结缔组织病相关间质性肺病中的维生素 D 缺乏。

Vitamin D deficiency in connective tissue disease-associated interstitial lung disease.

机构信息

Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Clin Exp Rheumatol. 2018 Nov-Dec;36(6):1049-1055. Epub 2018 May 24.

Abstract

OBJECTIVES

To determine and compare the prevalence of vitamin D deficiency in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD).

METHODS

The level of vitamin D was determined by the serum levels of 1,25(OH)2D3. We evaluated 144 patients in our study, including 53 subjects in the CTD-ILD group and 91 subjects in the CTD group without ILD. CTD was diagnosed following the American College of Rheumatology criteria, and ILD was diagnosed by high-resolution computed tomography. Patients with other known causes of ILD and other pulmonary diseases were excluded. Vitamin D deficiency level was <20 ng/ml. This is a retrospective study.

RESULTS

Serum vitamin D levels were significantly lower in CTD-ILD patients (p<0.0001). Vitamin D deficiency was lower in the CTD-ILD group (mean±SD: 11.5±4.1 ng/ml) than in the control group (13.9±4.8 ng/ml, p=0.004). The CTD-ILD group was older (p=0.002), had higher levels of fibrinogen (p=0.028) and positive anti-CCP (p=0.026), faster ESR (p=0.001), lower serum levels of serum calcium (p=0.002), and more immunosuppressive therapies (p=0.011). Decreased serum albumin and higher positive antinuclear antibodies (ANA) were associated with reduced vitamin D levels in the vitamin D subgroups. When the odds ratio was adjusted for CTD-ILD, vitamin D deficiency was also a risk factor for CTD-ILD, whereas serum levels of calcium was a protective factor for CTD-ILD.

CONCLUSIONS

Serum vitamin D deficiency is associated with CTD-ILD and is a risk factor. Therefore, vitamin D may play a role in the pathogenesis of CTD-ILD.

摘要

目的

确定并比较结缔组织病相关间质性肺病（CTD-ILD）患者维生素 D 缺乏的患病率。

方法

通过血清 1,25（OH）2D3 水平来确定维生素 D 水平。我们在研究中评估了 144 名患者，其中 CTD-ILD 组 53 例，无 ILD 的 CTD 组 91 例。CTD 按照美国风湿病学会标准诊断，ILD 通过高分辨率计算机断层扫描诊断。排除其他已知原因导致的 ILD 和其他肺部疾病的患者。维生素 D 缺乏水平<20ng/ml。这是一项回顾性研究。

结果

CTD-ILD 患者血清维生素 D 水平明显较低（p<0.0001）。CTD-ILD 组维生素 D 缺乏症发生率（11.5±4.1ng/ml）低于对照组（13.9±4.8ng/ml，p=0.004）。CTD-ILD 组年龄较大（p=0.002），纤维蛋白原水平较高（p=0.028），抗 CCP 阳性（p=0.026），ESR 较快（p=0.001），血清钙水平较低（p=0.002），免疫抑制治疗更多（p=0.011）。维生素 D 亚组中血清白蛋白降低和抗核抗体（ANA）阳性与维生素 D 水平降低相关。当调整 CTD-ILD 的比值比时，维生素 D 缺乏也是 CTD-ILD 的危险因素，而血清钙水平是 CTD-ILD 的保护因素。