维生素D缺乏对乙型肝炎患者的影响

肝脏 ›› 2020, Vol. 25 ›› Issue (9): 940-942.

维生素D缺乏对乙型肝炎患者的影响

高文, 杨雪, 窦爱华, 惠威, 刘梅, 徐斌, 段钟平

100069 首都医科大学附属北京佑安医院肝病内分泌科(高文,杨雪,窦爱华,惠威,刘梅,徐斌),疑难肝病及人工肝中心(段钟平)

出版日期:2020-09-30 发布日期:2020-10-22
通讯作者: 段钟平,Email: duan2517@163.com;徐斌,Email: xubin1016@126.com
基金资助:
国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2017ZX10203201-005);“北京市医院管理局临床医学发展专项经费资助(NO.ZYLX201806);北京市医院管理局消化内科学科协同发展中心项目(XXZ0503);北京市医院管理局“登峰”人才培养计划基金资助项目 (No.DFL20151601);佑安肝病艾滋病基金科研课题(YNKTTS20180116);佑安肝病艾滋病基金科研课题(YNKTTS20180208)

A study on the impact of vitamin D deficiency in patients with hepatitis B

GAO Wen¹, YANG Xue¹, DOU Ai-hua¹, HUI Wei¹, LIU Mei¹, XU Bin¹, DUAN Zhong-ping²

Department of Hepatology-endocrinology disease, Beijing You’an Hospital, Capital Medical University, Beijing 100069, China

Online:2020-09-30 Published:2020-10-22
Contact: DUAN Zhong-ping,Email: duan2517@163.com;XU Bin,Email: xubin1016@126.com

摘要/Abstract

摘要： 目的探讨维生素D缺乏对慢性乙型肝炎、肝硬化、肝细胞癌患者临床各指标的影响。方法选择慢性乙型肝炎14例,肝硬化44例,肝细胞癌33例和13名健康对照者,采用同位素稀释的液相色谱-串联质谱法测定血清中维生素D水平,同时检测T淋巴细胞亚群、肝功能、病毒学指标等。结果维生素D缺乏(<20 ng/mL)的发生率在肝癌(96.97%)和肝硬化(93.18%)患者中较高,健康人群为76.92%,乙型肝炎患者为77.83%。健康人群维生素D水平为(16.38±5.53) ng/mL,慢乙肝组为(15.06±4.91) ng/mL,肝硬化组为(11.85±2.66) ng/mL,肝癌组为(10.59±3.06) ng/mL。4组患者不同季节的血清维生素D水平差异均无统计学意义(P>0.05)。健康人群血清维生素D与慢性乙型肝炎组之间差异无统计学意义(P>0.05)。肝硬化组患者血清维生素D与肝癌组之间差异无统计学意义(P>0.05)。但肝硬化组及肝癌组维生素D与健康人群、慢性乙型肝炎患者组之间维生素D差异有统计学意义(P<0.05),考虑维生素D水平的降低与乙型肝炎的临床进展相关。维生素D水平与淋巴细胞、血红蛋白、血小板、PTA、白蛋白、前白蛋白、胆碱脂酶、T淋巴细胞亚群(CD3+、CD3+CD8+、CD45+)等参数相关,提示维生素D与肝脏合成功能及免疫功能有一定联系。结论大多数乙型肝炎患者存在维生素D缺乏。维生素D可能参与乙型肝炎免疫功能的调节,这可能为乙型肝炎发病机制的研究和治疗提供新的思路。

关键词: 维生素D 慢性乙型肝炎肝硬化肝癌

Abstract: Objective To investigate the impact of vitamin D deficiency on the clinical parameters of patients with chronic hepatitis B (CHB), liver cirrhosis and hepatocellular carcinoma (HCC). Methods Ninety-one hepatitis B patients including 14 cases of CHB, 44 cases of cirrhosis, 33 cases of HCC and 13 healthy controls were collected in this study. Vitamin D was determined by liquid chromatography-mass spectrometry with isotope dilution. Parameters such as T lymphocyte subsets, liver function and virological indexes were detected simultaneously. Univariate and multivariate analyses were performed to analysis the association between vitamin D levels and the clinical parameters. Results The prevalence of vitamin D deficiency (defined as < 20 ng/mL) in the patients with liver cancer (96.97%) and cirrhosis (93.18%) was higher than that in the healthy controls (76.92%) and the patients with chronic hepatitis B (77.83%). The content of vitamin D in the healthy controls was 16.38±5.53 ng/mL, 15.06±4.91 ng/mL in the patients with chronic hepatitis B, 11.85±2.66 ng/mL in the patients with liver cirrhosis and 10.59±3.06 ng/mL in the patients with liver cancer. The Vitamin D levels were not different in these four groups in different seasons (P> 0.05). The vitamin D levels between the healthy control and the chronic hepatitis B groups, or between the cirrhosis and HCC groups were not different (P> 0.05). However, there was a significant difference in the vitamin D levels of the cirrhosis and HCC patients when compared with the healthy controls and the chronic hepatitis B patients (P<0.05), indicating that vitamin D levels were decreased in association with hepatitis B progression. There were also correlation between the Vitamin D levels with the clinical parameters of lymphocyte, hemoglobin, platelet, PTA, albumin, prealbumin, cholinesterase, T lymphocyte subsets (CD3+, CD3+ CD8+, CD45+), suggesting that vitamin D was associated with the synthesis and immune function of the livers. Conclusion Most of the patients with chronic hepatitis B viral infection have vitamin D deficiency. Vitamin D may be involved in regulating immune function of hepatitis B patients, and its deficiency is associated with the clinical progression. These results may provide insight for the research and treatment of CHB.

Key words: Vitamin D, Chronic hepatitis B, Liver cirrhosis, Hepatocellular carcinoma

高文, 杨雪, 窦爱华, 惠威, 刘梅, 徐斌, 段钟平. 维生素D缺乏对乙型肝炎患者的影响[J]. 肝脏, 2020, 25(9): 940-942.

GAO Wen, YANG Xue, DOU Ai-hua, HUI Wei, LIU Mei, XU Bin, DUAN Zhong-ping. A study on the impact of vitamin D deficiency in patients with hepatitis B[J]. Chinese Hepatolgy, 2020, 25(9): 940-942.

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