类风湿关节炎患者血清25-(OH)D_3水平与骨密度的关系
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摘要
目的研究类风湿关节炎(RA)患者血清25-羟维生素D3[25-(OH)D3]水平与骨密度的关系。方法选取2016年2月~2018年2月四川省绵阳市中心医院(以下简称"我院")收治的RA患者512例作为研究组。另取同期于我院进行体检的健康者80名作为对照组。检测两组血清25-(OH)D3水平、骨密度以及骨密度T值。根据美国风湿病学会X线分期标准将研究组分为Ⅰ期128例、Ⅱ期162例、Ⅲ期133例、Ⅳ期89例,并比较不同分期RA患者的血清25-(OH)D3、骨密度、骨密度T值。根据血清25-(OH)D3不同缺乏程度将研究组分为血清25-(OH)D3不足130例、轻度缺乏168例、中度缺乏127例、重度缺乏的87例,并比较其骨密度、骨密度T值,并分析RA患者血清25-(OH)D3与骨密度、骨密度T值的相关性。结果研究组血清25-(OH)D3、骨密度、骨密度T值低于对照组(均P <0.01)。Ⅰ~Ⅳ期RA患者的血清25-(OH)D3、骨密度、骨密度T值水平均呈逐渐下降趋势,差异有高度统计学意义(均P <0.01)。血清25-(OH)D3不足、轻度缺乏、中度缺乏、重度缺乏的RA患者骨密度、骨密度T值呈逐渐下降趋势,差异有高度统计学意义(均P <0.01)。经Pearson相关性分析发现,RA患者血清25-(OH)D3与骨密度、骨密度T值均呈正相关(r=0.523、0.584,均P <0.05)。结论 RA患者血清25-(OH)D3水平与骨密度存在明显的降低,且两者呈明显正相关,即随着血清25-(OH)D3水平缺乏程度的不断加重,骨密度随之下降。
Objective To study the relationship between serum 25-hydroxyvitamin D3[25-(OH)D3] level and bone mineral density in patients with rheumatoid arthritis(RA). Methods A total of 512 cases of patients with RA admitted to Mianyang Central Hospital of Sichuan Province("our hospital" for short) from February 2016 to February 2018 were selected as the study group. Another 80 healthy people who underwent physical examination in our hospital at the same time were used as a control group. Serum 25-(OH)D3 levels, bone mineral density, and bone mineral density T values were measured in both groups. According to the X-ray staging criteria of American Rheumatism Society, the study group was divided into 128 cases in stage Ⅰ, 162 cases in stage Ⅱ, 133 cases in stage Ⅲ and 89 cases in stage Ⅳ,and compared serum 25-(OH)D3 and bone of patients with different stages of RA. According to the different levels of serum 25-(OH)D3 deficiency, the study group was divided into 130 cases of serum 25-(OH)D3 deficiency, 168 cases of mild deficiency, 127 cases of moderate deficiency and 87 cases of severe deficiency. The bone mineral density and bone mineral density T values were compared, and the correlation between serum 25-(OH)D3 and bone mineral density and bone mineral density T values in RA patients was analyzed. Results Serum 25-(OH)D3, bone mineral density and bone mineral density T values in the study group were lower than those in the control group(all P < 0.01). Serum25-(OH)D3, bone mineral density and bone mineral density T values in patients with stage Ⅰ-Ⅳ RA showed a gradual downward trend, with highly statistical significance(all P < 0.01). Bone mineral density and bone mineral density T value of RA patients with serum 25-(OH) D3 deficiency, mild deficiency, moderate deficiency and severe deficiency showed a decreasing trend, with highly statistical signif icance(all P < 0.01). Pearson correlation analysis showed that serum 25-(OH)D3 was positively correlated with bone mineral density and bone mineral density T value in RA patients(r = 0.523, 0.584, all P < 0.05). Conclusion Serum25-(OH)D3 level and bone mineral density in RA patients are significantly decreased, and there is a significant positive correlation between them. That is, bone mineral density decreases with the increasing lack of serum 25-(OH)D3 level.
