马新美+朱桂启+王凌+张华+侯娜莉+刘利鹏+张永泉+李璐

【摘 要】目的：觀察初诊强直性脊柱炎患者25（OH）D3水平，并探讨1，25（OH）2D3是否对强直性脊柱炎有潜在治疗作用。方法：收集60例初诊强直性脊柱炎患者和40例健康对照组血清标本，采用酶联免疫法测定血清25（OH）D3水平。将强直性脊柱炎组患者按1∶1比例随机分为1，25（OH）2D3治疗组和常规治疗组，每组30例。常规治疗组采用洛索洛芬钠+沙利度胺治疗，1，25（OH）2D3治疗组在常规治疗组基础上加维生素D治疗。观察2组患者在0，4，12周的25（OH）D3水平、BASDAI评分、ESR、CRP变化，评判治疗效果。结果：①初诊强直性脊柱炎患者血清25（OH）D3水平显著低于健康对照组（t = 7.19，P < 0.01），且与BASDAI评分、CRP呈显著负相关（r = -0.57，P < 0.05；r = -0.53，P < 0.05），

与ESR无明显相关性（r = -0.48，P > 0.05）。②治疗4周后，1，25（OH）2D3治疗组BASDAI评分、CRP及25（OH）D3显著低于常规治疗组，差异均有统计学意义（t = 2.23，P < 0.05；t = 2.16，P < 0.05；t = 2.38，P < 0.01）；治疗12周后，1，25（OH）2D3治疗组BASDAI评分、CRP及25（OH）D3显著低于常规治疗组，差异均有统计学意义（t = 3.15，P < 0.01；t = 2.38，P < 0.05；t = 6.32，P < 0.01）；在第4，12周，1，25（OH）2D3治疗组ESR低于常规治疗组，但差异无统计学意义（t = 0.92，t = 1.96，P > 0.05）。结论：25（OH）D3在强直性脊柱炎的发生、发展中有重要作用，1，25（OH）2D3添加治疗能有效改善强直性脊柱炎患者的BASDAI评分及临床症状，具有较高治疗前景。

【关键词】 脊柱炎，强直性；1，25（OH）2D3；25（OH）D3；BASDAI评分

Clinical Study on the Treatment of Ankylosing Spondylitis with 1，25（OH）2D3

MA Xin-mei，ZHU Gui-qi，WANG Ling，ZHANG Hua，HOU Na-li，LIU Li-peng，ZHANG Yong-quan，LI Lu

【ABSTRACT】Objective：To observe the level of 25（OH） D3 in patients with newly diagnosed ankylosing spondylitis and to investigate whether 1，25（OH）2D3 has a potential therapeutic effect on ankylosing spondylitis.Methods：Serum samples were collected from sixty patients with newly diagnosed ankylosing spondylitis and 40 healthy people，and the enzyme-linked immunosorbent assay was used to detect the level of serum 25（OH） D3.The patients of ankylosing spondylitis were randomly divided into a 1，25（OH）2D3 treatment group and a conventional treatment group according to the ratio of 1 to 1，with 30 cases in each group.The conventional treatment group was treated with Lo Solo Finn sodium and thalidomide，and the patients in the 1，25（OH）2D3 treatment group were treated with vitamin D based on the treatment for the conventional treatment group.The levels of 25（OH）D3，BASDAI scores，and changes ESR and CRP in the two groups were observed respectively before treatment，after four and twelve weeks of treatment to evaluate the results.Results：①The level of 25（OH）D3 in the serum of patients with ankylosing spondylitis was significantly lower than that of the healthy control group（t = 7.19，P < 0.01）.It was negatively correlated with the scores of BASDAI and CRP

（r = -0.57，P < 0.05；r = -0.53，P < 0.05），and had no significant correlation with ESR（r = -0.48，P > 0.05）.②After four weeks of treatment，the BASDAI score，

CRP and 25（OH）D3 of the 1，25（OH）2D3

treatment group were significantly lower than those of the conventional treatment group，and the differences were statistically significant（t = 2.23，P < 0.05；

t = 2.16，P < 0.05；t = 2.38，P < 0.01）.After 12 weeks of treatment，the BASDAI score，CRP and 25（OH）D3 of the 1，25（OH）2D3 treatment group were significantly lower than those of the conventional treatment group，and the differences were statistically significant（t = 3.15，P < 0.01；t = 2.38，P < 0.05；t = 6.32，P < 0.01）.In the fourth and twelfth weeks，the ESR of the 1，25（OH）2D3 treatment group was lower than that of the conventional treatment group，but the difference was not statistically significant（t = 0.92，t = 1.96，P > 0.05）.Conclusion：25（OH）D3 plays an important role in the occurrence and development of ankylosing spondylitis and therapy with 1，25（OH）2D3

can effectively improve the BASDAI score and clinical symptoms of patients，with high therapeutic potential.

【Keywords】spondylitis，ankylosing；1，25（OH）2D3；25（OH）D3；BASDAI score

强直性脊柱炎（ankylosing spondylitis，AS）是一种主要侵犯脊柱、骶髂关节和外周关节，也可累及眼、肾脏、心血管等器官的慢性自身炎症性疾病。其发病机制尚未完全明确。有研究报道，许多自身免疫性疾病患者存在维生素D缺乏，补充维生素D可能对系统性红斑狼疮、炎症性肠病等自身免疫性疾病有益[1]。目前国内外针对维生素D在AS中的作用仅限于少量横断面研究，入选患者大多并非初诊。……