血清胆红素与克罗恩病疾病活动度的相关性研究

Correlation between serum bilirubin and disease activity in Crohn′s disease

目的:分析克罗恩病(CD)患者血清总胆红素(Tbil)、非结合胆红素(Ibil)、结合胆红素(Dbil)水平与疾病临床活动度和内镜活动度的关系。方法:回顾性收集东南大学附属中大医院2018年1月至2022年6月的CD患者以及相匹配的健康对照组的人口学特征和相关临床数据,比较CD患者与对照组的血清胆红素水平,对血清胆红素水平与CD活动的关系进行分析。结果:共纳入196例CD患者和196例健康对照组。CD活动组患者的血清Tbil、Ibil和Dbil水平分别为7.2(5.4,9.7)μmol/L、4.6(3.4,6.6)μmol/L和2.5(1.7,3.6)μmol/L,分别低于对照组11.5(8.6,15.0)μmol/L、7.2(5.2,10.0)μmol/L和4.0(3.1,5.3)μmol/L,以及CD缓解组的11.8(8.5,14.6)μmol/L、8.2(5.1,9.5)μmol/L和4.0(2.8,5.2)μmol/L,差异均有统计学意义(P均<0.001)。在CD患者中,缓解组、轻、中、重度活动组间血清Tbil、Ibil、Dbil水平均有显著差异(P均<0.001),临床活动度高的患者胆红素水平低;在CD简化内镜评分(SES-CD)中,<3分、3~6分、7~15分、≥16分的CD患者的血清Tbil、Ibil、Dbil水平均有显著差异(P均<0.005),且内镜活动度高的患者胆红素水平低。有序Logistic回归显示,与最高四分位数血清胆红素水平相比,血清低水平的Tbil、Ibil、Dbil与CD活动指数和SES-CD增高呈正相关。结论:血清胆红素水平与CD疾病活动相关,低血清胆红素水平患者疾病活动的可能性大。

Objective To analyze the relationship of serum levels of total bilirubin(Tbil),indirect bilirubin(Ibil),direct bilirubin(Dbil)with disease symptom activity,and endoscopic activity in patients with Crohn′s disease(CD).Methods The demographic characteristics and relevant clinical data of patients with CD and matched healthy control groups from January 2018 to June 2022 were retrospectively collected,the level of serum bilirubin between CD patients and control groups were compared,and the relationship between serum bilirubin level and CD activity was analyzed.Results A total of 196 patients with CD and 196 healthy controls were included in this study.The serum Tbil,Ibil and Dbil levels of CD patients in the active group were 7.2(5.4,9.7)μmol/L,4.6(3.4,6.6)μmol/L and 2.5(1.7,3.6)μmol/L,which were lower than those in the control group 11.5(8.6,15.0)μmol/L,7.2(5.2,10.0)μmol/L and 4.0(3.1,5.3)μmol/L,and in the remission group 11.8(8.5,14.6)μmol/L,8.2(5.1,9.5)μmol/L and 4.0(2.8,5.2)μmol/L,all the differences were statistically significant(P all<0.001).In patients with CD,serum Tbil,Ibil and Dbil levels were significantly different between the remission group and the mild,moderate and severe activity group(P all<0.001),and the bilirubin levels were lower in patients with high disease activity.In simple endoscopic score for CD(SES⁃CD),there were significant differences of serum Tbil,Ibil and Dbil levels in patients with CD scores<3,3 to 6,7 to 15 and≥16(P all<0.005),and bilirubin levels were lower in patients with high endoscopic activity.Ordered Logistic regression showed that CD patients with low serum levels of Tbil,Ibil and Dbil had a higher risk of disease activity compared to the highest quartile bilirubin levels,both in CD activity index and SES⁃CD.Conclusion Serum bilirubin level is closely related to CD disease activity,and patients with low serum bilirubin level are more likely to develop into disease activity.