Patients With Chronic Viral Hepatitis Should Be Tested for Vitamin D

StephenW

http://www.gastroendonews.com/ViewArticle.aspx?d=Hepatology+in+Focus&d_id=481&i=October+2011&i_id=778&a_id=19475
Patients With Chronic Viral Hepatitis Should Be Tested for Vitamin D
            Low Prevalence of Testing Despite High Prevalence of Insufficiency
            

                        By David Wild
Chicago—Retrospective findings presented at the 2011 Digestive Disease Week meeting revealed that 64% of patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection have low levels of vitamin D (abstract Su1302). In light of the results, researchers are urging clinicians to monitor vitamin D levels in all patients with chronic viral hepatitis.
“If we treat vitamin D deficiency, we can potentially decrease the high rate of osteopenia and osteoporosis in this population, including bone loss related to some of the antiviral therapies” said co-investigator Maya Gambarin-Gelwan, MD, assistant professor of clinical medicine, Weill Cornell Medical College, New York City.
Up to 53% of patients with viral hepatitis–related cirrhosis develop osteoporosis. Given the risk for bone loss associated with low levels of serum 25-hydroxyvitamin D (25[OH]D), investigators set out to determine the prevalence of vitamin D deficiency and insufficiency among patients with HBV and HCV treated at Weill Cornell Medical Center. They defined vitamin D deficiency as serum 25[OH]D less than 20 ng/mL and vitamin D insufficiency as levels between 20 and 30 ng/mL.
Among 2,312 patients with chronic viral hepatitis seen at the center between 2007 and 2009, only 17% (395 of 2,312) had been tested for vitamin D levels. Of those who underwent vitamin D testing, 31% (122 of 395) were vitamin D insufficient and 33% (132 of 395) were vitamin D deficient. The prevalence of vitamin D insufficiency was similar among the 29% (115 of 395) of patients with chronic viral hepatitis who had cirrhosis and those who did not (26% vs. 33%, respectively; P=0.10). However, the difference in vitamin D deficiency among patients with cirrhosis and those without cirrhosis was significant (44% vs. 29%; P=0.01).
Interestingly, vitamin D insufficiency was more prevalent among those infected with HBV than among those infected with HCV (73% vs. 60%, respectively; P=0.01). Although she suspects that ethnicity may play a role in this difference, Dr. Gambarin-Gelwan said that her data set did not include adequate information on ethnicity to draw a conclusion.
Zobair Younossi, MD, MPH, a liver specialist who was not involved in the study, said that prior studies have shown low vitamin D levels tend to be more common in patients with advanced stage fibrosis and cirrhosis. “However, this study shows insufficiency can also be seen in non-cirrhotic patients with hepatitis B and C, and particularly in those with chronic hepatitis B,” said Dr. Younossi, vice president for research, Inova Health System, and chairman, Department of Medicine, Inova Fairfax Hospital, Falls Church, Va.
Dr. Gambarin-Gelwan said that she hopes her research will spur clinicians to routinely monitor vitamin D levels in patients with chronic HBV and HCV infection. She said the small percentage of patients who were screened for vitamin D levels demonstrates that “gastroenterologists and hepatologists are paying too little attention to vitamin D levels.”

StephenW

慢性病毒性肝炎患者应测试维生素D
尽管不全的高患病率发病率较低的测试

由大卫狂放

在2011年消化疾病周会议提出芝加哥回顾调查结果显示，64％与慢性乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）感染患者的维生素D水平低（摘要Su1302）。结果，研究人员正在敦促医生监测慢性病毒性肝炎患者的维生素D水平。

联合调查玛雅Gambarin Gelwan，医学博士，中医临床助理教授说：“如果我们把维生素D缺乏，我们在这个人口可能减少骨质疏松和骨质疏松症的高税率，其中包括一些抗病毒治疗相关的骨质流失” ，纽约市威尔康乃尔医学院。

与病毒性肝炎相关的肝硬化开发骨质疏松症患者的53％。鉴于风险与血清水平低相关的骨质流失25羟维生素D（25 [OH] D），调查，以确定Weill Cornell医学中心治疗与乙型肝炎和丙型肝炎患者的维生素D缺乏和不足的患病率。他们定义为维生素D缺乏症血清25 [OH] D小于20 ng / mL和维生素D不足20至30毫微克/毫升的水平。

