Raftery Tara, Merrick Megan, Healy Martin, Mahmud Nasir, O'Morain Colm, Smith Sinead, McNamara Deirdre, O'Sullivan Maria
Department of Medicine, Trinity Centre for Health Science, St. James's Hospital, Dublin, Ireland.
Dig Dis Sci. 2015 Aug;60(8):2427-35. doi: 10.1007/s10620-015-3620-1. Epub 2015 Mar 11.
Vitamin D, as potential immune modulator, has been implicated as an environmental risk factor for Crohn's disease (CD). Vitamin D status may be associated with disease risk, severity, activity, and progression. While associations between circulating 25OHD and markers of disease activity and inflammation in CD have been reported, the results are inconsistent.
To determine the association between vitamin D status and markers of disease activity and inflammation in CD.
One hundred and nineteen CD patients' active and inactive diseases were enrolled in the cross-sectional study. Subject demographics and clinical data were collected. A serum sample was collected for 25OHD and CRP analysis, and a stool sample was collected for fecal calprotectin (FC) measurement.
The mean serum 25OHD concentration of the group was 59.8 (24.9) nmol/L. After controlling for confounding variables, serum 25OHD inversely correlated with FC (r = -0.207, P = 0.030), particularly among those in clinical remission (r = -0.242, P = 0.022). The association between FC and 25OHD was further confirmed by linear regression (r = 31.3 %, P < 0.001). FC was lower in patients with 25OHD levels ≥75 nmol/L compared with levels <25 nmol/L [FC: 32.2 (16.3-98.2) vs 100.0 (34.4-213.5) μg/g, P = 0.004]. In the current study, however, 25OHD was not significantly associated with either CRP or CDAI.
Circulating 25OHD was significantly inversely associated with intestinal inflammation as determined by FC in CD. Subgroup analysis confirmed the association among those in clinical remission, but not in those with active disease. 25OHD was not associated with disease activity score (CDAI) or systemic inflammation (CRP). Vitamin D intervention studies are warranted to determine whether raising serum 25OHD levels in patients with CD may reduce intestinal inflammation as measured by FC.
维生素D作为潜在的免疫调节剂，被认为是克罗恩病（CD）的一种环境风险因素。维生素D状态可能与疾病风险、严重程度、活动度及进展相关。虽然已有关于循环25羟维生素D（25OHD）与CD疾病活动及炎症标志物之间关联的报道，但结果并不一致。
确定维生素D状态与CD疾病活动及炎症标志物之间的关联。
119例CD患者（包括疾病活动期和非活动期）纳入这项横断面研究。收集受试者人口统计学和临床数据。采集血清样本用于25OHD和CRP分析，采集粪便样本用于粪便钙卫蛋白（FC）测定。
该组血清25OHD平均浓度为59.8（24.9）nmol/L。在控制混杂变量后，血清25OHD与FC呈负相关（r = -0.207，P = 0.030），尤其在临床缓解患者中（r = -0.242，P = 0.022）。线性回归进一步证实了FC与25OHD之间的关联（r = 31.3%，P < 0.001）。25OHD水平≥75 nmol/L的患者FC低于<25 nmol/L的患者[FC：32.2（16.3 - 98.2）vs 100.0（34.4 - 213.5）μg/g，P = 0.004]。然而，在本研究中，25OHD与CRP或CDAI均无显著关联。
循环25OHD与CD中由FC测定的肠道炎症显著负相关。亚组分析证实了临床缓解患者中的这种关联，但活动期疾病患者中未证实。25OHD与疾病活动评分（CDAI）或全身炎症（CRP）无关。有必要开展维生素D干预研究，以确定提高CD患者血清25OHD水平是否可降低由FC测定的肠道炎症。
