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

参考文献 19

[1]	Cutolo M, Otsa K. Review: Vitamin D, immunity and lupus [J]. Lupus, 2008, 17(1):6-10. pmid: 18089676
[2]	Kamen DL. Vitamin D in lupus-new kid on the block? [J]. Bull NYU Hosp Jt Dis, 2010, 68(3):218-222.
[3]	Ritterhouse LL, Crowe SR, Niewold TB, et al. Vitamin D deficiency is associated with an increased autoimmune response in healthy individuals and in patients with systemic lupus erythematosus [J]. Ann Rheum Dis, 2011, 70(9):1569-1574. doi: 10.1136/ard.2010.148494 pmid: 21586442
[4]	Amital H, Szekanecz Z, Szücs G, et al. Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? [J]. Ann Rheum Dis, 2010, 69(6):1155-1157. doi: 10.1136/ard.2009.120329 pmid: 20439290
[5]	Yeap SS, Othman AZ, Zain AA, et al. Vitamin D levels: Its relationship to bone mineral density response and disease activity in premenopausal Malaysian systemic lupus erythematosus patients on corticosteroids [J]. Int J Rheum Dis, 2012, 15(1):17-24 doi: 10.1111/apl.2012.15.issue-1
[6]	Souto M, Coelho A, Guo C, et al. Vitamin D insufficiency in Brazilian patients with SLE: Prevalence, associated factors, and relationship with activity [J]. Lupus, 2011, 20(10):1019-1026. doi: 10.1177/0961203311401457 pmid: 21646315
[7]	De Souza VA, Bastos MG, Fernandes NM, et al. Association of hypovitaminosis D with systemic lupus erythematosus and inflammation [J]. Bras Nefrol, 2014, 36(4):430-436.
[8]	Leventis P, Patel S. Clinical aspects of vitamin D in the management of rheumatoid arthritis [J]. Rheumatology (Oxford), 2008, 47(11):1617-1621. doi: 10.1093/rheumatology/ken296 pmid: 18682414
[9]	Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [J]. Arthritis Rheum, 1997, 40(9):1725-1734.
[10]	Ding Y, Liao W, He XJ, et al. Effects of 1,25(OH)₂ D₃ and vitamin D receptor on peripheral CD4⁺/CD8⁺double-positive T lymphocytes in a mouse model of systemic lupus erythematosus [J]. J Cell Mol Med, 2017, 21(5):975-985. doi: 10.1111/jcmm.13037 pmid: 28063200
[11]	Mok CC. Vitamin D and systemic lupus erythematosus: an update [J]. Expert Rev Clin Immunol, 2013, 9(5):453-463. doi: 10.1586/eci.13.19
[12]	张竞, 罗静, 王静, 等. 血清25(OH)D水平与初诊系统性红斑狼疮疾病活动度的相关性研究 [J]. 中华风湿病学杂志, 2019, 23(1):36-41.
[13]	方慧玲, 禹松林, 韩建华, 等. 中国北方健康人群血清 25羟维生素D₃和25羟维生素D₂水平 [J]. 中华骨质疏松和骨矿盐疾病杂志, 2014, 7(3):199-205.
[14]	Cashman KD, Dowling KG. Vitamin D deficiency in Europe: Pandemic? [J]. Am J Clin Nutr, 2016, 103(4):1033-1044. doi: 10.3945/ajcn.115.120873 pmid: 26864360
[15]	张永锋, 郑毅. 初发系统性红斑狼疮患者血清25-羟-维生素D和维生素D抗体水平变化及意义 [J]. 中华风湿病学杂志, 2012, 16(10):661-664.
[16]	卢勤燕, 蔡小燕, 林小军, 等. 系统性红斑狼疮患者外周血维生素D水平及其临床意义 [J]. 实用医学杂志, 2015, 31(7):1123-1125.
[17]	洪琼. 25羟基维生素D与类风湿关节炎及系统性红斑狼疮的相关性研究 [D]. 安徽, 安徽医科大学, 2013: 1-108.
[18]	Shoenfeld N, Amital H, Shoenfeld Y. The effect of melanism and vitamin D synjournal on the incidence of autoimmune disease [J]. Nat Clin Pract Rheumatol, 2009, 5(2):99-105. doi: 10.1038/ncprheum0989 pmid: 19182816
[19]	陈铭聿, 孙彬, 张波, 等. 狼疮肾炎患者血维生素D3水平与疾病活动度的相关性研究 [J]. 中华肾脏病杂志, 2015, 31(2):881-886.

