目的:评估维生素D水平在IPAF患者中的水平。方法:回顾性分析比较2020年9月至2021年9月期间于青岛大学附属医院呼吸与危重症医学科初诊IPAF的患者共63例。记录入组患者的基本资料、实验室检查数据等,用1,25(OH)2D3的水平评估维生素D水平。应用SPSS25.0进行数据分析。结果:血清25-OH-D水平分别和D二聚体、IL-6、CD4细胞绝对计数、二氧化碳分压、空腹血糖、血钙水平之间无显著相关性(P > 0.05)。与BMI (r = 0.265, P < 0.05)、氧饱和度(r = 0.327, P < 0.01)、FEV1/FVC (r = −0.373, P < 0.01)、TLC (r = 0.357, P < 0.01)、肺动脉压(r = −0.367, P < 0.01)水平之间为弱相关性。与血沉(r = −0.587, P < 0.01)、氧分压(r = 0.580, P < 0.01)、六分钟步行距离(r = 0.507, P < 0.01)、FEV1 (r = 0.537, P < 0.01)、FVC (r = 0.580, P < 0.01)、mMRC评分(r = 0.588, P < 0.01)之间为中等程度相关性,与DLCO (r = 0.686, P < 0.01)为强相关性。结论:IPAF患者血清维生素D水平越低,患者六分钟步行距离、DLCO水平越低,提示血清维生素D水平与IPAF患者的肺功能损害、疾病严重程度相关。 Objective: To assess the level of vitamin D levels in patients with IPAF. Methods: A total of 63 newly diagnosed IPAF patients in the Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Qingdao University between September 2020 and September 2021 were retrospectively analyzed and compared. The basic data and laboratory data of the patients were recorded, assessed with the level of 1,25(OH)2D3. SPSS25.0 was applied for data analysis. Results: There was no significant correlation between serum 25-OH-D levels and D-dimer, IL-6, absolute CD4 cell count, partial pressure of carbon dioxide, lactate, fasting blood glucose, serum calcium, and creatinine levels, respectively (P > 0.05). There was a weak correlation with BMI (r = 0.265, P < 0.05), oxygen saturation (r = 0.327, P < 0.01), FEV1/FVC (r = −0.373, P < 0.01), TLC (r = 0.357, P < 0.01), and pulmonary arterial pressure (r = −0.367, P < 0.01). ESR (r = −0.587, P < 0.01), Oxygen partial pressure (r = 0.580, P < 0.01), 6-minute walking distance (r = 0.507, P < 0.01), FEV1 (r = 0.537, P < 0.01), FVC (r = 0.580, P < 0.01), mMRC score (r = 0.588, P < 0.01) were moderately correlated, and strongly with DLCO (r = 0.686, P < 0.01). Conclusion: The lower the serum vitamin D level, the lower the six-minute walk distance and DLCO level in patients with IPAF, suggesting that the serum vitamin D level is related to the pulmonary function impairment and disease severity in patients with IPAF.
