Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha.
Centre for Global Health, Zhejiang University, Hangzhou.
Int J Surg. 2024 Jul 1;110(7):4275-4285. doi: 10.1097/JS9.0000000000001369.
Although the beneficial properties of vitamin D in anti-inflammation and immunity-modulation are promising in the management of inflammatory bowel disease (IBD), data were limited for the critical IBD prognosis. The association between serum vitamin D levels and the risk of bowel resection in individuals with IBD remains largely unknown.
The authors performed a longitudinal cohort study among 5474 individuals with IBD in the UK Biobank. Serum 25-hydroxyvitamin D [25(OH)D] was measured using direct competitive chemiluminescent immunoassay. Bowel resection events were ascertained via national inpatient data. Multivariable-adjusted Cox proportional hazard regression was used to examine the association between serum 25(OH)D and bowel resection risk, presented with hazard ratios (HRs) and 95% CIs. Restricted cubic spline (RCS) was used to evaluate dose-response associations.
During a mean follow-up of 13.1 years, the authors documented 513 incident bowel resection cases. Compared to participants with vitamin D deficiency, nondeficient participants showed a significantly reduced bowel resection risk in IBD (HR 0.72, 95% CI: 0.59-0.87, P =0.001), Crohn's disease (CD, HR 0.74, 95% CI: 0.56-0.98, P =0.038), and ulcerative colitis (UC, HR 0.73, 95% CI: 0.57-0.95, P =0.020). When comparing extreme quintiles of 25(OH)D level, participants with IBD showed a 34% reduced risk of bowel resection (95% CI: 11-51%, P =0.007) and participants with UC showed a 46% reduced risk (95% CI: 19-64%, P =0.003), while this association was not significant in CD (HR 0.93, 95% CI: 0.59-1.45, P =0.740). Linear dose-response associations were observed using the RCS curve (all P -nonlinearity>0.05).
Increased serum level of 25(OH)D is independently associated with reduced bowel resection risk in IBD. This association was significant in UC but may not be stable in CD. Vitamin D deficiency is a risk factor for bowel resection in individuals with IBD, and may be an effective metric in predicting and risk-screening surgical events.
尽管维生素 D 在抗炎和免疫调节方面的有益特性在炎症性肠病 (IBD) 的治疗中具有很大的前景，但关于其对关键 IBD 预后的影响的数据仍很有限。血清维生素 D 水平与 IBD 患者肠切除术风险之间的关系在很大程度上仍不清楚。
作者在英国生物库中对 5474 名 IBD 患者进行了一项纵向队列研究。使用直接竞争化学发光免疫分析法测量血清 25-羟维生素 D [25(OH)D]。通过国家住院数据确定肠切除术事件。使用多变量调整的 Cox 比例风险回归来检查血清 25(OH)D 与肠切除术风险之间的关联，以风险比 (HR) 和 95%CI 表示。限制性立方样条 (RCS) 用于评估剂量反应关系。
在平均 13.1 年的随访期间，作者记录了 513 例肠切除术后新发病例。与维生素 D 缺乏的参与者相比，非缺乏的参与者的 IBD（HR 0.72，95%CI：0.59-0.87，P =0.001）、克罗恩病（CD，HR 0.74，95%CI：0.56-0.98，P =0.038）和溃疡性结肠炎（UC，HR 0.73，95%CI：0.57-0.95，P =0.020）的肠切除术风险明显降低。在比较 25(OH)D 水平的最极端五分位数时，IBD 患者的肠切除术风险降低了 34%（95%CI：11-51%，P =0.007），UC 患者的肠切除术风险降低了 46%（95%CI：19-64%，P =0.003），而 CD 患者的这种关联并不显著（HR 0.93，95%CI：0.59-1.45，P =0.740）。使用 RCS 曲线观察到线性剂量反应关系（所有 P-非线性>0.05）。
血清 25(OH)D 水平升高与 IBD 患者的肠切除术风险降低独立相关。这种关联在 UC 中显著，但在 CD 中可能不稳定。维生素 D 缺乏是 IBD 患者肠切除术的一个危险因素，可能是预测和筛查手术事件的有效指标。
