25-(OH)D对早期类风湿关节炎的预测价值及与疾病活动度和免疫功能指标的相关性分析  

The predictive value of 25-(OH)D in early rheumatoid arthritis and its correlation analysis with disease activity and immune function indicators

作　　者：华丽[1] 施晓蔚 樊佳[1] 洪雪莲[1] 王柳青 杜红卫[1] HUA Li;SHI Xiao-wei;FAN Jia;HONG Xue-lian;WANG Liu-qing;DU Hong-wei(Department of Rheumatology and Immunology,Jinhua Municipal Central Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市中心医院风湿免疫科,浙江金华321000

出　　处：《中华全科医学》2020年第3期403-407,共5页Chinese Journal of General Practice

基　　金：2020年浙江省医药卫生科技计划(2020KY1013);2019年金华市科学技术研究计划项目(2019-4-025)。

摘　　要：目的探讨25羟基维生素D[25-(OH)D]对早期类风湿关节炎(RA)的预测价值及与疾病活动度、免疫功能指标的相关性。方法选取2016年3月-2018年5月来金华市中心医院就诊的早期RA患者100例为研究对象,并选取健康者100例作为对照组,采用受试者工作特征曲线(ROC)下面积(AUC)值评价25-(OH)D对早期RA的预测价值;将RA患者按照25-(OH)D水平分为:缺乏组50例、不足组30例、正常组20例,比较各组之间的关节压痛数、关节肿胀数、C反应蛋白(CRP)、红细胞沉降率(ESR)、视觉模拟评分(VAS),采用Spearman相关性分析25-(OH)D与疾病活动度以及与免疫功能指标的相关性。结果 25-(OH)D对早期RA预测的AUC值为0.904;3组间关节压痛数、关节肿胀数、ESR、VAS比较差异具有统计学意义(P<0.05),正常组的关节压痛数、ESR和VAS明显低于缺乏组和不足组(P<0.05),正常组的关节肿胀数和CRP明显低于缺乏组(P<0.05),不足组的VAS明显低于缺乏组(P<0.05);早期RA患者的25-(OH)D的水平与28个关节疾病活动度评分(DAS28)呈负相关;早期RA患者的25-(OH)D的水平与调节性T细胞水平呈正相关(P<0.05),与免疫功能指标未发现相关(P>0.05)。结论 25-(OH)D对早期RA具有较高的预测价值。Objective To investigate the predictive value of 25-hydroxyvitamin D [25-(OH)D] in early rheumatoid arthritis(RA) and its correlation with disease activity and immune function indicators. Methods A total of 100 patients with early RA who came to Jinhua Municipal Central Hospital from March 2016 to May 2018 were selected as research objects, and 100 healthy patients were selected as control group. The predictive value of 25-(OH)D for early RA was evaluated using the area(AUC) under the receiver operator characteristics curve(ROC). Patients with RA were divided into the following groups according to the level of 25-(OH)D: 50 cases in the deficient group, 30 cases in the unsufficient group, and 20 cases in the normal group. Clinical indicators [joint tenderness number, joint swelling number, C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), visual analogue score(VAS)] were compared between each groups. Spearman correlation analysis was used to analyze the correlation between 25-(OH)D and disease activity and immune function indicators. Results The AUC value predicted by 25-(OH)D for early RA was 0.904. There were statistically significant differences in the number of joint tenderness number, joint swelling number, ESR and VAS in the three groups(all P<0.05). The number of joint tenderness number, ESR and VAS in normal group were significantly lower than those in deficient group and unsufficient group(all P<0.05). The number of joint swelling and CRP in normal group were obviously lower than those in the deficient group(P<0.05). The VAS in the unsufficient group was significantly lower than that in the deficient group(P<0.05). The level of 25-(OH)D in early RA patients was negatively correlated with disease activity score-28(DAS28 score). The 25-(OH)D in early RA patients was positively correlated with regulatory T cells(P<0.05), but not correlated with immune function indicators(P>0.05). Conclusion 25-(OH)D has a high predictive value for early RA, which may play an important role in assessing the pathog

关 键 词：类风湿关节炎 25羟基维生素D 疾病活动度 免疫功能 预测价值 

分 类 号：R593.22[医药卫生—内科学] R446[医药卫生—临床医学]