新诊断成人克罗恩病治疗升级风险中维生素D和血小板与淋巴细胞比值的关系

IF 4.4 2区医学 Q1 NUTRITION & DIETETICS

Nutrition Journal Pub Date : 2025-03-28 DOI:10.1186/s12937-025-01115-7

Kan Wang, Shichen Zhu, Lingya Yao, Qian Cao, Bule Shao

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引用次数: 0

摘要

背景：越来越多的研究表明，维生素D （VD）可能在克罗恩病（CD）的发病机制中起重要作用，而血小板与淋巴细胞比率（PLR）正在成为免疫疾病的生物标志物。然而，VD和PLR对新诊断的CD患者治疗升级的协同作用尚不清楚。因此，本研究旨在评估PLR和VD对CD患者后续使用英夫利昔单抗和/或免疫抑制剂的相互作用。方法：从邵逸夫医院炎症性肠病生物库（SRRSH-IBC）中选择新诊断的CD患者。采用COX比例风险模型评估CD患者中VD、PLR和治疗升级之间的关系。结果：108例新诊断的成年CD患者中，维生素D缺乏症（VDD）普遍存在（78.7%）。与没有VDD的CD患者相比，VDD患者表现出更高的治疗升级风险，即使用英夫利昔单抗和/或免疫抑制剂（HR = 3.22, 95% CI = 1.24-8.35, P = 0.016）。随着VD水平的升高，治疗升级的风险有明显的降低趋势（HR = 0.26, 95% CI = 0.09-0.76, P = 0.014）。分层分析显示，PLR和VD水平在治疗升级方面存在显著的相互作用。基线VDD放大了PLR升高患者治疗升级的风险（HR = 4.17, 95% CI = 1.51-11.53， p相互作用= 0.031）。当VD水平分层为四分位数时，也观察到类似的趋势（最高四分位数vs最低四分位数：HR = 0.18, 95% CI = 0.05-0.62， P为趋势= 0.014）。结论：本研究强调了VD水平和PLR之间的显著相互作用对CD治疗结果的影响。VDD主要在PLR水平升高的个体中加剧了治疗升级的风险，强调了维生素D状态和炎症对CD疾病进展的综合影响。

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Association of vitamin D and platelet-to-lymphocyte ratio in treatment escalation risk for newly diagnosed Crohn's disease adults.

Background: Accumulating research has implicated that vitamin D (VD) may be important in the pathogenesis of Crohn's disease (CD), while the platelet-to-lymphocyte ratio (PLR) is emerging as a biomarker in immune disorders. However, the synergistic effect of VD and PLR on treatment escalation in newly diagnosed CD patients remains unclear. Therefore, this study aims to assess the interaction between PLR and VD on the subsequent use of infliximab and/or immunosuppressants in patients with CD.

Methods: Newly diagnosed CD patients were selected from the Sir Run Run Shaw Hospital Inflammatory Bowel Disease Biobank (SRRSH-IBC). COX proportional hazards models were employed to assess the association between VD, PLR, and treatment escalation among CD patients.

Results: Among 108 newly diagnosed CD adult patients, vitamin D deficiency (VDD) was prevalent (78.7%). Compared to CD patients without VDD, those with VDD exhibited a higher risk of treatment escalation, i.e., using infliximab and/or immunosuppressants (HR = 3.22, 95% CI = 1.24-8.35, P = 0.016). There is a clear trend of decreasing risk of treatment escalation as VD levels elevating (HR = 0.26, 95% CI = 0.09-0.76, P for trend = 0.014). The stratified analysis revealed a noteworthy interaction between PLR and VD levels concerning treatment escalation. Baseline VDD amplified the risk of treatment escalation among patients with elevated PLR (HR = 4.17, 95% CI = 1.51-11.53, P_interaction = 0.031). Similar trends were observed when VD levels were stratified into quartiles (highest quartile vs. lowest quartile: HR = 0.18, 95% CI = 0.05-0.62, P for trend = 0.014).

Conclusion: This study underscores a significant interplay between VD levels and PLR in influencing treatment outcomes in CD. VDD exacerbates the risk of treatment escalation primarily in individuals with heightened PLR levels, highlighting the combined impact of vitamin D status and inflammation on disease progression of CD.

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来源期刊

Nutrition Journal NUTRITION & DIETETICS-

CiteScore

9.80

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： Nutrition Journal publishes surveillance, epidemiologic, and intervention research that sheds light on i) influences (e.g., familial, environmental) on eating patterns; ii) associations between eating patterns and health, and iii) strategies to improve eating patterns among populations. The journal also welcomes manuscripts reporting on the psychometric properties (e.g., validity, reliability) and feasibility of methods (e.g., for assessing dietary intake) for human nutrition research. In addition, study protocols for controlled trials and cohort studies, with an emphasis on methods for assessing dietary exposures and outcomes as well as intervention components, will be considered. Manuscripts that consider eating patterns holistically, as opposed to solely reductionist approaches that focus on specific dietary components in isolation, are encouraged. Also encouraged are papers that take a holistic or systems perspective in attempting to understand possible compensatory and differential effects of nutrition interventions. The journal does not consider animal studies. In addition to the influence of eating patterns for human health, we also invite research providing insights into the environmental sustainability of dietary practices. Again, a holistic perspective is encouraged, for example, through the consideration of how eating patterns might maximize both human and planetary health.