初步探索中国白癜风患者血清25（OH）维生素D水平及其与疾病的关系
摘要
背景白癜风是一种自身免疫相关性疾病,治疗困难。维生素D被证实可抑制异常免疫反应,维持自身免疫稳态。众多临床研究提示血清维生素D水平偏低可能与多种自身免疫疾病的发病及病情活动有关,口服补充可改善预后。维生素D衍生物在临床一直以外用形式应用于白癜风患者,理论和实践均证明其安全有效。但仅局限于外用。最新美国研究关注了白癜风患者的血清维生素D水平,提示血清维生素D水平偏低可能与白癜风存在联系。而国内尚未见关于白癜风患者血清维生素D的报道。
目的了解中国白癜风患者血清维生素D现状,探索其影响因素,观察其与病情变化之间的联系。为今后深入研究提供流行病学资料,为临床治疗提供理论依据。方法280例患者。50例对照。检测血清25(OH)维生素D水平。比较患者与正常对照血清维生素D值。进行单因素及多因素分析,了解患者性别、年龄、类型、分期、受累面积、伴随疾病、家族史、检测月份与维生素D的联系。半年后随访20名患者,观察维生素D与病情变化之间的关系。
结果患者维生素D均值29.9±9.6nmol/L,其中无人达到“足够”标准(维生素D>=75nmol/I),不足(25-75nmol/L)占66.7%,缺乏(<25nmol/L)占33.3%。与对照组无统计学差异。男性维生素D缺乏占23%,女性占40.5%,女性较男性更易缺乏维生素D(P=0.019)。在维生素D缺乏的患者中,甲状腺异常占36.2%,其中甲亢或甲减占14.9%。维生素D不足的患者中,甲状腺异常占25.8%,其中甲亢或甲减占2.9%。维生素D缺乏患者较不足患者伴随甲状腺疾病,尤其是甲状腺功能不全的比例升高(P=0.017)。维生素D值一年中3月最低,为26.1±9.7nmol/L,后逐渐上升,9.10月升至峰值,为45.1±14.0nmol/L-44.1±15.2nmol/L,后逐渐下降。多因素分析示性别(p=0.035)、甲状腺情况(p=0.034)、检验月份(P=0.049)是影响响维生素D水平的独立因素。随访患者中,经一般治疗(非口服激素或光疗)后病情进展的3名患者维生素D值均低于当月均值。其中2人为男性,占维生素D低于当月均值的男性患者的66.7%,1人为女性,占维生素D值低于当月均值的女性患者的16.7%。3名患者均为肢端型,占维生素D低于当月均值的肢端型患者的75%,而维生素D高于当月均值的肢端型患者病情无进展。维生素D低于当月均值的其余患者维生素D值均随病情好转而上升,除1名伴随甲状腺疾病的患者,虽病情好转,维生素D值不升高。
结论中国白癜风患者普遍缺少维生素D。女性较男性更易缺乏。维生素D缺乏者更易伴随甲状腺疾病。白癜风患者维生素D水平在一年内九、十月份达到最高值,但仍不能达到“足够”标准。维生素D值偏低可能提示自身免疫紊乱,预后及治疗敏感性不佳,尤其在男性及肢端型患者中。维生素D在评价患者自身免疫状态,选择治疗方案、评估预后方面可能具有一定价值。建议中国白癜风患者应适量增加日照,并口服补充维生素D。
Background:Vitligo is now regarded as an autoimmune disease which badly affect patient's social activity and psychological health。It is difficult to cure. Vitamin D is proved to be able to inhibit abnormal immune response and keep immune homeostasis. Lots of clinical studies have shown that low serum vitamin D levels could be related to the occurrence and activity of many autoimmune diseases. Oral supplementation could improve their prognosis. Vitamin D analog is applied for vitiligo patients externally for years. Its effect has been supported by both theory and practice. But it is used only as external application. Latest study in America paid attention to serum vitamin D level in vitiligo patients, indicating that low serum vitamin D levels are probably associated with vitiligo. In China, no such research has been conducted.
Objectives:To find out serum vitamin D levels among Chinese vitiligo patients and influence factors. To observe the association of serum vitamin D level with disease activity. Which help to provide epidemiological data and clue for further research. Methods:280patients.50normal controls. Serum25(OH) vitamin D levels were tested. Comparison between patients and controls was developed. Univariate and multivariate analysis of the association of serum25(OH) vitamin D with related feature was performed, including gender, age, type, stage, surface area, history of other autoimmune diseases, family history, testing month.6months later,20patients were followed up, to observe the relationship between vitamin D and disease evolution.
