慢性肝病中维生素D的重要性

肝胆速递

http://www.sciencedirect.com/science/article/pii/S0168827812003601
D-livering the message: The importance of vitamin D status in chronic liver disease慢性肝病中维生素D的重要性

    Matthew T. Kitson,
    Stuart K. Roberts Corresponding author contact information, E-mail the corresponding author

    Department of Gastroenterology, The Alfred, Melbourne, Australia

Summary

Vitamin D is synthesized predominantly in the liver and functions as an important secosteroid hormone with pleiotropic effects. While its key regulatory role in calcium and bone homeostasis is well established, recently there is increasing recognition that vitamin D also regulates cell proliferation and differentiation, and has immunomodulatory, anti-inflammatory and anti-fibrotic properties. These non-skeletal effects are relevant in the pathogenesis and treatment of many causes of chronic liver disease. Vitamin D deficiency is frequently present in chronic liver disease and may predict non-response to antiviral therapy in chronic hepatitis C. Small studies suggest that vitamin D supplementation improves sustained viral response rates, while 1α-hydroxylase polymorphisms and vitamin D-binding protein are also implicated in therapeutic outcomes. Vitamin D deficiency also closely relates to the severity of non-alcoholic fatty liver disease (NAFLD) and is implicated in the pathogenesis of insulin resistance, a key factor in the development of NAFLD. In preclinical studies, phototherapy and vitamin D supplementation ameliorate NAFLD histopathology, while vitamin D is a powerful anti-fibrotic against thioacetamide liver injury. In liver transplant recipients severe vitamin D deficiency predicts, and vitamin D supplementation prevents, acute cellular rejection. The role of vitamin D in the activation and regulation of both innate and adaptive immune systems may explain its importance in the above liver diseases. Further prospective studies are therefore warranted to investigate the therapeutic impact of vitamin D supplementation in chronic liver disease.

肝胆速递

在慢性肝病的维生素D状态的重要性

    马修T.基特森，
    斯图尔特·K.·罗伯茨通讯作者的联系信息，E-mail的通讯作者

    阿尔弗雷德消化内科，墨尔本，澳大利亚

总结

维生素D合成主要在肝脏和功能作为一个重要的开环甾类化合物与多效性作用的激素。虽然其主要的钙和骨骼平衡的调节作用是公认的，最近有越来越多的认可，维生素D也调节细胞的增殖和分化，具有免疫调节，抗炎和抗肝纤维化的性能。这些非骨骼影响的原因很多慢性肝病的发病机制和治疗的相关。维生素D缺乏症是经常出现在慢性肝病和可预测非抗病毒治疗的慢性丙型肝炎的小型研究表明，补充维生素D，提高持续病毒应答率，同时也1α-羟化酶基因多态性与维生素D结合蛋白牵连的治疗效果。维生素D缺乏症密切相关的非酒精性脂肪肝病（NAFLD）的严重程度和被牵连在胰岛素抵抗的发病机制，NAFLD的发展的一个关键因素。在临床前研究中，光疗和维生素D的补充，改善非酒精性脂肪肝组织病理学，而维生素D是一种强大的抗肝纤维化对硫代乙酰胺肝损伤。预测肝移植受者严重缺乏维生素D，补充维生素D预防，急性细胞排斥反应。在先天免疫和适应性免疫系统的激活和调节的作用，维生素D可以解释上述肝脏疾病中的重要性。因此，进一步的前瞻性研究，保证调查的补充维生素D在慢性肝病的治疗作用。