Perez Mariana O, Oliveira Ricardo M, Levy-Neto Mauricio, Caparbo Valeria F, Pereira Rosa M R
Divisao de Reumatologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
RDO Diagnosticos Medicos, Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2017 Dec;72(12):723-728. doi: 10.6061/clinics/2017(12)02.
To determine the possible association of serum 25-hydroxyvitamin D (25OHD) levels with disease activity and respiratory infection in granulomatosis with polyangiitis patients during two different periods: winter/spring and summer/autumn.
Thirty-two granulomatosis with polyangiitis patients were evaluated in the winter/spring, and the same patients (except 5) were evaluated in summer/autumn (n=27). The 25OHD levels were measured by radioimmunoassay. Disease activity was assessed by the Birmingham Vasculitis Activity Score Modified for Wegener's Granulomatosis (BVAS/WG) and antineutrophil cytoplasmic antibody (ANCA) positivity. Respiratory infection was defined according the Centers for Disease Control and Prevention criteria.
25OHD levels were lower among patients in winter/spring than in summer/autumn (32.31±13.10 vs. 38.98±10.97 ng/mL, p=0.04). Seven patients met the criteria for respiratory infection: 5 in winter/spring and 2 in summer/autumn. Patients with respiratory infection presented lower 25OHD levels than those without infection (25.15±11.70 vs. 36.73±12.08 ng/mL, p=0.02). A higher frequency of low vitamin D levels (25OHD<20 ng/mL) was observed in patients with respiratory infection (37.5% vs. 7.8, p=0.04). Serum 25OHD levels were comparable between patients with (BVAS/WG≥1 plus positive ANCA) and without disease activity (BVAS/WG=0 plus negative ANCA) (35.40±11.48 vs. 35.34±13.13 ng/mL, p=0.98).
Lower 25OHD levels were associated with respiratory infection but not disease activity in granulomatosis with polyangiitis patients. Our data suggest that hypovitaminosis D could be an important risk factor for respiratory infection in granulomatosis with polyangiitis patients.
确定在两个不同时期（冬季/春季和夏季/秋季），肉芽肿性多血管炎患者血清25-羟维生素D（25OHD）水平与疾病活动及呼吸道感染之间可能存在的关联。
在冬季/春季对32例肉芽肿性多血管炎患者进行评估，夏季/秋季对同一批患者（5例除外）进行评估（n = 27）。采用放射免疫分析法测定25OHD水平。通过针对韦格纳肉芽肿改良的伯明翰血管炎活动评分（BVAS/WG）和抗中性粒细胞胞浆抗体（ANCA）阳性情况评估疾病活动度。根据美国疾病控制与预防中心的标准定义呼吸道感染。
冬季/春季患者的25OHD水平低于夏季/秋季（32.31±13.10 vs. 38.98±10.97 ng/mL，p = 0.04）。7例患者符合呼吸道感染标准：冬季/春季5例，夏季/秋季2例。发生呼吸道感染的患者25OHD水平低于未感染患者（25.15±11.70 vs. 36.73±12.08 ng/mL，p = 0.02）。呼吸道感染患者中维生素D水平低（25OHD<20 ng/mL）的发生率更高（37.5% vs. 7.8%，p = 0.04）。疾病活动患者（BVAS/WG≥1且ANCA阳性）与无疾病活动患者（BVAS/WG = 0且ANCA阴性）的血清25OHD水平相当（35.40±11.48 vs. 35.34±13.13 ng/mL，p = 0.98）。
肉芽肿性多血管炎患者中，较低的25OHD水平与呼吸道感染相关，但与疾病活动无关。我们的数据表明，维生素D缺乏可能是肉芽肿性多血管炎患者发生呼吸道感染的重要危险因素。
