原发性干燥综合征患者抑郁与血25羟维生素D缺乏的相关性研究

李慧; 孟德芳; 魏华; 刘英

doi:10.16766/j.cnki.issn.1674-4152.003994

原发性干燥综合征患者抑郁与血25羟维生素D缺乏的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003994

李慧¹,
孟德芳²,
魏华²,
刘英^1, ,

1.
山东中医药大学附属医院风湿免疫科，山东济南 250011
2.
苏北人民医院风湿免疫科，江苏扬州 225002

基金项目:

国家中医药管理局第三届国医大师传承工作室及全国名中医传承工作室建设项目国中医药办人教函〔2018〕119号

山东省卫生健康委员会齐鲁医派中医学术流派传承项目鲁卫函〔2020〕132号

山东省自然科学基金面上项目 ZR2023MH332

详细信息

通讯作者:
刘英，E-mail: lytt_1994@163.com

中图分类号: R593.2
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出版历程
- 收稿日期: 2024-04-10
- 网络出版日期: 2025-08-14

Correlation between depression and serum 25-hydroxyvitamin D deficiency in patients with primary Sjögren' s syndrome

LI Hui¹,
MENG Defang²,
WEI Hua²,
LIU Ying^{1
, ,}

1.
Department of Rheumatology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250011, China

摘要

摘要: 目的探讨原发性干燥综合征(pSS)患者抑郁焦虑的发生与25羟维生素D[25(OH)D]缺乏的相关性，为临床早发现及干预提供理论基础。方法选取苏北人民医院2023年1—6月就诊pSS患者58例及健康对照24例，检测血清25(OH)D水平，实时荧光定量PCR检测外周血单个核细胞维生素D受体(VDR)表达。收集临床指标，抑郁及焦虑分别使用抑郁自评量表(SDS)和焦虑自评量表(SAS)测评，采用多元logistic回归分析研究pSS患者情绪障碍发生的相关影响因素。结果 pSS无情绪障碍者血清25(OH)D水平为62.67(35.82, 83.00)ng/mL，合并情绪障碍者为23.03(15.33, 60.00)ng/mL，差异有统计学意义(Z=-2.970，P=0.003)，其中合并抑郁者较无情绪障碍者显著降低[19.23(13.18, 27.54)ng/mL，Z=-3.844，P < 0.001]。pSS合并抑郁者VDR水平低于健康对照组(P < 0.05)。pSS患者25(OH)D水平与欧洲抗风湿联盟干燥综合征患者报告指数(ESSPRI)评分呈负相关关系(r=-0.473，P＜0.01)，与总球蛋白、IgG水平呈负相关关系(P＜0.05)。25(OH)D缺乏患者抑郁及间质性肺病发生率明显增高(P < 0.05)，且25(OH)D越低、总球蛋白越高、IgG越高，合并抑郁概率升高；25(OH)D(OR=0.958)和IgG(OR=1.268)水平是抑郁发生的独立影响因素(P < 0.05)。25(OH)D缺乏患者焦虑发生率无显著增加。结论 pSS患者抑郁与25(OH)D缺乏密切相关，25(OH)D缺乏有助于预测pSS患者抑郁的发生。
- 原发性干燥综合征 /
- 抑郁 /
- 焦虑 /
- 25羟维生素D
Abstract: Objective To investigate the correlation between depression or anxiety and 25-hydroxyvitamin D (25(OH)D) deficiency in patients with primary Sjögren' s syndrome (pSS), aiming to provide a theoretical basis for early clinical identification and intervention. Methods A total of 58 pSS patients and 24 age- and sex-matched healthy controls were recruited from Northern Jiangsu People' s Hospital from January to June 2023. The levels of serum 25(OH)D were measured. Vitamin D receptor (VDR) expression in peripheral blood mononuclear cells was measured by RT-PCR. Clinical indicators were collected. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess patients' anxiety and depression, respectively. Multiple logistic regression analysis was used to analyze the factors associated with mood disorder occurrence in patients with pSS. Results Serum 25(OH)D levels were significantly different between pSS patients without mood disorders [62.67 (35.82, 83.00) ng/mL] and those with mood disorders [23.03 (15.33, 60.00) ng/mL, Z=-2.970, P=0.003]. Notably, patients with depression exhibited significantly lower levels [19.23 (13.18, 27.54) ng/mL] compared to those without mood disorders (Z=-3.844, P < 0.001). The VDR levels of pSS patients with depression were significantly decreased than that in the healthy control group (P < 0.05). 25(OH)D levels were negatively correlated with ESSPRI score (r=-0.473, P < 0.01), total globulin and IgG levels (P < 0.05). The incidence of depression and interstitial lung disease in pSS patients with 25(OH)D deficiency was significantly increased (P < 0.05), and the lower the 25(OH)D level, the higher the total globulin and IgG, the higher the probability of depression (OR>1). 25(OH)D (OR=0.958) and IgG (OR=1.268) levels were independent influencing factors for the development of depression (P < 0.05). The incidence of anxiety was not statistically increased in patients with 25(OH)D deficiency. Conclusion Depression in pSS patients is closely associated with 25(OH)D deficiency. 25(OH)D deficiency may help to predict depression in patients with pSS.
- Primary Sjögren' s syndrome /
- Depression /
- Anxiety /
- 25-hydroxyvitamin D

