维生素D状态与克罗恩病的关系：观察性研究的荟萃分析

Vitamin D status in relation to Crohn's disease: Meta-analysis of observational studies.

作者信息

Sadeghian Mehdi, Saneei Parvane, Siassi Fereydoun, Esmaillzadeh Ahmad

机构信息

Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Nutrition. 2016 May;32(5):505-14. doi: 10.1016/j.nut.2015.11.008. Epub 2015 Dec 22.

DOI:10.1016/j.nut.2015.11.008

PMID:26837598

Abstract

OBJECTIVES

Inconsistent findings have been published regarding vitamin D status among patients with Crohn's disease (CD) and the association with disease severity. We aimed to perform a meta-analysis evaluating serum 25-hydroxy vitamin D and 1,25 dehydroxyvitamin D among CD patients compared with healthy and non-healthy controls, the prevalence of vitamin D deficiency, and the association with disease.

METHODS

We searched MEDLINE, SCOPUS, EMBASE, and Google Scholar up to March 2015 for observational studies assessing serum vitamin D levels in CD patients. A total of 63 studies were included in the following four meta-analyses: 1) a meta-analysis on the mean difference of 25(OH)D levels in CD patients compared with healthy (number of studies = 27) and non-healthy (n = 25) controls; 2) a meta-analysis on the mean difference of 1,25(OH)2 D3 levels in CD patients compared with healthy (n = 7) and non-healthy (n = 8) controls; 3) a meta-analysis on the prevalence of vitamin D deficiency (n = 34); 4) a meta-analysis on the correlation coefficients between vitamin D status severity of CD (n = 6). Subgroup analysis and meta-regression were used to discover possible sources of between-study heterogeneity.

RESULTS

It was found that CD patients had lower levels of 25(OH)D compared with healthy (-3.99 ng/mL; 95% confidence interval [CI]: -5.91 to -2.08) but not non-healthy controls (-1.07 ng/mL; 95% CI: -2.84 to 0.70). There was also no significant mean difference for 1,25(OH)2 D3 for both healthy and non-healthy controls. Meta-analysis on the prevalence of vitamin D deficiency showed an overall prevalence of 57.7% (95% CI: 0.502-0.649). An inverse association was observed between serum vitamin D and severity of CD (-0.36; 95% CI: -0.48 to -0.24). Meta-regression showed that mean levels of 25(OH)D were decreased 0.09 for each unit change of latitude among CD patients compared with healthy controls (B = -0.09, P = 0.004, I(2) residual = 86.08%).

CONCLUSIONS

We found that patients with Crohn's disease had lower serum 25(OH)D concentrations compared with their healthy counterparts, and more than half of them have hypovitaminosis D. Moreover, there was an inverse correlation between circulating 25(OH)D concentrations and severity of Crohn's disease.

摘要

目的

关于克罗恩病（CD）患者的维生素D状态及其与疾病严重程度的关联，已有不一致的研究结果发表。我们旨在进行一项荟萃分析，评估CD患者与健康及非健康对照相比血清25-羟基维生素D和1,25-二羟基维生素D水平、维生素D缺乏的患病率以及与疾病的关联。

方法

我们检索了截至2015年3月的MEDLINE、SCOPUS、EMBASE和谷歌学术，以查找评估CD患者血清维生素D水平的观察性研究。共有63项研究纳入以下四项荟萃分析：1）CD患者与健康对照（研究数量=27）和非健康对照（n=25）相比血清25(OH)D水平均值差异的荟萃分析；2）CD患者与健康对照（n=7）和非健康对照（n=8）相比血清1,25(OH)2D3水平均值差异的荟萃分析；3）维生素D缺乏患病率的荟萃分析（n=34）；4）维生素D状态与CD严重程度之间相关系数的荟萃分析（n=6）。采用亚组分析和荟萃回归来发现研究间异质性的可能来源。

结果

发现CD患者与健康对照相比25(OH)D水平较低（-3.99 ng/mL；95%置信区间[CI]：-5.91至-2.08），但与非健康对照相比无差异（-1.07 ng/mL；95%CI：-2.84至0.70）。健康和非健康对照的1,25(OH)2D3水平均值差异也均无统计学意义。维生素D缺乏患病率的荟萃分析显示总体患病率为57.7%（�5%CI：0.502-0.649）。观察到血清维生素D与CD严重程度呈负相关（-0.36；95%CI：-0.48至-0.24）。荟萃回归显示，与健康对照相比，CD患者中纬度每变化一个单位，25(OH)D平均水平降低0.09（B=-0.09，P=0.004，I(2)残差=86.08%）。