维生素D缺乏对患者的预后不良影响慢性乙型肝炎

StephenW

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,*,‡and Vincent Wai-Sun Wong*,‡,§
*Institute of Digestive Disease,‡Department of Medicine and Therapeutics, and§State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China

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 (he- patocellular carcinoma, complications of cirrhosis, or death).

RESULTS: At baseline, the patients’ mean serum level of hepatitis B virus DNA was 5.0 – 2.1 log10IU/mL; their mean level of 25(OH)D3was 24.3 – 9.4 ng/mL, and 348 patients (82%) had vitamin D deficiency (<32 ng/mL). Serum levels of 25(OH)D3did 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 cu- mulative 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.

StephenW

维生素D缺乏对患者的预后不良影响慢性乙型肝炎

格雷斯丽黄洪，*，‡，§Henry沥，陈源，*，‡，§Hoi云陈*，‡，§Chi杭谢*，‡，§天使梅灵渐* ‡安吉莉娜爱山螺，*，‡和Vincent惠孙王*，‡，§
消化疾病研究所*，内科及药物治疗的‡部，消化疾病，香港中国大学and§State重点实验室，香港特区，中国

背景与目的：维生素D是可能参与了病毒性肝炎的发病机制的免疫调节剂。我们研究了维生素D缺乏症的慢性乙型肝炎（CHB）长期预后的影响。方法：我们进行的426例慢性乙型肝炎的前瞻性队列研究（65％为男性，平均年龄41 - 13岁），谁是1997年参加过的25-羟基胆钙化醇（25（OH）D3）2000年血清水平测定在研究中报名（基线）。随访159例 - 46个月直到去年就诊或死亡;大约33％在随访期间接受抗病毒治疗。主要成果是临床事件（他 - patocellular癌，肝硬化并发症或死亡）。

结果：在基线，乙肝病毒DNA病人的平均血清水平为5.0 - 2.1 log10IU /毫升;的25（OH）D3was 24.3它们的平均水平 - 9.4毫微克/毫升，和348名患者（82％）的维生素D缺乏症（<32毫微克/毫升）。 25血清水平（OH）D3did没有相关的肝硬化或病毒载量。 60个月研究入学后 - 九十七例（22.8％）由118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较低基线血清水平（23.2 - 10.4纳克/毫升），比病人谁没有（28.2 - 9.3毫微克/毫升，P <0.001）。低基线血清25（OH）D3是调整了性别，年龄，和肝硬化后的临床事件相关的独立因素。维生素D缺乏症的临床事件调整风险比为1.90（95％置信区间[CI]，1.06-2.43; P [0.04）。临床事件的患者中维生素D缺乏症的15年CU-mulative发病率为25.5％（95％CI，23.1％-27.9％），有11.1％（95％CI，7.4％-14.8％）的患者相比，为25（OH）D3的正常血清水平。

结论：维生素D缺乏是其中慢性乙肝患者普遍，这与不良的临床结果相关联。

老折腾

补起来 反正没害处

高高山顶立

乙肝患者的吸收功能欠佳，脂溶性营养的吸收很差，所以维生素D等缺乏。谁因谁果？

StephenW

These observations led to the speculation of vitamin
D supplementation as a potential therapeutic approach,
because it was found to be associated with higher sustained
virologic response rate of chronic hepatitis C patients
in a retrospective study24 and 2 randomized
controlled trials.26,27 The therapeutic benefits of vitamin
D supplementation might be exerted by T-cell antigen
receptor signaling and T-cell activation.28 However, patients
with CHB were underrepresented in previous
studies on vitamin D deficiency.9,29–31 Our observations
urged the need for a well-designed randomized trial to
investigate the efficacy of vitamin D supplementation to
improve the clinical outcomes of CHB patients.

这些观察结果导致维生素的炒作
D补充剂作为一个潜在的治疗方法，
因为它被认为是具有较高的持续关联
慢性丙型肝炎患者的病毒学应答率
在一项回顾性研究[24]和2个随机
受控trials.26,27维生素的治疗益处
D补充剂可能通过T细胞抗原可以施加
受体信号传导和T细胞activation.28然而，患者
慢性乙型肝炎人数不足以前
关于维生素D的研究deficiency.9,29-31我们的观察
呼吁需要一个精心设计的随机试验，
调查补充维生素D的功效
改善慢性乙型肝炎患者的临床结果。