维生素D_(3)改善美沙拉秦治疗溃疡性结肠炎疗效的初步观察  

A preliminary study on the improved efficacy of mesalazine combined with vitamin D_(3) in ulcerative colitis

作　　者：马国龙 曹曙光[1] 夏盛隆[1] 朱浩奇 蒋益[1] Guolong Ma;Shuguang Cao;Shenglong Xia;Haoqi Zhu;Yi Jiang(Department of Gastroenterology,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,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：《中华内科杂志》2022年第7期785-792,共8页Chinese Journal of Internal Medicine

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);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(19331101,19331104,19331206)。

摘　　要：目的分析补充维生素D_(3)对美沙拉秦治疗溃疡性结肠炎(UC)患者临床疗效的影响。方法回顾性连续纳入2015年1月至2020年12月于温州医科大学附属第二医院接受美沙拉秦治疗至少12个月的轻中度活动期UC患者,根据是否同时补充维生素D_(3)(125 IU/d)分为试验组和对照组。通过检索病历数据库,获取患者人口学信息、疾病特征、血清25-羟基维生素D[25(OH)D]水平等资料。采用t检验、Mann-Whitney秩和检验及卡方检验比较两组患者疾病特征的差异。采用配对t检验、配对Wilcoxon符号秩检验及卡方检验比较治疗前后两组患者的改良Mayo评分[ΔMayo]和25(OH)D的变化[Δ25(OH)D]。纳入单因素相关性分析P<0.2的变量,采用多元线性回归模型分析影响ΔMayo和Δ25(OH)D的独立因素。结果共纳入74例UC患者(男44例,女30例),中位年龄(范围)为39.5(20~76)岁,分为试验组36例和对照组38例。第12个月与第0月比较,试验组患者25(OH)D平均水平显著增高[(22.87±7.30)μg/L比(18.15±7.48)μg/L,P<0.001],而对照组患者25(OH)D平均水平变化差异无统计学意义[(19.17±8.49)μg/L比(19.82±9.47)μg/L,P=0.466]。第12个月时,试验组与对照组相比,改良Mayo评分的下降幅度更大[-3(-4.75,-1.25)分比-2(-3.25,0)分,P=0.034],临床缓解率更高(55.6%比28.9%,P=0.020)。另外,依据美沙拉秦治疗前的基线25(OH)D水平,将74例UC患者分为维生素D缺乏组[38例,25(OH)D<20μg/L]和维生素D不缺乏组[36例,25(OH)D≥20μg/L]。第12个月时,在维生素D缺乏组中分析发现,补充维生素D_(3)的患者与未补充维生素D_(3)的患者相比,前者改良Mayo评分的下降幅度更大[-4(-5.75,-2)分比-2(-4,0)分,P=0.048],临床缓解率亦更高(60.0%比22.2%,P=0.019)。结论补充维生素D_(3)可能有助于改善美沙拉秦治疗轻中度UC患者的临床疗效,尤其是在维生素D缺乏的UC患者中。Objective To analyze the influence of vitamin D_(3) supplementation on the clinical efficacy of mesalazine in patients with ulcerative colitis(UC).Methods From January 2015 to December 2020,patients with mild-to-moderate active UC were retrospectively and continuously enrolled,who accepted mesalazine treatment for at least 12 months at the Second Affiliated Hospital of Wenzhou Medical University.According to simultaneous supplement of vitamin D_(3)(125 IU/d),the patients were divided into study group and control group.Demographic and disease characteristics,serum 25-hydroxyvitamin D[25(OH)D]levels and other information were collected through retrieving hospital database.Student′s t-test,Mann-Whitney U test and Chi-square test were applied for comparison of disease characteristics.The changes of modified Mayo scores[ΔMayo]and 25(OH)D[Δ25(OH)D]were compared before and after treatment by paired t-test,Wilcoxon signed rank test and Chi-square test.Multiple linear regression model was used to analyze the independent factors affectingΔMayo andΔ25(OH)D,and variables with P-values less than 0.20 in the univariate analysis were allowed for further multivariate analysis.Results A total of 74 UC patients(44 males,30 females),with median age(range)39.5(20-76)years old,were analyzed and respectively assigned into study group(n=36)and control group(n=38).In study group,the average level of serum 25(OH)D was significantly increased at month 12 compared with that at baseline[(22.87±7.30)μg/L vs.(18.15±7.48)μg/L,P<0.001].However,no significant elevation of serum 25(OH)D was found in control group[(19.17±8.49)μg/L vs.(19.82±9.47)μg/L,P=0.466].Furthermore,there was a significant decrease of modified Mayo score[-3(-4.75,-1.25)vs.-2(-3.25,0),P=0.034]and a higher clinical remission rate(55.6%vs.28.9%,P=0.020)at month 12 in study group than those in control group.In addition,according to the baseline level of serum 25(OH)D before mesalazine treatment,74 UC patients were divided into vitamin D deficiency group(n=38,serum 2

关 键 词：结肠炎 溃疡性 胆骨化醇 氨水杨酸 治疗结果 

分 类 号：R574.62[医药卫生—消化系统]