Zold Eva, Szodoray Peter, Gaal Janos, Kappelmayer János, Csathy Laszlo, Gyimesi Edit, Zeher Margit, Szegedi Gyula, Bodolay Edit
Division of Clinical Immunology, 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs, Str, 22, Debrecen, 4032, Hungary.
Arthritis Res Ther. 2008;10(5):R123. doi: 10.1186/ar2533. Epub 2008 Oct 18.
Both experimental and clinical data provide evidence that vitamin D is one of those important environmental factors that can increase the prevalence of certain autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, insulin-dependent diabetes mellitus, and inflammatory bowel disease. The aim of the present study was to investigate the prevalence of vitamin D insufficiency in patients with undifferentiated connective tissue disease (UCTD).
Plasma 25(OH)D3 levels in 161 UCTD patients were measured in both summer and winter periods. Autoantibody profiles (antinuclear antibody, anti-U1-ribonucleoprotein, anti-SSA, anti-SSB, anti-Jo1, anti-Scl70, anti-double-stranded DNA, anti-centromere, anti-cardiolipin, rheumatoid factor, and anti-cyclic citrullinated peptide) and clinical symptoms of the patients were assessed.
Plasma levels of 25(OH)D3 in UCTD patients were significantly lower compared with controls in both summer and winter periods (UCTD summer: 33 +/- 13.4 ng/mL versus control: 39.9 +/- 11.7 ng/mL, P = 0.01; UCTD winter: 27.8 +/- 12.48 ng/mL versus control: 37.8 +/- 12.3 ng/mL, P = 0.0001). The presence of dermatological symptoms (photosensitivity, erythema, and chronic discoid rash) and pleuritis was associated with low levels of vitamin D. During the average follow-up period of 2.3 years, 35 out of 161 patients (21.7%) with UCTD further developed into well-established connective tissue disease (CTD). Patients who progressed into CTDs had lower vitamin D levels than those who remained in the UCTD stage (vitamin D levels: CTD: 14.7 +/- 6.45 ng/mL versus UCTD: 33.0 +/- 13.4 ng/mL, P = 0.0001).
In patients with UCTD, a seasonal variance in levels of 25(OH)D3 was identified and showed that these levels were significantly lower than in controls during the corresponding seasons. Our results suggest that vitamin D deficiency in UCTD patients may play a role in the subsequent progression into well-defined CTDs.
实验和临床数据均表明，维生素D是重要的环境因素之一，可增加某些自身免疫性疾病的患病率，如系统性红斑狼疮、类风湿关节炎、胰岛素依赖型糖尿病和炎症性肠病。本研究旨在调查未分化结缔组织病（UCTD）患者中维生素D不足的患病率。
在夏季和冬季分别测量了161例UCTD患者的血浆25(OH)D3水平。评估了患者的自身抗体谱（抗核抗体、抗U1核糖核蛋白、抗SSA、抗SSB、抗Jo1、抗Scl70、抗双链DNA、抗着丝点、抗心磷脂、类风湿因子和抗环瓜氨酸肽）及临床症状。
UCTD患者的血浆25(OH)D3水平在夏季和冬季均显著低于对照组（UCTD夏季：33±13.4 ng/mL，对照组：39.9±11.7 ng/mL，P = 0.01；UCTD冬季：27.8±12.48 ng/mL，对照组：37.8±12.3 ng/mL，P = 0.0001）。皮肤症状（光敏性、红斑和慢性盘状红斑）和胸膜炎的存在与维生素D水平低有关。在平均2.3年的随访期内，161例UCTD患者中有35例（21.7%）进一步发展为明确的结缔组织病（CTD）。进展为CTD的患者维生素D水平低于仍处于UCTD阶段的患者（维生素D水平：CTD：14.7±6.45 ng/mL，UCTD：33.0±13.4 ng/mL，P = 0.0001）。
在UCTD患者中，发现25(OH)D3水平存在季节性变化，且在相应季节显著低于对照组。我们的结果表明，UCTD患者维生素D缺乏可能在随后进展为明确的CTD中起作用。
