中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2013年
3期
159-163
,共5页
洪琼%徐建华%徐胜前%张锐%张明铭%邹延峰
洪瓊%徐建華%徐勝前%張銳%張明銘%鄒延峰
홍경%서건화%서성전%장예%장명명%추연봉
类风湿,关节炎%维生素D%骨质疏松%25羟基维生素D
類風濕,關節炎%維生素D%骨質疏鬆%25羥基維生素D
류풍습,관절염%유생소D%골질소송%25간기유생소D
Arthritis,rheumatoid%Vitamin D%Osteoporosis%25-hydroxyvitamin D
目的 观察类风湿关节炎(RA)患者血清中25羟基维生素D[25(OH)D]水平变化,并探讨其临床意义.方法 收集130例RA患者及80名健康对照者的血清,酶联免疫法测定其25(OH)D浓度,比较RA患者25(OH)D水平的变化；同时运用双能X线吸收仪(DXA)测定RA患者骨密度,双手X线Sharp评分(SHS)评定患者骨侵蚀及狭窄程度并详细记录RA患者临床、实验室及影像学资料,计算疾病活动性.采用t检验或单因素方差分析,组间比较采用x2检验,相关性采用Pearson相关分析,危险因素分析采用多元线性回归分析和Logistic回归分析进行统计学分析.结果 ①RA患者血清25(OH)D水平较健康对照组明显降低[(17±6) ng/ml与(23±6) ng/ml,t=-6.624,P＜0.01],且RA患者25(OH)D不足者明显多于健康对照组(98.5％与87.5％,x2=26.291,P＜0.01)；②25(OH)D水平分别与RA患者晨僵时间、关节压痛数(TJC)、关节肿胀数(SJC)、红细胞沉降率(ESR)、C反应蛋白(CRP)、生活质量(HAQ)评分等呈负相关(r=-0.370,-0.307,-0.243,-0.369,-0.175,-0.381,P均＜0.05)；③根据DAS28评分,稳定或轻度活动组明显高于中度活动组和重度活动组的RA患者血清25(OH)D水平(P均＜0.05)；线性回归分析进一步提示RA患者血清25(OH)D水平减低是疾病活动性的危险因素(b=-0.46,P=0.029)；④25(OH)D水平与RA患者骨侵蚀度无相关性(P＞0.05)；⑤根据骨密度分为RA骨量正常组、骨量减少组及骨质疏松组,3组间的25(OH)D水平呈依次下降趋势且相互间比较差异均有统计学意义(P＜0.05),经Logistic回归分析,RA患者血清25(OH)D是其骨质疏松的保护因素(OR=0.898,95％CI 0.830～0.972,P=0.008).结论 RA患者血清25(OH)D水平显著低下,与RA疾病活动性、骨质疏松相关；25(OH)D水平减低是RA疾病活动以及高发骨质疏松症的危险因素.
目的 觀察類風濕關節炎(RA)患者血清中25羥基維生素D[25(OH)D]水平變化,併探討其臨床意義.方法 收集130例RA患者及80名健康對照者的血清,酶聯免疫法測定其25(OH)D濃度,比較RA患者25(OH)D水平的變化；同時運用雙能X線吸收儀(DXA)測定RA患者骨密度,雙手X線Sharp評分(SHS)評定患者骨侵蝕及狹窄程度併詳細記錄RA患者臨床、實驗室及影像學資料,計算疾病活動性.採用t檢驗或單因素方差分析,組間比較採用x2檢驗,相關性採用Pearson相關分析,危險因素分析採用多元線性迴歸分析和Logistic迴歸分析進行統計學分析.結果 ①RA患者血清25(OH)D水平較健康對照組明顯降低[(17±6) ng/ml與(23±6) ng/ml,t=-6.624,P＜0.01],且RA患者25(OH)D不足者明顯多于健康對照組(98.5％與87.5％,x2=26.291,P＜0.01)；②25(OH)D水平分彆與RA患者晨僵時間、關節壓痛數(TJC)、關節腫脹數(SJC)、紅細胞沉降率(ESR)、C反應蛋白(CRP)、生活質量(HAQ)評分等呈負相關(r=-0.370,-0.307,-0.243,-0.369,-0.175,-0.381,P均＜0.05)；③根據DAS28評分,穩定或輕度活動組明顯高于中度活動組和重度活動組的RA患者血清25(OH)D水平(P均＜0.05)；線性迴歸分析進一步提示RA患者血清25(OH)D水平減低是疾病活動性的危險因素(b=-0.46,P=0.029)；④25(OH)D水平與RA患者骨侵蝕度無相關性(P＞0.05)；⑤根據骨密度分為RA骨量正常組、骨量減少組及骨質疏鬆組,3組間的25(OH)D水平呈依次下降趨勢且相互間比較差異均有統計學意義(P＜0.05),經Logistic迴歸分析,RA患者血清25(OH)D是其骨質疏鬆的保護因素(OR=0.898,95％CI 0.830～0.972,P=0.008).結論 RA患者血清25(OH)D水平顯著低下,與RA疾病活動性、骨質疏鬆相關；25(OH)D水平減低是RA疾病活動以及高髮骨質疏鬆癥的危險因素.
