摘要
目的:探讨干燥综合征(SS)患者血清微量元素水平变化及其与疾病严重程度的关系。方法:收集2022年10月至2023年8月于首都医科大学附属北京同仁医院眼科中心就诊的干眼患者65例(65只眼)。其中，男性5例(5只眼)，女性60例(60只眼)，年龄39~75岁，平均(54.3±18.4)岁。根据美国风湿病学会和欧洲风湿病联盟(ACR－EULAR)分类标准分为SS组和对照组。全部患者均进行眼表疾病指数(OSDI)评分和ACR－EULAR评分，检测下睑中央泪河高度(TMH)和泪膜破裂时间(TBUT)，化学试验检测铜、锌、铁、钙及镁等血清微量元素。年龄、OSDI评分、TMH、TBUT、泪液分泌试验(ST)、眼表染色评分(OSS)及血清微量元素浓度等均服从正态分布，采用±s进行描述，组间比较采用独立样本t检验。性别采用例数描述，组间比较采用卡方检验。血清微量元素浓度与OSDI评分、TMH、TBUT、ST及OSS之间的相关性采用Pearson分析，与抗干燥综合征A抗体、抗干燥综合征B抗体、类风湿因子(RF)、抗核抗体(ANA)、唇腺活检及唾液腺流率之间的相关性采用Spearman分析。结果:SS组和对照组患者血清铜水平分别为(1.67±0.32)μg/ml和(1.12±0.51)μg/ml，SS组血清铜浓度高于对照组，差异有统计学意义(t＝2.817，P<0.05)。SS组和对照组患者血清锌水平分别为(0.88±0.15)μg/ml和(0.99±0.13)μg/ml，SS组血清锌浓度低于对照组，差异有统计学意义(t＝－2.245，P<0.05)。SS组和对照组患者血清铁水平分别为(0.87±0.12)μg/ml和(1.04±0.24)μg/ml，SS组血清铁浓度低于对照组，差异有统计学意义(t＝－2.087，P<0.05)。SS组和对照组患者血清钙水平分别为(77.22±12.15)μg/ml和(92.07±15.42)μg/ml，SS组血清钙浓度低于对照组，差异有统计学意义(t＝－2.312，P<0.05)。SS组和对照组患者血清镁水平分别为(17.33±2.12)μg/ml和(20.51±3.14)μg/ml，SS组血清镁浓度低于对照组，差异有统计学意义(t＝－3.507，P<0.05)。血清铜与唇腺活检及OSDI呈正相关，其相关性具有统计学意义(r＝0.325，0.389；P<0.05)；与ST、TMH及TBUT呈负相关，其相关性具有统计学意义(r＝－0.471，－0.340，－0.408；P<0.05)。血清钙与OSS及TBUT呈负相关，其相关性具有统计学意义(r＝－0.389，－0.428；P<0.05)。血清镁与ST、唾液腺流率、TMH及TBUT呈正相关，其相关性具有统计学意义(r＝0.316，0.405，0.322，0.479；P<0.05)；与抗干燥综合征A抗体、RF、唇腺活检、OSS及OSDI呈负相关，其相关性具有统计学意义(r＝－0.351，－0.324，－0.429，－0.298，－0.422；P<0.05)。血清铁与唇腺活检及OSS呈负相关，其相关性具有统计学意义(r＝－0.320，－0.356；P<0.05)。结论:血清微量元素水平与SS疾病的严重程度相关，监测微量元素的变化有助于了解疾病的严重程度并指导治疗。
Abstract
Objective:To investigate the levels of serum trace element in patients with Sjögren′s Syndrome (SS) and its correlations with the severity of SS.Methods:Sixty-five dry eye patients (65 eyes) registered the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from October 2022 to August 2023 were selected. Among them, there were 5 males (5 eyes) and 60 females (60 eyes), aged 39 to 75 years, with an average age of (54.3±18.4) years. According to the classification standards of the American Rheumatology Society and the European Rheumatology Alliance (ACR-EULAR), they were divided into SS group and the control group. All patients were scored with the eye surface disease index (OSDI) and ACR-EULAR scores, and the central tear river height (TMH) and tear film rupture time (TBUT) of the lower eyelid were measured. The serum trace elements such as copper, zinc, iron, calcium, and magnesium were detected by chemical tests. Age, OSDI score, TMH, TBUT, tear secretion test (ST), eye surface staining score (OSS), and serum trace element concentration conforming to normal distribution were described by ±s, and compared by independent sample t test for groups. Gender was described using case numbers, and compared by chi square tests. The correlation between serum trace element concentrations and OSDI scores, TMH, TBUT, ST, and OSS was analyzed using Pearson analysis. The correlation between serum trace element concentrations and anti Sjogren′s syndrome A antibodies, anti Sjogren′s syndrome B antibodies, rheumatoid factor (RF), antinuclear antibodies (ANA), labial gland biopsy, and salivary gland flow rate was analyzed using Spearman analysis.Results:The serum copper levels in SS group and control group were (1.67±0.32)μg/ml and (1.12±0.51) μg/ml, respectively; the former concentration was higher than the latter. There was a statistically significant difference in the serum copper levels between groups (t=2.817, P<0.05). The serum zinc levels of patients in SS group and control group were (0.88±0.15)μg/ml and (0.99±0.13)μg/ml, respectively; the former concentration was lower than the latter. There was a statistically significant difference in the serum copper levels between groups (t=-2.245, P<0.05). The serum iron levels of patients in SS group and control group were (0.87±0.12)μg/ml and (1.04±0.24) μg/ml, respectively; the former concentration was lower than the latter. There was a statistically significant difference in the serum iron levels between groups (t=-2.087, P<0.05). The serum calcium levels of patients in SS and control group were (77.22±12.15)μg/ml and (92.07±15.42) μg/ml, respectively; the former concentration was lower than the latter. There was a statistically significant difference in the serum calcium levels between groups (t=-2.312, P<0.05). The serum magnesium levels in SS group and control group were (17.33±2.12)μg/ml and (20.51±3.14) μg/ml, respectively; the former concentration was lower than the latter. There was a statistically significant difference in the serum magnesium levels between groups (t=-3.507, P<0.05). Serum copper was positively correlated with labial gland biopsy and OSDI, and the correlation was statistically significant (r=0.325, 0.389; P<0.05). There was a negative correlation with ST, TMH, and TBUT, and the correlation was statistically significant (r=-0.471, -0.340, -0.408; P<0.05). Serum calcium was negatively correlated with OSS and TBUT, and the correlation was statistically significant (r=-0.389, -0.428; P<0.05). Serum magnesium was positively correlated with ST, salivary gland flow rate, TMH, and TBUT, and the correlation was statistically significant (r=0.316, 0.405, 0.322, 0.479; P<0.05). There was a negative correlation with anti Sjogren′s syndrome A antibodies, RF, labial gland biopsy, OSS, and OSDI, and the correlation was statistically significant (r=-0.351, -0.324, -0.429, -0.298, -0.422; P<0.05). Serum iron was negatively correlated with lip gland biopsy and OSS, and the correlation was statistically significant (r=-0.320, -0.356; P<0.05).Conclusions:The levels of trace element were related to the severity of SS, monitoring changes in trace elements can help understand the severity of the disease and guide treatment.
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