其中2312例慢性肝炎病毒出现在2007年和2009年之间的中心，只有17％（2312 395）进行了检测维生素D水平。那些接受了维生素D的测试中，31％（395 122），维生素D不足，33％（395 132）维生素D缺乏。维生素D不足的患病率是类似的29％（395 115），慢性病毒性肝炎患者，肝硬化和那些没有（分别为26％和33％，P = 0.10）之间。然而，在维生素D缺乏症肝硬化和无肝硬化的患者之间的差异是显著（44％比29％，P = 0.01）。

有趣的是，维生素D不足是比与丙型肝炎病毒（分别为73％比60％，P = 0.01）感染者中乙肝病毒感染者中更为普遍。虽然她怀疑，种族可能在这种差异中发挥的作用时，博士Gambarin Gelwan说，她的数据集不包括种族足够的信息，得出一个结论。

祖贝尔Younossi，医学博士，公共卫生硕士，谁没有参与这项研究的的肝病专家，说，此前的研究表明维生素D水平低，往往在晚期纤维化和肝硬化的患者中更常见。 “不过，这项研究显示不全也可以看到在非乙型和丙型肝炎肝硬化患者，特别是在那些与慢性乙型肝炎，说：”Younossi，博士研究的副总裁，INOVA卫生系统和系主席医学，Inova Fairfax医院，弗吉尼亚州福尔斯彻奇

Gambarin - Gelwan博士说，她希望她的研究将促使临床医生定期监测与慢性乙型肝炎和丙型肝炎病毒感染患者的维生素D水平。她说，为维生素D的水平筛选病人的小百分比表明，“胃肠病和肝病付出的关注太少，维生素D的水平。”

cam4930

有关替诺降低骨质密度的副作用。现在的研究认为是因为缺乏维生素D引起的。

StephenW

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同时
维生素D对免疫系统至关重要
据卡斯滕盖斯勒，在丹麦哥本哈根大学国际卫生，免疫学和微生物学系教授，当T细胞暴露于外来病原，他们暴露了维生素D受体，维生素D的搜索，如果细胞不接收的营养，细胞不会激活。
Vitamin D Crucial to Immune SystemAccording to Professor Carsten Geisler, of the Department of International Health, Immunology and Microbiology at the University of Copenhagen in Denmark, when T cells are exposed to foreign pathogens, they expose a vitamin D receptor that searches for vitamin D. If the cells do not receive the nutrient, the cells will not activate.

StephenW

維生素D也称抗佝偻病維生素，是一类脂溶性維生素，属类固醇化合物。
維他命D2也称骨化醇，由麦角固醇经过紫外线照射转化而成。
維他命D3(cholecalciferol)由紫外線照射7-脱氢胆固醇經光照後進行光化學反應轉變成，动物皮肤細胞中含有7-脱氢胆固醇，所以多晒日光是获取維生素D的简易方法。但它的活性不高，必須經肝臟及腎臟的酵素反應，最終生成calcitriol(1，25-dihydroxycholecalciferol)，這才是活性最高的形式，可以調節小腸，腎臟和骨骼對鈣的吸收與代謝。維他命D3的缺乏易患有軟骨病，此病症在寒帶地區較常發生，因當地居民須穿著厚重衣物以防寒，但也因此隔絕陽光的照射，無法產生維他命D3，此症可經由飲食攝取來改善。
維生素D是荷爾蒙的前驅物，與血液中鈣的代謝有關。如果維他命D攝取過量導致中毒，會使柔軟組織形成鈣化現象。

StephenW

http://www.sciencedaily.com/releases/2011/06/110617185105.htm
More Evidence Vitamin D Boosts Immune Response

ScienceDaily (June 17, 2011) — Laboratory-grown gingival cells treated with vitamin D boosted their production of an endogenous antibiotic, and killed more bacteria than untreated cells, according to a paper in the June 2011 issue of the journal Infection and Immunity. The research suggests that vitamin D can help protect the gums from bacterial infections that lead to gingivitis and periodontitis. Periodontitis affects up to 50 percent of the US population, is a major cause of tooth loss, and can also contribute to heart disease. Most Americans are deficient in vitamin D.