목적 관찰류풍습관절염(RA)환자혈청중25간기유생소D[25(OH)D]수평변화,병탐토기림상의의.방법 수집130례RA환자급80명건강대조자적혈청,매련면역법측정기25(OH)D농도,비교RA환자25(OH)D수평적변화；동시운용쌍능X선흡수의(DXA)측정RA환자골밀도,쌍수X선Sharp평분(SHS)평정환자골침식급협착정도병상세기록RA환자림상、실험실급영상학자료,계산질병활동성.채용t검험혹단인소방차분석,조간비교채용x2검험,상관성채용Pearson상관분석,위험인소분석채용다원선성회귀분석화Logistic회귀분석진행통계학분석.결과 ①RA환자혈청25(OH)D수평교건강대조조명현강저[(17±6) ng/ml여(23±6) ng/ml,t=-6.624,P＜0.01],차RA환자25(OH)D불족자명현다우건강대조조(98.5％여87.5％,x2=26.291,P＜0.01)；②25(OH)D수평분별여RA환자신강시간、관절압통수(TJC)、관절종창수(SJC)、홍세포침강솔(ESR)、C반응단백(CRP)、생활질량(HAQ)평분등정부상관(r=-0.370,-0.307,-0.243,-0.369,-0.175,-0.381,P균＜0.05)；③근거DAS28평분,은정혹경도활동조명현고우중도활동조화중도활동조적RA환자혈청25(OH)D수평(P균＜0.05)；선성회귀분석진일보제시RA환자혈청25(OH)D수평감저시질병활동성적위험인소(b=-0.46,P=0.029)；④25(OH)D수평여RA환자골침식도무상관성(P＞0.05)；⑤근거골밀도분위RA골량정상조、골량감소조급골질소송조,3조간적25(OH)D수평정의차하강추세차상호간비교차이균유통계학의의(P＜0.05),경Logistic회귀분석,RA환자혈청25(OH)D시기골질소송적보호인소(OR=0.898,95％CI 0.830～0.972,P=0.008).결론 RA환자혈청25(OH)D수평현저저하,여RA질병활동성、골질소송상관；25(OH)D수평감저시RA질병활동이급고발골질소송증적위험인소.
Objective To determine the serum level of 25-hydroxyvitamin D[25(OH)D] in rheumatoid arthritis (RA) patients and to assess the association of 25(OH)D with clinical presentations.Methods Serum 25(OH)D levels were detected by enzyme-linked immunosorbent assay (ELISA) in 130 cases with RA and 80 healthy controls.The detailed clinical data of the RA patients were recorded and bone mineral density (BMD) were measured by dual-energy X-ray absor-ptiometry (DXA).Sharp score of both hands were measured for evaluating the effects of 25(OH)D on bone erosion.T-test and one-way ANOVA test were used for data analysis,and x2 test was used to compare the differences between groups.Pearson's test was adsopted for correlation analysis.Muhi-variate analysis and Logistic analysis were carried out for risk factors identification.Results ① The serum levels of 25 (OH)D were markedly lower in the RA group than the control group [(17±6) ng/ml vs (23±6) ng/ml,t=-6.624,P＜0.01],while cases of 25(OH)D insufficiency/deficiency in the RA group were more than the control group (98.5％ vs 81.5％,x2=26.291,P＜0.01); ② Negative correlation was detected between 25(OH) D levels and the following:duration of morning stiffness,tender joint count (TJC),swollen joint count (SJC),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),health assessment questionnaire (HAQ) of the patients with RA (r=-0370,-0.307,-0.243,-0.369,-0.175,-0.381,both P＜0.05),respectively; ③ 25 (OH)D levels were signific-antly lower in group with moderate and severe disease activity than in group with stable or low disease activity (both P＜0.05); Insufficiency/deficiency of 25 (OH)D was the risk factor for disease activity by multiple regression analysis (b=-0.46,P=0.029); ④ No statistically significant association was detected between 25(OH)D and degree of bone erosion in RA (P＞0.05); ⑤ BMD was classified into three groups:normal,osteopenia and osteoporosis,and significant differences of serum 25(OH)D levels were found by compared with each group (P＜0.01).Normal serum 25 (OH)D level was a protective factor for RA-induced osteoporosis by Logistic rcgression analysis (OR=0.898,95％CI 0.830-0.972,P=0.008).Conclusion Significantly low 25 (OH)D level could be found in patients with RA.Negative correlation is detected between 25 (OH)D level and disease activity and osteoporosis respectively in patients with RA.Insufficiency/deficiency of 25 (OH)D is the risk factor for disease activity and RA-induced osteoporosis.
