OH)D≥23.53 ng/mL was independent protective factor for bone erosion in RA patients(P<0.05).Conclusion Serum 25-(OH)D and IgG4 levels relate closely to the occurrence of RA bone erosion,and have potential predictive value for RA bone erosion.