Study Between Vitamin D Level And Related Clinical Factors In Inflammatory Bowel Disease Patients And Its Impact On Quality Of Life

Purpose: Investigate the serum 25-hydroxyvitamin D(25OHD)levels of patients with inflammatory bowel disease(IBD)and its relationship with related clinical factors.Study the influence of vitamin D deficiency to the disease activity and quality of life.Method: 194 IBD outpatients and inpatients,100 healthy examined people from Anhui Provincial Hospital were divided into ulcerative colitis(UC)group,Crohn's disease(CD)group and normal control(NC)group.The serum 25 OHD level of all subjects were measured by electrochemiluminescence assays.Vitamin D levels criteria: vitamin D deficiency,insufficiency and sufficiency were respectively defined as serum 25 OHD concentration of?20 ng/ml,20–29.9 ng/ml and 30-100 ng/ml.The diagnostic criteria for the disease was based on IBD diagnostic consensus(2012,Guangzhou).Analyze the relation between the serum 25 OHD levels and age,sex,BMI,average sunshine time,medication history,disease behavior,disease location,CRP.Compare the serum 25 OHD levels between different disease activity in IBD patients,and the effect of different serum 25 OHD levels on quality of life.Result: 1)In UC group,the serum 25 OHD level was(14.65±6.32)ng/ml,92 patients(73%)had vitamin D deficiency;In CD group,the serum 25 OHD level was(10.75±3.21)ng/ml,62 patients(91.2%)had vitamin D deficiency;In IBD group,the serum 25 OHD level was(13.59±6.13)ng/ml,154 patients(79.4%)had vitamin D deficiency;In NC group the serum 25 OHD level was(19.27±6.39)ng/ml,59 patients (59%)had vitamin D deficiency.The serum 25 OHD level of UC,CD and IBD group were lower than that of NC group,and the rate of vitamin D deficiency of UC,CD and IBD group were higher than that of NC group(P all<0.05).2)In UC group,serum 25 OHD level of the subjects whose average sunshine time was less than 30 minutes per day was lower than that of the subjects whose average sunshine time was more than 30 minutes per day [(13.61±4.68)ng/ml vs(16.01±7.79)ng/ml],serum 25 OHD level of the subjects who had the application of steroids was lower than that of the subjects who hadn't had the application of steroids [(13.10±5.83)ng/ml vs(15.71±6.45)ng/ml](P all <0.05).The 25 OHD level was positively correlated with BMI(rp=0.486,P<0.05)but negatively correlated with CRP(rs=-0.482,P<0.05)(P all<0.05).However,age,gender,course of disease,whether the disease was at initial onset,scope of disease were not statistically related to serum 25 OHD level(P all>0.05).In CD group,serum 25 OHD level of the subjects whose average sunshine time was less than 30 minutes per day was lower than that of the subjects whose average sunshine time was more than 30 minutes per day[(8.67±4.22)ng/ml vs(12.59±5.21)ng/ml],serum 25 OHD level of the subjects who had the application of steroids was lower than that of the subjects who had never used steroids [(9.91±5.37)ng/ml vs(13.12±4.69)ng/ml],serum 25 OHD level of the subjects who had never used Infliximab was lower than that of the subjects who had had the application of Infliximab [(9.27±3.55)ng/ml vs(12.97±5.61)ng/ml](P all <0.05).The 25 OHD level was positively correlated with BMI(rp=0.486,P<0.05)but negatively correlated with CRP(rs=-0.504,P<0.05)(P all <0.05).However,age,gender,course of disease,disease behavior,whether the disease lesion involved the small intestine and whether the patients had used immunosuppressor were not statistically related to serum 25 OHD level(P all >0.05).3)When patients were stratified with disease activity,serum level of 25 OHD decreased in the order of remission,mild,moderate and severe active stage both in UC and CD group(P all<0.05).The serum level of 25 OHD was negatively correlated with Mayo score in UC group(rs=-0.622,P<0.05).The serum level of 25 OHD was negatively correlated with CDAI score in CD group(rs=-0.318,P<0.05).4)In UC group,the overall score of IBDQ and scores of the four dimensions of IBDQ referring to bowel symptom,systemic symptom,emotional function and social function of patients who were vitamin D deficient were significantly lower than that of whom were not vitamin D deficient,the results are in turn: [(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)](P all <0.05).Serum level of 25 OHD was positively correlated with scores of IBDQ,including overall score and four dimensional scores in UC group(P all <0.05).In CD group,the overall score of IBDQ and scores of the four dimensions of IBDQ referring to bowel symptom,systemic symptom,emotional function and social function of patients who were vitamin D deficient were significantly lower than that of whom were not vitamin D deficient,the results are in turn:[(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 all <0.05).Serum level of 25 OHD was positively correlated with scores of IBDQ,including overall score and four dimensional scores in CD group(P all <0.05).Conclusions: 1)vitamin D deficiency is prevalent in IBD patients,CD patients are more obvious than UC patients.2)Short average sunshine time,the application of glucocorticoid may be the leading factor in the decline of vitamin D levels.BMI increasing in a certain range,treatment of biological agents infliximab may help improving the level of vitamin D.3)Vitamin D deficiency may have an impact on disease activity and quality of life in IBD patients.4)The serum 25 OHD level in IBD patients was not correlated with age,sex,course of disease,disease behavior,disease range,disease site,and whether immunosuppressive agents were used.