本文選題：克羅恩病 + 維生素D�。� 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:探究血清維生素D水平和克羅恩病的疾病活動度之間的相關(guān)性。方法:回顧性分析2014年3月—2016年2月住院克羅恩病患者組(病例組)和同期健康對照組(對照組)的血清25(0H)D的水平差異。在病例組,分析治療前血清25(0H)D水平分別與各種疾病活動度指標(biāo)間的相關(guān)性;同時分析治療前后疾病活動度變化與血清25(OH)D水平變化之間的相關(guān)性。在克羅恩病活動度指標(biāo)的選取上,此研究選取了具有代表性的體重指數(shù)(Body Mass Index,BMI)、克羅恩病活動指數(shù)(Crohn's disease activity index,CDAI)、超敏 C 反應(yīng)蛋白(c-reactive protein,CRP)及血沉等指標(biāo)。最后使用ROC曲線探索血清25(0H)D水平作為一個評估克羅恩病活動的臨床指標(biāo)的具體分界值。結(jié)果:246例住院克羅恩病患者血清25(OH)D水平比40例健康組要低(中位數(shù)19.9 nmol/Lvs49.9nmol/L,p0.01)。在病例組,血清25(OH)D水平與活動度指標(biāo)包括CDAI(r=-0.582,p0.01)、CRP(r=-0.334,p0.01)、ESR(r=-0.313,p0.01)、BM(r=-0.216,p0.01)均呈負(fù)相關(guān);對最具代表性的活動度指標(biāo)CDAI評分進(jìn)行分層,血清25(OH)D水平隨著克羅恩病活動度的增加而降低[緩解期(中位數(shù)39.7 nmol/L)、輕度活動期(中位數(shù)29.7nmol/L)、中度活動期(中位數(shù)16.1nmol/L)、重度活動期(中位數(shù)7.5 nmol/L),P0.01]也呈現(xiàn)負(fù)相關(guān)�？肆_恩病患者治療后,血清 25(OH)D 水平(治療前 vs 后:15.4 nmol/L±6.6vs34.3 nmol/L±12.6,p0.01)隨著CDAI水平明顯下降(治療前vs后:321±92vs1 80±63,p0.01)反而明顯上升,同樣呈現(xiàn)負(fù)相關(guān)。最后根據(jù)CDAI評分,通過ROC曲線探索血清25(OH)D水平在克羅恩病的緩解期與活動期的臨床分界值為23.7nmol/L(AUCs大小為0.842,p0.01)。結(jié)論:住院克羅恩病患者25(OH)D水平比健康組要低且25(OH)D水平與疾病活動度呈負(fù)相關(guān)。25(OH)D水平可能可以作為一個克羅恩病活動的臨床指標(biāo),具體的分界值需要更大樣本的驗證。
[Abstract]:Objective: to investigate the correlation between serum vitamin D levels and disease activity of Crohn's disease. Methods: the levels of serum 25 (0H) D in patients with Crohn's disease (case group) and healthy control group (control group) from March 2014 to February 2016 were analyzed retrospectively. In the case group, the correlation between serum 25 (0H) D level and various disease activity indexes before and after treatment was analyzed, and the correlation between disease activity change and serum 25 (OH) D level before and after treatment was analyzed. In the selection of the activity index of Crohn's disease, the representative indexes of body mass index (BMI), Crohn's disease activity index (CDAI), high sensitive C-reactive protein (c-reactive) and erythrocyte sedimentation rate (ESR) were selected in this study. Finally, the ROC curve was used to explore the specific threshold of serum 25 (0H) D level as a clinical marker for evaluating Crohn's disease activity. Results the serum 25 (OH) D levels of 246 patients with Crohn's disease were lower than those of 40 healthy controls (median 19.9 nmol / L vs 49.9 nmol / L P 0.01). In the case group, the serum 25 (OH) D level was negatively correlated with the activity index, including CDAI (r-0.582p0.01) CRP (r-0.334p0.01) and ESR (r-0.313p0.01) BM (r-0.216p0.01), and the most representative activity index CDAI score was stratified. Serum 25 (OH) D levels decreased with the increase of Crohn's disease activity [remission period (median 39.7 nmol / L), mild active phase (median 29.7 nmol / L), moderate active phase (median 16.1 nmol / L), severe active phase (median 7.5 nmol / L) P 0.01]. After treatment with Crohn's disease, serum 25 (OH) D level (pre-treatment vs post-treatment: 15.4nmol / L 鹵6.6vs34.3 nmol-L 鹵12.6p0.01) increased significantly with the decrease of CDAI level (pre-treatment vs post-treatment: 321 鹵92vs1 80 鹵63p0.01), and also showed a negative correlation. Finally, according to the CDAI score, the clinical threshold of serum 25 (OH) D level in remission and active stage of Crohn's disease was found to be 23.7nmol / L (AUCs 0.842 / p0.01) by ROC curve. Conclusion: the level of 25 (OH) D in the patients with Crohn's disease is lower than that in the healthy group, and the level of 25 (OH) D is negatively correlated with the disease activity. 25 (OH) D level may be used as a clinical index of Crohn's disease activity.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574.62
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本文編號：2067617