Results:The mean value is29.9±9.6nmol/L, no one reached the standard of 'sufficiency'(>75nmol/L),66.7%patients were insufficient(25-75nmol/L),33.3%were deficient(<25nmol/L). No significant difference compared with controls.23%were deficient among males, while40.5%among females. Females were at an increased risk of vitamin D deficiency (p=0.019). Among patients with vitamin D deficiency,36.2%were with thyroid abnormality when29%were with hyperthyroidism or hypothyroidism. Among those with insufficiency, thyroid abnormality accounted for25.8%, when hyperthyroidism or hypothyroidism accounted for2.9%. Patients with vitamin D deficiency were at an increased risk of thyroid disease, especially thyroid dysfunction (P=0.017). Vitamin D value was lowest in March,26.1±9.7nmol/L, then went up to the highest in September and October,45.1±14.0nmol/L-44.1±15.2nmol/L, then went down. Multivariate analysis indicated gender(p=0.035), thyroid condition(p=0.034), testing month(p=0.049) were independent factors affecting vitamin D level. In the follow-up, the3patients with disease progression after common therapy (without steroids or UV therapy) all had vitamin d values lower than month average.2of them were males,66.7%in males with lower vitamin D values then month average,1was female,16.7%in females with lower vitamin D values than month average. All3patients were lip-digit type, accounted for75%in patients with lower vitamin D levels than month average, while counterparts in higher vitamin D group had no progression. Other patients in lower-than-month-average vitamin D group had it go up as disease improved, except1with thyroid disease, whose vitamin D value didn't go up though vitiligo improved.
Conclusion:Chinese vitiligo patients generally lack vitamin D. Females have higher risk. Patients with vitamin D deficiency are more likely to have thyroid diseases. Vitamin D level reaches the peak of the year in September and October, but doesn't reach the'sufficient'standard. Lower pretreatment vitamin D level is probably associated with autoimmunity, unsatisfied prognosis and sensitivity to treatment, especially among males and lip-digit type. Vitamin D may be valuable for judging patients'autoimmune state, determining therapy and evaluating prognosis. For Chinese vitiligo patients, adequately increasing sunshine exposure and oral supplementation of vitamin D are suggested.
目的了解中国白癜风患者血清维生素D现状,探索其影响因素,观察其与病情变化之间的联系。为今后深入研究提供流行病学资料,为临床治疗提供理论依据。方法280例患者。50例对照。检测血清25(OH)维生素D水平。比较患者与正常对照血清维生素D值。进行单因素及多因素分析,了解患者性别、年龄、类型、分期、受累面积、伴随疾病、家族史、检测月份与维生素D的联系。半年后随访20名患者,观察维生素D与病情变化之间的关系。
结果患者维生素D均值29.9±9.6nmol/L,其中无人达到“足够”标准(维生素D>=75nmol/I),不足(25-75nmol/L)占66.7%,缺乏(<25nmol/L)占33.3%。与对照组无统计学差异。男性维生素D缺乏占23%,女性占40.5%,女性较男性更易缺乏维生素D(P=0.019)。在维生素D缺乏的患者中,甲状腺异常占36.2%,其中甲亢或甲减占14.9%。维生素D不足的患者中,甲状腺异常占25.8%,其中甲亢或甲减占2.9%。维生素D缺乏患者较不足患者伴随甲状腺疾病,尤其是甲状腺功能不全的比例升高(P=0.017)。维生素D值一年中3月最低,为26.1±9.7nmol/L,后逐渐上升,9.10月升至峰值,为45.1±14.0nmol/L-44.1±15.2nmol/L,后逐渐下降。多因素分析示性别(p=0.035)、甲状腺情况(p=0.034)、检验月份(P=0.049)是影响响维生素D水平的独立因素。随访患者中,经一般治疗(非口服激素或光疗)后病情进展的3名患者维生素D值均低于当月均值。其中2人为男性,占维生素D低于当月均值的男性患者的66.7%,1人为女性,占维生素D值低于当月均值的女性患者的16.7%。3名患者均为肢端型,占维生素D低于当月均值的肢端型患者的75%,而维生素D高于当月均值的肢端型患者病情无进展。维生素D低于当月均值的其余患者维生素D值均随病情好转而上升,除1名伴随甲状腺疾病的患者,虽病情好转,维生素D值不升高。
结论中国白癜风患者普遍缺少维生素D。女性较男性更易缺乏。维生素D缺乏者更易伴随甲状腺疾病。白癜风患者维生素D水平在一年内九、十月份达到最高值,但仍不能达到“足够”标准。维生素D值偏低可能提示自身免疫紊乱,预后及治疗敏感性不佳,尤其在男性及肢端型患者中。维生素D在评价患者自身免疫状态,选择治疗方案、评估预后方面可能具有一定价值。建议中国白癜风患者应适量增加日照,并口服补充维生素D。
Background:Vitligo is now regarded as an autoimmune disease which badly affect patient's social activity and psychological health。It is difficult to cure. Vitamin D is proved to be able to inhibit abnormal immune response and keep immune homeostasis. Lots of clinical studies have shown that low serum vitamin D levels could be related to the occurrence and activity of many autoimmune diseases. Oral supplementation could improve their prognosis. Vitamin D analog is applied for vitiligo patients externally for years. Its effect has been supported by both theory and practice. But it is used only as external application. Latest study in America paid attention to serum vitamin D level in vitiligo patients, indicating that low serum vitamin D levels are probably associated with vitiligo. In China, no such research has been conducted.
