慢性乙型肝炎患者血清维生素D水平的临床意义

The clinical significance of vitamin D levels in chronic hepatitis B patients

目的探讨慢性乙型肝炎患者血清维生素D水平的临床意义。方法收集201例慢性乙型肝炎患者及100例按照年龄、性别配对的健康体检人群的外周静脉血清,化学发光微粒子免疫检测法定量检测HBsAg及HBeAg,荧光定量PCR检测血清乙型肝炎病毒载量,全自动生化分析仪检测肝功能,电化学发光法测定血清25-羟维生素D水平。结果慢性乙型肝炎患者血清25-(OH)D水平高于健康人群[(24.48±10.51)ng/mL VS.(21.69±7.45)ng/mL,P=0.008],纳入采样时间因素考虑后前者血清25-(OH)D浓度为(28.66±11.65)ng/mL,两组差异更加明显(P<0.001)。慢性乙型肝炎组维生素D充足的发生率高于对照组(P=0.001)。慢性乙型肝炎患者血清25-(OH)D与ALT(r=0.18,P=0.04)、GGT(r=0.27,P<0.01)、HBeAg(r=-0.20,P=0.02)呈显著线性相关;当限定Log10 HBV DNA在(4.2~8)IU/mL时,血清25-(OH)D与其存在显著线性负相关(n=119,r=-0.20,P=0.03)。结论与健康人群相比,慢性乙型肝炎患者血清维生素D水平更高。慢性乙型肝炎患者血清维生素D水平与肝脏炎症及乙型肝炎病毒复制状态有关。慢性乙型肝炎患者HBeAg滴度及中高度水平的乙型肝炎病毒载量与维生素D水平呈负相关。

Objective To investigate the clinical significance of serum vitamin D levels in patients with chronic hepatitis B.Methods The peripheral vein serum samples of 201 patients with chronic hepatitis B and 100 cases of healthy controls matched by age and gender were collected.Markers of hepatitis B vius(HBV)were detected quantificationally with chemiluminescent micropartical immunoassay;HBV DNA load was detected with fluorescence quantitative polymerase chain reaction(PCR);Paremeters of the liver function test were detected by automatic biochemical analyzer.Serum 25-hydroxy vitamin D concentration was detected with electrochemiluminescence assay.Results The serum 25-(OH)D levels of chronic hepatitis B patients were higher than healthy controls[(24.48±10.51)ng/ml vs(21.69±7.45)ng/ml,P=0.008].After a correction with sampling time,the average serum 25-(OH)D levels of chronic hepatitis B patients was(28.66±11.65)ng/ml and much more higher than that of the healthy controls(P<0.001).The incidence of sufficient vitamin D in chronic hepatitis B group was higher than that in the control group(P=0.001).The 25-(OH)D levels in patients with chronic hepatitis B showed significant linear correlations with ALT(r=0.18,P=0.04),GGT(r=0.27,P<0.01)and HBeAg(r=-0.20,P=0.02);when defining Log10 HBV DNA load as(4.2~8)IU/ml,there was a significant negative linear correlation between vitamin D levels and Log10 HBV DNA(n=119,r=-0.20,P=0.03).Conclusion The serum vitamin D levels increase in chronic hepatitis B patients and are associated with liver inflammation and HBV replication status.A moderate to high levels of HBV DNA loads and the titers of HBeAg in chronic hepatitis B patients are reversely co-related with their serum vitamin D levels.