慢性HBV感染者血清维生素D水平及其临床意义

Clinical study of serum vitamin D in chronic HBV infected patients

目的检测不同疾病状态慢性HBV感染者的血清25(OH)D水平,并探讨其临床意义。方法收集慢性HBV感染者246例(慢性乙型肝炎患者90例,乙肝肝硬化代偿期患者70例,乙肝肝硬化失代偿期患者86例),80例健康体检者为对照,检测所有患者的血清25(OH)D水平、肝功、凝血及乙肝病毒学标志物并对肝硬化患者进行Child-Pugh分级、计算肝脏纤维化FIB-4评分等。结果①慢性HBV感染者血清25(OH)D平均水平为(14.37±7.18)ng/mL,低于正常对照组[(23.60 ± 6.20 ) ng/mL,P<0.05],其中乙肝肝硬化失代偿期患者血清25(OH)D水平[(11.20± 5.99 )ng/mL]低于慢性乙型肝炎患者[(15.22±6.84)ng/mL,P<0.001]和乙肝肝硬化代偿期患者[(17.16± 7.55)ng/mL ,P< 0.001 ],差异均有统计学意义;②血清25(OH)D与ALB水平均呈正相关,与PT水平呈负相关,肝硬化患者的血清25(OH)D水平与FIB-4评分呈负相关;③在肝硬化Child-Pugh C级的患者中血清25(OH)D缺乏者占91.9%,Child-Pugh B级的患者中血清25(OH)D缺乏者占81.6%,Child-Pugh A级的患者中血清25(OH)D缺乏者占67.1%;④单因素及多因素 Logistic 回归分析结果提示,FIB-4评分≥1.45的慢性乙型肝炎患者,发生肝硬化代偿的可能性大;血清25(OH)D水平<20 ng/mL的肝硬化代偿期患者,发生肝硬化失代偿的可能性大,肝脏病变程度重。结论维生素D缺乏在慢性HBV感染者中普遍存在,肝硬化失代偿患者尤为显著;血清维生素D水平可作为评估慢性HBV感染者疾病严重程度的指标之一。

Objective To assess the level of serum 25(OH)D in patients infected with chronic hepatitis B virus (HBV) at different stages so as to explore their clinical significance. Methods We quantified the levels of serum 25(OH)D from 246 chronic HBV-infected patients (chronic hepatitis B, n =90;compensated liver cirrhosis, n =70;and decompensated liver cirrhosis, n =86) in the study. Serum 25(OH)D level,liver function,coagulation index,and HBV markers were tested in all the patients. Child-Pugh grade and FIB-4 score of liver fibrosis were calculated in patients with liver cirrhosis. Results ① The mean serum level of vitamin D in chronic HBV infection patients was significantly lower than that in healthy controls [(14.37±7.18)ng/mL vs.(23.60±6.20)ng/mL, P <0.05]. Serum 25(OH)D level in patients with decompensated cirrhosis was obviously lower than that in patients with chronic hepatitis B [(15.22±6.84)ng/mL, P <0.001] and compensated cirrhosis [(17.16±7.55)ng/mL, P < 0.001 ].② Serum 25(OH)D had a positive correlation with ALB level,but a negative correlation with PT level. Serum 25(OH)D level in liver cirrhosis patients was significant negatively correlated with FIB-4 scores.③ Of the liver cirrhosis patients,91.9% patients in Child-Pugh C group,81.6% patients in Child-Pugh B group,and 67.1% patients in Child-Pugh A group had serum 25(OH)D level deficiency. Univariate and multivariate logistic regression analysis showed that CHB patients with FIB-4 score≥1.45 were more likely to develop compensated liver cirrhosis. Compensated liver cirrhosis patients with serum 25(OH) D level <20 ng/mL had the high possibility of decompensation cirrhosis and more severe hepatic injury. Conclusion Vitamin D deficiency is prevalent in chronic HBV-infected patients,especially in those with decompensated cirrhosis. Vitamin D level can be used as an indicator to assess the severity of chronic HBV infection.