慢性HBV感染者血清维生素D水平的临床观察

Clinical observation on the serum vitamin D level of the patients with chronic hepatitis B infection

目的:观察慢性HBV感染者血清维生素D水平的变化。方法:对152例正常人和451例慢性HBV感染者(慢性乙型病毒性肝炎、肝硬化、肝癌患者)进行血清25(OH)D浓度、肝功能、乙型肝炎病毒标记物、T淋巴细胞亚群的测定,观察慢性HBV感染者血清25(OH)D的变化,并对25(OH)D与各观察指标的相关性进行分析。结果:①慢性乙型病毒性肝炎、肝硬化、肝癌患者的血清25(OH)D水平均较正常人降低,肝硬化失代偿期患者的水平最低,差异有统计学意义(P<0.05);慢性HBV感染者中低浓度25(OH)D者的比例均高于正常人,差异均有统计学意义(P<0.05)。②在25(OH)D高、中、低浓度组中,低浓度组患者ALT低于高浓度组,差异有统计学意义(P<0.05);3组患者HBsAg、HBVDNA、CD8^+、CD56^+水平的差异均无统计学意义(P>0.05)。③在慢性乙型肝炎组、肝硬化失代偿期组和肝癌组患者中,25(OH)D分别与ALT、HBsAg、HBV DNA呈显著正相关;高浓度组患者中,25(OH)D与CD56^+呈显著负相关。④不同HBeAg、HBV DNA状态人群的25(OH)D水平无显著差异。结论:慢性HBV感染者普遍存在维生素D不足,要进一步阐明维生素D在HBV感染发生发展过程中的作用,需更为科学规范的前瞻性研究。

Objective：To observe the vitamin D level of the patients with chronic HBV infection. Metheds： Fifty-two controls and 451 CHB,liver cirrhosis,HCC patients related to HBV infection were collected to test the 25（OH） D,ALT,HBV - M, CD4 ＋, CD8 ＋ and CD56 ＋ ,analysis the change of the vitamin D level,and the association between 25（ OH）D and the parameters above. Results：（1）the 25（OH） D level was lower in patients with chronic HBV infection than the controls, there was significant difference between liver cirrhosis group and control group（P 〈0.05 ） ;the ratios of low 25（OH） D concentration in chronic HBV infection was significantly higher than the control（ P 〈0. 05）. （2）the level was significantly lower in the low 25 （OH） D concentration group than the high one （ P 〈 0.05 ） ; there were no significant difference of HBsAqg,HBV DNA,CD8 ＋ ,CD56 ＋ among the high, middle and low 25（OH） D concentration group. （3）there were significant positive relationships between 25（ OH）D and ALT, HBsAg,HBV DNA in CHB, decomponsated cirrhosis and HCC group respectively, and significantly negative relationship with CD56 ＋ in high concentration group. （4）there were no sitmificont differences of 25 （OH） D level in HBeAg ＋ / - or HBV DNA ＋ / - patients. Condustoa ：the vitamin D insufficiency was very common in the patients with chronic HBV infec- tion, the strictly prospective research was needed to explain the mechanism of vitamin D in the progress of the chronic HBV infection.