類風濕關節炎患者血清25-（OH）D₃水平與骨密度的關系

鄒晉梅 李思吟 楊靜 李敏

[摘要] 目的 研究類風濕關節炎（RA）患者血清25-羥維生素D3[25-（OH）D3]水平與骨密度的關系。 方法 選取2016年2月～2018年2月四川省綿陽市中心醫院（以下簡稱“我院”）收治的RA患者512例作為研究組。另取同期于我院進行體檢的健康者80名作為對照組。檢測兩組血清25-（OH）D3水平、骨密度以及骨密度T值。根據美國風濕病學會X線分期標準將研究組分為Ⅰ期128例、Ⅱ期162例、Ⅲ期133例、Ⅳ期89例，并比較不同分期RA患者的血清25-（OH）D3、骨密度、骨密度T值。根據血清25-（OH）D3不同缺乏程度將研究組分為血清25-（OH）D3不足130例、輕度缺乏168例、中度缺乏127例、重度缺乏的87例，并比較其骨密度、骨密度T值，并分析RA患者血清25-（OH）D3與骨密度、骨密度T值的相關性。 結果 研究組血清25-（OH）D3、骨密度、骨密度T值低于對照組（均P < 0.01）。Ⅰ～Ⅳ期RA患者的血清25-（OH）D3、骨密度、骨密度T值水平均呈逐漸下降趨勢，差異有高度統計學意義（均P < 0.01）。血清25-（OH）D3不足、輕度缺乏、中度缺乏、重度缺乏的RA患者骨密度、骨密度T值呈逐漸下降趨勢，差異有高度統計學意義（均P < 0.01）。經Pearson相關性分析發現，RA患者血清25-（OH）D3與骨密度、骨密度T值均呈正相關（r = 0.523、0.584，均P < 0.05）。 結論 RA患者血清25-（OH）D3水平與骨密度存在明顯的降低，且兩者呈明顯正相關，即隨著血清25-（OH）D3水平缺乏程度的不斷加重，骨密度隨之下降。

[關鍵詞] 類風濕關節炎;25-羥維生素D3;骨密度;相關性

[中圖分類號] R593.22? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）07（a）-0109-04

Relationship between serum 25-（OH）D3 level and bone mineral density in patients with rheumatoid arthritis

ZOU Jinmei? ?LI Siyin? ?YANG Jing? ?LI Min

Department of Rheumatology and Immunology， Mianyang Central Hospital， Sichuan Province， Mianyang? ?621000， China

[Abstract] Objective To study the relationship between serum 25-hydroxyvitamin D3[25-（OH）D3] level and bone mineral density in patients with rheumatoid arthritis （RA）. Methods A total of 512 cases of patients with RA admitted to Mianyang Central Hospital of Sichuan Province （“our hospital” for short） from February 2016 to February 2018 were selected as the study group. Another 80 healthy people who underwent physical examination in our hospital at the same time were used as a control group. Serum 25-（OH）D3 levels， bone mineral density， and bone mineral density T values were measured in both groups. According to the X-ray staging criteria of American Rheumatism Society， the study group was divided into 128 cases in stage Ⅰ， 162 cases in stage Ⅱ， 133 cases in stage Ⅲ and 89 cases in stage Ⅳ， and compared serum 25-（OH）D3 and bone of patients with different stages of RA. According to the different levels of serum 25-（OH）D3 deficiency， the study group was divided into 130 cases of serum 25-（OH）D3 deficiency， 168 cases of mild deficiency， 127 cases of moderate deficiency and 87 cases of severe deficiency. The bone mineral density and bone mineral density T values were compared， and the correlation between serum 25-（OH）D3 and bone mineral density and bone mineral density T values in RA patients was analyzed. Results Serum 25-（OH）D3， bone mineral density and bone mineral density T values in the study group were lower than those in the control group （all P < 0.01）. Serum 25-（OH）D3， bone mineral density and bone mineral density T values in patients with stage Ⅰ-Ⅳ RA showed a gradual downward trend， with highly statistical significance （all P < 0.01）. Bone mineral density and bone mineral density T value of RA patients with serum 25-（OH） D3 deficiency， mild deficiency， moderate deficiency and severe deficiency showed a decreasing trend， with highly statistical significance （all P < 0.01）. Pearson correlation analysis showed that serum 25-（OH）D3 was positively correlated with bone mineral density and bone mineral density T value in RA patients （r = 0.523， 0.584， all P < 0.05）. Conclusion Serum 25-（OH）D3 level and bone mineral density in RA patients are significantly decreased， and there is a significant positive correlation between them. That is， bone mineral density decreases with the increasing lack of serum 25-（OH）D3 level.