Objective: To analyze the influence of vitamin D3 supplementation on the clinical efficacy of mesalazine in patients with ulcerative colitis (UC). Methods: From January 2015 to December 2020, patients with mild-to-moderate active UC were retrospectively and continuously enrolled, who accepted mesalazine treatment for at least 12 months at the Second Affiliated Hospital of Wenzhou Medical University. According to simultaneous supplement of vitamin D3 (125 IU/d), the patients were divided into study group and control group. Demographic and disease characteristics, serum 25-hydroxyvitamin D[25(OH)D] levels and other information were collected through retrieving hospital database. Student's t-test, Mann-Whitney U test and Chi-square test were applied for comparison of disease characteristics. The changes of modified Mayo scores[ΔMayo] and 25(OH)D[Δ25(OH)D] were compared before and after treatment by paired t-test, Wilcoxon signed rank test and Chi-square test. Multiple linear regression model was used to analyze the independent factors affecting ΔMayo and Δ25(OH)D, and variables with P-values less than 0.20 in the univariate analysis were allowed for further multivariate analysis. Results: A total of 74 UC patients (44 males, 30 females), with median age (range) 39.5 (20-76) years old, were analyzed and respectively assigned into study group (n=36) and control group (n=38). In study group, the average level of serum 25(OH)D was significantly increased at month 12 compared with that at baseline [(22.87±7.30) μg/L vs. (18.15±7.48) μg/L,P<0.001]. However, no significant elevation of serum 25(OH)D was found in control group [(19.17±8.49) μg/L vs. (19.82±9.47) μg/L,P=0.466]. Furthermore, there was a significant decrease of modified Mayo score [-3(-4.75, -1.25) vs.-2(-3.25, 0), P=0.034] and a higher clinical remission rate (55.6% vs. 28.9%, P=0.020) at month 12 in study group than those in control group. In addition, according to the baseline level of serum 25(OH)D before mesalazine treatment, 74 UC patients were divided into vitamin D deficiency group (n=38, serum 25(OH)D<20 μg/L) and non-deficiency group (n=36, serum 25(OH)D≥20 μg/L). At month 12 in vitamin D deficiency group, patients with vitamin D3 supplementation had a greater decline in modified Mayo score [-4(-5.75, -2) vs.-2(-4, 0), P=0.048] and a higher clinical remission rate (60.0% vs. 22.2%, P=0.019) compared with those without. Conclusions: In patients with mild-to-moderate active UC receiving mesalazine treatment, vitamin D3 supplementation may improve the clinical efficacy, especially in patients with vitamin D deficiency.
目的： 分析补充维生素D3对美沙拉秦治疗溃疡性结肠炎（UC）患者临床疗效的影响。 方法： 回顾性连续纳入2015年1月至2020年12月于温州医科大学附属第二医院接受美沙拉秦治疗至少12个月的轻中度活动期UC患者，根据是否同时补充维生素D3（125 IU/d）分为试验组和对照组。通过检索病历数据库，获取患者人口学信息、疾病特征、血清25-羟基维生素D［25（OH）D］水平等资料。采用t检验、Mann-Whitney秩和检验及卡方检验比较两组患者疾病特征的差异。采用配对t检验、配对Wilcoxon 符号秩检验及卡方检验比较治疗前后两组患者的改良Mayo评分［ΔMayo］和25（OH）D的变化［Δ25（OH）D］。纳入单因素相关性分析P<0.2的变量，采用多元线性回归模型分析影响ΔMayo和Δ25（OH）D的独立因素。 结果： 共纳入74例UC患者（男44例，女30例），中位年龄（范围）为39.5（20~76）岁，分为试验组36例和对照组38例。第12个月与第0月比较，试验组患者25（OH）D平均水平显著增高［（22.87±7.30）μg/L比（18.15±7.48）μg/L，P<0.001］，而对照组患者25（OH）D平均水平变化差异无统计学意义［（19.17±8.49）μg/L比（19.82±9.47）μg/L，P=0.466］。第12个月时，试验组与对照组相比，改良Mayo评分的下降幅度更大［-3（-4.75，-1.25）分 比-2（-3.25，0）分，P=0.034］，临床缓解率更高（55.6%比28.9%，P=0.020）。另外，依据美沙拉秦治疗前的基线25（OH）D水平，将74例UC患者分为维生素D缺乏组［38例，25（OH）D<20 μg/L］和维生素D不缺乏组［36例，25（OH）D≥20 μg/L］。第12个月时，在维生素D缺乏组中分析发现，补充维生素D3的患者与未补充维生素D3的患者相比，前者改良Mayo评分的下降幅度更大［-4（-5.75，-2）分比-2（-4，0）分，P=0.048］，临床缓解率亦更高（60.0%比22.2%，P=0.019）。 结论： 补充维生素D3可能有助于改善美沙拉秦治疗轻中度UC患者的临床疗效，尤其是在维生素D缺乏的UC患者中。.