初诊溃疡性结肠炎患者与复发相关的营养代谢危险因素的队列研究

A cohort study of nutritional metabolic risk factors associated with recurrence in patients with initially diagnosed ulcerative colitis

目的探究初诊溃疡性结肠炎(ulcerative colitis,UC)患者复发的相关营养代谢水平危险因素,为临床更准确地预测复发提供依据。方法采用回顾性队列研究方法,依据纳入标准和排除标准,纳入自2016年1月至2019年1月于新疆维吾尔自治区人民医院就诊的初诊(轻、中度)UC并定期随访3年的210例,根据患者有无复发分为复发组和非复发组。再根据复发时间,将UC复发组患者分为短期(0~6个月)复发组、中期(6~12个月)复发组及远期(12~36个月)复发组。通过单因素分析和多因素Logistic回归分析评估初诊(轻度、中度)UC患者复发的相关营养代谢水平危险因素,采用受试者工作特征曲线下面积和约登指数评价预测效能。再对短期复发组、中期复发组及远期复发组进行复发影响因素的比较。结果纳入210例初诊(轻、中度)UC患者中,短期复发组38例,中期复发组27例,远期复发组24例,非复发组121例。复发组与非复组相比,在性别、年龄、吸烟史、家族史方面差异无统计学意义。单因素分析提示,复发组与非复发组的同型半胱氨酸、叶酸、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、载脂蛋白A/B、25羟维生素D3、体重指数(body mass index,BMI)差异均有统计学意义(P<0.05)。多因素二元Logistic回归分析提示,同型半胱氨酸(OR=0.869、95%CI:0.782~0.965、P=0.009)、甘油三酯(OR=0.176、95%CI:0.060~0.519、P=0.002)、低密度脂蛋白(OR=0.256、95%CI:0.089~0.733、P=0.011)、25羟维生素D3(OR=0.937、95%CI:0.895~0.0.982、P=0.006)、BMI(OR=1.319、95%CI:1.162~1.498、P<0.01)是UC复发的独立危险因素;危险因素预测效能从大到小依次为:低密度脂蛋白(AUC=0.762,YI=0.42,预测界值=2.345)、甘油三酯(AUC=0.718,YI=0.361,预测界值=1)、同型半胱氨酸(AUC=0.666,YI=0.283,预测界值=13.265)。短期复发组、中期复发组及远期复发组在性别、年龄、吸烟史、家族史方面差异无统计学意义。短期复发组与远期复发组的高密度脂蛋白和载脂蛋白A/B比较,差异有统计学意义(P<0.05)。结论UC患者病情复发是多种因素综合作用的结果,为避免复发,临床上应积极关注UC患者同型半胱氨酸、甘油三酯、低密度脂蛋白、25羟维生素D3、BMI指标的变化情况。

Objective To investigate the nutritional and metabolic risk factors associated with recurrence in patients with newly diagnosed ulcerative colitis(UC),so as to allow better clinical prediction of recurrence.Methods A retrospective cohort study was conducted.Patients newly diagnosed with UC(mild and moderate)from the People's Hospital of Xinjiang Uygur Autonomous Region were screened based on prespecified inclusion and exclusion criteria from January 2016 to January 2019.Patients were followed up regularly for three years.Subgroups were determined according to the presence or absence of recurrence.The patients in the UC recurrence group were further stratified according to the time to recurrence into short-term(0-6 months),mid-term(6-12 months)and long-term(12-36 months)recurrence groups.The nutritional and metabolic risk factors related to recurrence were evaluated by univariate analysis and multifactorial logistic regression analysis,and the predictive value was evaluated via receiver operating characteristic curve.The risk factors were then compared across the 3 subgroups with recurrence.Results A total of 210 patients newly diagnosed with UC(mild and moderate)were included,including 38 experiencing recurrence within 0-6 months,27 within 6-12 months,24 within 12-36 months,and 121 without recurrence.There were no statistically significant differences in gender,age,smoking history,and family history in the recurrence group compared with the non-recurrence group.Univariate analysis suggested significant differences in homocysteine,folate,total cholesterol,triglycerides,high-density lipoprotein(HDL),low-density lipoprotein(LDL),apolipoprotein A/B(ApoA/B),25-hydroxy vitamin D3,and body mass index(BMI)between recurrence and non-recurrence groups(P<0.05).Multifactorial binary logistic regression analysis suggested that homocysteine(OR=0.869,95%CI:0.782 to 0.965,P=0.009),triglycerides(OR=0.176,95%CI:0.060 to 0.519,P=0.002),LDL(OR=0.256,95%CI:0.089 to 0.733,P=0.011),25-hydroxy vitamin D3(OR=0.937,95%CI:0.895 to 0.0.982,P=0.006),and BMI(OR=1.319,95%CI:1.162 to 1.498,P<0.01)were independent risk factors for UC recurrence.The predictive efficiency of individual risk factors in descending order was as following:LDL(AUC=0.762,Youden's index[YI]=0.42,cut-off value=2.345),triglycerides(AUC=0.718,YI=0.361,cut-off value=1),homocysteine(AUC=0.666,YI=0.283,cut-off value=13.265).There were no statistically significant differences in gender,age,smoking history,and family history across the short-term,mid-term and long-term recurrence groups.There were significant differences in HDL and ApoA/B levels between the short-term and the long-term recurrence groups(P<0.05).Conclusions Recurrence of the disease in UC patients results from the combined effects of multiple factors.The changes in homocysteine,triglycerides,LDL,25-hydroxy vitamin D3,and BMI in UC patients should be proactively monitored to prevent recurrence.