炎症性肠病患者维生素 C 缺乏的流行情况及其相关因素。
Prevalence and factors associated with vitamin C deficiency in inflammatory bowel disease.
机构信息
Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United States.
Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States.
出版信息
World J Gastroenterol. 2022 Sep 7;28(33):4834-4845. doi: 10.3748/wjg.v28.i33.4834.
BACKGROUND
Patients with inflammatory bowel disease (IBD) are prone to several nutritional deficiencies. However, data are lacking on vitamin C deficiency in Crohn's disease (CD) and ulcerative colitis (UC) patients, as well as the impact of clinical, biomarker and endoscopic disease severity on the development of vitamin C deficiency.
AIM
To determine proportions and factors associated with vitamin C deficiency in CD and UC patients.
METHODS
In this retrospective study, we obtained clinical, laboratory and endoscopic data from CD and UC patients presenting to the IBD clinic at a single tertiary care center from 2014 to 2019. All patients had an available plasma vitamin C level. Of 353 subjects who met initial search criteria using a cohort discovery tool, 301 ultimately met criteria for inclusion in the study. The primary aim described vitamin C deficiency (≤ 11.4 μmol/L) rates in IBD. Secondary analyses compared proportions with deficiency between active and inactive IBD. Multivariate logistic regression analysis evaluated factors associated with deficiency.
RESULTS
Of 301 IBD patients, 21.6% had deficiency, including 24.4% of CD patients and 16.0% of UC patients. Patients with elevated C-reactive protein (CRP) (39.1% 16.9%, < 0.001) and fecal calprotectin (50.0% 20.0%, = 0.009) had significantly higher proportions of deficiency compared to those without. Penetrating disease ( = 0.03), obesity ( = 0.02) and current biologic use ( = 0.006) were also associated with deficiency on univariate analysis. On multivariate analysis, the objective inflammatory marker utilized for analysis (elevated CRP) was the only factor associated with deficiency (odds ratio = 3.1, 95% confidence interval: 1.5-6.6, = 0.003). There was no difference in the presence of clinical symptoms of scurvy in those with vitamin C deficiency and those without.
CONCLUSION
Vitamin C deficiency was common in IBD. Patients with elevated inflammatory markers and penetrating disease had higher rates of vitamin C deficiency.
背景
炎症性肠病（IBD）患者易发生多种营养缺乏症。然而，关于克罗恩病（CD）和溃疡性结肠炎（UC）患者维生素 C 缺乏症的数据尚缺乏，并且关于临床、生物标志物和内镜疾病严重程度对维生素 C 缺乏症发展的影响的数据也缺乏。
目的
确定 CD 和 UC 患者中维生素 C 缺乏的比例和相关因素。
方法
在这项回顾性研究中，我们从 2014 年至 2019 年在一家三级护理中心的 IBD 诊所就诊的 CD 和 UC 患者中获得了临床、实验室和内镜数据。所有患者均有可用的血浆维生素 C 水平。使用队列发现工具对符合初步搜索标准的 353 名受试者进行筛选，最终有 301 名受试者符合纳入研究的标准。主要目的描述 IBD 患者中维生素 C 缺乏（≤11.4 μmol/L）的发生率。次要分析比较了活动期和非活动期 IBD 之间的缺乏比例。多变量逻辑回归分析评估了与缺乏相关的因素。
结果
在 301 名 IBD 患者中，21.6%存在缺乏，其中 CD 患者占 24.4%，UC 患者占 16.0%。C 反应蛋白（CRP）升高的患者（39.1%比 16.9%， < 0.001）和粪便钙卫蛋白升高的患者（50.0%比 20.0%， = 0.009）与无缺乏的患者相比，缺乏的比例明显更高。穿透性疾病（ = 0.03）、肥胖症（ = 0.02）和当前生物制剂的使用（ = 0.006）也是单变量分析中与缺乏相关的因素。多变量分析中，用于分析的客观炎症标志物（CRP 升高）是唯一与缺乏相关的因素（比值比=3.1，95%置信区间：1.5-6.6， < 0.001）。缺乏维生素 C 的患者与无缺乏的患者相比，临床症状的缺乏并无差异。
结论
维生素 C 缺乏在 IBD 中很常见。炎症标志物升高和穿透性疾病的患者维生素 C 缺乏症的发生率更高。
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