来源：风湿病与关节炎,2017,6（7）:15-18.

1,25（OH）₂D₃治疗强直性脊柱炎的临床研究

马新美，朱桂启，王　凌，张　华，侯娜莉，刘利鹏，张永泉，李　璐

　　【摘　要】目的：观察初诊强直性脊柱炎患者25（OH）D₃水平，并探讨1,25（OH）₂D₃是否对强直性脊柱炎有潜在治疗作用。方法：收集60例初诊强直性脊柱炎患者和40例健康对照组血清标本，采用酶联免疫法测定血清25（OH）D₃水平。将强直性脊柱炎组患者按1∶1比例随机分为1,25（OH）₂D₃治疗组和常规治疗组，每组30例。常规治疗组采用洛索洛芬钠＋沙利度胺治疗，1,25（OH）₂D₃治疗组在常规治疗组基础上加维生素D治疗。观察2组患者在0，4，12周的25（OH）D₃水平、BASDAI评分、ESR、CRP变化，评判治疗效果。结果：①初诊强直性脊柱炎患者血清25（OH）D₃水平显著低于健康对照组（t = 7.19，P < 0.01），且与BASDAI评分、CRP呈显著负相关（r = -0.57，P < 0.05；r = -0.53，P < 0.05），与ESR无明显相关性（r = -0.48，P > 0.05）。②治疗4周后，1,25（OH）₂D₃治疗组BASDAI评分、CRP及25（OH）D₃显著低于常规治疗组，差异均有统计学意义（t = 2.23，P < 0.05；t = 2.16，P < 0.05；t = 2.38，P < 0.01）；治疗12周后，1,25（OH）₂D₃治疗组BASDAI评分、CRP及25（OH）D₃显著低于常规治疗组，差异均有统计学意义（t = 3.15，P < 0.01；t = 2.38，P < 0.05；t = 6.32，P < 0.01）；在第4，12周，1,25（OH）₂D₃治疗组ESR低于常规治疗组，但差异无统计学意义（t = 0.92，t = 1.96，P > 0.05）。结论：25（OH）D₃在强直性脊柱炎的发生、发展中有重要作用，1,25（OH）₂D₃添加治疗能有效改善强直性脊柱炎患者的BASDAI评分及临床症状，具有较高治疗前景。

【关键词】　脊柱炎，强直性；1,25（OH）₂D₃；25（OH）D₃；BASDAI评分

Clinical Study on the Treatment of Ankylosing Spondylitis with 1,25（OH）₂D₃

MA Xin-mei,ZHU Gui-qi,WANG Ling,ZHANG Hua,HOU Na-li,LIU Li-peng,ZHANG Yong-quan,LI Lu

　　【ABSTRACT】Objective:To observe the level of 25（OH） D₃ in patients with newly diagnosed ankylosing spondylitis and to investigate whether 1,25（OH）₂D₃ has a potential therapeutic effect on ankylosing spondylitis.Methods:Serum samples were collected from sixty patients with newly diagnosed ankylosing spondylitis and 40 healthy people,and the enzyme-linked immunosorbent assay was used to detect the level of serum 25（OH） D₃.The patients of ankylosing spondylitis were randomly divided into a 1,25（OH）₂D₃ treatment group and a conventional treatment group according to the ratio of 1 to 1,with 30 cases in each group.The conventional treatment group was treated with Lo Solo Finn sodium and thalidomide,and the patients in the 1,25（OH）₂D₃ treatment group were treated with vitamin D based on the treatment for the conventional treatment group.The levels of 25（OH）D₃,BASDAI scores,and changes ESR and CRP in the two groups were observed respectively before treatment,after four and twelve weeks of treatment to evaluate the results.Results:①The level of 25（OH）D₃ in the serum of patients with ankylosing spondylitis was significantly lower than that of the healthy control group（t = 7.19,P < 0.01）.It was negatively correlated with the scores of BASDAI and CRP（r = -0.57,P < 0.05;r = -0.53,P < 0.05）,and had no significant correlation with ESR（r = -0.48,P > 0.05）.②After four weeks of treatment,the BASDAI score,CRP and 25（OH）D₃ of the 1,25（OH）₂D₃ treatment group were significantly lower than those of the conventional treatment group,and the differences were statistically significant（t = 2.23,P < 0.05;t = 2.16,P < 0.05;t = 2.38,P < 0.01）.After 12 weeks of treatment,the BASDAI score,CRP and 25（OH）D₃ of the 1,25（OH）₂D₃ treatment group were significantly lower than those of the conventional treatment group,and the differences were statistically significant（t = 3.15,P < 0.01;t = 2.38,P < 0.05;t = 6.32,P < 0.01）.In the fourth and twelfth weeks,the ESR of the 1,25（OH）₂D₃ treatment group was lower than that of the conventional treatment group,but the difference was not statistically significant（t = 0.92,t = 1.96,P > 0.05）.Conclusion:25（OH）D₃ plays an important role in the occurrence and development of ankylosing spondylitis and therapy with 1,25（OH）₂D₃ can effectively improve the BASDAI score and clinical symptoms of patients,with high therapeutic potential.

　　【Keywords】spondylitis,ankylosing;1,25（OH）₂D₃;25（OH）D₃;BASDAI score