丙型肝炎患者HCV RNA载量、肝脏纤维化指数与25羟基维生素D水平的相关性分析

Analysis on the correlations of 25-hydroxyvitamin D concentrations with HCV RNA loads and cirrhosis severity in hepatitis C patients

目的分析丙型肝炎(简称丙肝)患者血清25羟基维生素D[25(OH)D]水平和病毒载量、肝脏纤维化程度之间的关系。方法收集271例丙肝患者和218名表面健康人(正常对照组)的血清标本,定量检测血清25(OH)D浓度、HCV RNA病毒载量以及Fibrotest分级标准中的5项指标[包括α2巨球蛋白(α2M)、触珠蛋白(HPT)、载脂蛋白A1(apo A1)、总胆红素(TBil)和γ-谷氨酰基转移酶(GGT)]。根据Fibrotest分级标准判断丙肝患者的肝纤维化程度。比较丙肝组与正常对照组之间25(OH)D浓度的差异;比较HCV RNA阳性组与阴性组25(OH)D浓度的差异;分析HCV RNA阳性组HCV RNA载量与25(OH)D浓度的相关性。根据25(OH)D浓度进行四分位分组,分析25(OH)D浓度与肝脏纤维化指数(Fibrotest分级)的关系。结果丙肝组25(OH)D浓度为(49.31±1.39)nmol/L,明显低于正常对照组[(60.42±1.34)nmol/L,P<0.01]。丙肝组中25(OH)D缺乏(<50 nmol/L)和严重缺乏(<25 nmol/L)的比例为41.33%(112/271)和14.40%(39/271),明显高于正常对照组[27.98%(61/218)和3.67%(8/218)](P<0.01)。丙肝患者中HCV RNA阳性组与HCV RNA阴性组25(OH)D浓度分别为48.98±21.59、(49.89±25.27)nmol/L,两组比较差异无统计学意义(P>0.05)。线性相关分析显示HCV RNA阳性组病毒载量对数值与其25(OH)D浓度无相关性(r=0.056,P=0.412)。四分位25(OH)D最低浓度分位和最高浓度分位患者的Fibrotest分级F0-F1级、F1-F3级和F3-F4级的比例差异无统计学意义(P>0.05);无肝纤维化、轻度肝纤维化、重度肝纤维化患者25(OH)D浓度分别为49.12±5.80、48.27±4.90和(49.89±8.20)nmol/L,3组之间差异无统计学意义(P>0.05)。结论丙肝患者体内25(OH)D浓度明显低于健康对照人群,建议对该类人群进行维生素D的补充。丙肝患者25(OH)D浓度与HCV RNA载量及肝纤维化的严重程度并不明显相关。

Objective To investigate the correlations of serum 25-hydroxyvitamin D [25（ OH） D]concentrations with hepatitis C virus（ HCV） RNA loads and cirrhosis severity in hepatitis C patients. Methods A total of 271 hepatitis C patients and 218 healthy subjects were enrolled,and their serum samples were collected. Serum 25（ OH） D concentrations and HCV RNA loads were determined. Moreover,serum alpha 2-macroglobulin（ α2M）,haptoglobin（HPT）,apolipoprotein A1（apo A1）,total bilirubin（TBil） and gamma-glutamyl transpeptidase（GGT） concentrations were determined. According to Fibrotest classification, the severity of cirrhosis was evaluated. The 25（ OH） D concentrations between hepatitis C and healthy control groups were compared. Furthermore,the difference of serum25（ OH） D between HCV RNA positive group and HCV RNA negative group was also evaluated. The correlation between serum 25（ OH） D concentrations and HCV RNA loads in HCV RNA positive group was analyzed. Hepatitis C patients were classified according to the quartile concentrations of 25（ OH） D,and the correlation between serum 25（ OH） D concentrations and Fibrotest classification was investigated. Results Serum 25（ OH） D concentrations were significantly higher in healthy control group than in hepatitis C group [means were（ 60. 42 ± 1. 34） nmol / L and（ 49. 31 ±1. 39） nmol / L,P〈0. 01]. The proportions of patients with the deficiency of 25（ OH） D（ 50 nmol / L） and the ones with severe deficiency（ 〈25 nmol / L） in hepatitis C group were 41. 33%（ 112 /271） and 14. 40%（ 39 /271）,which were significantly higher than those in healthy control group[27. 98%（61 /218） and 3. 67%（8 /218）]（ P〈0. 01）.No significant difference for serum 25（ OH） D concentrations was observed between HCV RNA positive and HCV RNA negative groups[means were 48. 98 ± 21. 59 and（49. 89 ± 25. 27） nmol / L,P〉0. 05]. Linearity regression revealed that there was no correlation between the logarithmic of HCV RNA loads and the concentration of 25（ OH） D in HCV RNA positive group（ r = 0. 056,P = 0. 412）. Moreover,there was no statistical significance for the proportion of patients with different Fibrotest classifications（ F0-F1,F1-F3 and F3-F4） between the highest quartile concentration and the lowest quartile concentration of 25（ OH） D [means were 49. 12 ± 5. 80,48. 27 ± 4. 90 and（49. 89 ± 8. 20） nmol / L,P〉0. 05]. Conclusions The hepatitis C patients are prone to encounter 25（ OH） D deficiency compared with healthy subjects,which implys that these patients are suggested to uptake vitamin D supply. Furthermore,no clinical correlation is found between the logarithmic of HCV RNA loads,cirrhosis severity and the concentrations of 25（ OH） D.