Study On Correlation Between 25 Hydroxyvitamin D And Clinical Features And Glandular Involvement In Primary Sjogren’s Syndrome

Abjective:To explore the relationship between serum 25 hydroxyvitamin D(25(OH)D)levels and clinical features and severity of glandular involvement in patients with Primary Sjogren’s syndrome(p SS),To explore the significance of 25(OH)D in evaluating the prognosis and glandular involvement of p SS.Method:1.Clinical data of 216 patients with p SS admitted to Affiliated Hospital of Yangzhou University from November 2018 to September 2022 were retrospectively collected.Serum 25(OH)D levels were detected by mass spectrometry.p SS patients were divided into reduced group(25(OH)D level<30ng/ml)and adequate group(25(OH)D level≥30ng/ml)according to 25(OH)D level.2.Correlations between general clinical data,biochemical markers,immunological markers,visceral involvement,Patient-Reported Outcomes(Pros),and the degree of glandular involvement were analyzed between the 25(OH)D reduction group and the25(OH)D adequate group.Pros include the European League Against Rheumatism(EULAR)SS disease activity index(Sjogren’s syndrome disease activity index,ESSDAI)score,EULAR SS’s syndrome patient reported index(ESSPRI)score,Clinical Oral Dryness Scale,Ocular surface disease index(OSDI)score,Ocular Surface Disease Index(OSDI)score,Oral health impact profile,OHIP,Visual analogue score(VAS)for fatigue and pain.imaging involvement of salivary glands was evaluated using Magnetic resonance imaging(MRI)and Magnetic resonance sialography(MRS).3.t test was used to analyze the measurement data of normal distribution.The Mann-Whitney U test was used to compare the skewness distribution measurement data groups.Chi-square test was used for comparison between counting data groups.In correlation analysis,Pearson correlation analysis was used for data that met normal and homogeneity of variance,and Spearman rank correlation was used for data that did not meet the above conditions,and the test levelα=0.05.Results1.A total of 216 patients with p SS were included in this study,and were divided into 25(OH)D reduction group(132 cases)and 25(OH)D adequate group(84 cases)according to serum 25(OH)D level.The serum 25(OH)D level in the reduced group was20.90±6.39(ng/ml),and that in the adequate group was 34.41±4.63(ng/ml).2.The general clinical data,biochemical indexes and immunological indexes of the two groups were compared,and the results showed that the positive rate of anti-Ro-52antibody,the level of complement C3,the positive rate of hypocomplement,immunoglobulin Ig G levels and immunoglobulin increased positive rate were statistically different(P<0.05).There were no significant differences between the two groups in clinical manifestations of dry mouth,dry eyes,rampant teeth,glandular swelling,and joint pain(P>0.05),and blood routine indexes of White blood cell(WBC)count,Red blood cell(RBC)count,Platelet(PLT)count,and Hemoglobin(HGB)count(P>0.05).C reactive protein(CRP),Erythrocyte sedimentation rate(Erythrocyte sedimentation rate,erythrocyte sedimentation rate,erythrocyte sedimentation rate,Platelet to Lymphocyte Ratio(PLR),platelet to Lymphocyte Ratio(PLR),Neutrophil to Lymphocyte Ratio(NLR),Monocyte to Lymphocyte Ratio(MLR)had no significant differences in blood cells(P>0.05).There were no significant differences between the two groups in Hyperglobulinemia positive rate immunoglobulin(Ig A、Ig M、Ig E),complement C4 levels,Antinuclear antibody(ANA)positive rate,anti-SSA(Anti-sjogren’s syndrome A antibody,SSA)positive rate,anti-SSB(Anti-sjogren’s syndrome B antibody,SSB)positive rate,RF positive rate,and in CD3~+T lymphocytes,CD4~+T lymphocytes,CD8~+T lymphocytes,CD4~+/CD8~+ratio,CD19~+B lymphocytes,lymphy cells,and NK cells(P>0.05).The serum 25(OH)D level was negatively correlated with the immunoglobulin Ig G level(P<0.05)but had no significant correlation with the levels of C3,C4,Ig A,Ig M and Ig E.There were more systemic involvement in 25(OH)D reduction group,mainly involving lung and thyroid,and there was no statistical difference between the two groups in digestive system involvement,kidney involvement,blood system involvement and nervous system involvement(P>0.05).Compared with the Pros of the two groups,the reduced group had higher ESSDAI index and ESSPRI score,and there were statistical differences between the two groups(P<0.05).Serum 25(OH)D level was correlated with ESSDAI index(r=-0.474,P<0.05)and ESSPRI score(r=-0.154,P<0.05)showed a negative correlation,and there were no significant differences in CODS score,OSDI score,OHIP scale,fatigue and pain VAS score between the two groups(P>0.05).3.The tear break time(TBUT)in 25(OH)D reduction group was shorter than that in adequate group,and there were more abnormalities in corneal fluorescence staining,TBUT and schirmer tests.There was no statistical difference between the two groups and binocular OCT abnormalities(P>0.05).25(OH)D level was negatively correlated with abnormal corneal fluorescence staining(r=-0.145,P=0.034),positively correlated with TBUT(r=0.186,P=0.006),There was no correlation with OSDI score(r=-0.310,P=0.963),binocular OCT abnormality(r=0.118,P=0.082),schirmer test(+)(r=-0.209,P=0.110).The ratio of Grade II、III and IV in the serum 25(OH)D reduction group was higher than that in the adequate group,and the ratio of Grade II、III and IV in the MRS Group was also higher than that in the adequate group.There were statistical differences between the two groups and the parotid MRI grading III and IV and the MRS Grading IV(P<0.05).The reduction group had a higher rate of positive lip gland biopsy.Serum25(OH)D level parotid MRI(r=-0.608,P<0.001),MRS Grade(r=-0.400,P<0.001)and labial gland biopsy pathological grade(r=-0.425,P<0.001)were negatively correlated.The rate of chronic thyroiditis in p SS patients in 25(OH)D reduction group was higher,and there were no significant differences in thyroid function(levels of T3,T4,FT3,FT4,TSH,Tg Ab,TPOAb,and thyroid color ultrasound)and whether the thyroid had hyperthyroidism,hypothyroidism,and nodular thyroid disease between the two groups(P>0.05).ConclusionSerum 25(OH)D levels were correlated with p SS Pros,and the 25(OH)D reduction group had more visceral involvement,more involvement in the lacrimal,salivary,and thyroid glands.