类风湿关节炎患者25-羟维生素D与血清学及免疫功能指标的关系研究被引量：36

The correlation between 25-hydroxy-vitamin D and serological indexes,immunological indexes in patients with rheumatoid arthritis

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摘要目的观察维生素D与RA疾病活动度、血清学抗体、免疫功能等指标相关性,并探讨其临床意义。方法收集资料完整的初诊250例RA患者及150名健康对照组,分析比较25-羟维生素D[25-(OH)D]水平与RA患者的临床指标[性别、病程、年龄、关节肿胀数、关节压痛数、疼痛视觉模拟评分(VAS)、DSA28评分]、实验室指标[ESR、CRP、RF、抗CCP抗体、ANA、AKA、APF、抗突变型瓜氨酸波形蛋白(MCV)抗体、抗葡萄糖-6-磷酸异构酶(GPI)抗体、外周血淋巴细胞亚群及CD4^(+)T细胞亚群]的相关性。统计学方法采用单因素方差分析,Kruskal-Wallis检验,相关性分析采用Pearson相关性分析,Spearman秩相关分析。结果①RA组25-(OH)D水平明显低于健康对照组[(12±6)mg/ml与(21±8)mg/ml],差异有统计学意义(t=11.676,P<0.01);②根据25-(OH)D水平将RA患者分为缺乏组、不足组、正常组,3组间关节压痛数(χ^(2)=17.793,P<0.01)、关节肿胀数(χ^(2)=12.635,P=0.002)、ESR(F=6.330,P=0.002)、疼痛视觉模拟评分(VAS)(F=5.095,P=0.007)、DAS28(F=4.990,P=0.008)比较差异有统计学意义;③25-(OH)D水平不同的3组间比较RF(χ^(2)=6.742,P=0.034)及抗CCP抗体(χ^(2)=6.836,P=0.033)差异有统计学意义,25-(OH)D水平与血清RF(r=-0.202,P=0.001)、抗CCP抗体(r=-0.220,P<0.01)、MCV(r=-0.109,P=0.002)、AKA(r=-0.215,P=0.001)呈负相关;④RA组RF(t=-2.715,P=0.007)、抗CCP抗体(t=-2.03,P=0.044)、AKA(t=-2.108,P=0.036)阴性组25-(OH)D水平高于阳性组,差异有统计学意义(P<0.05);⑤25-(OH)D水平不同的3组间比较辅助性T细胞(Th)1(IFN-γ)细胞(F=3.259,P=0.043)、调节性T细胞(CD4^(+)CD25^(+)Foxp3^(+))细胞(F=4.342,P=0.031)水平差异有统计学意义,25-(OH)D水平与调节性T细胞(CD4^(+)CD25^(+)Foxp3^(+))细胞(r=0.146,P=0.025)呈正相关。结论维生素D缺乏在RA患者中普遍存在,且维生素D水平与疾病活动度及RF、抗CCP抗体抗体、抗MCV抗体、AKA及Th1、调节性T细胞相关,提示维生素D可能在RA的免疫学发病机制中起到重要的作用。 Objective To explore the expression and significance of vitamin D(VitD)in patients with rheumatoid arthritis(RA),and analyze the relationship between its expression and clinical indicators.MethodsClin-ical parameters and laboratory examinations of RA cases(n=250)were collected.Clinical parameters included were gender,age,disease course,swollen joints number,tenderness joints number,visual analog pain score(VAS),disease activity score(DAS)28 score.Laboratory examinations included erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF)and anti-cyclic citrullinated peptide(CCP)antibody,antinuclear(ANA)antibody,antikeratin(AKA)antibody,anti-perinuclear factor(APF),anti-mutated citrullinated vimentin(MCV),antibody and anti-6-glucose phosphate isomerase(GPI)antibody,lymphocyte subsets in the peripheral blood and lymphocyte subsets of CD4^(+)T cells.The level of 25-(OH)-Vit-D and clinical parameters,laboratory examinations were analyzed retrospectively.One-way ANOVA and Kruskal-Wallis test were used for comparison among the groups,and the correlation analysis was performed by Pearson and Spearman rank correlation analysis.Results①The level of 25-(OH)D in RA patients was significantly lower than that in healthy controls(t=11.676,P<0.01).②According to 25-(OH)D level,RA patients were divided into the deficiency group,insufficient group and normal group,the tender joints count(χ^(2)=17.793,P<0.001),the number of swollen joints(χ^(2)=12.635,P=0.002),ESR(F=6.330,P=0.002),VAS score(F=5.095,P=0.007,DAS28(F=4.990,P=0.008)were different significantly among the three groups.③RF(χ^(2)=6.742,P=0.034)and anti-CCP antibody(χ^(2)=6.836,P=0.033)were different significantly among the three groups and the level of 25-(OH)D was negatively correlated with RF(r=-0.202,P=0.001),anti-CCP antibody(r=-0.220,P<0.01),anti-MCV antibody(r=-0.109,P=0.002)and AKA(r=-0.215,P=0.001).④The level of 25-(OH)D in the RF(t=-2.715,P=0.007),anti-CCP antibody(t=-2.03,P=0.044),AKA(t=-2.108,P=0.036)negative group was significantly higher than that in patients with antibody positive group.⑤The level of Th1(IFN-γ)cells(F=3.259,P=0.043)and Treg(CD4^(+)CD25^(+)Foxp3^(+))cells(F=4.342,P=0.031)were significantly different among the three groups and the level of 25-(OH)D was positively correlated with Treg(CD4^(+)CD25^(+)Foxp3^(+))cells(r=0.146,P=0.025).ConclusionVitamin D is generally deficient in RA patients,which is significantly correlated with disease activity,RF,anti-CCP antibody,anti-MCV antibody,AKA and Th1,Treg cells.It is suggested that vitamin D may play an important role in the immunological pathogenesis and disease progression of RA.

作者赵慧温鸿雁刘洋曹蕾段亚楠郑晓娟侯志清李小峰 Zhao Hui;Wen Hongyan;Liu Yang;Cao Lei;Duan Yanan;Zheng Xiaojuan;Hou Zhiqing;Li Xiaofeng(Department of Rheumatology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区山西医科大学第二医院风湿免疫科

出处《中华风湿病学杂志》 CAS CSCD 北大核心 2019年第2期95-101,共7页 Chinese Journal of Rheumatology

基金山西省留学回国人员科技活动择优资助项目(2017) 山西省重点研发计划项-社会发展方面(201603D321074) 山西省回国留学人员科研资助项目(2017-119).

关键词关节炎类风湿 25-羟维生素13 自身抗体免疫活性 Arthritis,rheumatoid 25-Hydroxy-vitamin D Autoantibodies Immunocompetence

分类号 R593.22 [医药卫生—内科学]

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1温鸿雁,罗静,张军锋,高惠英,张晓英,张辰,王鑫,李小峰.初诊类风湿关节炎患者外周血维生素D及其受体mRNA的水平和意义[J].中华风湿病学杂志,2013,17(12):805-809. 被引量：5

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