维生素D缺乏与酒精性肝病的相关性研究

Associations between vitamin D deficiency and alcoholic liver disease

目的 探讨维生素D缺乏与酒精性肝病(ALD)的相关性。方法 按照入选标准收集ALD患者70例,选取同期性别、年龄匹配的健康对照70例。收集完整的临床及生化检查资料,采用两独立样本t检验、秩和检验、Gamma检验、Logistic回归分析血清25-羟维生素D[25(OH)D]水平与ALD的相关性。结果 ALD组体质量指数、总胆红素、直接胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、谷氨酰转肽酶、碱性磷酸酶、空腹血糖等均高于对照组,差异均有统计学意义(P<0.05);而白细胞、血红蛋白、血小板、血清白蛋白、25(OH)D、血钙水平均低于对照组,差异均有统计学意义(P<0.05)。整体样本中,维生素D缺乏的群体发生ALD例数明显升高(Z=-2.135,P<0.05)。将ALD组分为酒精性脂肪肝组、酒精性肝炎组和酒精性肝硬化组,在维生素D缺乏和不足的群体中发生酒精性肝炎和酒精性肝硬化的例数明显增加(Gamma=-0.495,P<0.01)。多元Logistic回归分析在调整了年龄、空腹血糖、体质量指数等混杂因素后显示,25(OH)D水平是ALD发病的危险因素,25(OH)D水平与ALD呈负相关(OR=4.144,95%CI:1.191~14.415,P=0.025)。结论 维生素D缺乏可能是ALD炎症和纤维化进展的危险因素。

Objective To explore the association between vitamin D deficiency and alcoholic liver disease(ALD).Methods Seventy patients met ALD diagnostic criteria and seventy age and gender matched healthy individuals were enrolled.The clinical data,physical examination and lab tests were collected.The association between the 25(OH)D level and alcoholic liver disease was analyzed with two independent sampling t analysis,rank-sum test,Gamma test and Logistic regression analysis.Results The clinical indexes including body index,total bilirubin,direct bilirubin,alanine aminotransferase,aspartate aminotransferase,glutamyl transpeptidase,alkaline phosphatase,fasting blood glucose of ALD group were higher than those of the control group,and the differences were statistically significant(P<0.05).But the levels of leukocyte,hemoglobin,platelet,serum albumin,25(OH)D and serum calcium were all lower than the control group,and the differences were statistically significant(P<0.05).In the overall sample,the number of ALD cases was significantly increased in the vitamin D deficient population(Z=-2.135,P<0.05).ALD group was divided into alcoholic fatty liver group,alcoholic hepatitis group and alcoholic cirrhosis group,and the number of cases of alcoholic hepatitis and alcoholic cirrhosis was significantly increased in the group with vitamin D deficiency and insufficient(Gamma=-0.495,P<0.01).After adjusting for age,fasting blood glucose,body mass index and other confounding factors,multivariate logistic regression analysis showed that,25(OH)D level was a risk factor for ALD,and 25(OH)D level was negatively correlated with ALD(OR=4.144,95%CI:1.191~14.415,P=0.025).Conclusion Vitamin D deficiency may be a risk factor for inflammatory and fibrotic progression in alcoholic liver disease.