摘要目的 分析IBD患者血清25羟基维生素D[25(OH)D]、肠黏膜组织维生素D受体(VDR)和维生素D1-α羟化酶(CYP27B1)的表达情况.方法 纳入2014年1月1日至12月31日就诊的105例IBD患者,其中UC 49例,CD 56例;缓解期20例,轻度活动26例,中度活动37例,重度活动22例;病变位于左半结肠50例,右半结肠55例.另纳入同期疑似IBD后经排查为健康的45名健康者,作为对照组.检测所有纳入对象的乳果糖和甘露醇的吸收比(LMR),血清内毒素、TNF-α和25(OH)D水平,肠黏膜组织VDR和CYP27B1的表达情况.统计学方法采用t检验、单因素方差分析和卡方检验.结果 UC组LMR、内毒素、TNF-α分别为(63.2±13.9)％、(118.9±19.7)EU/mL、(109.6±18.4)ng/L,分别高于健康对照组的(3.3±1.2)％、(34.2±5.6) EU/mL、(0.6±0.3) ng/L,25(OH)D水平为(36.6±9.7) nmol/L,低于健康对照组的(49.6±10.9)nmol/L,差异均有统计学意义(￡=28.796、29.284、27.817、6.118,P均＜0.05);CD组LMR、内毒素、TNF-α分别为(52.9±11.3)％、(96.4±10.6)EU/mL、(83.0±16.1) ng/L,均高于健康对照组,25(OH)D水平为(44.4±9.4) nmol/L,低于健康对照组,差异均有统计学意义(t=34.555、39.716、34.293、0.012,P均＜0.05).健康对照组、缓解期组、轻度活动组、中度活动组和重度活动组的LMR、内毒素、TNF-a和25(OH)D水平差异均有统计学意义(F=286.731、385.690、657.830、18.932,P均＜0.01),呈活动性依赖关系.与健康对照组相比,左半结肠组和右半结肠组的LMR、内毒素和TNF-α水平增高,25(OH)D水平降低.UC组和CD组的VDR高表达率分别为36.7％(18/49)和55.4％ (31/56),均低于健康对照组的80.0％(36/45),差异均有统计学意义(x2 =38.574、13.837,P均＜0.05);UC组和CD组的CYP27B1高表达率分别为26.5％(13/49)、35.7％(20/56),均高于健康对照组的22.2％(10/45),差异均有统计学意义(x2=6.499、4.430,P均＜0.05).健康对照组、缓解期组、轻度活动组、中度活动组和重度活动组的VDR、CYP27B1高表达率差异均有统计学意义(F=33.470、27.142,P均＜0.01),呈活动性依赖关系.与健康对照组相比,左半结肠组和右半结肠组的VDR高表达率降低,CYP27B1高表达率增高.结论 IBD患者存在维生素D代谢失衡,血清25(OH)D水平偏低,结肠黏膜组织VDR高表达率偏低,CYP27B1高表达率偏高.

abstractsObjective To investigate the expression of serum 25(OH)D,vitamin D receptor (VDR)and vitamin D1-α hydroxylase (CYP27B1) in intestinal mucosa tissues of patients with inflammatory bowel disease (IBD).Methods From January 1st to December 31st in 2014,105 patients with IBD were enrolled,among them there were 49 cases of ulcerative colitis (UC) and 56 cases of Crohn's disease (CD);there were 20 cases in remission,26 cases in mild active phase,37 cases in moderate active phase and 22 cases in severe active phase;and 50 cases with lesions located in the left colon and 55 cases with lesions located in the right colon.At the same period,45 healthy individuals were also recruited as controls,whom were suspected as IBD but at last proved healthy.The lactulose and mannitol absorption ratio (LMR),serum endotoxin,tumor necrosis factor-α (TNF-α) and 25(OH)D levels,and the expressions of VDR and CYP27B1 in the intestinal mucosa tissues were detected in all the subjects.T test,one-way analysis of variance and chi square test were used for statistical analysis.Results The LMR,endotoxin and TNF-α levels of UC group were (63.2 ± 13.9)％,(118.9 ± 19.7) EU/mL,and (109.6 ± 18.4) ng/L,respectively,which were higher than those of the healthy control group ((3.3 ± 1.2)％,(34.2 ±5.6) EU/mL,and (0.6±0.3) ng/L);the level of 25 (OH)D was (36.6± 9.7) nmol/L,which was lower than that of healthy control group ((49.6± 10.9) nmol/L),and all the differences were statistically significant (t =28.796,29.284,27.817 and 6.118,all P＜0.05).LMR,endotoxin and TNF-α levels of CD group were (52.9±11.3)％,(96.4±10.6) EU/mL and (83.0±16.1) ng/L,respectively,which were higher than those of the healthy control group,25(OH)D level was (44.4±9.4) nmol/L,which was lower than that of healthy control group,and all the differences were statistically significant (t=34.555,39.716,34.293 and 0.012,all P＜0.05).The differences in LMR,endotoxin,TNF-α and 25 (OH)D levels among healthy control group,remission group,mild active group,moderate active group and severe active group were statistically significant (F=286.731,385.690,657.830 and 18.932,all P＜0.01) which was dependent on the disease activity.Compared with those of the healthy controls,the levels of LMR,endotoxin and TNF-α of the left colon group and the right colon group increased,and 25(OH)D levels decreased.The high expression rates of VDR in UC group and CD group were 36.7％ (18/49) and 55.4％ (31/ 56),respectively,which were both lower than that of healthy control group (80.0％ (36/45)),and the differences were statistically significant (x2 =38.574 and 13.837,both P＜0.05).The high expression rates of CYP27B1 of UC group and CD group were 26.5％ (13/49) and 35.7％ (20/56),respectively,which were both higher than that of healthy control group (22.2％ (10/45)),and the differences were statistically significant (x2=6.499 and 4.430,both P＜0.05).The differences in the high expression rates of VDR and CYP27B1 among healthy control group,remission group,mild active group,moderate active group and severe active group were statistically significant (F=33.470 and 27.142,both P＜0.01),which was dependent on the disease activity.Compared with that of the healthy control group,the high expression rates of VDR of the left colon group and the right colon group decreased,and the high expression rates of CYP27B1 increased.Conclusion There is vitamin D metabolic imbalance in IBD patients,as well as low serum 25(OH)D level,low rate of high VDR expression in colonic mucosa tissues and high rate of high CYP27B1.