类风湿关节炎患者肌少症与甲襞微循环、血清25-（OH）D3及IL-17水平的相关性研究

Correlation analysis of 25-(OH)D3, IL-17, and nailfold capillaroscopy score with sarcopenia in female patients with rheumatoid arthritis

摘要:

目的 探讨类风湿关节炎（RA）患者肌少症与甲襞微循环、血清25-羟维生素D₃［25-（OH）D₃］及IL-17水平的相关性。方法 选取2018年1月—2019年12月胜利油田中心医院130例RA女性患者作为RA组，同期选取该院80例体检健康人群为对照者，测定甲襞微循环积分（NFCS），生物电阻抗测试法（BIA）测定骨骼肌质量，光化学免疫分析法测定血清25-（OH）D₃浓度，酶联免疫吸附试验（ELISA）检测血清白细胞介素-17（IL-17）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平，记录RA患者各项相关资料，计算疾病活动性。相关性分析采用Pearson法，影响因素采用Logistic回归分析。结果 RA组ESR、CRP、NFCS、IL-17高于对照组（P <0.05），25-（OH）D₃、SMI低于对照组（P <0.05）。Pearson相关性分析发现：SMI与25-（OH）D₃呈正相关（r =0.515，P <0.05），与IL-17和NFCS呈负相关（r =-0.468和-0.229，均P <0.05）；Logistic回归分析结果提示：25-（OH）D₃是肌少症发生的保护因素［O^R=0.392（95% CI：0.183，0.841）］，IL-17［O^R=1.516（95% CI：1.001，2.297）］、NFCS［O^R=3.497（95% CI：1.562，7.892）］、CRP［O^R=1.469（95% CI：0.992，2.175）］是肌少症发生的危险因素。结论 RA伴肌少症与微循环障碍密切相关，NFCS是肌少症发生的危险因素。血清25-（OH）D₃水平降低、IL-17水平升高与肌少症相关。

Abstract:

Objective To explore the correlation of serum 25-(OH)D₃, IL-17 and nailfold microcirculation with sarcopenia in female patients with rheumatoid arthritis.Methods Totally 130 female RA patients and 80 healthy controls were enrolled. Nailfold capillaroscopies were performed and Skeletal muscle mass of extremities were determinate with bioimpedance analvsis method, serum 25-(OH)D₃ were detected with photochemical immunoassay, and serum IL-17, IL-6, TNF-α levels were detected with enzyme-1inked immunosorbent assay (ELISA). The detailed clinical data of the RA patients were recorded. Pearson's test was adopted for correlation analysis and logistic analysis was carried out for the identification of risk factors.Results (1) The levels of nailfold capillaroscopy scores and serum IL-17 in RA group were higher than those in control group (P < 0.05). The levels of 25-(OH)D₃ and SMI (Skeletal mass index) in RA group were lower than those in control group (P < 0.05). (2) Pearson 's test showed that SMI and serum IL-17, nailfold capillaroscopy scores (NFCS) were negatively correlated (r = -0.468 and -0.229, all P < 0.05), while serum 25-(OH)D₃ was positively correlated (r = 0.515, P < 0.05). (3) Logistic regression analysis shows that serum 25(OH)D₃ was a protective factor for sarcopenia [O^R = 0.392 (95% CI: 0.183, 0.841) ], while IL-17 [O^R = 1.516 (95% CI: 1.001, 2.297) ], CRP [O^R = 1.469 (95% CI: 0.992, 2.175) ], and NFCS [O^R = 3.497 (95% CI: 1.562, 7.892) ] were risk factors for it.Conclusions Sarcopenia in femail patients with RA is not uncommon and is closely related to microcirculation disturbance. The increase of NFCS is the risk factor of sarcopenia. The decrease of serum 25-(OH)D₃ and the increase of serum IL-17 are also risk factors of sarcopenia, but the mechanism of participation in sarcopenia and microcirculation disturbance needs to be further studied.