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首页 » Gastroenterology:高维生素D或可使女性克罗恩病风险减半

Gastroenterology:高维生素D或可使女性克罗恩病风险减半

来源:爱思唯尔 2012-03-05 18:47

3月1日,《胃肠病学杂志》(Gastroenterology)发表了哈佛大学医学院研究人员的一项研究成果,血浆维生素D水平较高与女性克罗恩病(CD)风险降低一半有关。

在本研究中,哈佛大学医学院的Ashwin N. Ananthakrishnan医生分析了来自护士健康研究的1,492,811人·年的随访数据,重点关注72,719例女性(基线时中位年龄为53岁)的数据,这些患者返回了1986年问卷,其中包括关于膳食摄入和身体活动的数据。受试者既往无CD、溃疡性结肠炎(UC)或肿瘤(除外非黑色素瘤的皮肤肿瘤)病史。使用之前发表过的经验证的回归模型得出血浆25(OH)D水平,该模型中纳入膳食和补充的维生素D摄入量、日光暴露、种族和体重指数(J. Natl. Cancer Inst. 2006;98:451-9)。当发现有新诊断的CD或UC病例时,联系受试者,发送补充问卷,并由研究者回顾其病历记录。

1986~2008年,共记录122例CD和123例UC病例,CD和UC诊断时的中位年龄分别为64岁和63.5岁。根据预测的血浆25(OH)D水平的四分位数,对这些女性进行分层。结果显示,与处于最低四分位数女性相比,处于最高的2个四分位数的女性CD风险显著降低,最高四分位数的多变量危险比(HR)为0.50[95%置信区间(CI),0.28~0.90],第二高四分位数的HR为0.55(95%CI,0.30~1.00)。关于UC,最高四分位数的女性风险也较低,但无统计学意义(HR,0.68;95%CI,0.5~1.31)。
 
之后,作者又评估了CD和UC风险与预先定义的25(OH)D水平之间的相关性。将25(OH)D330 ng/ml定义为维生素D充足;将介于20~30 ng/mL之间定义为不足,将<20 ng/ml定义为缺乏。“与预测的维生素D缺乏女性相比,预测的维生素D充足女性CD的多变量HR为0.38(95%CI,0.15~0.97)”。“对于预测的维生素D充足女性,对应的UC的多变量HR为0.57(95%CI,0.19~1.70)”。最后,从另一个角度进行评估发现,血浆25(OH)D每升高1 ng/ml,CD风险相对降低6%(多变量HR,0.94;95%CI,0.89~0.99),UC风险降低4%,但无统计学意义(多变量HR,0.96;95%CI,0.91~1.02)。膳食维生素D摄入和补充也与CD和UC风险相关,每天每摄入100 IU,UC风险降低10%,CD风险降低7%。

研究者总结认为,血浆维生素D水平升高与CD风险降低相关,进一步支持了补充维生素D用于治疗活动性CD和预防疾病复发的理论基础,并提示在CD高危个体中,常规筛查维生素D缺乏或补充维生素D可能具有一定意义。

该研究获得了由美国胃肠病学会和Broad医学研究基金会提供的基金资助。2位作者披露与宝洁、沙尔制药、Cytokine制药、华纳奇考特、拜耳医药和千年制药等多家公司存在利益关系。(生物谷Bioon.com)

Higher Predicted Vitamin D Status Is Associated With Reduced Risk of Crohn's Disease

Ashwin N. Ananthakrishnan, Hamed Khalili, Leslie M. Higuchi

Background & Aims
Vitamin D influences innate immunity, which is believed to be involved in the pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC). However, data examining vitamin D status in relation to risk of CD and UC are lacking.

Methods
We conducted a prospective cohort study of 72,719 women (age, 40–73 y) enrolled in the Nurses' Health Study. In 1986, women completed an assessment of diet and lifestyle, from which a 25-hydroxy vitamin D [25(OH)D] prediction score was developed and validated against directly measured levels of plasma 25(OH)D. Through 2008, we confirmed reported diagnoses of incident CD or UC through medical record review. We used Cox proportional hazards modeling to examine the hazard ratio (HR) for incident CD or UC after adjusting for potential confounders.

Results
During 1,492,811 person-years of follow-up evaluation, we documented 122 incident cases of CD and 123 cases of UC. The median predicted 25(OH)D level was 22.3 ng/mL in the lowest and 32.2 ng/mL in the highest quartiles. Compared with the lowest quartile, the multivariate-adjusted HR associated with the highest quartile of vitamin D was 0.54 (95% confidence interval [CI], 0.30–.99) for CD (Ptrend = .02) and 0.65 (95% CI, 0.34–1.25) for UC (Ptrend = .17). Compared with women with a predicted 25(OH)D level less than 20 ng/mL, the multivariate-adjusted HR was 0.38 (95% CI, 0.15–0.97) for CD and 0.57 (95% CI, 0.19–1.70) for UC for women with a predicted 25(OH)D level greater than 30 ng/mL. There was a significant inverse association between dietary and supplemental vitamin D and UC, and a nonsignificant reduction in CD risk.

Conclusions
Higher predicted plasma levels of 25(OH)D significantly reduce the risk for incident CD and nonsignificantly reduce the risk for UC in women.

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