| Objective:To explore the expression and significance of vitamin D(VitD)in patients with rheumatoid arthritis,and analyze the relationship between the expression and clinical indicators.Methods:Clinical indicators and laboratory examinations of RA cases(n=250)were enrolled.Clinical indicators included gender,age,course of the disease,swollen joints count(SJC),tenderness joints count(TJC),visual analog pain score(VAS),and DAS28 score.Laboratory indicators included erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF)and anti-cyclic citrullinated peptide(CCP)antibody,antinuclear(ANA)antibody,antikeratin(AKA)antibody,anti-perinuclear factor(APF),anti-mutated citrullinated vimentin(MCV)antibody and anti-6-glucose phosphate isomerase(GPI)antibody,lymphocyte subsets in the peripheral blood of[T(CD3~+CD19~-)cells,B(CD3~-CD19~+)cells,Th(CD3~+CD4~+)cells,Ts(CD3~+CD8~+)cells,Th/Ts(CD3~+CD4~+/CD3~+CD8~+),NK(CD3~-CD16~+CD56~+)cells]and lymphocyte subsets of CD4~+T cells[Th1(IFN-?)cells,Th2(IL-4)cells,Th17(IL-17)cells,Treg(CD4~+CD25~+Foxp3~+)cells,Th1/Th2(IFN-?/IL-4)and Th17/Treg(IL-17/CD4~+CD25~+Foxp3~+)].The level of vitamin D was determined by 25-hydroxy-vitamin D[25-(OH)D].The level of 25-(OH)D and clinical indicators,laboratory examinations were analyzed retrospectively.Results:(1)The level of 25-(OH)D in group RA was significantly lower than that in healthy controls(male t=5.348,P<0.001,female t=10.672,P<0.001),and the level of serum25-(OH)D in female patients was significantly lower than that in male patients(t=-2.924,P<0.05).(2)According to 25-(OH)D level,RA patients were divided into deficiency group,deficiency group and normal group,swollen joints count(?~2=10.538,P=0.006),tenderness joints count(?~2=10.317,P=0.005),ESR(F=6.330,P=0.002),VAS(F=5.095,P=0.007),DAS28(F=4.990,P=0.008)were difference significantly among the three groups;the level of 25-(OH)D was negatively correlated with swollen joints count(r=-0.322,P<0.001),tenderness joints count(r=-0.238,P<0.001),ESR(r=-0.297,P<0.001),VAS(r=-0.295,P<0.001),DAS28(r=-0.314,P<0.001).(3)RF(?~2=6.742,P=0.034)and anti-CCP(?~2=6.836,P=0.033)were difference significantly among the three groups;the level of 25-(OH)D was negatively correlated with RF(r=-0.202,P=0.001),anti-CCP(r=-0.220,P<0.001),anti-MCV(r=-0.109,P=0.002)and AKA(r=-0.215,P=0.001).(4)The level of 25-(OH)D in the RF(t=-2.715,P=0.007),anti-CCP(t=-2.03,P=0.044),AKA(t=-2.108,P=0.036)negative group was significantly higher than that in positive group.(5)The level of Th1(IFN-?)cells(F=3.295,P=0.043)and Treg(CD4~+CD25~+Foxp3~+)cells(F=4.342,P=0.031)were difference significantly among the three groups.The level of 25-(OH)D was positively correlated with Treg(CD4~+CD25~+Foxp3~+)cells(r=0.146,P=0.025).Conclusion:Vitamin D is generally deficient in RA patients,which is significantly correlated with disease activity(SJC,TJC,ESR,VAS and DAS28),serologic antibodies(RF,anti-CCP antibody,anti-MCV antibody,AKA)and Th1(IFN-?),Treg(CD4~+CD25~+Foxp3~+)cells.It is suggested that vitamin D may play an important role in the immunological pathogenesis of RA. |
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