类风湿关节炎寒热证候与血清维生素D的关系

目的探讨类风湿关节炎(rheumatoid arthritis,RA)寒热证候与维生素D的关系。方法收集RA患者72例,其中热证42例,寒证30例。同期确诊为强直性脊柱炎(ankylosing spondylitis,AS)的患者30例,健康人40例。收集患者的血沉(ESR)、C反应蛋白(CRP)、血清维生素D浓度、疼痛视觉模拟评分(Visual analogue scale,VAS)、28个关节疾病活动度(DAS28)等资料,分析各指标在RA寒热证候中的差异。结果 RA中存在维生素D缺乏和不足的比例分别为45.8%和41.7%,其比例显著高于健康人(P0.01);RA组维生素D水平低于AS组和健康组(P0.01);RA热证组维生素D水平低于寒证组(P0.01);RA维生素D水平与RA病程、CRP、DAS28评分、RF、抗CCP之间无明显相关性(P0.05)。结论 RA患者普遍存在维生素D的不足或缺乏,其浓度与RA寒热证候有关,RA热证组维生素D水平低于寒证组,提示维生素D浓度降低是RA热证的客观表现。

Association between serum vitamin D level and the cold and heat syndrome of rheumatoid arthritis in traditional Chinese medicine

Objective To study the association between serum vitamin D levels and the cold and heat pattern of rheumatoid arthritis (RA) in traditional Chinese medicine. Methods Seventy-two patients diagnosed with RA were collected, including 42 cases with heat syndrome group and 30 cases with cold syndrome. Thirty ankylosing spondylitis (AS) patients and 40 healthy controls were included in this analysis. Erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), serum vitamin D level, visual analogue pain scores (VAS), and 28 joint disease activity scores (DAS28) were collected. The difference of each index was analyzed between the heat syndrome and the cold syndrome of RA patients. Results The prevalence of vitamin D insufficiency and deficiency in RA patients was 41.7% and 45.8%, respectively, which was significantly higher than that in healthy controls (P<0.01). Serum vitamin D levels in RA patients were significantly lower than in AS patients and healthy controls (P<0.01). The serum vitamin D levels in RA patients with heat syndrome were lower than those with cold syndrome (P<0.01). No correlations were found between serum vitamin D levels and disease duration, CRP, DAS28 scores, RF, and CCP (P>0.05). Conclusion Vitamin D deficiency is common in RA patients. Serum vitamin D level is associated with the cold and heat syndrome of RA. The serum vitamin D levels in RA patients with heat syndrome are lower than those with cold syndrome, suggesting that the decreasing concentration of vitamin D is the objective manifestation of heat syndrome in RA.