血清25-羟维生素D与系统性红斑狼疮活动的关系

doi:10.19723/j.issn.1671-167X.2021.05.021

摘要/Abstract

摘要：

目的: 探讨血清25-羟维生素D[25-dihydroxy vitamin D,25(OH)D]在系统性红斑狼疮(systemic lupus erythematosus,SLE)活动中的应用价值。方法: 收集2016年7月至2019年7月就诊新疆维吾尔自治区人民医院风湿免疫科158例SLE患者。根据SLE疾病活动指数评分(systemic lupus erythematosus disease activity index,SLEADI)将158例SLE患者分为两组:活动组59例(SLEADI>4),非活动组99例(SLEDAI≤4)。选取新疆维吾尔自治区人民医院风湿免疫科体检中心性别、年龄相匹配的健康人群50例作为健康对照组。收集入选患者的一般资料、实验室数据及血清25(OH)D水平。结果: (1)SLE组25(OH)D水平[10.4(5.6,15.8)μg/L]明显低于健康对照组[25.5(22.8,32.3) μg/L,P <0.01];SLE活动组25(OH)D水平为[6.2(3.7,13.8)μg/L],非活动组为[12.3(7.2,16.7) μg/L],组间差异有统计学意义(P<0.01);狼疮肾炎(lupus nephritis,LN)组患者血清25(OH)D水平[6.7(4.4,12.9) μg/L]明显低于SLE无肾脏损害患者[13.3(7.4,18.7) μg/L,P <0.01]。(2)SLE患者中25(OH)D水平与SLEDAI、24h尿蛋白定量(24h urinary protein quantification,24h-pro)升高均呈负相关(r=-0.35和-0.39,P<0.01);与补体C3降低呈正相关(r=0.24,P<0.01)。(3)通过单因素分析发现抗双链DNA抗体(anti-ds DNA antibodies,ds-DNA)、抗史密斯抗体(anti-Smith antibodies,Sm)、IgG、C3、C4、红细胞沉降率(erythrocyte sedimentation rate,ESR)、24h-pro以及25(OH)D与SLE患者疾病活动相关,通过多因素Logistic回归分析发现25(OH)D降低是SLE患者疾病活动的独立危险因素。结论: 血清25(OH)D的下降与SLE患者病情活动有相关性,而且可能与LN相关,在SLE的发生、发展中有重要作用。

关键词: 系统性红斑狼疮, 狼疮肾炎, 25-羟维生素D, 疾病活动

Abstract:

Objective: To investigate the application value of serum 25-hydroxy vitamin D [25(OH)D] in systemic lupus erythematosus (SLE). Methods: Data of 158 patients with SLE in Department of Rheumatology and Immunology in the People’s Hospital of Xinjiang Uygur Autonomous Region from July 2016 to July 2019. All the SLE patients were divided into two groups by SLE scores of the disease activity index (SLEADI): 59 cases of active group (SLEADI>4), 99 cases of non-active group (SLEDAI ≤4). Fifty healthy people were selected as healthy control group. The patients’ general information and their laboratory data including serum 25(OH)D levels were collected. Statistical methods used were t-test, Spearman’s correalation analysis and Logistic regression analysis. Results: (1) A total of 208 cases were included in this study. The level of 25(OH)D in SLE group [10.4(5.6,15.8) μg/L] was significantly lower than that in healthy control group [25.5(22.8,32.3) μg/L, P<0.01]. 25(OH)D level in active SLE patients [6.2(3.7,13.8) μg/L] was significantly lower than that in remission SLE patients [12.3(7.2,16.7) μg/L, P<0.01]. The serum 25(OH)D level in lupus nephritis [6.7 (4.4, 12.9) μg/L] was significantly lower than that in SLE without renal involvement [13.3 (7.4, 18.7) μg/L, P<0.01]. (2) A significant negative correlation was demonstrated between the serum level of 25(OH)D and SLEDAI (r=-0.35,P<0.01), and the 24h urinary protein excretion (r=-0.39, P<0.01).Positive correlation was demonstrated between the serum level of 25(OH)D and C3 that decreased (r=0.249, P<0.05). (3) Univariate analysis showed anti- dsDNA antibodies(ds-DNA), anti-Sm antibodies(Sm), IgG, C3, C4, erythrocyte sedimentation rate (ESR), 24h urinary protein quantification(24h-pro) and 25(OH)D were associated with disease activity in the SLE patients; Multivariate Logistic regression analysis showed that 25(OH)D was associated with the disease activity of the lupus patients. Conclusion: The decrease of vitamin D level is related to the disease activity of SLE patients, and may be related to lupus nephritis, which plays an important role in the occurrence and development of SLE.

