中文摘要：

目的检测初诊类风湿关节炎（RA）患者的1，25-二羟维生素D3[1，25（OH）2D3]血清水平及其受体mRNA水平，并分析其与RA疾病活动度的相关性，探讨维生素D在RA发病中的作用。方法选取初诊RA患者100例，符合1987年美国风湿病学会分类标准。健康对照50名，均来自我院医务人员的健康志愿者，其性别和年龄均与RA患者相匹配。放射免疫法（RIA）检测血清1，25（OH）2D3水平，利用实时定量反转录一聚合酶链反应（RT-PCR）技术检测外周血维生素D受体（VDR）mRNA表达水平。RA患者临床指标评估包括：疼痛视觉模拟评分（VAS）、患者对疾病总体状况的VAS评分（PaGA）、医生对疾病总体状况的VAS评分（PhGA）、压痛关节数（TJC）、肿胀关节数（SJC）。RA患者疾病活动度评估包括：患者疾病活动度指数（RAPID3）评分、28个关节疾病活动指数（DAS28）评估、临床疾病活动指数（CDAI）评估。采用正态性检验和方差齐性检验，满足正态性和方差齐性条件，2组比较采用完全随机两样本t检验。相关分析满足正态性条件时采用Pearson相关检验，否则采用Speaman秩相关检验。结果RA组外周血1，25（OH）2D3水平明显低于健康对照组，RA组外周血单个核细胞（PBMC）的VDRmRNA表达水平（4．3±1．1）明显高于健康对照组（1．0±0．7），RA组1，25（OH）2D3水平与DAS28、CDAI、C反应蛋白（CRP）、SJC和TJC呈负相关，提示1，25（OH）2D3参与了RA的免疫反应并与关节炎症有关，检测1，25（OH）2D3水平可作为判断RA病情的一个临床指标。结论RA患者确实存在维生素D和VDRmRNA异常，补充维生素D将为RA的治疗和预防提供新的途径。

英文摘要：

Objective To investigate the level of vitamin D endocrine system in the peripheral blood of patients with newly diagnosed rheumatoid arthritis （RA） and to study its effect on RA. Its relationships with the disease activity was analyzed. Methods The level of the 1,25-dihydroxyvitamin D3 [ 1,25 （OH）2D3] in plasma from 100 RA patients and 50 normal controls were detected by radioimmunoassay assays. Vitamin D receptor （VDR） expression was determined by real-time PCR in peripheral blood. Clinical measures of disease activity including tender and swollen joint counts, rheumatologist and patient global assessments were available in all cases. Disease activity score in 28 joints （DAS28） ESR scores, clinical disease activity index, the routine assessment of patient index data were calculated for patients with complete data. Pain was assessed with a 100 mm-visual analogue scale. The relationship between vitamin D endocrine system and the disease activity. Results We observed that patients with RA had decreased levels of 1,25（OH）2D3 and that the levels were lowest in those with increased DAS28, clinical disease activity index （CDAI）, C-reactive protein （CRP）, swelling joint counts （SJC） and tender joint counts （TJC）. Conclusion Our data indicate that 1,25 （OH）2D3 may play an important role in RA, and that vitamin D deficiency may be useful in the treatment of RA.