维生素 D 与类风湿关节炎。
Vitamin D and rheumatoid arthritis.
机构信息
Department of Endocrinology, Red Cross Hospital, 7 Korinthias Street, 115 26 Athens, Greece.
出版信息
Ther Adv Endocrinol Metab. 2012 Dec;3(6):181-7. doi: 10.1177/2042018812471070.
OBJECTIVES
Vitamin D deficiency has been implicated in the pathogenesis of autoimmune diseases, such as diabetes mellitus type 1 and multiple sclerosis. Reduced vitamin D intake has been linked to increased susceptibility to the development of rheumatoid arthritis (RA) and vitamin D deficiency has been found to be associated with disease activity in patients with RA. The objective was to evaluate vitamin D status in patients with RA and to assess the relationship between vitamin D levels and disease activity.
METHODS
In a cohort of 44 patients with RA, 25-hydroxyvitamin D(3) [25(OH)D(3)] levels, parathyroid hormone levels, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured. Disease activity was evaluated by calculating the 28-joint Disease Activity Score (DAS28). A control group (n = 44), matched for age and sex, was evaluated as well.
RESULTS
In the cohort of 44 patients with RA 25(OH)D(3) levels were found to be low compared with the control group, 25(OH)D(3) being 15.26 ± 1.07 ng/ml [mean ± standard error of the mean (SEM)] and 25.8 ± 1.6 ng/ml in the patient and control group respectively (Student's t test, p < 0.001). Parathyroid hormone levels were 71.08 ± 7.02 pg/ml (mean ± SEM) (normal values 10.0-65.0 pg/ml), CRP 7.6 ± 1.57 mg/litre (mean ± SEM) (normal values < 3 mg/litre) and ESR was 38.0 ± 4.6 mm/h (mean ± SEM) in the group of patients with RA. Levels of 25(OH)D(3) were found to be negatively correlated to the DAS28, the correlation coefficient being -0.084. Levels of 25(OH)D(3) were also found to be negatively correlated to CRP and ESR, the correlation coefficient being -0.115 and -0.18, respectively.
CONCLUSION
It appears that vitamin D deficiency is highly prevalent in patients with RA, and that vitamin D deficiency may be linked to disease severity in RA. As vitamin D deficiency has been linked to diffuse musculoskeletal pain, these results have therapeutic implications. Vitamin D supplementation may be needed both for the prevention of osteoporosis as well as for pain relief in patients with RA.
目的
维生素 D 缺乏与 1 型糖尿病和多发性硬化等自身免疫性疾病的发病机制有关。维生素 D 摄入减少与类风湿关节炎 (RA) 的易感性增加有关，并且已经发现维生素 D 缺乏与 RA 患者的疾病活动有关。目的是评估 RA 患者的维生素 D 状态，并评估维生素 D 水平与疾病活动之间的关系。
方法
在 44 例 RA 患者的队列中，测量了 25-羟维生素 D(3)[25(OH)D(3)]水平、甲状旁腺激素水平、C 反应蛋白 (CRP) 和红细胞沉降率 (ESR)。通过计算 28 关节疾病活动评分 (DAS28) 来评估疾病活动。还评估了年龄和性别相匹配的对照组 (n=44)。
结果
与对照组相比，44 例 RA 患者的 25(OH)D(3)水平较低，患者组和对照组的 25(OH)D(3)分别为 15.26±1.07ng/ml[平均值±标准误差(SEM)]和 25.8±1.6ng/ml(学生 t 检验，p<0.001)。甲状旁腺激素水平为 71.08±7.02pg/ml(平均值±SEM)(正常值 10.0-65.0pg/ml)，CRP 为 7.6±1.57mg/l(平均值±SEM)(正常值<3mg/l)，ESR 为 38.0±4.6mm/h(平均值±SEM)RA 患者组。发现 25(OH)D(3)水平与 DAS28 呈负相关，相关系数为-0.084。还发现 25(OH)D(3)水平与 CRP 和 ESR 呈负相关，相关系数分别为-0.115 和-0.18。
结论
似乎维生素 D 缺乏在 RA 患者中非常普遍，并且维生素 D 缺乏可能与 RA 的严重程度有关。由于维生素 D 缺乏与弥漫性肌肉骨骼疼痛有关，因此这些结果具有治疗意义。RA 患者可能既需要补充维生素 D 以预防骨质疏松症，也需要补充维生素 D 以缓解疼痛。
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