血清维生素D水平与克罗恩病活动度的关系

发布时间：2018-06-25 21:45

  本文选题：克罗恩病 + 维生素D　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:探究血清维生素D水平和克罗恩病的疾病活动度之间的相关性。方法:回顾性分析2014年3月—2016年2月住院克罗恩病患者组(病例组)和同期健康对照组(对照组)的血清25(0H)D的水平差异。在病例组,分析治疗前血清25(0H)D水平分别与各种疾病活动度指标间的相关性;同时分析治疗前后疾病活动度变化与血清25(OH)D水平变化之间的相关性。在克罗恩病活动度指标的选取上,此研究选取了具有代表性的体重指数(Body Mass Index,BMI)、克罗恩病活动指数(Crohn's disease activity index,CDAI)、超敏 C 反应蛋白(c-reactive protein,CRP)及血沉等指标。最后使用ROC曲线探索血清25(0H)D水平作为一个评估克罗恩病活动的临床指标的具体分界值。结果:246例住院克罗恩病患者血清25(OH)D水平比40例健康组要低(中位数19.9 nmol/Lvs49.9nmol/L,p0.01)。在病例组,血清25(OH)D水平与活动度指标包括CDAI(r=-0.582,p0.01)、CRP(r=-0.334,p0.01)、ESR(r=-0.313,p0.01)、BM(r=-0.216,p0.01)均呈负相关;对最具代表性的活动度指标CDAI评分进行分层,血清25(OH)D水平随着克罗恩病活动度的增加而降低[缓解期(中位数39.7 nmol/L)、轻度活动期(中位数29.7nmol/L)、中度活动期(中位数16.1nmol/L)、重度活动期(中位数7.5 nmol/L),P0.01]也呈现负相关。克罗恩病患者治疗后,血清 25(OH)D 水平(治疗前 vs 后:15.4 nmol/L±6.6vs34.3 nmol/L±12.6,p0.01)随着CDAI水平明显下降(治疗前vs后:321±92vs1 80±63,p0.01)反而明显上升,同样呈现负相关。最后根据CDAI评分,通过ROC曲线探索血清25(OH)D水平在克罗恩病的缓解期与活动期的临床分界值为23.7nmol/L(AUCs大小为0.842,p0.01)。结论:住院克罗恩病患者25(OH)D水平比健康组要低且25(OH)D水平与疾病活动度呈负相关。25(OH)D水平可能可以作为一个克罗恩病活动的临床指标,具体的分界值需要更大样本的验证。
[Abstract]:Objective: to investigate the correlation between serum vitamin D levels and disease activity of Crohn's disease. Methods: the levels of serum 25 (0H) D in patients with Crohn's disease (case group) and healthy control group (control group) from March 2014 to February 2016 were analyzed retrospectively. In the case group, the correlation between serum 25 (0H) D level and various disease activity indexes before and after treatment was analyzed, and the correlation between disease activity change and serum 25 (OH) D level before and after treatment was analyzed. In the selection of the activity index of Crohn's disease, the representative indexes of body mass index (BMI), Crohn's disease activity index (CDAI), high sensitive C-reactive protein (c-reactive) and erythrocyte sedimentation rate (ESR) were selected in this study. Finally, the ROC curve was used to explore the specific threshold of serum 25 (0H) D level as a clinical marker for evaluating Crohn's disease activity. Results the serum 25 (OH) D levels of 246 patients with Crohn's disease were lower than those of 40 healthy controls (median 19.9 nmol / L vs 49.9 nmol / L P 0.01). In the case group, the serum 25 (OH) D level was negatively correlated with the activity index, including CDAI (r-0.582p0.01) CRP (r-0.334p0.01) and ESR (r-0.313p0.01) BM (r-0.216p0.01), and the most representative activity index CDAI score was stratified. Serum 25 (OH) D levels decreased with the increase of Crohn's disease activity [remission period (median 39.7 nmol / L), mild active phase (median 29.7 nmol / L), moderate active phase (median 16.1 nmol / L), severe active phase (median 7.5 nmol / L) P 0.01]. After treatment with Crohn's disease, serum 25 (OH) D level (pre-treatment vs post-treatment: 15.4nmol / L 卤6.6vs34.3 nmol-L 卤12.6p0.01) increased significantly with the decrease of CDAI level (pre-treatment vs post-treatment: 321 卤92vs1 80 卤63p0.01), and also showed a negative correlation. Finally, according to the CDAI score, the clinical threshold of serum 25 (OH) D level in remission and active stage of Crohn's disease was found to be 23.7nmol / L (AUCs 0.842 / p0.01) by ROC curve. Conclusion: the level of 25 (OH) D in the patients with Crohn's disease is lower than that in the healthy group, and the level of 25 (OH) D is negatively correlated with the disease activity. 25 (OH) D level may be used as a clinical index of Crohn's disease activity.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62
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本文编号：2067617