慢性乙型肝炎肝纤维化患者血清25羟维生素D3水平临床研究

Clinical study of levels on serum 25-hydroxy vitamin D in patients with hepatitis B-related liver fibrosis

目的探索慢性乙型肝炎(chronic hepatitis B,CHB)患者体内25羟维生素D3(25-hydroxy vitamin D3,25(OH) D3)水平及其与肝纤维化进展之间的关系;探索羟化酶CYP24A1代谢对25(OH) D3水平的影响。方法选取武汉协和医院感染科门诊2016年1月1日~2017年5月28日CHB肝纤维化患者121例,依据肝脏弹性测量值(liver stiffness measurement,LSM)进行肝纤维化分组,收集临床数据,用酶联免疫吸附(enzyme-linked immuno sorbent assay,ELISA)法测定血清25 (OH) D3及CYP24A1水平。结果不同肝纤维化组患者血清25 (OH) D3、CYP24A1水平组间差异均有统计学意义(均有P <0. 05),25(OH) D3随肝纤维化程度加重呈下降趋势。CHB患者CYP24A1水平与25(OH) D3呈负相关(r=-0. 267,P=0. 003)。多因素Logistic回归分析显示低水平25(OH) D3(OR=0. 906,95%CI:0. 850~0. 965,P=0. 002)、高年龄(OR=1. 073,95%CI:1. 015~1. 134,P=0. 013)、高水平凝血酶原时间(prothrombin time,PT)(OR=3. 705,95%CI:1. 594~8. 611,P=0. 002)与重度肝纤维化独立相关。结论 CHB患者25(OH) D3水平的下降程度与肝纤维化进展相关,可能成为预测严重肝纤维化的危险因素;而其下降原因可能与CYP24A1浓度的上调有关。

Objective To explore the relationship between 25-hydroxy vitamin D3 levels and progression of liver fibrosis in patients with chronic hepatitis B; to explore the effect of hydroxylase CYP24A1 metabolism on 25 （OH）D3 levels. Methods A total of 121 outpatients with chronic hepatitis B related hepatic fibrosis were divided into five groups depending on liver elasticity measurement （ LSM ） , and their clinical data were collected. The 25 （OH） D3 and CYP24A1 serum levels were measured by ELISA. Results There were significant differences in the levels of 25 （OH）D3 and CYP24A1 among different liver fibrosis groups （ all P 〈 0. 05 ）. The 25 （OH） D3 levels decreased gradually with the degree of liver fibrosis aggravating. The CYP24A1 levels in chronic hepatitis B patients were negatively correlated with 25 （OH）D3 （r = - 0. 267 ） （ P = 0. 003 ）. Low 25 （OH） D3 （ OR = 0. 906,95 % CI：0. 850 - 0. 965, P = 0. 002） levels, older age （ OR = 1. 073, 95 % CI： 1. 015 - 1. 134,P = 0. 013 ） , and prolonged PT （ OR = 3. 705,95 % CI： 1. 594 - 8.611, P = 0. 002 ） were independently associated with severe fibrosis by multivariate Logistic analysis. Conclusions The degree of decrease in 25 （OH） D3 levels in CHB patients is associated with the progression of liver fibrosis, and it could be a risk factor for predicting severe liver fibrosis; which may be related to up-regulation of CYP24AI concentration.