25羟维生素D与原发性干燥综合征患者报告结局及腺体受累的相关性研究

Correlation study between 25-hydroxyvitamin D and reported outcomes and glandular involvement in patients with primary Sjogren’s syndrome

目的研究血清25羟维生素D[25(OH)D]水平与原发性干燥综合征(primary Sjogren’s syndrome,pSS)患者报告结局及腺体受累严重程度之间的相关性,并探讨血清25(OH)D水平对于监测pSS的意义。方法回顾性分析2018年11月至2022年9月就诊于扬州大学附属医院风湿免疫科的216例pSS患者临床资料,采用质谱分析法检测血清25(OH)D水平,根据25(OH)D水平将pSS患者分为血清25(OH)D水平<30 ng/mL组(研究组)132例和血清25(OH)D水平≥30 ng/mL组(对照组)84例。收集两组患者的报告结局,比较两组患者泪腺、腮腺、唇腺及甲状腺的受累程度。结果研究组具有更高的干燥综合征疾病活动指数(ESSDAI)及干燥综合征患者自我报告指数(ESSPRI)(P<0.05),且血清25(OH)D水平与ESSDAI、ESSPRI均呈负相关(r=-0.474,P<0.001;r=-0.154,P=0.023);两组患者的口腔干燥指数评分、眼表疾病指数评分、口腔健康影响程度量表、疲劳和疼痛视觉模拟评分差异均无统计学意义(P>0.05)。研究组腮腺MRI分级中Ⅱ级、Ⅲ级、Ⅳ级者比例均高于对照组,MRS分级中Ⅱ级、Ⅲ级、Ⅳ级者比例也高于对照组,两组腮腺MRI分级中Ⅲ级、Ⅳ级及MRS分级中Ⅳ级占比差异均具有统计学意义(P<0.05)。研究组唇腺活检阳性者占比更大(P<0.05);血清25(OH)D水平与腮腺MRI(r=-0.608)、MRS分级(r=-0.400)及唇腺活检病理分级(r=-0.425)均呈负相关(P<0.001)。研究组患者合并慢性甲状腺炎占比更大(P<0.05),两组患者甲状腺功能生化指标、甲状腺彩超检查异常,以及与是否合并甲亢、甲减、结节性甲状腺病,组间比较差异均无统计学意义(P>0.05)。结论血清25(OH)D水平与pSS患者报告结局相关,且血清25(OH)D水平<30 ng/mL的患者腺体受累程度更严重,监测pSS患者血清25(OH)D水平对pSS疾病控制具有重要临床价值。

Objective To investigate the correlation between serum 25-hydroxyvitamin D[25(OH)D]levels and reported outcomes and severity of glandular involvement in patients with primary Sj gren’s syndrome(pSS),and to explore the significance of serum 25(OH)D levels in monitoring pSS disease.Methods A retrospective analysis of clinical data of 216 pSS patients who visited between November 2018 and September 2022 was conducted.Serum 25(OH)D levels were measured using mass spectrometry.The pSS patients were divided into two groups based on their 25(OH)D levels:the study group[serum 25(OH)D level<30 ng/mL,n=132]and the control group[serum 25(OH)D level≥30 ng/mL,n=84].The reported outcomes of the two groups were collected,and the severity of involvement in the lacrimal gland,salivary gland,lip gland,and thyroid gland was compared.Results The study group had higher European League Against Rheumatism Sj gren’s Syndrome Disease Activity Index(ESSDAI)and ESSPRI scores(P<0.05),and the serum 25(OH)D level was negatively correlated with ESSDAI and ESSPRI(r=-0.474,P<0.001;r=-0.154,P=0.023).The proportions of gradeⅡ,Ⅲ,andⅣin the Chisholm and Mason grading system for salivary gland involvement and the proportions of gradeⅡ,Ⅲ,andⅣin the minor salivary gland biopsy focus score were higher in the study group than in the control group,and the differences between the two groups were statistically significant(P<0.05).The proportion of positive lip gland biopsies was higher in the study group(P<0.05).The serum 25(OH)D level was negatively correlated with the Chisholm and Mason grading system for salivary gland involvement(r=-0.608),the minor salivary gland biopsy focus score(r=-0.400),and the lip gland biopsy pathological grading(r=-0.425)(P<0.001).The proportion of patients with concurrent chronic thyroiditis was higher in the study group,the difference was statistically significant.(P<0.05).Conclusions Serum 25(OH)D levels are correlated with reported outcomes in pSS patients,and lower levels of serum 25(OH)D are associated with more severe glandular involvement.Monitoring serum 25(OH)D levels in pSS patients is of great clinical value in controlling pSS disease.