本文選題：炎癥性腸病 + 潰瘍性結(jié)腸炎�。� 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:調(diào)查炎癥性腸病(IBD)患者血清25-羥維生素D(25OHD)水平,探討影響維生素D水平的相關(guān)臨床因素,并分析維生素D缺乏對(duì)疾病活動(dòng)度和生活質(zhì)量的影響。方法:納入在安徽省立醫(yī)院門診及住院已確診為IBD的患者194例,健康體檢者100例,分為126例潰瘍性結(jié)腸炎(UC)組、68例克羅恩病(CD)組、100例正常對(duì)照(NC)組,以電化學(xué)發(fā)光法檢測(cè)血清25OHD水平。維生素D水平判斷標(biāo)準(zhǔn):缺乏(25OHD≤20ng/ml),不足(21-29ng/ml),充足(30-100ng/ml)。疾病診斷標(biāo)準(zhǔn)依據(jù)IBD診斷共識(shí)意見(jiàn)(2012年廣州)。分析IBD患者血清25OHD水平與年齡、性別、身體質(zhì)量指數(shù)(BMI)、平均日照時(shí)間、用藥史、疾病行為、疾病部位、CRP的關(guān)系,比較不同疾病活動(dòng)度IBD患者維生素D水平差異以及不同維生素D水平對(duì)生活質(zhì)量的影響。結(jié)果:1)UC組血清25OHD水平為(14.65±6.32)ng/ml,92例(73%)患者存在維生素D缺乏;CD組血清25OHD水平為(10.75±3.21)ng/ml,62例(91.2%)患者存在維生素D缺乏;IBD組患者血清25OHD水平(13.59±6.13)ng/ml,154例(79.4%)患者存在維生素D缺乏;NC組血清25OHD水平為(19.27±6.39)ng/ml,59例(59%)患者存在維生素D缺乏。UC組、CD組以及IBD組血清25OHD水平均低于NC組,維生素D缺乏率均高于NC組(P均0.05)。2)UC組中平均日照時(shí)間30min/d患者血清25OHD水平較平均日照時(shí)間≥30min/d者偏低[(13.61±4.68)ng/ml vs(16.01±7.79)ng/ml],應(yīng)用激素治療者血清25OHD水平較未應(yīng)用激素治療者偏低[(13.10±5.83)ng/ml vs(15.71±6.45)ng/ml](P均0.05);UC患者血清25OHD水平與BMI呈顯著正相關(guān)(rp=0.486,P0.05),與CRP呈顯著負(fù)相關(guān)(rs=-0.482,P0.05),與年齡、性別、病程、是否初發(fā)型、疾病范圍無(wú)關(guān)(P均0.05);CD組中平均日照時(shí)間30min/d患者血清25OHD水平較平均日照時(shí)間≥30min/d者偏低[(8.67±4.22)ng/ml vs(12.59±5.21)ng/ml]、應(yīng)用激素者較未應(yīng)用激素者偏低[(9.91±5.37)ng/ml vs(13.12±4.69)ng/ml]、未用過(guò)英夫利昔單抗治療者較應(yīng)用英夫利昔單抗治療者偏低[(9.27±3.55)ng/ml vs(12.97±5.61)ng/ml](P均0.05);CD患者血清25OHD水平與BMI呈顯著正相關(guān)(rp=0.486,P0.05),與CRP呈顯著負(fù)相關(guān)(rs=-0.504,P0.05),與年齡、性別、病程、疾病行為、是否累及小腸、是否應(yīng)用免疫抑制劑無(wú)關(guān)(P均0.05)。3)UC組及CD組血清25OHD水平均隨疾病活動(dòng)度的升高而逐漸降低(P均0.05)。UC組血清25OHD水平與Mayo評(píng)分呈負(fù)相關(guān)(rs=-0.622,P0.05),CD組血清25OHD水平與CDAI評(píng)分呈負(fù)相關(guān)(rs=-0.318,P0.05)。4)UC組中維生素D缺乏者的IBDQ總分以及腸道癥狀、全身癥狀、情感功能、社會(huì)功能四個(gè)維度的評(píng)分均顯著低于非維生素D缺乏者,結(jié)果依次為[(161.60±29.49)vs(188.85±22.83),(50.33±12.52)vs(61.79±7.28),(24.73±4.73)vs(27.64±4.48),(59.80±13.31)vs(69.50±10.14),(26.80±5.78)vs(29.91±4.80)],UC組血清25OHD水平與IBDQ總分以及4個(gè)維度評(píng)分均呈顯著正相關(guān)(P均0.05);CD組中維生素D缺乏者的IBDQ總分以及腸道癥狀、全身癥狀、情感功能、社會(huì)功能四個(gè)維度的評(píng)分均顯著低于非維生素D缺乏者,結(jié)果依次為[(178.71±11.83)vs(195.00±11.62),(61.52±5.53)vs(64.17±1.47),(24.10±3.31)vs(27.50±2.74),(68.58±7.44)vs(75.33±6.12),(22.92±3.98)vs(28.00±3.46)](P均0.05),CD組血清25OHD水平與IBDQ總分以及4個(gè)維度評(píng)分均呈顯著正相關(guān)(P均0.05)。結(jié)論:1)IBD患者普遍存在維生素D缺乏,CD患者較UC患者更加明顯。2)平均日照時(shí)間短、應(yīng)用激素可能是維生素D水平下降的影響因素;BMI在一定范圍內(nèi)增高、生物制劑英夫利昔治療可能有助于維生素D水平提高。3)維生素D缺乏可能對(duì)IBD患者的疾病活動(dòng)以及生活質(zhì)量有影響。4)未發(fā)現(xiàn)IBD患者血清25OHD水平與年齡、性別、病程、疾病行為、疾病范圍、疾病部位、是否使用免疫抑制劑等因素有關(guān)。
[Abstract]:Objective: To investigate the serum levels of 25- hydroxyvitamin D (25OHD) in patients with inflammatory bowel disease (IBD), to explore the related clinical factors affecting the level of vitamin D, and to analyze the effect of vitamin D deficiency on the degree of activity and quality of life. Methods: 194 patients who had been diagnosed with IBD in the outpatient department of Anhui Provincial Hospital and 100 cases of healthy physical examination were included. For 126 cases of ulcerative colitis (UC), 68 cases of Crohn's disease (CD) and 100 normal controls (NC), the level of serum 25OHD was detected by electrochemiluminescence. The standard of vitamin D was judged: deficiency (25OHD < 20ng/ml), insufficiency (21-29ng/ml) and sufficient (30-100ng/ml). The diagnostic criteria of the disease were based on the consensus opinion of IBD (2012). The analysis of IBD patients Serum 25OHD levels were related to age, sex, body mass index (BMI), average sunshine time, drug history, disease behavior, location of disease, CRP, and the difference of vitamin D levels in IBD patients with different disease activity and the