His interest piqued by another laboratory's discovery that vitamin D could stimulate white blood cells to produce natural proteins that have antibiotic activity, Gill Diamond of the UMDNJ -- New Jersey Dental School, Newark, showed that vitamin D could stimulate lung cells to produce LL-37, a natural antibiotic protein, and kill more bacteria. That suggested that , vitamin D might help cystic fibrosis patients. Next, in the new research, he showed that vitamin D has the same effct on gingival cells.

Then, Diamond found that vitamin D also stimulates gingival cells to produce another protein, called TREM-1, which had not been well-studied, but which was thought to be made by white blood cells. He found that it boosts production of pro-inflammatory cytokines.

The new research also showed that vitamin D coordinates expression of a number of genes not previously considered to be part of the vitamin D pathway. Those genes may be involved in additional infection-fighting pathways. A more comprehensive understanding of how vitamin D carries out this regulation at the molecular level -- something Diamond hopes to investigate -- will enable targeted therapies using vitamin D, he says.

Interestingly, Diamond also found that lung and gum cells appear to have the ability to activate inactive forms of vitamin D, says Diamond. "This means that we may even be able to use vitamin D therapy topically, if that proves true."

Vitamin D has become a hot area of research in recent years. In addition to infectious diseases, studies suggest that it has protective effects against autoimmune diseases, and certain cancers.

Diamond says that after he began conducting research on vitamin D, he began taking it as a supplement. Since then, "I have had only one cold in four years, and that one lasted only three days," he says. "Other people I've met who have done the same have seen similar results. We are trying to figure out how it's working, and what other infectious diseases can be mitigated by it."

StephenW

更多的证据，维生素D增强免疫反应

每日科学（2011年6月17日） - 用维生素D治疗牙龈细胞实验室培养提高了他们的一种内源性抗生素生产，比未经处理的细胞杀死更多的细菌，在2011年6月该杂志感染与免疫问题的文件。研究表明，维生素D能帮助保护牙龈，导致牙龈炎和牙周炎是由细菌感染。牙周炎的影响高达50％的美国人口，是一个牙齿脱落的重要原因，也有助于心脏疾病。大多数美国人都缺乏维生素D


他的兴趣，激发了另一个实验室的发现，维生素D能刺激白血细胞产生的具有抗菌活性的天然蛋白质，UMDNJ - 吉尔钻石，纽瓦克，新泽西州牙科学院表明，维生素D能刺激肺细胞产生的LL - 37，天然抗生素蛋白，并杀死更多的细菌。这表明，维生素D可能有助于囊性纤维化患者。接下来，在新的研究，他发现，维生素D具有相同effct牙龈细胞。

然后，钻石发现，维生素D也刺激牙龈细胞产生另一种蛋白质，叫做TREM - 1，没有得到很好的研究，但被认为是白血细胞。他发现，它能增强促炎性细胞因子的生产。

这项新的研究还表明，维生素D的坐标不是以前被认为是维生素D通路的一部分基因的表达。这些基因可能会涉及额外的抗感染途径。一些钻石，希望调查 -  - 一个更全面地了解维生素D如何开展这在分子水平上的调节将使使用维生素D的有针对性的治疗，他说。

有趣的是，钻石还发现，肺癌和胶细胞似乎能够激活非活动形式的维生素D，钻石说。 “这意味着，我们甚至可以局部使用维生素D治疗，如果证明属实”。

维生素D已成为近年来的研究热点领域。除了传染病，研究表明，它已经对自身免疫性疾病和某些癌症的保护作用。

Diamond说后，他开始进行关于维生素D的研究，他开始服用它作为补充。从那时起，“我曾在四年中只有一冷，和一个只持续了3天，”他说。 ：“我见过也做了同样的的其他人都看到了类似的结果，我们试图找出它是如何工作的，并可以通过减轻其他传染病。”

baobao7676

这个提醒很有价值。另外，本人建议有条件的战友服用100mg/天以上的辅酶Q10作为对抗肝细胞衰老的辅助用药， 此药还可以兼顾阻止T细胞的衰老和凋零。

StephenW

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维生素D价格便宜，也可以用太阳光，免费的.