Lydia Becker Institute of Immunology and Inflammation, Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester.
Department of Rheumatology, Sandwell and West Birmingham NHS Trust.
Rheumatology (Oxford). 2021 Oct 2;60(10):4737-4747. doi: 10.1093/rheumatology/keab090.
Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in SLE. We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance.
The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10-36 nmol/l), T2 (37-60 nmol/l) and T3 (61-174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels.
Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased high-density lipoprotein (HDL) were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance.
MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.
维生素 D（25（OH）D）缺乏和代谢综合征（MetS）都可能增加系统性红斑狼疮（SLE）的心血管风险。我们旨在研究人口统计学因素、SLE 表型、治疗和维生素 D 水平与 MetS 和胰岛素抵抗的关系。
系统性红斑狼疮国际合作临床中心（SLICC）于 2000 年从 11 个国家的 33 个中心招募了最近确诊的 SLE 患者（<15 个月）。收集了临床、实验室和治疗数据。根据该队列的分布情况，将维生素 D 水平定义为三个三分位数，分别为 T1（10-36 nmol/L）、T2（37-60 nmol/L）和 T3（61-174 nmol/L）。代谢综合征根据 2009 年国际糖尿病联合会的共识声明定义。使用 HOMA-IR 模型确定胰岛素抵抗。线性和逻辑回归用于评估变量与维生素 D 水平的关系。
在 1847 名患者中，有 1163 名（63%）进行了维生素 D 检测，其中 398 名（34.2%）患者处于最低的 25（OH）D 三分位数。在能够确定状态的 860 名患者中，有 286 名（33%）存在 MetS。维生素 D 水平较低的患者更有可能患有 MetS 和更高的 HOMA-IR。代谢综合征的成分，高血压、高三酰甘油血症和高密度脂蛋白（HDL）降低均与较低的 25（OH）D 显著相关。糖皮质激素暴露量增加与胰岛素抵抗相关。
SLE 患者的 MetS 和胰岛素抵抗与维生素 D 水平降低有关。进一步的研究可以确定维生素 D 补充是否可以更好地控制这些心血管危险因素，并改善 SLE 的长期预后。
