补充维生素D3对英夫利昔单抗治疗克罗恩病临床缓解的影响  

The effects of vitamin D3 supplementation on clinical remission in patients with Crohn′s disease treated with infliximab

作　　者：徐缘 邵晓晓[1] 胡定元[1] 林道泼 蒋益[1] Xu Yuan;Shao Xiaoxiao;Hu Dingyuan;Lin Daopo;Jiang Yi(Department of Gastroenterology,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou325000,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院消化内科,温州325000

出　　处：《中华消化杂志》2022年第2期95-102,共8页Chinese Journal of Digestion

基　　金：浙江省自然科学基金(LY17H030011,LY18H030009);浙江省医药卫生科技计划项目(2021KY802,2021KY803);浙江省中医药科技计划项目(2019ZB075);温州市科技计划项目(Y20190603,Y2020011,Y2020281,Y2020282,Y2020285);贺林院士工作站科研基金(19331101,19331104)。

摘　　要：目的回顾性研究英夫利昔单抗(IFX)治疗过程中补充维生素D3对克罗恩病患者临床缓解的影响。方法通过检索温州医科大学附属第二医院临床资料数据库,筛选2014年1月至2020年1月于消化内科接受IFX治疗的73例初发型中重度克罗恩病患者,其中血清25羟维生素D[25(OH)D]水平<50 nmol/L即维生素D缺乏者50例。采用Harvey-Bradshaw指数(HBI)评估克罗恩病疾病活动度。所有患者均接受IFX(5 mg/kg)治疗至少54周,根据IFX治疗时是否补充维生素D3(125 U/d)分为补充组(37例)、未补充组(36例)。比较补充组患者IFX治疗第54周与IFX治疗前的25(OH)D水平,以及IFX治疗第54周时补充组与未补充组患者的临床缓解率和HBI下降幅度,分析克罗恩病患者临床缓解率的影响因素。统计学方法采用配对t检验、独立样本t检验、卡方检验、多元logistic回归分析。结果补充组患者IFX治疗第54周时血清25(OH)D水平高于IFX治疗前[(50.83±15.45)nmol/L比(37.68±16.75)nmol/L],差异有统计学意义(t=-4.55,P<0.001);补充组患者IFX治疗第54周时,患者的临床缓解率高于未补充组[83.8%(31/37)比61.1%(22/36)],HBI下降幅度大于未补充组[(7.41±3.00)分比(6.28±2.75)分],差异均有统计学意义(χ^(2)=4.71,t=2.41;P=0.030、0.023)。多元logistic回归分析结果显示,补充维生素D3是克罗恩病患者(73例)和维生素D缺乏的克罗恩病患者(50例)临床缓解的独立影响因素(b=-1.67、-1.92,P=0.015、0.019)。结论在IFX治疗的克罗恩病患者中,补充维生素D3可显著提高临床缓解率,尤其是维生素D缺乏的克罗恩病患者。Objective To retrospectively analyze the effects of vitamin D3 supplementation on clinical remission of patients with Crohn′s disease(CD)in the treatment of infliximab(IFX).Methods From January 2014 to January 2020,73 patients with initial moderate to severe CD(50 patients with vitamin D deficiency(the level of serum 25-hydroxyvitamin D(25(OH)D)<50 nmol/L))receiving IFX treatment at Department of Gastroenterology were screened from the clinical database of the Second Affiliated Hospital of Wenzhou Medical University.Harvey-Bradshaw index(HBI)was applied to evaluate the disease activity of CD patients.All the patients underwent IFX treatment(5 mg/kg)for at least 54 weeks.According to whether vitamin D3(125 U/d)was supplemented during IFX treatment,the patients were divided into supplemented group(n=37)and non-supplemented group(n=36).In supplemented group,the level of 25(OH)D of patients at the 54th week was compared with that before IFX treatment.At the 54th week,the clinical remission rate and decline range of HBI were compared between supplemented group and non-supplemented group.And the influencing factors of clinical remission rate were analyzed in CD patients.Paired t test,independent sample t test,chi-square test and multivariable logistic regression were used for statistical analysis.Results In supplemented group,the level of serum 25(OH)D at the 54th week was higher than that before IFX treatment((50.83±15.45)nmol/L vs.(37.68±16.75)nmol/L),and the difference was statistically significant(t=-4.55,P<0.001).At the 54th week,the clinical remission rate of supplemented group was higher than that of non-supplemented group(83.8%,31/37 vs.61.1%,22/36),the decline range of HBI was larger than that of non-supplemented group(7.41±3.00 vs.6.28±2.75),and the differences were statistically significant(χ^(2)=4.71,t=2.41;P=0.030 and 0.023).The results of multivariable logistic regression analysis showed that vitamin D3 supplementation was an independent factor affecting the clinical remission rate in CD patients(n

关 键 词：CROHN病 胆骨化醇 英夫利昔单抗 缓解诱导 

分 类 号：R574[医药卫生—消化系统]