Key words: Systemic lupus erythematosus, Lupus nephritis, 25-hydroxy vitamin D, Disease activity

中图分类号:

R593.24

邹健梅,武丽君,罗采南,石亚妹,吴雪. 血清25-羟维生素D与系统性红斑狼疮活动的关系[J]. 北京大学学报（医学版）, 2021, 53(5): 938-941.

Jian-mei ZOU,Li-jun WU,Cai-nan LUO,Ya-mei SHI,Xue WU. Relationship of serum 25- hydroxy vitamin D and systemic lupus erythematosus[J]. Journal of Peking University (Health Sciences), 2021, 53(5): 938-941.

图/表 1

表1

SLE患者活动组与非活动组一般数据对比"

Items	Active group	Non-active group	P
Cases, n(%)	59 (37)	99 (63)	0.95
Gender, n(%)
Female	55 (34.8)	92 (58.3)
Male	4 (2.5)	7 (4.4)
Age/year, $x ?$ ±s	25.1±12.9	24.8±12.7	0.88
Course of disease/month, M (P₂₅, P₇₅)	9.6 (4.8, 12.0)	13.2 (10.8, 36.0)	<0.01
ANA, n(%), M (P₂₅, P₇₅)	59 (100)	97 (98.0)	0.82
ds-DNA, n(%), M (P₂₅, P₇₅)	30 (50.8)	12 (12.1)	<0.01
Sm, n(%), M (P₂₅, P₇₅)	19 (32.2)	12 (12.2)	<0.05
SSA, n(%), M (P₂₅, P₇₅)	30 (50.8)	53 (54.1)	0.70
SSB, n(%), M (P₂₅, P₇₅)	7 (11.9)	10 (10.2)	0.75
Acl/(RU/mL), M (P₂₅, P₇₅)	3.4 (2.0, 8.3)	2.3 (2.0, 4.8)	0.06
β2-GPI/(RU/mL), M (P₂₅, P₇₅)	5.1 (2.0, 12.9)	5.9 (2.2, 13.3)	0.67
C1q/(AU/mL), M (P₂₅, P₇₅)	49.0 (8.3, 174.0)	7.7 (3.9, 26.9)	<0.01
Complement C1q/(mg/L), M (P₂₅, P₇₅)	169.0 (129.8, 210.9)	165.4 (138.0, 26.9)	0.98
IgG/(g/L), M (P₂₅, P₇₅)	13.5 (8.6, 22.1)	12.5 (10.1, 16.4)	0.33
IgA/(g/L), M (P₂₅, P₇₅)	2.6 (1.6, 3.4)	2.3 (1.5, 3.3)	0.61
IgM/(g/L), M (P₂₅, P₇₅)	1.0 (0.6, 1.3)	0.9 (0.6, 0.9)	0.61
C3/(g/L), M (P₂₅, P₇₅) C4/(g/L), M (P₂₅, P₇₅) ESR/(mm/H), M (P₂₅, P₇₅) CRP/(mg/L), M (P₂₅, P₇₅) 24h-pro/(g), M (P₂₅, P₇₅) BUN/(mmol/L), M (P₂₅, P₇₅) Cr/(μmol/L), M (P₂₅, P₇₅) BGP/(μg/L), M (P₂₅, P₇₅) 25(OH)D/(μg/L), M (P₂₅, P₇₅)	0.6 (0.4, 0.8) 0.1 (0.0, 0.1) 41.0 (20.3, 54.0) 5.0 (2.5, 15.0) 0.3 (0.1, 1.9) 5.6 (3.9, 8.2) 56.7 (48.2, 71.2) 8.0 (5.0, 13.8) 6.2 (3.7, 13.8)	0.8 (0.9, 0.6) 0.1 (0.1, 0.2) 18.0 (10.8, 28.0) 2.8 (1.9, 5.0) 0.1 (0.0, 0.1) 4.6 (3.6, 5.4) 57.8 (49.8, 64.3) 10.0 (7.0, 14.0) 12.3 (7.2, 16.7)	<0.01 <0.01 <0.01 <0.01 <0.01 <0.01 0.58 0.11 <0.01

表1

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