Objectives:To find out serum vitamin D levels among Chinese vitiligo patients and influence factors. To observe the association of serum vitamin D level with disease activity. Which help to provide epidemiological data and clue for further research. Methods:280patients.50normal controls. Serum25(OH) vitamin D levels were tested. Comparison between patients and controls was developed. Univariate and multivariate analysis of the association of serum25(OH) vitamin D with related feature was performed, including gender, age, type, stage, surface area, history of other autoimmune diseases, family history, testing month.6months later,20patients were followed up, to observe the relationship between vitamin D and disease evolution.
Results:The mean value is29.9±9.6nmol/L, no one reached the standard of 'sufficiency'(>75nmol/L),66.7%patients were insufficient(25-75nmol/L),33.3%were deficient(<25nmol/L). No significant difference compared with controls.23%were deficient among males, while40.5%among females. Females were at an increased risk of vitamin D deficiency (p=0.019). Among patients with vitamin D deficiency,36.2%were with thyroid abnormality when29%were with hyperthyroidism or hypothyroidism. Among those with insufficiency, thyroid abnormality accounted for25.8%, when hyperthyroidism or hypothyroidism accounted for2.9%. Patients with vitamin D deficiency were at an increased risk of thyroid disease, especially thyroid dysfunction (P=0.017). Vitamin D value was lowest in March,26.1±9.7nmol/L, then went up to the highest in September and October,45.1±14.0nmol/L-44.1±15.2nmol/L, then went down. Multivariate analysis indicated gender(p=0.035), thyroid condition(p=0.034), testing month(p=0.049) were independent factors affecting vitamin D level. In the follow-up, the3patients with disease progression after common therapy (without steroids or UV therapy) all had vitamin d values lower than month average.2of them were males,66.7%in males with lower vitamin D values then month average,1was female,16.7%in females with lower vitamin D values than month average. All3patients were lip-digit type, accounted for75%in patients with lower vitamin D levels than month average, while counterparts in higher vitamin D group had no progression. Other patients in lower-than-month-average vitamin D group had it go up as disease improved, except1with thyroid disease, whose vitamin D value didn't go up though vitiligo improved.
Conclusion:Chinese vitiligo patients generally lack vitamin D. Females have higher risk. Patients with vitamin D deficiency are more likely to have thyroid diseases. Vitamin D level reaches the peak of the year in September and October, but doesn't reach the'sufficient'standard. Lower pretreatment vitamin D level is probably associated with autoimmunity, unsatisfied prognosis and sensitivity to treatment, especially among males and lip-digit type. Vitamin D may be valuable for judging patients'autoimmune state, determining therapy and evaluating prognosis. For Chinese vitiligo patients, adequately increasing sunshine exposure and oral supplementation of vitamin D are suggested.
引文
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[32]Y.Braun-Moscovici, K.Toledano, D.Markrovits, A, Rozin, AM., Nahir A, Balbir-Guman. Vitamin D level:is it related to disease activity in inflammatory joint diseases? Rheumatol Int,2009. [Epub ahead of print]
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[43]G. Calzolari, V. Data, R. Carignola, A Angeli. Hypovitaminosis D in systemic sclerosis. J Rheumatol,2009,36(12):2844.
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[45]L.Y Matsuoka, M.J.Dannenberg, J.Wortsman, B.W. Hollis, S.A. Jimenez, J. Varga. Cutaneous vitamin D3 formation in progressive systemic sclerosis. J Rheumatol, 1991,18(8):1196-8.
[46]J. Serup, H. Hagdrup. Vitamin D metabolites in generalized scleroderma evidence of a normal cutaneous and intestinal supply with vitamin D. Acta Derm Venereol, 1985,65(4):343-5.
[47]J. Serup, H. Hagdrup. Increased.1,25-dihydroxyvitamin D in patients with generalized scleroderma and no aberrant calcifications. Arch Dermatol Res,1984, 276(3):205-6.
[48]P.Caramaschi, A Dalla Gassa, O. Ruzzenente, A. Volpe, V. Pavagnani, I. Tinazze et al. Very low levels of vitamin D in systemic sclerosis patients. Clin Rheumatol, 2010.[Epub ahead of print]
[49]A. Vacca, C. Cormier, M. Piras, A. Mathieu, A. Kahan, Y. Allanore. Vitamin D deficiency and insufficiency in 2 independent cohorts of patients with systemic sclerosis. J Rheumatol,2009,36(9):1924-9.
[50]P. Humbert, J.L. Dupond, P. Agache, P. Laurent, A. Rochefort et al. Treatment of scleroderma with oral 1,25-dihydroxyvitamin D3:evaluation of skin involvement using non-invasive techniques:Results of an open prospective trial. Acta Derm Venereol,1993,73(6):449-51.
[51]M.M. Hulshof, S. Pavel, F.C. Breedveld, B.A.dijkmans, B.J.Vermeer. Oral calcitriol as a new therapeutic modality for generalized morphea. Arch Dermatol, 1994,130(10):1290-3.
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