相关文章 15

[1]	汤晓菲, 丁秋玲, 张阳, 王育梅, 田美伊, 孙卓, 王荣荣, 陈妍, 刘坚. 阿伐曲泊帕治疗难治性系统性红斑狼疮相关血小板减少1例[J]. 北京大学学报（医学版）, 2026, 58(2): 405-409.
[2]	李欣艺, 赵金霞, 穆荣. 阿司匹林对系统性红斑狼疮妊娠者结局的影响[J]. 北京大学学报（医学版）, 2025, 57(6): 1074-1080.
[3]	王晓林, 郭邵逸, 陈大召, 温锡杰, 华勇, 张亮, 张秦. 全髋关节置换术治疗系统性红斑狼疮继发股骨头缺血性坏死的随访研究[J]. 北京大学学报（医学版）, 2025, 57(6): 1081-1088.
[4]	卫春, 杨月, 赵新菊, 刘栩, 贾园. 系统性红斑狼疮合并自身免疫性郎飞结病1例[J]. 北京大学学报（医学版）, 2025, 57(6): 1174-1179.
[5]	赵凯, 鲁芙爱, 王永福. 中枢神经系统感染模拟神经精神狼疮1例[J]. 北京大学学报（医学版）, 2025, 57(6): 1188-1192.
[6]	王小梦, 曾晓君, 李娟. 黎族与汉族系统性红斑狼疮患者的主要临床特征[J]. 北京大学学报（医学版）, 2025, 57(6): 1213-1218.
[7]	王文琼, 侯玉珂, 李春, 张学武. 系统性红斑狼疮患者不良妊娠结局的预测因素[J]. 北京大学学报（医学版）, 2025, 57(3): 599-603.
[8]	王红彦, 李鑫铭, 房柯池, 朱华群, 贾汝琳, 王晶. 系统性红斑狼疮疾病活动度相关特征分析及评估模型的构建[J]. 北京大学学报（医学版）, 2024, 56(6): 1017-1022.
[9]	陈丹丹, 李云, 卢情怡, 相晓红, 孙峰, 李英妮, 赵静, 王红彦, 李春. 育龄期系统性红斑狼疮患者卵巢功能的评价及其影响因素[J]. 北京大学学报（医学版）, 2024, 56(6): 1023-1028.
[10]	王莉, 高超, 任欢欢, 沈艳平, 黄晓玮, 姚鸿, 韩丹丹. 系统性红斑狼疮患者自我管理能力现状及相关因素分析[J]. 北京大学学报（医学版）, 2024, 56(6): 1029-1035.
[11]	柴静, 王钥, 穆荣, 赵金霞. 系统性红斑狼疮累及穹窿柱导致低钠血症1例[J]. 北京大学学报（医学版）, 2024, 56(6): 1115-1118.
[12]	王明霞, 丁菱, 王敏, 邹婵娟, 颜丝语, 梁颖文, 王伟佳, 何善智. 双靶点嵌合抗原受体T细胞治疗系统性红斑狼疮患者停药后安全孕产1例[J]. 北京大学学报（医学版）, 2024, 56(6): 1119-1125.
[13]	翟佳羽, 赵金霞, 安卓, 刘蕊. 低疾病活动度的中轴型脊柱关节炎患者残留症状评估及其相关因素分析[J]. 北京大学学报（医学版）, 2024, 56(6): 987-993.
[14]	武志慧, 胡明智, 赵巧英, 吕凤凤, 张晶莹, 张伟, 王永福, 孙晓林, 王慧. miR-125b-5p修饰脐带间充质干细胞对系统性红斑狼疮的免疫调控机制[J]. 北京大学学报（医学版）, 2024, 56(5): 860-867.
[15]	乔佳佳,田聪,黄晓波,刘军. 肾结石合并系统性红斑狼疮行经皮肾镜碎石取石术的安全性和有效性评估[J]. 北京大学学报（医学版）, 2024, 56(4): 745-749.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed