| Background:Cardiovascular disease(CVD)is the leading cause of major complications and death in patients with rheumatoid arthritis(RA),while deaths caused by atherosclerosis(AS)in RA patients are 42%-50%higher than the normal population.Most deaths are due to accelerated AS.Vitamin D deficiency is common in RA patients,and epidemiological studies have shown that 25(OH)D deficiency is a new risk factor for CVD that can predict cardiovascular events and mortality.However,in patients with RA,the relationship between low levels vitamin D and atherosclerosis has been contradicted by domestic and foreign reports.Objective:To explore the correlation between serum 25 hydroxyvitamin D level and atherosclerosis in patients with rheumatoid arthritis(RA),and then analyze the risk factors of carotid atherosclerosis(CAS)and cardiovascular events in patients with RA so as to guide clinical intervention of serum 25(OH)D level in advance to improve the degree of carotid atherosclerosis in RA patients.Methods:From November 2017 to June 2019,120 patients diagnosed with rheumatoid arthritis in the inpatient department of the Department of Immunology and Rheumatology of the Affiliated Hospital of Yan’an University were selected,as well as all of these diagnosed cases were in line with the standard of classification proposed by the American College of Rheumatology(ACR)in 2010 and excluded acute and chronic infections,combined with patients who suffered from other autoimmune diseases,Body Mass Index(BMI)>30kg/m~2,heart,liver and kidney dysfunction,diabetes,hypertension chronic diseases.First of all,sixty healthy volunteers of the same age and gender were selected as the control group and then the general information of each patient such as gender,age,weight,height,course of disease,etc.,were recorded and BMI(weight/height~2)was calculated.What’s more,serum total cholesterol(TC),triglycerides(TG),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C),C-reactive protein(CRP)Erythrocyte sedimentation rate(ESR);Rheumatoid factors(RF),interleukin 6(IL-6),anti(Cyclic citrullinated peptide,CCP)antibodies,serum 25(OH)D levels.Then 28 Disease Activity Scores(DAS28)for each patient were calculated.Carotid intima media thickness(CIMT)was detected by color Doppler ultrasound.Carotid intima media thickness(CIMT)was divided into RA without AS group and RA with AS atherosclerosis group on the basis of Carotid ultrasound results.According to25(OH)D level,it was divided into normal group[25(OH)D level>30ng/ml],insufficient group[25(OH)D level 20~30ng/ml],and deficient group[25(OH)D level<20ng/ml.The correlation between serum 25(OH)D levels and atherosclerosis in RA patients was analyzed.Results:1.In this study,there were 60 healthy controls,54 RA patients without CAS and 46 RA patients with CAS.The age of subjects in the three groups were(46.35±10.14),(50.19±10.66,47.33±11.06)respectively,the gender and male to female ratio were(20/40),(14/40),(12/34),BMI were(22.57±3.02)kg/m~2,(22.73±3.63)kg/m~2and(22.23±4.27)respectively,and so there was no statistically significant difference in general information.(P>0.05).2.The DAS28 score of the RA combined CAS group was higher than that of the RA non-CAS group,and the statistical value:[(5.23±1.87)points vs.((4.56±1.46)points][(14.05±10.25)years vs.(9.26±9.36)years],so the difference is statistically significant(P<0.05).3.Compared with the healthy control group,the HDL-C level in the RA-unincorporated CAS group and the RA-incorporated CAS group decreased.The statistic:[(1.45±0.41)mmol/L vs.(1.03±0.28)mmol/L],the difference was statistically significant(P<0.05).Compared with the control group,the 25(OH)D level in the RA-unincorporated CAS group and the RA-incorporated CAS group was lower than that in the control group.)ng/ml vs.(19.44±10.02)ng/ml],the 25(OH)D level of RA combined with CAS group was significantly lower than that of RA without combined CAS group and control group,the difference was statistically significant(P<0.05);The level of 25(OH)D in the RA without CAS group was lower than that in the healthy control group,and the difference was not statistically significant(P>0.05).4.The IMT of RA combined CAS group is significantly higher than that of RA and CAS group[(0.96±0.07)mm vs.(0.74±0.08)][(0.96±0.07)mm vs.(0.72±0.85)mm],and the difference was statistically significant(P<0.05).The IMT of RA combined CAS group was significantly higher than that of RA uncombined group[(0.96±0.07)mm vs.(0.74±0.08)mm],the difference was statistically significant(P<0.05).5.The level of IL-6 in RA combined CAS group was higher than that in RA non-combined CAS group[(57.23±50.98)pg/ml]vs.(39.51±30.06)pg/ml],the difference was statistically significant(P<0.05).6.The 25(OH)D level in mildly active group,moderately active group,and severely active group in RA subgroup were[(32.06±7.89)ng/ml,(23.55±8.72)ng/ml,(14.88±5.63)ng/ml]respectively,the difference was statistically significant(P<0.05).7.DAS28 score of 25(OH)D deficiency group,IMT higher than 25(OH)D sufficient group,and 25(OH)D insufficient group((5.78±1.64)vs.(3.43±0.66),(5.78±1.64)vs(5.08±1.52)],[(0.89±0.13)mm vs.(0.80±0.11)mm,(0.89±0.13)mm vs.(0.80±0.14)mm]and the difference was statistically significant(P<0.05).The DAS8score of the 25(OH)D-deficient group was higher than that of the 25(OH)D-adequate group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in IMT between 25(OH)D sufficient group and 25(OH)D insufficient group(P>0.05).The level of HDL-C in the VitD sufficient group was higher than that in the VitD insufficient group and VitD deficient group,the statistical values were[(1.29±0.22)mmol/L vs.(1.06±0.24)mmol/L,(1.29±0.22)mmol/L vs.(0.90±0.27)mmol/l],the difference holds the statistical significance(P<0.05).HDL-C in VitD deficiency group was higher than that in VitD deficiency group(P<0.05).8.The level of IL-6 in the 25(OH)D deficiency group was[(57.24±51.66)]higher than that in the VitD sufficient group[(36.18±23.66)],and the difference was statistically significant.The level of IL-6[(57.24±51.66)]in the VitD-deficient group was higher than that in the VitD-deficient group[(46.38±39.21)],and the difference was not statistically significant.9.25(OH)D level was negatively correlated with DAS28(r=-0.552,P=0.000),IMT(r=-0.313,P=0.002),IL-6(r=-0.227,P=0.023)and HDL-C(r=0.505,P=0.000)in RA patients.Conclusions:1.The level of 25(OH)D in patients with rheumatoid arthritis was significantly reduced,which was negatively correlated with DAS28 score and IL-6.It may participate in the autoimmune response of and plays a significance role in the evaluation of the disease and prognosis.2.25(OH)D deficiency may lead to dyslipidemia and increase the risk of atherosclerosis in RA patients.3.The level of 25(OH)D in patients with rheumatoid arthritis may be closely related to the occurrence of carotid atherosclerosis. |
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