Vitamin D及疾病活动性指标在强直性脊柱炎继发骨质疏松中的作用研究

目的 研究 AS 患者中25（OH）VitaminD3水平以及疾病活动性指标（ESR、CRP）与 BMD 的关系及维生素D 的营养状况。方法 46例确诊的 AS 患者，按照 BMD 的检测结果分成三组：骨量正常组、骨量减少组、骨质疏松组，分别检测三组人群中25（OH）VitaminD3、CRP、ESR 的水平。同时对所有受试对象进行 BMD 的测量，检测部位包括腰椎后前位（L1-L4）、股骨颈（neck）、大转子（troch）。结果 三组人群的25（OH）VitaminD3水平无显著性差异（P＞0．05）。CRP 与大转子处的骨密度呈负相关（r＝-0．330，P ＜0．05）。骨质疏松组的 ESR、CRP 的水平与骨量正常、骨量减少组比较差异有统计学意义（P ＜0．05），骨质疏松组的 AS 患者 ESR、CRP 水平显著增加。结论 AS 继发骨质疏松的发生可能与疾病的活动性相关。绝大多数的 AS 患者存在 VD 的缺乏和不足，并且随着骨量丢失的增加， VD 缺乏率有逐渐增加的趋势，但是维生素 D 是否参与其发病还有待进一步研究。

The roles of vitamin D and disease activity indicators in ankylosing spondylitis-related osteoporosis

Objective To study the the relationships between 25 （OH）vitamin D3 ,disease activity indicators （erythrocyte sedimentation rate,C-reactive protein）and bone mineral density （BMD）and investigate the status of vitamin D in AS patients.Methods 46 cases of patients with confirmed AS,according to the results of BMD ,were divided into three groups：bone mineral density normal group,osteopenia,osteoporosis.25 （OH）VitaminD3,CRP,ESR were detected respectively.At the same time BMD was measured for all study subjects .The testing sites of measurement included anterior-posterior lumbar spine （L1-L4）,femoral neck （neck）,trochiter （troch）.Results There was no significant difference between 25 （OH）VitaminD3 in three groups of patients （P ＆gt; 0.05）.The negative correlation between CRP and trochiter BMD was detected （r=-0.330,P 〉0.05）.There were significant differences of ESR and CRP levels between the normal group and low BMD groups（osteopenia or osteoporosis）（P〈0.05）.ESR and CRP levels increased significantly in AS patients with osteoporosis.Conclusions AS-related osteoporosis might occur with gradually increasing inflammation.Most subjects with AS were suffering vitamin D insufficiency.Furthermore with the aggravation of the loss of bone mass,the trend of vitamin D lack became obvious gradually.But the role of vitamin D in the pathophysiology of AS-related osteoporosis needed further research.