Objective To study the relationship between serum 25-hydroxyvitamin D3[25-(OH)D3] level and bone mineral density in patients with rheumatoid arthritis(RA). Methods A total of 512 cases of patients with RA admitted to Mianyang Central Hospital of Sichuan Province("our hospital" for short) from February 2016 to February 2018 were selected as the study group. Another 80 healthy people who underwent physical examination in our hospital at the same time were used as a control group. Serum 25-(OH)D3 levels, bone mineral density, and bone mineral density T values were measured in both groups. According to the X-ray staging criteria of American Rheumatism Society, the study group was divided into 128 cases in stage Ⅰ, 162 cases in stage Ⅱ, 133 cases in stage Ⅲ and 89 cases in stage Ⅳ,and compared serum 25-(OH)D3 and bone of patients with different stages of RA. According to the different levels of serum 25-(OH)D3 deficiency, the study group was divided into 130 cases of serum 25-(OH)D3 deficiency, 168 cases of mild deficiency, 127 cases of moderate deficiency and 87 cases of severe deficiency. The bone mineral density and bone mineral density T values were compared, and the correlation between serum 25-(OH)D3 and bone mineral density and bone mineral density T values in RA patients was analyzed. Results Serum 25-(OH)D3, bone mineral density and bone mineral density T values in the study group were lower than those in the control group(all P < 0.01). Serum25-(OH)D3, bone mineral density and bone mineral density T values in patients with stage Ⅰ-Ⅳ RA showed a gradual downward trend, with highly statistical significance(all P < 0.01). Bone mineral density and bone mineral density T value of RA patients with serum 25-(OH) D3 deficiency, mild deficiency, moderate deficiency and severe deficiency showed a decreasing trend, with highly statistical signif icance(all P < 0.01). Pearson correlation analysis showed that serum 25-(OH)D3 was positively correlated with bone mineral density and bone mineral density T value in RA patients(r = 0.523, 0.584, all P < 0.05). Conclusion Serum25-(OH)D3 level and bone mineral density in RA patients are significantly decreased, and there is a significant positive correlation between them. That is, bone mineral density decreases with the increasing lack of serum 25-(OH)D3 level.
引文
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[14]洪琼,徐建华,徐胜前,等.类风湿关节炎患者骨质疏松症的危险因素分析[J].安徽医科大学学报,2013,48(9):1083-1087.
[15]于春艳,张磊,高照猛,等.女性类风湿关节炎患者甲襞微循环异常与疾病活动度及骨质疏松发生的相关性研究[J].中国全科医学,2018,21(20):2437-2443.
[16]张磊,高照猛,徐建,等.早期类风湿关节炎患者甲襞微循环积分与病情活动度及骨质疏松的相关性分析[J].中国骨质疏松杂志,2018,24(8):1021-1028.
[17]王鑫,俞钟明,孙佳颖,等.类风湿关节炎不同疾病活动度下骨代谢指标的变化[J].浙江医学,2018,40(22):2462-2465.
[18]Bae SC,Lee YH.Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis:a Mendelian randomization[J].Clin Rheumatol,2018,37(9):2415-2421.
[19]鲍晓,何成松.糖皮质激素诱发骨质疏松的类风湿关节炎患者血清25-羟维生素D的表达与骨密度的关系[J].中国老年学杂志,2018,38(2):429-431.20]房德玉.类风湿关节炎合并骨质疏松患者骨密度及骨转换生化标志物水平变化分析[J].国际免疫学杂志,2018,41(3):296-299.
[21]肖敏,黄夏寒,李琴,等.类风湿关节炎患者骨密度改变与血清25-羟维生素D3水平的关系分析[J].标记免疫分析与临床,2018,25(3):391-394.
[22]杨孝兵,孙颖慧,邵丰,等.血清25-羟-维生素D与类风湿关节炎相关性研究[J].浙江中西医结合杂志,2017,27(1):957-960.
