25羟维生素D水平与不同病因肝硬化的相关性

摘要/Abstract

摘要： 目的探讨血清中25(OH)D水平与肝硬化的相关性。方法收集慢性乙型肝炎30例和不同病因肝硬化患者61例,包括乙型肝炎肝硬化28例、酒精性肝硬化5例、混合性(丙型肝炎、酒精性肝炎)肝硬化11例、隐匿性肝硬化17例,其中代偿期28例,失代偿期33例。所有患者进行血清生化学检测,分成慢性乙型肝炎组、肝硬代偿组、肝硬化失代偿组,比较3组的生化指标。比较不同病因肝硬化中的25(OH)D水平。分析不同病因肝硬化25(OH)D水平与多变量间的相关性,采用logistic回归分析评价不同病因肝硬化25(OH)D缺乏的影响因素。结果慢性乙型肝炎组、肝硬化代偿期组、肝硬化失代偿期组三组的年龄、TBIL、ALT、ALB、血肌酐、血钾、血钠、血钙、25(OH)D组间比较差异有统计学意义(P<0.05),慢性乙型肝炎组的25(OH)D水平高于肝硬化代偿期组、肝硬化失代偿期组分别为25.22(22.54,27.36) ng/mL、18.05(10.35,23.93) ng/mL、15.46(11.83,23.60) ng/mL,(P<0.01)。在61例不同原因肝硬化中56例(91.8%)25(OH)D水平缺乏/不足,乙型肝炎肝硬化组为(16.74±6.96) ng/mL、酒精性肝硬化组为(19.49±10.93) ng/mL、混合性肝硬化组为(16.62±9.29) ng/mL、隐匿性肝硬化组为(17.89±8.86) ng/mL,不同病因肝硬化之间维生素D水平差异无统计学意义(P>0.05)。Pearson/Spearman相关分析结果显示25(OH)D与Alb(r=0.46,P<0.01)、血钾(r=0.34,P=0.01)呈正相关,与INR负相关(r=-0.30,P=0.022)。多因素logistic回归分析结果表明,Alb是不同病因肝硬化患者发生25(OH)D缺乏的危险因素(P<0. 05)。结论维生素D缺乏/不足在肝硬化患者中非常普遍,并随肝脏疾病程度的进展而加重,与肝硬化病因无关。Alb是肝硬化患者发生25(OH)D缺乏的危险因素。

关键词: 肝硬化, 25羟维生素D

Abstract: Objective To investigate the correlation between serum 25 hydroxyvitamin D [25(OH)D] level and cirrhosis.Methods Thirty patients with chronic hepatitis B (CHB) and 61 patients with liver cirrhosis of different etiologies (28 with hepatitis B-related liver cirrhosis, 5 with alcoholic liver cirrhosis, 11 with hepatitis C overlapping alcoholic liver cirrhosis, 17 with occult liver cirrhosis) were enrolled, including 28 patients in compensated stage and 33 patients in decompensated stage. All the patients were divided into 3 groups: CHB group, compensated liver cirrhosis group and decompensated liver cirrhosis group. The biochemical indexes of the 3 groups were analyzed and compared. The 25(OH)D level in cirrhosis of different etiologies was analyzed and compared. Pearson/Spearman correlation analysis was used to analyze the correlation between 25(OH)D levels and variables in cirrhosis. Binomial logistic regression analysis was used to evaluate the risk factors for 25(OH)D deficiency in cirrhosis. Results 1.There were significant differences in age, serum total bilirubin, serum alanine aminotransferase, serum albumin (ALB), serum creatinine, serum potassium, serum sodium, serum calcium and 25(OH)D among the 3 groups (P<0.05). The level of 25(OH)D in CHB group was higher than that in compensated cirrhosis and decompensated cirrhosis groups (25.22 ng/mL, 18.05 ng/mL, 15.46 ng/mL,P<0.01). 2.Among 61 cases of liver cirrhosis, 56 cases (91.8%) had 25(OH)D insufficiency/deficiency, including 28 (45.9%) in hepatitis B-related cirrhosis group, 5 (8.2%) in alcoholic cirrhosis group, 11 (18.0%) in mixed cirrhosis group, and 17 (27.9%) in occult cirrhosis group. And there was no significant difference in 25(OH)D level among 4 groups (P>0.05). 3. Pearson/Spearman correlation analysis showed that 25(OH)D was positively correlated with ALB (r=0.46, P<0.001) and blood potassium (r=0.34, P<0.01), but negatively correlated with international normalized ratio (r=-0.30, P<0.022). 4.Multivariate binomial logistic regression analysis showed that ALB was a risk factor for 25(OH)D deficiency in patients with liver cirrhosis (P<0.05).Conclusion Vitamin D insufficiency/deficiency is very common in patients with liver cirrhosis, and aggravate with the progress of liver disease, which has nothing to do with the etiology of liver cirrhosis. ALB is a risk factor for 25(OH)D deficiency in patients with liver cirrhosis.

Key words: Cirrhosis, 25 hydroxyvitamin D

胡晨波, 严蓉妹, 金宏慧, 火永康, 李仲平. 25羟维生素D水平与不同病因肝硬化的相关性[J]. 肝脏, 2020, 25(5): 486-490.

HU Chen-bo, YAN Rong-mei, JIN Hong-hui, HUO Yong-kang, LI Zhong-ping. Correlation between 25 hydroxyvitamin D level and liver cirrhosis of different etiologies[J]. Chinese Hepatolgy, 2020, 25(5): 486-490.

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