炎症性肠病患者维生素D水平与临床相关因素及其对生活质量影响研究

发布时间：2018-04-30 18:58

本文选题：炎症性肠病 + 溃疡性结肠炎　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:调查炎症性肠病(IBD)患者血清25-羟维生素D(25OHD)水平,探讨影响维生素D水平的相关临床因素,并分析维生素D缺乏对疾病活动度和生活质量的影响。方法:纳入在安徽省立医院门诊及住院已确诊为IBD的患者194例,健康体检者100例,分为126例溃疡性结肠炎(UC)组、68例克罗恩病(CD)组、100例正常对照(NC)组,以电化学发光法检测血清25OHD水平。维生素D水平判断标准:缺乏(25OHD≤20ng/ml),不足(21-29ng/ml),充足(30-100ng/ml)。疾病诊断标准依据IBD诊断共识意见(2012年广州)。分析IBD患者血清25OHD水平与年龄、性别、身体质量指数(BMI)、平均日照时间、用药史、疾病行为、疾病部位、CRP的关系,比较不同疾病活动度IBD患者维生素D水平差异以及不同维生素D水平对生活质量的影响。结果:1)UC组血清25OHD水平为(14.65±6.32)ng/ml,92例(73%)患者存在维生素D缺乏;CD组血清25OHD水平为(10.75±3.21)ng/ml,62例(91.2%)患者存在维生素D缺乏;IBD组患者血清25OHD水平(13.59±6.13)ng/ml,154例(79.4%)患者存在维生素D缺乏;NC组血清25OHD水平为(19.27±6.39)ng/ml,59例(59%)患者存在维生素D缺乏。UC组、CD组以及IBD组血清25OHD水平均低于NC组,维生素D缺乏率均高于NC组(P均0.05)。2)UC组中平均日照时间30min/d患者血清25OHD水平较平均日照时间≥30min/d者偏低[(13.61±4.68)ng/ml vs(16.01±7.79)ng/ml],应用激素治疗者血清25OHD水平较未应用激素治疗者偏低[(13.10±5.83)ng/ml vs(15.71±6.45)ng/ml](P均0.05);UC患者血清25OHD水平与BMI呈显著正相关(rp=0.486,P0.05),与CRP呈显著负相关(rs=-0.482,P0.05),与年龄、性别、病程、是否初发型、疾病范围无关(P均0.05);CD组中平均日照时间30min/d患者血清25OHD水平较平均日照时间≥30min/d者偏低[(8.67±4.22)ng/ml vs(12.59±5.21)ng/ml]、应用激素者较未应用激素者偏低[(9.91±5.37)ng/ml vs(13.12±4.69)ng/ml]、未用过英夫利昔单抗治疗者较应用英夫利昔单抗治疗者偏低[(9.27±3.55)ng/ml vs(12.97±5.61)ng/ml](P均0.05);CD患者血清25OHD水平与BMI呈显著正相关(rp=0.486,P0.05),与CRP呈显著负相关(rs=-0.504,P0.05),与年龄、性别、病程、疾病行为、是否累及小肠、是否应用免疫抑制剂无关(P均0.05)。3)UC组及CD组血清25OHD水平均随疾病活动度的升高而逐渐降低(P均0.05)。UC组血清25OHD水平与Mayo评分呈负相关(rs=-0.622,P0.05),CD组血清25OHD水平与CDAI评分呈负相关(rs=-0.318,P0.05)。4)UC组中维生素D缺乏者的IBDQ总分以及肠道症状、全身症状、情感功能、社会功能四个维度的评分均显著低于非维生素D缺乏者,结果依次为[(161.60±29.49)vs(188.85±22.83),(50.33±12.52)vs(61.79±7.28),(24.73±4.73)vs(27.64±4.48),(59.80±13.31)vs(69.50±10.14),(26.80±5.78)vs(29.91±4.80)],UC组血清25OHD水平与IBDQ总分以及4个维度评分均呈显著正相关(P均0.05);CD组中维生素D缺乏者的IBDQ总分以及肠道症状、全身症状、情感功能、社会功能四个维度的评分均显著低于非维生素D缺乏者,结果依次为[(178.71±11.83)vs(195.00±11.62),(61.52±5.53)vs(64.17±1.47),(24.10±3.31)vs(27.50±2.74),(68.58±7.44)vs(75.33±6.12),(22.92±3.98)vs(28.00±3.46)](P均0.05),CD组血清25OHD水平与IBDQ总分以及4个维度评分均呈显著正相关(P均0.05)。结论:1)IBD患者普遍存在维生素D缺乏,CD患者较UC患者更加明显。2)平均日照时间短、应用激素可能是维生素D水平下降的影响因素;BMI在一定范围内增高、生物制剂英夫利昔治疗可能有助于维生素D水平提高。3)维生素D缺乏可能对IBD患者的疾病活动以及生活质量有影响。4)未发现IBD患者血清25OHD水平与年龄、性别、病程、疾病行为、疾病范围、疾病部位、是否使用免疫抑制剂等因素有关。
[Abstract]:Objective: To investigate the serum levels of 25- hydroxyvitamin D (25OHD) in patients with inflammatory bowel disease (IBD), to explore the related clinical factors affecting the level of vitamin D, and to analyze the effect of vitamin D deficiency on the degree of activity and quality of life. Methods: 194 patients who had been diagnosed with IBD in the outpatient department of Anhui Provincial Hospital and 100 cases of healthy physical examination were included. For 126 cases of ulcerative colitis (UC), 68 cases of Crohn's disease (CD) and 100 normal controls (NC), the level of serum 25OHD was detected by electrochemiluminescence. The standard of vitamin D was judged: deficiency (25OHD < 20ng/ml), insufficiency (21-29ng/ml) and sufficient (30-100ng/ml). The diagnostic criteria of the disease were based on the consensus opinion of IBD (2012). The analysis of IBD patients Serum 25OHD levels were related to age, sex, body mass index (BMI), average sunshine time, drug history, disease behavior, location of disease, CRP, and the difference of vitamin D levels in IBD patients with different disease activity and the effect of different vitamin D levels on the quality of life. Results: 1) the serum 25OHD level of UC group was (14.65 + 6.32) ng/ml, 92 cases (73%) The patients had vitamin D deficiency; the