2型糖尿病中第一跖趾关节滑膜肥厚与维生素D状态的关系：一项超声分级研究

First metatarsophalangeal joint synovial hypertrophy associated with vitamin D status in type 2 diabetes mellitus: An ultrasound-graded study.

作者信息

Li Qing-Shan, Xiao Xiao-Hui, Cai Yu-Ying, Xiao Xiao-Peng, Hu Ping-Xiang, Li Hong

机构信息

Department of Ultrasound, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine (Shenzhen Traditional Chinese Medicine Hospital), Shenzhen 518000, Guangdong Province, China.

Department of Endocrinology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine (Shenzhen Traditional Chinese Medicine Hospital), Shenzhen 518000, Guangdong Province, China.

出版信息

World J Diabetes. 2025 Jul 15;16(7):107019. doi: 10.4239/wjd.v16.i7.107019.

DOI:10.4239/wjd.v16.i7.107019

PMID:40697613

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12278095/

Abstract

BACKGROUND

The existing semi-quantitative ultrasound grading system inadequately evaluates synovial hypertrophy at the dorsal recess of the first metatarsophalangeal joint (MTPJ). Vitamin D deficiency is prevalent in type 2 diabetes mellitus (T2DM) and may influence joint inflammation. This study hypothesizes that serum 25-hydroxyvitamin D [25(OH)D] levels are inversely associated with synovial hypertrophy severity of the first MTPJ in patients with T2DM.

AIM

To refine ultrasound grading for the first MTPJ synovial hypertrophy and investigate its association with vitamin D in T2DM.

METHODS

This cross-sectional study included 56 patients (112 MTPJs) with T2DM from Shenzhen Traditional Chinese Medicine Hospital. Synovial hypertrophy was evaluated using a refined semi-quantitative ultrasound grading system focusing on the dorsal recess overlying the metatarsal bone. Serum 25(OH)D levels were measured. Logistic regression and threshold analyses assessed associations between vitamin D status and hypertrophy severity.

RESULTS

Of 112 joints assessed, 98 exhibited synovial hypertrophy (grade 1: 40; grade 2: 50; grade 3: 8). The refined grading system demonstrated strong intra- and inter-observer reliability (intraclass correlation coefficients = 0.79 and 0.73, respectively). Lower serum 25(OH)D (< 24.3 ng/mL) was independently associated with moderate-to-severe hypertrophy [odds ratio (OR) = 0.83; = 0.0163]. Vitamin D deficiency significantly increased the likelihood of moderate-to-severe hypertrophy compared with non-deficiency (OR = 3.86; = 0.0422). Threshold analysis identified 23.8 ng/mL as a critical serum 25(OH)D level, below which each increment reduced moderate-to-severe hypertrophy risk by 21% (OR = 0.79; = 0.0078).

CONCLUSION

The refined ultrasound grading system demonstrated strong reliability. Serum 25(OH)D may serve as a protective factor against the severity of synovial hypertrophy in T2DM patients with lower 25(OH)D levels.

摘要

背景

现有的半定量超声分级系统对第一跖趾关节（MTPJ）背侧隐窝处的滑膜肥厚评估不足。维生素D缺乏在2型糖尿病（T2DM）中普遍存在，且可能影响关节炎症。本研究假设，T2DM患者血清25-羟基维生素D[25(OH)D]水平与第一MTPJ滑膜肥厚严重程度呈负相关。

目的

优化第一MTPJ滑膜肥厚的超声分级，并研究其与T2DM中维生素D的关联。

方法

这项横断面研究纳入了来自深圳市中医院的56例T2DM患者（112个MTPJ）。使用一种优化的半定量超声分级系统评估滑膜肥厚，该系统重点关注覆盖跖骨的背侧隐窝。测量血清25(OH)D水平。逻辑回归和阈值分析评估维生素D状态与肥厚严重程度之间的关联。

结果

在评估的112个关节中，98个表现出滑膜肥厚（1级：40个；2级：50个；3级：8个）。优化后的分级系统在观察者内和观察者间均显示出很强的可靠性（组内相关系数分别为0.79和0.73）。较低的血清25(OH)D（<24.3 ng/mL）与中度至重度肥厚独立相关[比值比（OR）=0.83；P=0.0163]。与非缺乏相比，维生素D缺乏显著增加了中度至重度肥厚的可能性（OR = 3.86；P = 0.0422）。阈值分析确定23.8 ng/mL为血清25(OH)D的临界水平，低于该水平，每增加一个单位，中度至重度肥厚风险降低21%（OR = 0.79；P = 0.0078）。