硬皮病骨密度、血清维生素D水平与皮肤纤维化的关系

摘要

目的 通过测定初诊女性硬皮病患者的骨密度,检测其血清25羟维生素D水平,评估皮肤纤维化程度,探究3者之间的相关性.方法 纳入本院2013年6月至2016年6月门诊或住院初诊女性硬皮病患者(n=60)和健康体检者(n=20),采用双能X线吸收法测定腰椎、双髋骨密度,收集实验室25(OH)D3的结果,计算皮肤病变的mRSS评分,然后进行组间及组内的统计分析.结果 初诊女性硬皮病患者双髋、腰椎的骨密度明显低于健康体检者(P＜0.05),其中弥漫硬皮型患者上述部位骨密度均显著低于局限硬皮型患者(P＜0.05).硬皮病患者25(OH)D3水平也显著低于健康体检者(P＜0.05),其中弥漫硬皮型患者25 (OH)D3水平低于局限硬皮型患者(P＜0.05)且与皮肤病变的mRSS评分成负相关(r=-0.946,P＜0.05).结论 初诊女性硬皮病患者在未应用激素与免疫抑制剂治疗前已经存在显著骨矿含量下降,维生素D缺乏,这与患者皮肤受累硬化程度相关.皮肤纤维化程度的升高,阻碍了皮肤维生素D的合成,可能是导致初诊女患者骨矿含量下降,骨质疏松的一个重要原因.%Objective To explore the correlation between the three by measuring bone mineral density,serum 25 hydroxy vitamin D level,and skin fibrosis degree in new female patients with scleroderma.Methods Bone mineral density,serum level of 25 (OH) D3,and the modified Rodnan Skin Score were collected from women scleroderma patients (n =60) and normal controls (n =20) in the outpatient of our hospital from June 2013 to June 2016.The data were then statistically analyzed.Results The bone mineral density of the lumbar spine and both hips in new female patients with scleroderma was significantly lower than that in normal controls (P ＜ 0.05).Bone mineral density in patients with diffuse cutaneous were significantly lower than that in patients with limited cutaneous (P ＜ 0.05).The serum level of 25 (OH) D3 in scleroderma patients was also significantly lower than that in normal controls (P ＜ 0.05).The serum level of 25 (OH) D3 in scleroderma patients were negatively correlated with modified Rodnan Skin Score.Conclusion Bone mineral density and vitamin D level reduce in the newly diagnosed female scleroderma patients,which is associated with patients' skin lesion.Skin fibrosis inhibits vitamin D synthesis and leds to the decrease of the bone mineral content in female patients with scleroderma.