Department of Medicine, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
Dig Dis Sci. 2013 Jun;58(6):1698-702. doi: 10.1007/s10620-012-2531-7. Epub 2013 Jan 19.
Previous studies on experimental mouse models have suggested a role of vitamin D in immune system regulation and IBD disease severity. In this study, we examine the relationship between vitamin D levels and clinical disease activity in human subjects with ulcerative colitis (UC). We hypothesized that patients with vitamin D deficiency will display increased UC disease activity as compared to patients with normal vitamin D levels.
A cross-sectional study was performed by querying the outpatient electronic medical record of our health system for patients seen in the gastroenterology clinic from January 2007 to October 2009 who carried both a diagnosis of UC and a documented 25-OH vitamin D level within 30 days of their clinic visit. Demographic and clinical variables were collected. Clinical disease activity was calculated using the six-point partial Mayo index. Active disease was defined as a six-point index score of ≥ 1. Vitamin D deficiency was defined as a 25-OH D level below 30 ng/ml. Data were analyzed using the chi-square distribution test.
Thirty-four patients met inclusion criteria (53 % female, mean age 45.7 ± 24.7 years). Fifteen patients had normal vitamin D levels and 19 patients were vitamin D deficient. Twelve patients had vitamin D levels <20 ng/ml. Vitamin D deficient patients were statistically more likely to have increased disease activity than patients with normal vitamin D levels (p = 0.04), with 68 % of deficient patients displaying active disease compared with 33 % in the sufficient group. There was also a statistically significant association between vitamin D status and need for treatment with steroids, with a higher percentage of vitamin D deficient patients (47 %) requiring such treatment compared with 7 % in the sufficient group (p = 0.02). There was no association between season of visit and disease activity.
Vitamin D deficiency is common among patients with active UC, particularly those requiring corticosteroids. Further investigation is needed to determine the clinical utility of vitamin D monitoring in patients with UC and whether there is a role for vitamin D as a treatment for UC.
先前的实验性小鼠模型研究表明维生素 D 在免疫系统调节和 IBD 疾病严重程度中发挥作用。在本研究中，我们检查了溃疡性结肠炎 (UC) 患者的维生素 D 水平与临床疾病活动之间的关系。我们假设与维生素 D 水平正常的患者相比，维生素 D 缺乏症患者的 UC 疾病活动会增加。
通过查询我们的医疗系统门诊电子病历，对 2007 年 1 月至 2009 年 10 月在胃肠病学诊所就诊的同时患有 UC 诊断且在就诊后 30 天内有记录的 25-OH 维生素 D 水平的患者进行了一项横断面研究。收集了人口统计学和临床变量。使用六点部分 Mayo 指数计算临床疾病活动。活动疾病定义为六点指数评分≥1。维生素 D 缺乏症定义为 25-OH D 水平低于 30ng/ml。使用卡方分布检验分析数据。
34 名患者符合纳入标准（53%为女性，平均年龄 45.7 ± 24.7 岁）。15 名患者维生素 D 水平正常，19 名患者维生素 D 缺乏。12 名患者的 25-OH D 水平<20ng/ml。维生素 D 缺乏症患者的疾病活动度明显高于维生素 D 水平正常的患者（p=0.04），缺乏症患者中有 68%的患者出现活动疾病，而充足组中有 33%的患者出现活动疾病。维生素 D 状态与需要类固醇治疗之间也存在统计学显著关联，缺乏维生素 D 的患者（47%）需要此类治疗的比例明显高于充足组（7%）（p=0.02）。就诊季节与疾病活动度之间无关联。
活动期 UC 患者维生素 D 缺乏症很常见，尤其是需要皮质类固醇治疗的患者。需要进一步研究以确定监测 UC 患者的维生素 D 水平的临床效用，以及维生素 D 是否可作为 UC 的治疗方法。
