基线25-羟维生素D水平可预测维生素D补充剂对膝骨关节炎患者关节症状和软骨流失的影响。
Baseline 25-hydroxyvitamin D levels predict the effects of vitamin D supplementation on joint symptoms and cartilage loss in patients with knee osteoarthritis.
作者信息
Wang Tian, Zheng Shuang, Jin Xingzhong, Cen Han, Zhu Zhaohua, Han Weiyu, Wluka Anita, Cicuttini Flavia, Cao Peihua, Ding Changhai
机构信息
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Beijing United Family Hospital, Beijing, China.
出版信息
Rheumatol Adv Pract. 2025 May 27;9(3):rkaf061. doi: 10.1093/rap/rkaf061. eCollection 2025.
OBJECTIVES
To examine whether the baseline vitamin D level modifies the effects of vitamin D supplementation on knee symptoms and cartilage loss in patients with symptomatic knee OA.
METHODS
This was a post hoc analysis for the VIDEO study, which was a large ( = 413), randomized, double-blind, placebo-controlled clinical trial in knee OA patients with 25-hydroxyvitamin D [25(OH)D levels ranging from 12.5 to 60 nmol/l]. Knee pain was assessed using the WOMAC pain scale. MRI scans of the knee were obtained. Cartilage volume, cartilage defects (0-4) and bone marrow lesions were measured or graded. Classification trees were applied to categorize the subgroups.
RESULTS
A total of 413 participants (mean age 63.2 years; 50% women) were randomly assigned to vitamin D and placebo groups. A baseline 25(OH)D level of 43 nmol/l was found as the cut-off value. For the total WOMAC score, vitamin D supplementation decreased more than placebo in patients with 25(OH)D levels of 12.5-43 nmol/l (-256.41 -72.10, = 0.0060) over 2 years but not in those with 25(OH)D levels of 43-60 nmol/l. Comparatively, vitamin D supplementation reduced the total cartilage volume loss (-0.21 -0.31, = 0.0415) and total cartilage defects progression (0.26 0.92, = 0.0029) in patients with 25(OH)D levels of 43-60 nmol/l but not in those with 25(OH)D of 12.5-43 nmol/l.
CONCLUSION
Supplementation of vitamin D in patients with OA who have 25(OH)D levels ≤43 nmol/l could relieve pain and improve physical function, while in OA patients with 25(OH)D levels >43 nmol/l, supplementation may ameliorate cartilage lesions.
TRIAL REGISTRATION
clinicaltrials.gov, NCT01176344; anzctr.org.au, ACTRN12610000495022.
目的
探讨基线维生素D水平是否会改变维生素D补充剂对有症状的膝关节骨关节炎（OA）患者膝关节症状和软骨丢失的影响。
方法
这是对VIDEO研究的事后分析，该研究是一项针对膝关节OA患者的大型（n = 413）随机、双盲、安慰剂对照临床试验，患者的25-羟维生素D [25(OH)D]水平在12.5至60 nmol/l之间。使用WOMAC疼痛量表评估膝关节疼痛。对膝关节进行MRI扫描。测量或分级软骨体积、软骨缺损（0 - 4级）和骨髓病变。应用分类树对亚组进行分类。
结果
共有413名参与者（平均年龄63.2岁；50%为女性）被随机分配到维生素D组和安慰剂组。发现基线25(OH)D水平为43 nmol/l为临界值。对于总WOMAC评分，在25(OH)D水平为12.5 - 43 nmol/l的患者中，补充维生素D在2年期间比安慰剂组降低得更多（-256.41 -72.10，P = 0.0060），但在25(OH)D水平为43 - 60 nmol/l的患者中并非如此。相比之下，补充维生素D在25(OH)D水平为43 - 60 nmol/l的患者中减少了总软骨体积丢失（-0.21 -0.31，P = 0.0415）和总软骨缺损进展（0.26 0.92，P = 0.0029），但在25(OH)D水平为12.5 - 43 nmol/l的患者中并非如此。
结论
对于25(OH)D水平≤43 nmol/l的OA患者补充维生素D可缓解疼痛并改善身体功能，而对于25(OH)D水平>43 nmol/l的OA患者，补充维生素D可能改善软骨病变。
试验注册
clinicaltrials.gov，NCT01176344；anzctr.org.au，ACTRN12610000495022。
Zotero 插件