Del Pinto Rita, Pietropaoli Davide, Chandar Apoorva K, Ferri Claudio, Cominelli Fabio
*Division of Internal Medicine, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy; †Division of Gastroenterology and Liver Disease, Case Western Reserve University, Cleveland, Ohio; ‡Division of Dentistry, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy; and §Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
Inflamm Bowel Dis. 2015 Nov;21(11):2708-17. doi: 10.1097/MIB.0000000000000546.
Vitamin D plays a role in several immune-mediated diseases, but its association with inflammatory bowel disease (IBD) is unclear. We conducted a systematic review and meta-analysis to assess the association between IBD and vitamin D deficiency.
We searched electronic databases from inception to December 2014 for observational studies reporting the presence of vitamin D deficiency (defined as serum 25-hydroxycholecalciferol [25(OH)D] level of ≤20 ng/mL) in IBD patients and having a control group without IBD. Odds ratios (ORs) were combined using a random-effects model. Meta-regression was performed using latitude as a moderator. Study quality was assessed using the Newcastle-Ottawa scale.
Out of 816 citations, 14 eligible studies were identified, comprising 1891 participants (938 IBD cases and 953 controls). Meta-analysis showed that patients with IBD had 64% higher odds of vitamin D deficiency when compared with controls (OR = 1.64; 95% confidence interval, 1.30-2.08; I = 7%; P < 0.0001). Patients with ulcerative colitis had more than double the odds of vitamin D deficiency when compared with normal controls (OR = 2.28; 95% confidence interval, 1.18-4.41; I = 41%; P = 0.01). Latitude did not influence the association between IBD and vitamin D deficiency (P = 0.34). Generalizability of our results might be limited as we summarized unadjusted ORs, because of nonavailability of adjusted ORs in individual studies.
IBD is significantly associated with having higher odds of vitamin D deficiency. Well-designed randomized controlled trials and longitudinal studies are needed to further explain the role of vitamin D in IBD pathogenesis and its therapy.
维生素D在多种免疫介导性疾病中发挥作用，但其与炎症性肠病（IBD）的关联尚不清楚。我们进行了一项系统评价和荟萃分析，以评估IBD与维生素D缺乏之间的关联。
我们检索了从数据库建立至2014年12月的电子数据库，查找报告IBD患者中维生素D缺乏（定义为血清25-羟胆钙化醇[25(OH)D]水平≤20 ng/mL）情况且设有无IBD对照组的观察性研究。使用随机效应模型合并比值比（OR）。以纬度作为调节变量进行荟萃回归分析。使用纽卡斯尔-渥太华量表评估研究质量。
在816篇文献中，确定了14项符合条件的研究，共1891名参与者（938例IBD病例和953名对照）。荟萃分析显示，与对照组相比，IBD患者维生素D缺乏的几率高64%（OR = 1.64；95%置信区间，1.30 - 2.08；I² = 7%；P < 0.0001）。与正常对照组相比，溃疡性结肠炎患者维生素D缺乏的几率增加了一倍多（OR = 2.28；95%置信区间，1.18 - 4.41；I² = 41%；P = 0.01）。纬度并未影响IBD与维生素D缺乏之间的关联（P = 0.34）。由于各研究中未提供调整后的OR，我们汇总的是未调整的OR，因此我们结果的可推广性可能有限。
IBD与维生素D缺乏几率较高显著相关。需要设计良好的随机对照试验和纵向研究，以进一步解释维生素D在IBD发病机制及其治疗中的作用。