[2]Thambiah SC,Wong TH,Gupta ED,et al.Calculation of free and bioavailable vitamin D and its association with bone mineral density in Malaysian women[J].Malays J Pathol,2018,40(3):287-294.
[3]张群燕,蔡辉.维生素D3在类风湿关节炎中的作用[J].国际免疫学杂志,2018,41(1):114-120.
[4]曹贤,曹青凤,任水明,等.类风湿关节炎患者血清骨代谢标志物检测与分析[J].国际检验医学杂志,2017,38(12):1680-1682.
[5]王利,吕艳艳,邱红霞,等.女性更年期后类风湿关节炎并发骨质疏松126例临床研究[J].陕西医学杂志,2017,46(5):584-585.
[6]黄嘉,黄慈波.类风湿关节炎的诊断治疗进展[J].临床药物治疗杂志,2010,8(1):1-5.
[7]赵蕾,张志华,王天成,等.维生素D水平与骨密度检测对早期类风湿关节炎的诊断价值[J].广东医学,2016,37(16):2421-2423.
[8]麻璨琛,徐胜前,龚勋,等.少肌症和维生素D缺乏在类风湿关节炎合并骨质疏松中的临床研究[J].中华风湿病学杂志,2017,21(2):94-98.
[9]周静威,柴立民,王翚.通痹透邪法治疗类风湿关节炎[J].国际中医中药杂志,2017,39(7):642.
[10] Cheng TT,Lai HM,Yu SF,et al.The impact of low-dose glucocorticoids on disease activity,bone mineral density,fragility fractures,and 10-year probability of fractures in patients with rheumatoid arthritis[J].J Investig Med,2018,66(6):1004-1007.
[11]范俊,郭洪佩,徐瑛,等.老年女性类风湿关节炎合并骨质疏松症的代谢特点分析[J].现代生物医学进展,2014,14(18):3493-3496.
[12]庞琳娜,徐连那,刘颖,等.类风湿关节炎患者骨密度横断面研究[J].中华临床医师杂志:电子版,2013,23(24):11 236-11 240.
[13]石颜军.250HD与类风湿关节炎患者骨质疏松的相关性研究[J].山东医药,2013,53(38):62-63.
[14]洪琼,徐建华,徐胜前,等.类风湿关节炎患者骨质疏松症的危险因素分析[J].安徽医科大学学报,2013,48(9):1083-1087.
[15]于春艳,张磊,高照猛,等.女性类风湿关节炎患者甲襞微循环异常与疾病活动度及骨质疏松发生的相关性研究[J].中国全科医学,2018,21(20):2437-2443.
[16]张磊,高照猛,徐建,等.早期类风湿关节炎患者甲襞微循环积分与病情活动度及骨质疏松的相关性分析[J].中国骨质疏松杂志,2018,24(8):1021-1028.
[17]王鑫,俞钟明,孙佳颖,等.类风湿关节炎不同疾病活动度下骨代谢指标的变化[J].浙江医学,2018,40(22):2462-2465.
[18]Bae SC,Lee YH.Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis:a Mendelian randomization[J].Clin Rheumatol,2018,37(9):2415-2421.
[19]鲍晓,何成松.糖皮质激素诱发骨质疏松的类风湿关节炎患者血清25-羟维生素D的表达与骨密度的关系[J].中国老年学杂志,2018,38(2):429-431.20]房德玉.类风湿关节炎合并骨质疏松患者骨密度及骨转换生化标志物水平变化分析[J].国际免疫学杂志,2018,41(3):296-299.
[21]肖敏,黄夏寒,李琴,等.类风湿关节炎患者骨密度改变与血清25-羟维生素D3水平的关系分析[J].标记免疫分析与临床,2018,25(3):391-394.
[22]杨孝兵,孙颖慧,邵丰,等.血清25-羟-维生素D与类风湿关节炎相关性研究[J].浙江中西医结合杂志,2017,27(1):957-960.