董晓霞?刘琳?徐帅?于进洪

【摘要】目的 研究血清維生素D与透明质酸水平对短肠综合征（SBS）患者预后的预测价值。方法 选取100例SBS患者为SBS组，另选取同期体检的100名健康人为健康组。SBS患者经营养、肠康复、手术等方式治疗，随访1年观察患者预后并根据预后分为良好组、不良组。比较SBS组、健康组血清25-羟维生素D3[25（OH）D3]、透明质酸水平;比较良好组、不良组血清25（OH）D3、透明质酸水平及其他SBS 1年预后可能影响因素差异;logistic回归分析SBS 1年预后影响因素;绘制受试者工作特征（ROC）曲线，分析血清25（OH）D3、透明质酸单独及联合对SBS 1年预后预测价值。结果 SBS组血清25（OH）D3水平低于健康组，透明质酸水平高于健康组（P均< 0.05）;不良组残余小肠长度≤60 cm构成比、血清透明质酸水平高于良好组，血清25（OH）D3水平低于良好组（P < 0.05），经logistic回归分析3者均是SBS 1年预后影响因素（P均< 0.05）。ROC结果显示，血清25（OH）D3、透明质酸预测SBS 1年预后不良最佳截断点分别为15.74 μg/L、235.70 μg/L，单独及联合预测的AUC分别为0.825、0.763、0.855，两者联合检测的预测价值高于单独血清透明质酸检测（P < 0.05）。结论 SBS患者中血清25（OH）D3水平异常降低、透明质酸水平异常升高，两者联合检测对SBS患者预后预测价值高于单独血清透明质酸检测。

【关键词】短肠综合征;预后;维生素D;透明质酸

Predictive values of serum vitamin D and hyaluronic acid levels for clinical prognosis of patients with short bowel syndrome Dong Xiaoxia， Liu Lin， Xu Shuai， Yu Jinhong. Department of Nutrition， East District， Handan Central Hospital， Handan 056000， China

【Abstract】Objective To evaluate the predictive values of serum vitamin D and hyaluronic acid（HA） levels for clinical prognosis of patients with short bowel syndrome（SBS）. Methods A total of 100 patients with SBS were recruited into the SBS group， and 100 healthy controls for physical examination during the same period were assigned into the control group. SBS patients received nutritional therapy， intestinal rehabilitation， and surgical treatment and followed up for one year to observe clinical prognosis. All SBS patients were classified into the good prognosis and poor prognosis groups. The serum 25-hydroxyvitamin D3 （25（OH）D3） and HA levels were compared between the SBS and control groups. The serum 25（OH）D3， HA levels and other potential risk factors of 1-year prognosis were statistically compared between the good and poor prognosis groups. The 1-year prognostic factors of SBS patients were identified by logistic regression analysis. The receiver operating characteristic （ROC） curve was delineated to analyze the predictive values of serum 25（OH）D3， HA alone and two combined for 1 year prognosis of SBS. Results The serum 25（OH）D3 level in the SBS group was significantly lower， whereas the HA level was remarkably higher than those in the control group （both P < 0.05）. In the poor prognosis group， the composition ratio of residual small intestine length of ≤60 cm and the serum HA level were significantly higher， whereas the serum 25（OH）D3 level was considerably lower than those in the good prognosis group （all P < 0.05）. Logistic regression showed that all these parameters were the risk factors affecting the 1-year prognosis of SBS patients （all P < 0.05）. The ROC curve results demonstrated that the optimal cut-off values of serum 25（OH）D3 and HA levels for predicting poor prognosis of SBS patients were 15.74 μg/L and 235.70 μg/L. The area under the curve （AUC） predicted by serum

25（OH）D3 and HA levels alone and two combined were 0.825， 0.763， and 0.855， respectively. The predictive value of the combination of the two is higher than that of the serum hyaluronic acid test alone（P < 0.05）. Conclusions In SBS patients， serum 25（OH）D3 level is abnormally decreased， whereas serum HA level is abnormally increased. The combined detection of the two is more valuable than the detection of serum hualuronic acid in predicting the prognosis of SBS patients.

【Key words】Short bowel syndrome;Prognosis;Vitamin D;Hyaluronic acid

短肠综合征（SBS）是指由于各种先天或后天疾病行广泛小肠切除术后，残余小肠消化及吸收面積不足，无法维持机体正常生理代谢的营养需求，从而导致全身性并发症的一系列综合征[1]。目前SBS以肠内、肠外营养及手术治疗为主，治疗周期长且疗效不一，探寻有效的预后预测指标可为医师判断预后、及时调整治疗方案提供参考。维生素D广泛存在于机体中，研究认为其不仅是促进骨骼发育、维护骨量与骨质量的重要营养因子，并且可调控机体炎症因子及免疫功能[2-3]。近年来研究发现，SBS患者普遍存在维生素缺乏，且治疗后其水平有所改善。透明质酸是一种由间质细胞合成的高分子多糖，具有维持组织体积、形态及抗压缩、抗张力等作用，常作为肝脏疾病肝纤维化程度的血清标志物[4]。……