Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument Street Suite 7500, Baltimore, MD 21205, USA.
Rheumatology (Oxford). 2013 Nov;52(11):2071-6. doi: 10.1093/rheumatology/ket271. Epub 2013 Aug 16.
Vitamin D deficiency is common in SLE. Cardioprotective effects of vitamin D have been postulated due to modulation of inflammatory cytokines. However, the effects of vitamin D supplementation on inflammatory cytokines in trials have been inconsistent. We determined whether levels of vitamin D at baseline were associated with subclinical measures of atherosclerosis, or with changes in subclinical measures over 2 years.
Of the 200 patients enrolled in the Lupus Atherosclerosis Prevention Study, complete baseline and follow-up data [including coronary artery calcium (CAC), carotid intima-media thickness (IMT), 25-hydroxy vitamin D [25(OH)D] and high-sensitivity CRP (hsCRP) levels] were available for 154 patients. Assessments were repeated 2 years later.
25(OH)D values ranged from 4 to 79 ng/ml. Among African American patients, 25(OH)D values ranged from 4 to 55 ng/ml. With low 25(OH)D (vitamin D <21 ng/ml), a higher proportion had a CAC score >100 (11%) compared with those with vitamin D insufficiency (21-32 ng/ml) (10%) and normal (≥32 ng/ml) 25(OH)D (3%), which was not statistically significant. 25(OH)D was neither associated with nor did it predict progression of CAC or carotid IMT over 2 years. The mean hsCRP decreased over 2 years.
25(OH)D was not associated with any measure of subclinical atherosclerosis. 25(OH)D deficiency was associated with higher hsCRP at baseline, but did not predict a change in hsCRP over 2 years.
SLE 患者普遍存在维生素 D 缺乏。维生素 D 具有调节炎性细胞因子的作用,因此具有心脏保护作用。然而,临床试验中维生素 D 补充对炎性细胞因子的影响并不一致。我们旨在确定基线维生素 D 水平是否与亚临床动脉粥样硬化指标相关,或者与 2 年内亚临床指标的变化相关。
在 Lupus Atherosclerosis Prevention Study 中,共纳入 200 例患者,其中 154 例患者具有完整的基线和随访数据(包括冠状动脉钙含量[CAC]、颈动脉内膜中层厚度[IMT]、25-羟维生素 D[25(OH)D]和高敏 C 反应蛋白[hsCRP]水平)。2 年后重复评估。
25(OH)D 值范围为 4-79ng/ml。在非裔美国患者中,25(OH)D 值范围为 4-55ng/ml。低 25(OH)D(维生素 D<21ng/ml)患者的 CAC 评分>100(11%)的比例高于维生素 D 不足(21-32ng/ml)(10%)和正常(≥32ng/ml)(3%)患者,但无统计学差异。25(OH)D 与 CAC 或颈动脉 IMT 在 2 年内的进展均无相关性,也不能预测其进展。hsCRP 平均值在 2 年内逐渐降低。
25(OH)D 与任何亚临床动脉粥样硬化指标均无相关性。25(OH)D 缺乏与基线时 hsCRP 升高相关,但不能预测 2 年内 hsCRP 的变化。