Bruzzese Vincenzo, Zullo Angelo, Picchianti Diamanti Andrea, Ridola Lorenzo, Lorenzetti Roberto, Marrese Cinzia, Scolieri Palma, De Francesco Vincenzo, Hassan Cesare, Migliore Alberto, Laganà Bruno
Medicina Interna, Reumatologia e Gastroenterologia, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153, Rome, Italy.
Allergy, Clinical Immunology and Rheumatology, 'Sapienza'University of Rome, S. Andrea University Hospital, Rome, Italy.
Intern Emerg Med. 2016 Sep;11(6):803-7. doi: 10.1007/s11739-016-1415-9. Epub 2016 Mar 3.
Vitamin D deficiency has been reported in patients with chronic inflammatory conditions, such as rheumatic and inflammatory bowel diseases (IBD). We evaluated the role of biologic therapy on vitamin D, calcium and parathormone (PTH) levels. This cross-sectional study enrolled consecutive patients with either rheumatic diseases or IBD who underwent an ambulatory visit. Patients receiving vitamin D/calcium supplementation were excluded. Vitamin D deficiency or insufficiency was diagnosed when values were <20 ng/mL and 21-29 ng/ml, respectively. Patients were sub-grouped according to biologic therapy. A multivariate analysis was performed. Two-hundred patients, including 136 with a rheumatic disease (M/F 37/99; mean age 60.7 ± 12.9 years) and 64 with IBD (M/F 41/23; Mean age 49.6 ± 13.1 years) were enrolled. Vitamin D deficiency/insufficiency was detected in as many as 63.5 % patients, being 61.8 and 67.2 % in patients with either rheumatic diseases or IBD, respectively. The prevalence of vitamin D deficiency/insufficiency was higher in those receiving biologics than other therapies (78.3 vs 43.2 %; p < 0.0001), in either rheumatic diseases (78.7 vs 41 %; p < 0.0001) or IBD (75 vs 50 %; p = 0.03) group. At multivariate analysis, only biologic therapy was independently associated with vitamin D deficit (OR 4.61; p = 0.001). Patients with vitamin D deficiency/insufficiency had hypocalcemia more frequently than controls (22.8 vs 10.9 %; p = 0.03), while PTH values did not differ significantly. This study finds that the prevalence of vitamin D deficiency/insufficiency was very high in patients with either rheumatic diseases or IBD receiving a biologic therapy.
据报道，慢性炎症性疾病患者，如风湿性疾病和炎症性肠病（IBD），存在维生素D缺乏的情况。我们评估了生物治疗对维生素D、钙和甲状旁腺激素（PTH）水平的作用。这项横断面研究纳入了连续接受门诊就诊的风湿性疾病或IBD患者。排除接受维生素D/钙补充剂的患者。当维生素D值分别<20 ng/mL和21 - 29 ng/ml时，诊断为维生素D缺乏或不足。患者根据生物治疗进行亚组划分。进行了多变量分析。共纳入200例患者，其中136例患有风湿性疾病（男/女37/99；平均年龄60.7±12.9岁），64例患有IBD（男/女41/23；平均年龄49.6±13.1岁）。多达63.5%的患者检测到维生素D缺乏/不足，其中风湿性疾病患者和IBD患者分别为61.8%和67.2%。接受生物制剂治疗的患者中维生素D缺乏/不足的患病率高于接受其他治疗的患者（78.3%对43.2%；p<0.0001），在风湿性疾病组（78.7%对41%；p<0.0001）和IBD组（75%对50%；p = 0.03）中均如此。多变量分析显示，只有生物治疗与维生素D缺乏独立相关（OR 4.61；p = 0.001）。维生素D缺乏/不足的患者比对照组更频繁地出现低钙血症（22.8%对10.9%；p = 0.03），而PTH值无显著差异。本研究发现，接受生物治疗的风湿性疾病或IBD患者中维生素D缺乏/不足的患病率非常高。
