维生素D缺乏会增加南非克罗恩病患者中度至重度疾病活动的风险，通过哈维·布拉德肖指数衡量。

Vitamin D Deficiency Increases the Risk for Moderate to Severe Disease Activity in Crohn's Disease Patients in South Africa, Measured by the Harvey Bradshaw Index.

作者信息

Raffner Basson Abigail, Swart Rina, Jordaan Esme, Mazinu Mikatako, Watermeyer Gillian

机构信息

a Dietetics Department.

b Statistics and Population Studies Department.

出版信息

J Am Coll Nutr. 2016;35(2):163-74. doi: 10.1080/07315724.2015.1039665. Epub 2015 Oct 2.

DOI:10.1080/07315724.2015.1039665

PMID:26430776

Abstract

OBJECTIVE

Vitamin D has immunoregulatory properties and appears to influence disease outcomes in patients with Crohn's disease (CD). The primary aim of this study was to evaluate the association between vitamin D status and CD activity in South Africa.

METHODS

In a cross-sectional study performed between September 2011 and January 2013, serum 25-hydroxyvitamin D (25(OH)D) was measured in 186 consecutive patients with CD seen at 2 inflammatory bowel disease (IBD) centers and 199 healthy controls in the Western Cape, South Africa. Lifestyle and clinical variables were identified using an investigator-administered questionnaire, as well as clinical examination and patient case notes. Vitamin D status was evaluated in 2 ways: ≤ 20 ng/mL vs ≥ 21 ng/mL and ≤ 29 ng/mL vs ≥ 30 ng/mL. Disease activity was measured by the Harvey Bradshaw Index (HBI). Various 25(OH)D threshold concentrations for predicting a higher HBI score were also investigated.

RESULTS

On multiple log-binomial regression analysis, higher HBI scores and not having taken vitamin D supplementation in the 6 months prior to enrollment were identified as risk factors for vitamin D deficiency in patients with CD, defined either as ≤ 20 ng/mL or as ≤ 29 ng/mL (p < 0.03). Compared to patients with HBI < 5, those with HBI ≥ 8 were 2.5 times more likely to have 25(OH)D concentrations ≤ 21 ng/mL (prevalence risk [PR] = 2.5; 95% confidence interval [CI], 1.21-6.30). The risk was similar, though not as high, when defined as ≤ 29 ng/mL (PR = 2.0; 95% CI, 1.13-3.51). When vitamin D deficiency was defined as <20, <30, <40, and <50 ng/mL, the sensitivity and specificity obtained were 44.9% and 78.8%; 75.5% and 62.4%; 86.7% and 44.7%; and 92.9% and 23.5%, respectively (area under the curve = 0.71; p < 0.0001).

CONCLUSION

Low serum 25(OH)D was associated with increased CD activity in a South African cohort.

摘要

目的

维生素D具有免疫调节特性，似乎会影响克罗恩病（CD）患者的疾病转归。本研究的主要目的是评估南非维生素D状态与CD活动度之间的关联。

方法

在2011年9月至2013年1月进行的一项横断面研究中，对在南非西开普省的2个炎症性肠病（IBD）中心就诊的186例连续性CD患者及199例健康对照者检测了血清25-羟基维生素D（25(OH)D）。通过研究者填写的问卷、临床检查及患者病历确定生活方式和临床变量。维生素D状态通过两种方式评估：≤20 ng/mL与≥21 ng/mL，以及≤29 ng/mL与≥30 ng/mL。采用哈维·布拉德肖指数（HBI）测量疾病活动度。还研究了用于预测较高HBI评分的各种25(OH)D阈值浓度。

结果

在多对数二项回归分析中，较高的HBI评分以及在入组前6个月未补充维生素D被确定为CD患者维生素D缺乏的危险因素，维生素D缺乏定义为≤20 ng/mL或≤29 ng/mL（p<0.03）。与HBI<5的患者相比，HBI≥8的患者25(OH)D浓度≤21 ng/mL的可能性高2.5倍（患病风险[PR]=2.5；95%置信区间[CI]，1.21 - 6.30）。当定义为≤29 ng/mL时，风险相似但没那么高（PR = 2.0；95% CI，1.13 - 3.51）。当维生素D缺乏定义为<20、<30、<40和<50 ng/mL时，获得的敏感性和特异性分别为44.9%和78.8%；75.5%和62.4%；86.7%和44.7%；以及92.9%和23.5%（曲线下面积 = 0.71；p<0.0001）。