Use of Vitamin D With Anti-Tumor Necrosis Factor Therapy for Crohn's Disease
Use of Vitamin D With Anti-Tumor Necrosis Factor Therapy for Crohn's Disease
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DOI：
10.14740/gr1264
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发表时间：
2020-06-01
影响因子：
1.5
通讯作者：
Rezende Filho, Joffre
中科院分区：
文献类型：
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作者：
Bafutto, Mauro;Oliveira, Enio Chaves;Rezende Filho, Joffre
背景资料：维生素D（VD）在调节肠道粘膜免疫方面具有重要作用，并且似乎与炎症性肠病的疾病活动性和更频繁的复发呈负相关。在这项研究中，我们评估了患者克罗恩病（CD）治疗抗肿瘤坏死因子（TNF）与VD。方法：一个双盲，随机，前瞻性研究进行。30例有中度至重度CD病史，使用抗TNF的患者，男性和女性，18至70岁，VD剂量< 75 nmol/L（30 ng/mL）随机分为3组：第1组（G1）：10例患者接受2，000 IU VD，口服（PO）/周，持续8周;第2组（G2）：10例患者接受10，000 IU VD，PO/周，持续8周;第3组（G3）：10例患者接受50，000 IU VD，PO/周，持续8周。在治疗前和治疗8周结束时，患者接受VD、粪便钙卫蛋白（FC）和C反应蛋白（CRP）剂量。随访52周，观察克罗恩病活动指数（CDAI）> 150、FC > 300及CT扫描等疾病活动复发情况，并检测FC、CRP、VD水平。CRP无变化。G3期FC明显下降（1，014 +/- 850 vs. 483 +/- 564; P = 0.04），G2无显著降低（76，767 +/- 751 vs. 535 +/- 823; P = 0.2）和G1增加（1，101 +/- 744 vs. 1，357 +/- 819; P = 0.4）。52周随访期间，VD < 30组以CDAI > 150、FC > 200和CT复查的疾病活动性复发为主，VD > 30组以缓解率为主（P = 0.0001）。一个统计学上的显着差异，在VD水平的CD患者52周后，提出耀斑或疾病缓解（P = 0.001）。结论：使用VD与抗TNF治疗可能会改善CD的临床反应。VD水平大于30 ng/mL的缓解率更高。
Background: Vitamin D (VD) has an important role in regulating gut mucosal immunity, and seems to be inversely linked to disease activity and more frequent relapses in inflammatory bowel disease. In this study, we evaluated patients with Crohn's disease (CD) treated with anti-tumor necrosis factor (TNF) in association with VD.Methods: A double-blind, randomized, prospective study was conducted. Thirty patients with a history of moderate to severe CD, in use of anti-TNF, of both sexes, 18 to 70 years, with the dosage of VD < 75 nmol/L (30 ng/mL) were randomized and divided into three groups: group 1 (G1): 10 patients received 2,000 IU VD, per os (PO)/week for 8 weeks; group 2 (G2): 10 patients received 10,000 IU VD, PO/week for 8 weeks; group 3 (G3): 10 patients received 50,000 IU VD, PO/week for 8 weeks. Before and at the end of 8 weeks patients were submitted to VD, fecal calprotectin (FC) and C-reactive protein (CRP) dosage. Follow-up period was 52 weeks, and they are checked for disease activity recurrence (Crohn's disease activity index (CDAI) > 150, FC > 300 and computerized tomography (CT) scan), FC, CRP, and VD levels.Results: Increased VD levels were observed in all groups (P < 0.0001). CRP did not change. There was a significant decrease of FC in G3 (1,014 +/- 850 vs. 483 +/- 564; P = 0.04), no significant decrease in G2 (76,767 +/- 751 vs. 535 +/- 823; P = 0.2) and increase in G1 (1,101 +/- 744 vs. 1,357 +/- 819; P = 0.4). During the 52-week follow-up period, it was showed that recurrent disease activity (CDAI > 150, FC > 200 and CT scan) was predominant in patients with VD < 30 group, and the remission rate was predominant in patients with VD > 30 group (P = 0.0001). A statistically significant difference in VD levels was noted in CD patients after 52 weeks that presented flare or disease remission (P = 0.001).Conclusions: Use of VD associated with anti-TNF treatment may improve clinical response in CD. VD levels greater than 30 ng/mL have better rates of remission.