effect of different vitamin D levels on the quality of life. Results: 1) the serum 25OHD level of UC group was (14.65 + 6.32) ng/ml, 92 cases (73%) The patients had vitamin D deficiency; the serum 25OHD level of CD group was (10.75 + 3.21) ng/ml, 62 cases (91.2%) had vitamin D deficiency; the serum 25OHD level (13.59 + 6.13) ng/ml in group IBD patients and 154 cases (79.4%) had vitamin D deficiency; the 25OHD level of NC group was (19.27 + 6.39) ng/ml, 59 cases (59%) patients had vitamin deficiency deficiency group. The level of serum 25OHD in IBD group was lower than that in group NC, and the rate of vitamin D deficiency was higher than that in group NC (P 0.05).2) the average sunshine time in the UC group was lower than that of the average sunshine time > 30min/d (13.61 + 4.68) ng/ml (16.01 + 7.79). [(13.10 + 5.83) ng/ml vs (15.71 + 6.45) ng/ml] (P 0.05); the serum 25OHD level of patients with UC was significantly positively correlated with BMI (rp=0.486, P0.05), and was negatively correlated with CRP (rs=-0.482, P0.05). It was not related to age, sex, course of disease, initial hairstyle, and the range of disease (0.05). The low [(8.67 + 4.22) ng/ml vs (12.59 + 5.21) ng/ml]] were lower than those of 30min/d (9.91 + 5.37) ng/ml vs (13.12 + 4.69) ng/ml], and those who did not use infliximab were lower than those with infliximab (9.27 + 3.55) ng/ml vs (12.97 + 5.61) ng/ml] (P all 0.05); There was a significant positive correlation between D and BMI (rp=0.486, P0.05), and a significant negative correlation with CRP (rs=-0.504, P0.05), with age, sex, course of disease, disease behavior, whether the use of immunosuppressive agents was not related to the use of immunosuppressive agents (P 0.05).3) and CD group serum 25OHD levels gradually decreased with the increase of disease activity (0.05) The score of Mayo was negatively correlated (rs=-0.622, P0.05), and the level of serum 25OHD in CD group was negatively correlated with CDAI score (rs=-0.318, P0.05). The score of four dimensions of IBDQ total and intestinal symptoms, systemic symptoms, emotional function and social function in the UC group were significantly lower than those of non vitamin deficiency, and the result was [(161.60 + 29.49). ) vs (188.85 + 22.83), (50.33 + 12.52) vs (61.79 + 7.28), (24.73 + 4.73) vs (27.64 + 4.48), (59.80 + 13.31) vs (69.50 +%), vs (7.28) and IBDQ total score and dimension score (P all); the total IBDQ total score of vitamin D in the CD group and intestinal symptoms and systemic symptoms in the CD group The scores of four dimensions of emotional function and social function were significantly lower than those of non vitamin D deficiency, and the results were (178.71 + 11.83) vs (195 + 11.62), (61.52 + 5.53) vs (64.17 + 1.47), (24.10 + 3.31) vs (27.50 + 2.74), vs vs (P all), and CD group serum 25OHD level and IBDQ total score And the score of 4 dimensions showed significant positive correlation (P 0.05). Conclusion: 1) IBD patients generally have vitamin D deficiency, CD patients are more obvious than UC patients, the average sunshine time is shorter, the use of hormone may be the influence factor of the decrease of vitamin D level; BMI in a certain range, the biological agent inflixime therapy may contribute to vitamin D water. .3) vitamin D deficiency may affect the activity of disease and the quality of life of IBD patients with.4). The serum 25OHD level of patients with IBD is not found to be related to age, sex, course of disease, disease behavior, disease area, location of disease, and the use of immunosuppressive agents.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R574

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