目的:评估维生素D水平在IPAF患者中的水平。方法:回顾性分析比较2020年9月至2021年9月期间于青岛大学附属医院呼吸与危重症医学科初诊IPAF的患者共63例。记录入组患者的基本资料、实验室检查数据等,用1,25(OH)2D3的水平评估维生素D水平。应用SPSS25.0进行数据分析。结果:血清25-OH-D水平分别和D二聚体、IL-6、CD4细胞绝对计数、二氧化碳分压、空腹血糖、血钙水平之间无显著相关性(P > 0.05)。与BMI (r = 0.265, P < 0.05)、氧饱和度(r = 0.327, P < 0.01)、FEV1/FVC (r = −0.373, P < 0.01)、TLC (r = 0.357, P < 0.01)、肺动脉压(r = −0.367, P < 0.01)水平之间为弱相关性。与血沉(r = −0.587, P < 0.01)、氧分压(r = 0.580, P < 0.01)、六分钟步行距离(r = 0.507, P < 0.01)、FEV1 (r = 0.537, P < 0.01)、FVC (r = 0.580, P < 0.01)、mMRC评分(r = 0.588, P < 0.01)之间为中等程度相关性,与DLCO (r = 0.686, P < 0.01)为强相关性。结论:IPAF患者血清维生素D水平越低,患者六分钟步行距离、DLCO水平越低,提示血清维生素D水平与IPAF患者的肺功能损害、疾病严重程度相关。
自身免疫特征的间质性肺炎,维生素D,结缔组织病
Tiantian Wan, Wencheng Yu*
The Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: Feb. 18th, 2022; accepted: Mar. 11th, 2022; published: Mar. 22nd, 2022
Objective: To assess the level of vitamin D levels in patients with IPAF. Methods: A total of 63 newly diagnosed IPAF patients in the Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Qingdao University between September 2020 and September 2021 were retrospectively analyzed and compared. The basic data and laboratory data of the patients were recorded, assessed with the level of 1,25(OH)2D3. SPSS25.0 was applied for data analysis. Results: There was no significant correlation between serum 25-OH-D levels and D-dimer, IL-6, absolute CD4 cell count, partial pressure of carbon dioxide, lactate, fasting blood glucose, serum calcium, and creatinine levels, respectively (P > 0.05). There was a weak correlation with BMI (r = 0.265, P < 0.05), oxygen saturation (r = 0.327, P < 0.01), FEV1/FVC (r = −0.373, P < 0.01), TLC (r = 0.357, P < 0.01), and pulmonary arterial pressure (r = −0.367, P < 0.01). ESR (r = −0.587, P < 0.01), Oxygen partial pressure (r = 0.580, P < 0.01), 6-minute walking distance (r = 0.507, P < 0.01), FEV1 (r = 0.537, P < 0.01), FVC (r = 0.580, P < 0.01), mMRC score (r = 0.588, P < 0.01) were moderately correlated, and strongly with DLCO (r = 0.686, P < 0.01). Conclusion: The lower the serum vitamin D level, the lower the six-minute walk distance and DLCO level in patients with IPAF, suggesting that the serum vitamin D level is related to the pulmonary function impairment and disease severity in patients with IPAF.
Keywords:Interstitial Pneumonia with Autoimmune Characteristics, Vitamin D, Connective Tissue Disease
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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间质性肺疾病(Interstitial lung disease, ILD)是一系列以肺泡为单位的炎症和间质纤维化为基本病变的异质性非肿瘤性、非感染性的肺部疾病的总称,病因非常广泛,包括病因不明的间质性肺病、与自身免疫性疾病和环境暴露有关的间质性肺病等 [
