邹晋梅 李思吟 杨静 李敏

[摘要] 目的 研究类风湿关节炎（RA）患者血清25-羟维生素D3[25-（OH）D3]水平与骨密度的关系。 方法 选取2016年2月～2018年2月四川省绵阳市中心医院（以下简称“我院”）收治的RA患者512例作为研究组。另取同期于我院进行体检的健康者80名作为对照组。检测两组血清25-（OH）D3水平、骨密度以及骨密度T值。根据美国风湿病学会X线分期标准将研究组分为Ⅰ期128例、Ⅱ期162例、Ⅲ期133例、Ⅳ期89例，并比较不同分期RA患者的血清25-（OH）D3、骨密度、骨密度T值。根据血清25-（OH）D3不同缺乏程度將研究组分为血清25-（OH）D3不足130例、轻度缺乏168例、中度缺乏127例、重度缺乏的87例，并比较其骨密度、骨密度T值，并分析RA患者血清25-（OH）D3与骨密度、骨密度T值的相关性。 结果 研究组血清25-（OH）D3、骨密度、骨密度T值低于对照组（均P < 0.01）。Ⅰ～Ⅳ期RA患者的血清25-（OH）D3、骨密度、骨密度T值水平均呈逐渐下降趋势，差异有高度统计学意义（均P < 0.01）。血清25-（OH）D3不足、轻度缺乏、中度缺乏、重度缺乏的RA患者骨密度、骨密度T值呈逐渐下降趋势，差异有高度统计学意义（均P < 0.01）。经Pearson相关性分析发现，RA患者血清25-（OH）D3与骨密度、骨密度T值均呈正相关（r = 0.523、0.584，均P < 0.05）。 结论 RA患者血清25-（OH）D3水平与骨密度存在明显的降低，且两者呈明显正相关，即随着血清25-（OH）D3水平缺乏程度的不断加重，骨密度随之下降。

[关键词] 类风湿关节炎;25-羟维生素D3;骨密度;相关性

[中图分类号] R593.22          [文献标识码] A          [文章编号] 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.