Adverse Effects of Vitamin D Deficiency on Outcomes of Patients With Chronic Hepatitis B
Grace Lai-Hung Wong
, Henry Lik-Yuen Chan
, Hoi-Yun Chan
, Chi-Hang Tse
, Angel Mei-Ling Chim
, Angeline Oi-Shan Lo
, Vincent Wai-Sun Wongcorrespondenceemail
Published Online: October 28, 2014
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DOI: http://dx.doi.org/10.1016/j.cgh.2014.09.050 |
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Published Online: October 28, 2014
Background & Aims
Vitamin D is an immunomodulator that might be involved in the pathogenesis of viral hepatitis. We investigated the effects of vitamin D deficiency on long-term outcomes of patients with chronic hepatitis B (CHB).
Methods
We performed a prospective cohort study of 426 patients with CHB (65% male; mean age, 41 ± 13 years), who were enrolled from 1997 through 2000. Serum levels of 25-hydroxycholecalciferol (25(OH)D3) were measured on study enrollment (baseline). Patients were followed for 159 ± 46 months until last clinic visit or death; approximately 33% received antiviral therapy during the follow-up period. The primary outcome was a clinical event (hepatocellular carcinoma, complications of cirrhosis, or death).
Results
At baseline, the patients’ mean serum level of hepatitis B virus DNA was 5.0 ± 2.1 log10 IU/mL; their mean level of 25(OH)D3 was 24.3 ± 9.4 ng/mL, and 348 patients (82%) had vitamin D deficiency (<32 ng/mL). Serum levels of 25(OH)D3 did not correlate with cirrhosis or viral load. Ninety-seven patients (22.8%) developed clinical events by a mean time of 118 ± 60 months after study enrollment. Patients who developed clinical events had lower baseline serum levels of 25(OH)D3 (23.2 ± 10.4 ng/mL) than patients who did not (28.2 ± 9.3 ng/mL, P < .001). Low baseline serum 25(OH)D3 was an independent factor associated with clinical events after adjustment for sex, age, and cirrhosis. The adjusted hazard ratio of vitamin D deficiency for clinical events was 1.90 (95% confidence interval [CI], 1.06–2.43; P = .04). The 15-year cumulative incidence rate of clinical events among patients with vitamin D deficiency was 25.5% (95% CI, 23.1%–27.9%), compared with 11.1% (95% CI, 7.4%–14.8%) in patients with normal serum levels of 25(OH)D3.
Conclusions
Vitamin D deficiency is common among patients with CHB and is associated with adverse clinical outcomes.
Keywords:
HBV, HCC, Mortality, Hepatic Event, Liver Cancer
Abbreviations used in this paper:
ALT (alanine aminotransferase), CHB (chronic hepatitis B), CI (confidence interval), HBeAg (hepatitis B e antigen), HBsAg (hepatitis B surface antigen), HBV (hepatitis B virus), HCC (hepatocellular carcinoma)作者: StephenW 时间: 2015-7-8 17:10
在基线,乙型肝炎病毒DNA的患者的平均血清水平为5.0±2.1日志10 IU /毫升;的25(OH)D3的它们的平均水平为24.3±9.4纳克/毫升,和348名患者(82%)的维生素D缺乏症(<32毫微克/毫升)。 25个血清(OH)D3并没有相关的肝硬化或病毒载量。九十名病人(22.8%)由118±60个月的学习后,入学平均开发时间的临床事件。谁开发的临床事件的患者有25(OH)D3(23.2±10.4纳克/毫升)较低基线血清水平比病人谁没有(28.2±9.3纳克/毫升,P <0.001)。低基线血清25(OH)D3与调整性别,年龄,肝硬化临床后事件相关的独立因素。维生素D缺乏症的临床事件调整后的风险比为1.90(95%置信区间[CI],1.06-2.43; P = 0.04)。临床事件中的患者的维生素D缺乏症的15年累积发生率为25.5%(95%CI,23.1%-27.9%),有11.1%(95%CI,7.4%-14.8%)患者与正常相比,血清水平的25(OH)D 3。
结论