维生素D被认为是一种类固醇激素,具有免疫调节特性,也可调节骨骼发育、钙稳态。25-羟基维生素D3(25(OH)D)是维生素D的最后一种代谢产物。最近的研究表明,维生素D在肺组织重塑、保持肺功能和免疫系统调节中也起着作用。本文将会探讨维生素D水平与IPAF的相关性。
最近的研究表明,维生素D在肺组织重塑、维持肺功能和免疫系统调节中也起着作用与健康对照患者比,RA、SLE和未分化结缔组织病(UCTD)患者血清25(OH)D较低。但有人认为皮质类固醇的使用通过增加消耗来降低25(OH)D水平。少数研究表明,维生素D缺乏与CTD-ILD和肺功能降低有关。然而,目前还没有研究维生素D缺乏是否与较短的生存时间有关。
本组共纳入IPAF患者63例,男性患者39例占62%,有吸烟史36例,为IPAF患者57%,年龄为66.0 (59.0, 80.0)岁。本研究已取得患者的知情同意。
1) 所有患者未行系统性治疗及应用激素;2) 为初诊IPAF的患者,诊断标准参考(ATS/ERS)制定的分类诊断标准。
1) 排除肿瘤患者;2) 除外合并慢阻肺、哮喘、肺部感染患者;3) 除外临床资料不全者。
收集患者的血清维生素D水平、血气分析、风湿四项、ENA酶谱、抗核抗体及滴度、肺功能检查结果及六分钟步行实验等。
使用SPSS25.0进行统计学分析。符合正态分布的计量资料以均数 ± 标准差描述,t检验分析,非正态分布的计量资料以中位数四分位数间距描述,非参数检验分析。采用Pearson相关分析血清维生素D水平与肺功能、血气分析等相关指标之间的相关关系。
发现在IPAF患者血清维生素D水平呈缺乏及不足状态,为21.3 (16.2, 26.9) ng/ml。其余指标详细结果见表1。
IPAF | |
---|---|
血沉(mm/1h) | 24.0 ± 17.7 |
D二聚体 | 413.2 ± 148.0 |
IL-6 | 8.3 ± 13.4 |
CD4细胞绝对计数 | 562.5 ± 166.7 |
动脉血氧分压 | 78.6 ± 16.6 |
动脉血二氧化碳分压 | 40.35 ± 4.1 |
血氧饱和度 | 95.8 ± 3.9 |
FEV1 | 86.6 ± 18.5 |
FVC | 77.3 ± 21.0 |
FEV1/FVC | 106.7 ± 10.4 |
TLC | 65.7 ± 20.1 |
DLCO% | 63.79 ± 23.8 |
空腹血糖 | 5.5 ± 1.4 |
血钙 | 2.3 ± 0.1 |
肺动脉压 | 30.4 ± 5.9 |
表1. IPAF组其它相关指标
进行皮尔逊相关性分析发现在IPAF患者中血清25-OH-D水平分别和D二聚体、IL-6、CD4细胞绝对计数、二氧化碳分压、空腹血糖、血钙水平之间无显著相关性(P > 0.05)。血清25-OH-D水平与BMI、氧饱和度、FEV1/FVC、TLC、肺动脉压水平之间为弱相关性。血清25-OH-D水平与血沉、氧分压、六分钟步行距离、FEV1、FVC、mMRC评分之间为中等程度相关性,与DLCO为强相关性。见表2。
r值 | |
---|---|
BMI | 0.265* |
血沉 | −0.587** |
D二聚体 | −0.214 |
白介6 | −0.012 |
CD4细胞绝对计数 | −0.058 |
氧分压 | 0.580 |
二氧化碳分压 | 0.21 |
氧饱和度 | 0.327** |
六分钟步行距离 | 0.507** |
FEV1 | 0.537** |
FVC | 0.580** |
FEV1/FVC | −0.373** |
TLC | 0.357** |
DLCO | 0.686** |
空腹血糖 | 0.094 |
血钙 | 0.209 |
肺动脉压 | −0.367** |
mMRC评分 | 0.588** |
表2. IPAF组血清25羟维生素D与其它指标的相关性分析
*P < 0.05,**P < 0.01;r的绝对值在0~0.2之间表示变量间极弱相关或无相关;0.2~0.4表示弱相关;0.4~0.6表示中等程度相关;0.6~0.8表示强相关;在0.8~1,表示极强相关。
结缔组织病(CTD)是一组全身性自身免疫性疾病,病变累及多种脏器。由于肺和胸膜均富含胶原、血管等结缔组织,因此结缔组织疾病大多可以损伤肺和胸膜等呼吸系统多个器官,包括:呼吸肌、胸膜、肺血管、气道、肺实质和肺间质,且部分患者呼吸道表现为首发症状。间质性肺病(ILD)是一种常见而严重的肺部病变,其特点是在高分辨率CT (HRCT)扫描和肺活检标本上表现为多种类型的炎症和纤维化 [
维生素D的生物活性形式1,25-(OH)2D3的免疫调节作用为维生素D缺乏在自身免疫性疾病和终末器官功能障碍(如ILD)的发展中的致病作用提供了生物学合理性。适应性免疫系统的所有细胞都表达VDR并对1,25-(OH)2D的作用敏感 [
目前研究主要在探讨维生素D水平与CTD-ILD (结缔组织病相关性肺疾病)之间的关系。在CTD-ILD中维生素D水平与患者的肺功能呈正相关,且与疾病的预后相关 [
IPAF患者血清维生素D水平越低,患者六分钟步行距离、DLCO水平越低,提示血清维生素D水平与IPAF患者的肺功能损害、疾病严重程度相关。
万甜甜,于文成. 血清维生素D水平与IPAF的相关性分析Correlation Analysis between Serum Vitamin D Level and IPAF[J]. 临床医学进展, 2022, 12(03): 2064-2069. https://doi.org/10.12677/ACM.2022.123296