serum 25OHD level of CD group was (10.75 + 3.21) ng/ml, 62 cases (91.2%) had vitamin D deficiency; the serum 25OHD level (13.59 + 6.13) ng/ml in group IBD patients and 154 cases (79.4%) had vitamin D deficiency; the 25OHD level of NC group was (19.27 + 6.39) ng/ml, 59 cases (59%) patients had vitamin deficiency deficiency group. The level of serum 25OHD in IBD group was lower than that in group NC, and the rate of vitamin D deficiency was higher than that in group NC (P 0.05).2) the average sunshine time in the UC group was lower than that of the average sunshine time > 30min/d (13.61 + 4.68) ng/ml (16.01 + 7.79). [(13.10 + 5.83) ng/ml vs (15.71 + 6.45) ng/ml] (P 0.05); the serum 25OHD level of patients with UC was significantly positively correlated with BMI (rp=0.486, P0.05), and was negatively correlated with CRP (rs=-0.482, P0.05). It was not related to age, sex, course of disease, initial hairstyle, and the range of disease (0.05). The low [(8.67 + 4.22) ng/ml vs (12.59 + 5.21) ng/ml]] were lower than those of 30min/d (9.91 + 5.37) ng/ml vs (13.12 + 4.69) ng/ml], and those who did not use infliximab were lower than those with infliximab (9.27 + 3.55) ng/ml vs (12.97 + 5.61) ng/ml] (P all 0.05); There was a significant positive correlation between D and BMI (rp=0.486, P0.05), and a significant negative correlation with CRP (rs=-0.504, P0.05), with age, sex, course of disease, disease behavior, whether the use of immunosuppressive agents was not related to the use of immunosuppressive agents (P 0.05).3) and CD group serum 25OHD levels gradually decreased with the increase of disease activity (0.05) The score of Mayo was negatively correlated (rs=-0.622, P0.05), and the level of serum 25OHD in CD group was negatively correlated with CDAI score (rs=-0.318, P0.05). The score of four dimensions of IBDQ total and intestinal symptoms, systemic symptoms, emotional function and social function in the UC group were significantly lower than those of non vitamin deficiency, and the result was [(161.60 + 29.49). ) vs (188.85 + 22.83), (50.33 + 12.52) vs (61.79 + 7.28), (24.73 + 4.73) vs (27.64 + 4.48), (59.80 + 13.31) vs (69.50 +%), vs (7.28) and IBDQ total score and dimension score (P all); the total IBDQ total score of vitamin D in the CD group and intestinal symptoms and systemic symptoms in the CD group The scores of four dimensions of emotional function and social function were significantly lower than those of non vitamin D deficiency, and the results were (178.71 + 11.83) vs (195 + 11.62), (61.52 + 5.53) vs (64.17 + 1.47), (24.10 + 3.31) vs (27.50 + 2.74), vs vs (P all), and CD group serum 25OHD level and IBDQ total score And the score of 4 dimensions showed significant positive correlation (P 0.05). Conclusion: 1) IBD patients generally have vitamin D deficiency, CD patients are more obvious than UC patients, the average sunshine time is shorter, the use of hormone may be the influence factor of the decrease of vitamin D level; BMI in a certain range, the biological agent inflixime therapy may contribute to vitamin D water. .3) vitamin D deficiency may affect the activity of disease and the quality of life of IBD patients with.4). The serum 25OHD level of patients with IBD is not found to be related to age, sex, course of disease, disease behavior, disease area, location of disease, and the use of immunosuppressive agents.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574

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