血清25-羟基维生素D在儿童慢性乙型肝炎中的变化及临床意义

Clinical significance and changes of serum 25-hydroxyvitamin D in children with chronic hepatitis B

目的探讨血清25-羟基维生素D〔25(OH)D〕在慢性乙型肝炎(CHB)患儿体内的变化及临床意义。方法选择湖南省儿童医院2020年6—11月收治的69例CHB患儿作为CHB组,另外选择同期体检合格的74名健康儿童作为健康对照组。采用化学发光法检测健康对照组和CHB组血清25(OH)D水平;采用全自动生化分析仪检测肝功能指标〔包括总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆汁酸(TBA)、总蛋白(TP)、白蛋白(ALB)〕;采用荧光定量聚合酶链反应(PCR)对其中55例患者进行乙型肝炎病毒(HBV)-DNA载量检测。根据HBV血清学检测结果将CHB组患者分为大三阳组(34例)和小三阳组(35例);根据HBV-DNA载量检测结果分为HBV-DNA检出组(32例)和HBV-DNA未检出组(23例);根据转氨酶是否升高分为转氨酶升高组(31例)和转氨酶正常组(38例)。比较各组上述指标的差异。结果CHB组的血清25(OH)D水平明显低于健康对照组〔nmol/L:54.97(42.72,67.41)比61.78(53.16,70.40),P<0.05〕,且25(OH)D不充足率明显高于健康对照组〔39.1%(27/69)比12.2%(9/74),P<0.05〕。血清25(OH)D在大三阳组与小三阳组〔nmol/L:52.49(44.33,71.93)比53.12(44.45,76.75)〕、HBV-DNA检出组与未检出组(nmol/L:58.05±20.53比60.20±14.39)、转氨酶升高组和正常组(nmol/L:60.11±20.19比52.68±15.73)中比较差异均无统计学意义(均P>0.05)。结论HBV感染可能影响25(OH)D在肝脏中的合成,致使CHB患儿血清25(OH)D水平较健康儿童降低。因此,对于CHB患儿应适当补充25(OH)D。但血清25(OH)D水平与CHB患儿乙型肝炎E抗原(HBeAg)的血清学转换、HBV-DNA载量及转氨酶水平的相关性有待进一步研究。

Objective To investigate the changes and clinical significance of 25-hydroxyvitamin D[25(OH)D]in children with chronic hepatitis B(CHB).Methods A total of 69 children with CHB from June to November 2020 in Hunan Children's Hospital were enrolled as CHB group and 74 healthy children at the same period were selected as healthy control group.The serum 25(OH)D levels in CHB group and healthy control group were determined by chemiluminescent immunoassay method.The indexes of liver function[including total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bile acid(TBA),total protein(TP)and albumin(ALB)]were detected by automatic biochemical analyzer;hepatitis B virus(HBV)-DNA load of 55 patients was detected by fluorescent quantitative polymerase chain reaction(PCR).CHB group was divided into hepatitis B surface antigen(HBsAg)+hepatitis B e antigen(HBeAg)+hepatitis B core antibody(HBcAb)positive group(34 cases)and HBsAg+hepatitis B e antibody(HBeAb)+HBcAb positive group(35 cases)according to the HBV serological results,was divided into HBV-DNA detectable group(32 cases)and HBV-DNA undetectable group(23 cases)based on HBV-DNA load,and was divided into transaminase increasing group(31 cases)and transaminase normal group(38 cases)in term of the level of transaminase.The differences of the above indexes in each group were compared.Results The serum 25(OH)D level in CHB group was significantly lower than that in health control group[nmol/L:54.97(42.72,67.41)vs.61.78(53.16,70.40),P<0.05],and the insufficiency rate of 25(OH)D in CHB group was significantly higher than that in health control group[39.1%(27/69)vs.12.2%(9/74),P<0.05].There were no significant differences(all P>0.05)in serum 25(OH)Dlevels between the HBsAg+HBeAg+HBcAb positive group and HBsAg+HBeAb+HBcAb positive group[nmol/L:52.49(44.33,71.93)vs.53.12(44.45,76.75)],between HBV-DNA detectable and undetectable groups(nmol/L:58.05±20.53 vs.60.20±14.39),and between transaminase increasing group and transaminase normal group(nmol/L:60.11±20.19 vs.52.68±15.73).Conclusions HBV infection may affect the synthesis of 25(OH)D in liver,and the level of serum 25(OH)D decreased in children with CHB.Appropriate supplementation of 25(OH)D may be useful for children with CHB,but the association of serum 25(OH)D level with HBeAg seroconversion,HBV-DNA load and transaminase level in children with CHB warrants further study.