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表 1 25(OH)D水平与临床指标的相关性分析

Table 1. Correlation analysis of 25(OH)D levels and clinical indicators

变量	统计量	P值
ESSPRI评分	-0.473^a	< 0.001
总球蛋白(g/L)	-0.330^a	0.011
IgG(g/L)	-0.366^b	0.005
白细胞(×10⁹/L)	0.323^a	0.013
钾(mmol/L)	0.292^a	0.026
注：^a为r值，^b为r_s值。

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表 2 不同25(OH)D缺乏情况pSS患者抑郁、焦虑及间质性肺炎发生情况比较[例(%)]

Table 2. Comparison of depressive symptoms, anxiety levels, and interstitial pneumonia incidence among pSS patients with varying degrees of 25(OH)D deficiency

组别	例数	抑郁		焦虑		间质性肺炎
组别	例数	有	无	有	无	有	无
25(OH)D缺乏	25	18(72.0)	7(28.0)	13(52.0)	12(48.0)	15(60.0)	10(40.0)
25(OH)D正常	33	5(15.2)	28(84.8)	12(36.4)	21(63.6)	6(18.2)	27(81.8)
χ²值		19.210		1.418		10.769
P值		< 0.001		0.234		0.001

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表 3 pSS患者合并抑郁影响因素的单因素和多因素logistic回归分析

Table 3. Univariate and multifactorial logistic regression analysis of influencing factors for depression in patients with pSS

变量	单因素			多因素
变量	OR值	95% CI	P值	OR值	95% CI	P值
25(OH)D	0.953	0.929~0.978	< 0.001	0.958	0.930~0.986	0.004
总球蛋白	1.107	1.021~1.201	0.014	0.999	0.907~1.101	0.983
IgG	1.323	1.122~1.560	0.001	1.268	1.026~1.567	0.028
间质性肺炎	3.152	1.033~9.614	0.044	0.940	0.200~4.416	0.937
注：因变量是否抑郁赋值为无抑郁=0，抑郁=1。自变量25(OH)D、总球蛋白、IgG均为连续性变量，以实际值赋值；间质性肺炎赋值为无间质性肺炎=0，间质性肺炎=1。

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表 4 pSS患者合并焦虑影响因素的单因素和多因素logistic回归分析

Table 4. Univariate and multifactorial logistic regression analysis of influencing factors for anxiety in patients with pSS

变量	单因素分析			多因素分析
变量	OR值	95% CI	P值	OR值	95% CI	P值
ESR	1.024	1.000~1.049	0.049	1.021	0.996~1.046	0.097
钾	3.060	1.125~8.324	0.029	2.754	0.976~7.770	0.056
注：因变量是否焦虑赋值为无焦虑=0，焦虑=1。自变量ESR、钾为连续性变量，以实际值赋值。

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