| Objective:To measure the serum level of 25(OH)D in patients with inflammatory bowel disease(IBD),to explore the expression of serum vitamin D in IBD patients of different severities and to evaluate the clinical response of IBD patients to infliximab by measuring serum level of Vitamin D before and after infliximab treatment.Method:Based on the consensual opinion of IBD diagnosis and treatment(2012 Guangzhou),patients were selected from the period of March 2016 to January 2017 in the department of gastroenterology at the First Affiliated Hospital of Dalian Medical University.60 patients with ulcerative colitis and 18 patients with Crohn’s disease age from 18-60 years old were accrued and assigned to the UC group and CD group accordingly.Based on the modified Mayo scoring and Best CDAI scoring system,patients in UC group and CD group were classified into three different classes of severities:mild,moderate and severe.The UC along with CD constituted the IBD group.68 healthy persons were selected as the normal control group.25(OH)D Roche E170 electrochemical luminescence immunity analyzer was used to measure the serum levels of 25(OH)D in IBD group and normal control group.One-way analysis of variance method was used to compare the difference between serum levels of vitamin D in UC group and CD group among patients of the 3 different severities.17 UC patients and 10 CD patients in IBD group received intravenous infliximab at the dose of 5mg/kg per administration for 8-10 times.The serum levels of 25(OH)D,HB,PLT,ESR,CRP and ALB were measured before IFX therapy and after the third time IFX therapy.Gave evaluations according to the modified Mayo scoring and Best CDAI scoring system in patients with UC and CD.SPSS 20.0 software was used to analyze the data before and after the treatment,p<0.05 denoted statistical significance.Result:1.General material:IBD group comprised of 78 patients,47 males and 31 females with an average of 42.64±14.46 years old(range from 18 to 60 years old).The control group included 68 healthy subjects,40 males and 28 females with an average age of 45.82±8.45 years old(range from 24 to 60 years old).2.The 25(OH)D in IBD group was lower than that in control group(12.37±6.68ng/ml vs 18.88±9.16ng/ml,p=0.000<0.05).3.The serum level of 25(OH)D in IBD patients of different severities:3.1 The serum level of 25(OH)D in UC group with mild severity was 17.66±7.01ng/ml.The serum level of 25(OH)D in UC group with moderate severity was 13.19±3.39ng/ml.The serum level of 25(OH)D in UC group with serious severity was 7.09±4.31ng/ml.The differences of serum levels of 25(OH)D among UC patients with the three different severities were statistically significant(p=0.000<0.05).3.2 The serum level of 25(OH)D in CD group with mild severity was 25.26±4.04ng/ml.The serum level of 25(OH)D in CD group with moderate severity was 13.92±2.79ng/ml.The serum level of 25(OH)D in CD group with serious severity was 5.86±2.07ng/ml.The differences of serum levels of 25(OH)D among CD patients with the three different severities were statistically significant(p=0.000<0.05).4.The efficacy evaluation of IFX treatment for IBD patients.4.1 14(82.35%)out of 17 patients in UC group and 8(80%)out of 10 patients in CD group received IFX treatment after three rounds and showed positive effect.4.2 The comparison of serum 25(OH)D,Mayo score,HB,PLT,ESR,CRP and ALB in UC group before and after IFX treatment:The serum level of 25(OH)D after IFX treatment was significantly increased when compared with that before IFX treatment(8.28±4.19ng/ml vs 9.80±3.81ng/ml,p=0.004<0.05).The Mayo score after IFX treatment was significantly decreased when compared with that before IFX treatment(9.12±2.47 vs 4.82±3.59,p=0.000<0.05).The concentration of HB after IFX treatment wasn’t significantly increased when compared with that before IFX treatment(114.65±27.03g/1 vs 117.12±26.46g/l,p=0.179>0.05).The concentration of PLT after IFX treatment was significantly decreased when compared with that before IFX treatment[(267.47±78.96)×109/L vs(255.24±69.68)×109/L,p=0.003<0.05].The rate of ESR after IFX treatment was significantly decreased when compared with that before IFX treatment(17.00±11.03mm/h vs 13.59±7.37,p=0.026<0.05).The serum level of CRP after IFX treatment was significantly decreased when compared with that before IFX treatment(13.46×14.72mg/l vs 12.11±13.3 lmg/l,p=0.004<0.05).The concentration of ALB after IFX treatment wasn’t significantly increased when compared with that before IFX treatment(36.48±14.91g/l vs 36.60±4.25g/l,p=0.819>0.05).4.3 The comparison of serum 25(OH)D,Best CDAI,HB,PLT,ESR,CRP and ALB in CD group before and after IFX treatment:The serum level of 25(OH)D after IFX treatment was significantly increa,sed when compared with that before IFX treatment(15.76±18.17ng/ml vs 18.95±7.60ng/ml,p=0.020<0.05).The CDAI score after IFX treatment was significantly decreased when compared with that before IFX treatment(296.4±126.06 vs 202.3±106.34,p=0.002<0.05).The concentration of HB after.IFX treatment wasn’t significantly increased when compared with that before IFX treatment(107.25±12.73g/l vs 117.30±20.37g/l,p=0.078>0.05).The concentration of PLT after IFX treatment was significantly decreased when compared with that before IFX treatment[(275.60±95.19)×109/L vs(258.60±93.40)×109/L,p=0.005<0.05].The rate of ESR after IFX treatment was significantly decreased when compared with that before IFX treatment(14.10±8.08mm/h vs 9.10±5.40,p＝0.010<0.05).The serum level of CRP after IFX treatment was significantly decreased when compared with that before IFX treatment(18.44±16.35mg/l vs 14.7±14.99mg/l,p=0.010<0.05).The concentration of ALB after IFX treatment wasn’t significantly increased when compared with that before IFX treatment(32.87±8.81g/l vs 34.55±6.67g/l,p=0.479>0.05).Conclusion:1.The serum level of vitamin D in IBD patients is obviously lower than that of healthy subjects.Therefore the lack of vitamin D is thought to be related with the onset of the disease.2.To some extent,the level of serum vitamin D in IBD patients can reflect severity of the disease.The more serious is IBD,the lower is the level of vitamin D.3.The efficacy of IFX in treating IBD is manifested by the increased level of Vitamin D after treatment,which may indicate that lack of vitamin D may be one of the potential causes of IBD. |
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