Department of Internal Medicine, Division of Rheumatology, Rouhani Hospital, Babol University of Medical Science, Babol Iran R, Babol, Iran.
Rheumatol Int. 2012 Apr;32(4):991-5. doi: 10.1007/s00296-010-1736-3. Epub 2011 Jan 19.
Inadequate vitamin D may be involved in the pathogenesis and or progression of several disorders, including connective tissue diseases. To determine the status of vitamin D in different stages of inflammatory arthritis, the levels of vitamin D in established rheumatoid arthritis (RA) and undifferentiated inflammatory arthritis (UIA) were compared with controls. Patients with RA and UIA entered the study. Serum 25-hydroxyvitamin D (25-OHD) was measured by ELISA method, and concentrations less than 20 ng/ml were considered as deficient levels. In statistical analysis, the Mann-Whitney U test was used for comparing differences between groups and logistic regression analysis with calculation of adjusted odds ratio (OR) was used to determine the association between serum 25-OHD deficiency and disease condition. A total of 108 RA, 39 UIA, and 239 controls were studied. There were no significant differences in mean serum 25-OHD level and frequency of serum 25-OHD deficiency between RA and controls (37 ± 37.7 vs. 33.2 ± 28.6 ng/ml, P = 0.96). But the mean serum 25-OHD level in UIA was significantly lower than in the controls (25.1 ± 23.9 vs. 33.2 ± 28.6 ng ml, P = 0.04). A significant positive association was observed between serum 25-OHD deficiency and UIA (56.4% vs. 35.5%, OR = 2.34, 95% CI, 1.18-4.65, P = 0.021) which remained significant after adjustment for sex and age (adjusted OR = 2.24, 95% CI, 1.01-4.55, P = 0.026). Whereas the association between serum 25-OHD deficiency and RA did not reach statistical significance (40.7% vs. 35.5%, OR = 1.24, 95% CI, 0.78-1.99). These findings indicate higher serum vitamin D deficiency in patients with ongoing arthritis rather than established arthritis. Respecting to deleterious effects of vitamin D deficiency on immune system and progressive nature of UIA, a significant proportion of high risk UIA can be recognized by serum 25-OHD determination.
维生素 D 不足可能与几种疾病的发病机制和/或进展有关，包括结缔组织疾病。为了确定炎症性关节炎不同阶段的维生素 D 状态，比较了已确诊的类风湿关节炎 (RA) 和未分化炎症性关节炎 (UIA) 患者的维生素 D 水平与对照组。入组研究的患者为 RA 和 UIA。采用 ELISA 法测定血清 25-羟维生素 D（25-OHD），血清 25-OHD 浓度<20ng/ml 为缺乏水平。在统计分析中，采用 Mann-Whitney U 检验比较组间差异，采用 logistic 回归分析计算调整后的比值比（OR），以确定血清 25-OHD 缺乏与疾病状况之间的关系。共研究了 108 例 RA、39 例 UIA 和 239 例对照组。RA 和对照组之间的平均血清 25-OHD 水平和血清 25-OHD 缺乏频率无显著差异（37±37.7 vs. 33.2±28.6ng/ml，P=0.96）。但 UIA 患者的平均血清 25-OHD 水平显著低于对照组（25.1±23.9 vs. 33.2±28.6ng/ml，P=0.04）。血清 25-OHD 缺乏与 UIA 呈显著正相关（56.4% vs. 35.5%，OR=2.34，95%CI，1.18-4.65，P=0.021），调整性别和年龄后仍有显著相关性（调整 OR=2.24，95%CI，1.01-4.55，P=0.026）。而血清 25-OHD 缺乏与 RA 之间的相关性未达到统计学意义（40.7% vs. 35.5%，OR=1.24，95%CI，0.78-1.99）。这些发现表明，处于活动期关节炎的患者血清维生素 D 缺乏更为严重，而不是已确诊的关节炎。鉴于维生素 D 缺乏对免疫系统的有害影响以及 UIA 的进行性，通过血清 25-OHD 测定可以识别出相当一部分高危 UIA。
