幼年特发性关节炎血清维生素D水平与疾病活动度及骨密度相关性分析

摘要

Objective To assessed serum level of 25 (OH) D3 in children with juvenile idiopathic arthritis,in order to find the association between the vitamin D and disease activity as well as bone mineral density.Methods We evaluated 110 patients (58 females and 52 males,mean age being 9.04±3.37 years) that fulfilled the 2011 ILAR criteria for juvenile idiopathic arthritis.Patients underwent laboratory tests of serum25 (OH) D3,plasma parathyroidhormone and dualenergyx-ray absorptiometry examination.JIA patients were categorized by ACR standard of disease status in 2011,and the disease activity was measured by using JADAS-27.We analyzed the relationship between serum 25 (OH)D3 level and other indexes.Results The mean serum 25 (OH)D3 level of 110 JIA patients was (49.8± 15.3) μmol/L.Vitamin D deficiency was detected in 59 patients (53.6％) and insufficiency in 43 patients (39.1％).Patients with active disease had significantly reduced serum 25 (OH)D3 levels compared to patients with inactive disease (t =5.162,P ＜ 0.001),but there was no significant association between serum 25 (OH)D3 level and JADAS-27 (r =-0.72,P ＞ 0.05).JIA patients with vitamin D deficiency showed a significantly lower bone mineral density than those with normal 25 (OH)D3 level (t =3.791,P ＜ 0.05).Patients using glucocorticoid showed significantly lower 25 (OH) D3 level than those who never used glucocorticoid(t =2.823,P＜0.01).Conclusion JIA patients have reduced serum 25(OH)D3,particularly those with active disease or/and using glucocorticoid.JIA patients with vitamin D deficiency showed a significantly lower bone mineral density.%目的 检测幼年特发性关节炎(JIA)患儿血清25羟维生素D3[25(OH)D3]水平,研究维生素D与JIA疾病活动度及骨密度的关系.方法 按照2001年国际风湿病学联盟(ILAR)诊断标准,于2015年1月至2017年1月纳入重庆医科大学附属儿童医院风湿免疫科110例JIA患儿,其中女58例、男52例,年龄(9.04±3.37)岁.检测JIA患儿血清25(OH)D3、血浆PTH水平,双能X线检查评估骨密度.评价患儿疾病活动状态,并通过JADAS27评分衡量疾病活动度.比较JIA患儿血清25(OH)D3水平与其他指标之间的关系.结果 110例JIA患儿血清中25(OH)D3水平为(49.8± 15.3) μmol/L,其中59例(53.6％)为维生素D缺乏状态,43例(39.1％)表现为维生素D不足.活动期JIA 25 (OH)D3水平低于缓解期(t=5.162,P＜ 0.001),与JADAS27评分无相关性(r=-0.72,P＞ 0.05).维生素D缺乏状态下JIA患儿骨密度(Z值)低于维生素D充足状态(t=3.791,P＜0.05).未使用皮质激素(GC)治疗的JIA患儿25(OH)D3水平显著高于使用GC治疗者(t=2.823,P＜0.01).结论 JIA患儿普遍存在血清维生素D水平低下.处于疾病活动期、使用激素治疗的患儿血清25(OH) D3水平低下尤为显著,维生素D缺乏状态下JIA患儿骨密度降低.