类风湿关节炎患者维生素D营养状况及其与疾病活动度关联研究

doi:10.12183/j.scjpm.2026.1154

摘要/Abstract

摘要： 目的调查类风湿关节炎（rheumatoid arthritis,RA）患者维生素D营养状况,并分析其与疾病活动度的关联。方法采用横断面研究,于2025年9—11月在泰州市同一纬度带内（跨度≤2°）纳入400例RA患者,其中医院来源200例、社区/线上来源200例。采用高效液相色谱-串联质谱法检测血清25-羟维生素D[25（OH）D]和24,25-二羟维生素D3[24,25（OH）₂D₃],计算两者比值（VMR）。采用Spearman相关和多元线性回归分析25（OH）D与28个关节疾病活动度评分（DAS28）的关联,并检验招募来源交互效应及非线性关系。结果 RA患者25（OH）D平均水平为（16.62±5.45）μg/L,缺乏和不足检出率分别为20.00%和55.50%。不同招募来源患者25（OH）D水平及营养分布差异均无统计学意义（均P>0.05）。按DAS28-血沉（ESR）分为缓解组（85例）、低活动组（114例）、中高活动组（201例）。缓解组25（OH）D高于低、中高活动组,VMR低于低、中高活动组（P<0.05）;低活动组25（OH）D高于中高活动组,VMR低于中高活动组（P<0.05）。25（OH）D与DAS28-ESR呈负相关,VMR与DAS28-ESR呈正相关（P<0.001）,DAS28-C反应蛋白（CRP）趋势一致。多元线性回归显示,25（OH）D与DAS28独立关联（B=-0.079,95% CI：-0.100~-0.058,β=-0.352,P<0.001）。招募来源×25（OH）D交互项P=0.533。限制性立方样条显示,25（OH）D<16.66 μg/L时DAS28略高,>16.66 μg/L后负向关联显著。敏感性分析结果方向一致。结论泰州地区RA患者维生素D缺乏与不足普遍,25（OH）D与疾病活动度呈负相关,与VMR呈正相关。

关键词: 关节炎, 类风湿, 维生素D缺乏, 骨化二醇, 24,25-二羟维生素D3, 疾病活动度, 生物标志物

Abstract: Objective To investigate the vitamin D nutritional status of patients with rheumatoid arthritis (RA) and to analyze its association with disease activity. Methods A cross-sectional study was conducted from September to November 2025, enrolling 400 RA patients within the same latitudinal band (span ≤2°) in Taizhou City, comprising 200 hospital-recruited and 200 community- or online-recruited participants. Serum 25-hydroxyvitamin D [25(OH)D] and 24,25-dihydroxyvitamin D₃ [24,25(OH)₂D₃] were quantified by high-performance liquid chromatography-tandem mass spectrometry, and the vitamin D metabolite ratio (VMR) was calculated accordingly. Spearman correlation and multivariable linear regression analyses were performed to assess the associations between 25(OH)D and the Disease Activity Score in 28 joints (DAS28), with subsequent testing for recruitment source-by-exposure interaction effects and nonlinear relationships. Results The mean serum 25(OH)D level among RA patients was (16.62±5.45) μg/L, with detection rates of vitamin D deficiency and insufficiency of 20.00% and 55.50%, respectively. Neither 25(OH)D levels nor nutritional status distributions differed significantly between recruitment sources (P>0.05). Stratified by DAS28-erythrocyte sedimentation rate (ESR), 85 patients were classified into the remission group, 114 into the low disease activity group, and 201 into the moderate-to-high disease activity group. The remission group exhibited higher 25(OH)D levels and lower VMR relative to both the low and moderate-to-high disease activity groups (P<0.05); likewise, the low disease activity group demonstrated higher 25(OH)D and lower VMR compared with the moderate-to-high disease activity group (P<0.05). 25(OH)D was inversely correlated with DAS28-ESR, whereas VMR was positively correlated with DAS28-ESR (both P<0.001), with concordant trends observed for DAS28-C-reactive protein (CRP). Multivariable linear regression analyses demonstrated an independent association between 25(OH)D and DAS28 (B=-0.079, 95% CI: -0.100 to -0.058, β=-0.352, P<0.001). The recruitment source ×25(OH)D interaction term yielded P=0.533. Restricted cubic spline analyses indicated that DAS28 was marginally elevated when 25(OH)D was below 16.66 μg/L, with a significant inverse association emerging at concentrations exceeding 16.66 μg/L. Sensitivity analyses yielded directionally consistent results. Conclusion Vitamin D deficiency and insufficiency are highly prevalent among RA patients in the Taizhou region. Serum 25(OH)D is inversely associated with disease activity, whereas VMR exhibits a positive association.

Key words: Arthritis, Rheumatoid, Vitamin D deficiency, Calcifediol, 24,25-dihydroxyvitamin D3, Disease activity, Biomarkers

中图分类号:

R151

陈艳, 杨光, 王露晶, 刘俊. 类风湿关节炎患者维生素D营养状况及其与疾病活动度关联研究[J]. 华南预防医学, 2026, 52(10): 1154-1159.

Chen Yan, Yang Guang, Wang Lujing, Liu Jun. Vitamin D nutritional status and its association with disease activity in patients with rheumatoid arthritis[J]. South China Journal of Preventive Medicine, 2026, 52(10): 1154-1159.

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