Abstract:

Objective　To assessed serum level of 25（OH）D3 in children with juvenile idiopathic arthritis, in order to find the association between the vitamin D and disease activity as well as bone mineral density. Methods　We evaluated 110 patients（58 females and 52 males，mean age being 9.04±3.37 years） that fulfilled the 2011 ILAR criteria for juvenile idiopathic arthritis. Patients underwent laboratory tests of serum25（OH）D3，plasma parathyroidhormone and dual-energyx-ray absorptiometry examination. JIA patients were categorized by ACR standard of disease status in 2011，and the disease activity was measured by using JADAS-27. We analyzed the relationship between serum 25（OH）D3 level and other indexes. Results　The mean serum 25（OH）D3 level of 110 JIA patients was（49.8±15.3） μmol/L. Vitamin D deficiency was detected in 59 patients（53.6%） and insufficiency in 43 patients（39.1%）. Patients with active disease had significantly reduced serum 25（OH）D3 levels compared to patients with inactive disease（t＝5.162，P＜0.001），but there was no significant association between serum 25（OH）D3 level and JADAS-27（r＝-0.72，P＞0.05）. JIA patients with vitamin D deficiency showed a significantly lower bone mineral density than those with normal 25（OH）D3 level（t＝3.791，P＜0.05）. Patients using glucocorticoid showed significantly lower 25（OH）D3 level than those who never used glucocorticoid（t＝2.823，P＜0.01）. Conclusion　JIA patients have reduced serum 25（OH）D3，particularly those with active disease or/and using glucocorticoid. JIA patients with vitamin D deficiency showed a significantly lower bone mineral density.

Key words: juvenile idiopathic arthritis, vitamin D, 25（OH）D3, JADAS 27, bone mineral density

摘要：

目的　检测幼年特发性关节炎（JIA）患儿血清25羟维生素D3［25（OH）D3］水平， 研究维生素D与JIA疾病活动度及骨密度的关系。方法　按照2001年国际风湿病学联盟（ILAR）诊断标准，于2015年1月至2017年1月纳入重庆医科大学附属儿童医院风湿免疫科110例JIA患儿，其中女58例、男52例，年龄（9.04±3.37）岁。检测JIA患儿血清25（OH）D3、血浆PTH水平，双能X线检查评估骨密度。评价患儿疾病活动状态，并通过JADAS27评分衡量疾病活动度。比较JIA患儿血清25（OH）D3水平与其他指标之间的关系。结果　110例JIA患儿血清中25（OH）D3水平为（49.8±15.3） μmol/L， 其中59例（53.6%）为维生素D缺乏状态， 43例（39.1%）表现为维生素D不足。活动期JIA 25（OH）D3水平低于缓解期（t＝5.162，P＜0.001），与JADAS27评分无相关性（r＝-0.72，P＞0.05）。维生素D缺乏状态下JIA患儿骨密度（Z值）低于维生素D充足状态（t＝3.791，P＜0.05）。未使用皮质激素（GC）治疗的JIA患儿25（OH）D3水平显著高于使用GC治疗者（t＝2.823，P＜0.01）。结论　JIA患儿普遍存在血清维生素D水平低下。处于疾病活动期、使用激素治疗的患儿血清25（OH）D3水平低下尤为显著，维生素D缺乏状态下JIA患儿骨密度降低。

关键词: 幼年特发性关节炎, 维生素D, 25羟维生素D3, JADAS 27, 骨密度