基线维生素D水平与慢性乙型肝炎临床参数和治疗效果协会

StephenW

J Hepatol. 2015 Jul 1. pii: S0168-8278(15)00452-3. doi: 10.1016/j.jhep.2015.06.025. [Epub ahead of print]
Association of Baseline Vitamin D Levels With Clinical Parameters and Treatment Outcomes in Chronic Hepatitis B.Chan HL1, Elkhashab M2, Trinh H3, Tak WY4, Ma X5, Chuang WL6, Kim YJ7, Martins EB8, Lin L8, Dinh P8, Charuworn P8, Foster GR9, Marcellin P10.
Author information

• 1Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: [email protected].
• 2Toronto Liver Centre, Toronto, Ontario, Canada.
• 3San Jose Gastroenterology, San Jose, CA, USA.
• 4Kyungpook National University Hospital, Daegu, South Korea.
• 5Drexel University College of Medicine, Philadelphia, PA, USA.
• 6Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
• 7Seoul National University Hospital, Seoul, South Korea.
• 8Gilead Sciences, Inc, Foster City, CA, USA.
• 9Queen Mary University of London, London, United Kingdom.
• 10Hôpital Beaujon, University of Paris, Paris, France.
  

AbstractBACKGROUND & AIMS: The relationships between vitamin D levels and chronic hepatitis B (CHB) infection and treatment outcomes are poorly elucidated. We measured pre-treatment serum vitamin D (25-hydroxyvitamin D3; 25[OHD3) levels and determined their association with clinical parameters and treatment outcomes in active CHB patients without advanced liver disease enrolled in a global clinical trial.
METHODS: Patients were randomly assigned to either 48 weeks of tenofovir disoproxil fumarate (TDF) plus peginterferon alfa-2a (PEG-IFN), TDF plus PEG-IFN for 16 weeks followed by TDF for 32 weeks, PEG-IFN for 48 weeks, or TDF for 120 weeks. Univariate and multivariate analyses were conducted to determine associations between vitamin D, baseline factors, and week 48 clinical outcome.
RESULTS: Of 737 patients, 35% had insufficient (⩾20 but <31 ng/mL) and 58% had deficient (<20 ng/mL) vitamin D levels. In univariate analysis, lower vitamin D levels were significantly associated with the following baseline parameters: younger age, lower uric acid levels, HBeAg-positive status, lower calcium levels, blood draw in winter or autumn, and HBV genotype D. On multivariate analysis, only HBV genotype, season of blood draw, calcium level, and age retained their association. High baseline level of vitamin D was associated with low HBV DNA, normal ALT and HBsAg at week 48 independent of treatment groups, but the association - with the exception of ALT - became statistically insignificant after adjusting for age, gender and HBeAg and HBV genotype.
CONCLUSIONS: Abnormally low vitamin D levels are highly prevalent among untreated, active CHB patients. Baseline vitamin D levels are not associated with treatment outcomes, but were associated with normal ALT.
Copyright © 2015. Published by Elsevier B.V.


KEYWORDS: Hepatitis B; Seasonal variation; Tenofovir disoproxil fumarate; Vitamin D deficiency

StephenW

肝脏病学杂志。 2015年1月PII：S0168-8278（15）00452-3。 DOI：10.1016 / j.jhep.2015.06.025。 [打印EPUB的提前]
基线维生素D水平与慢性乙型肝炎临床参数和治疗效果协会
陈HL1，Elkhashab M2，H3郑氏，德WY4，马X5，闯WL6，金YJ7，马丁斯EB8，林L8，亭P8，P8 Charuworn福斯特GR9，Marcellin P10。
作者信息

    中国的香港大学，香港1Prince威尔斯医院。电子地址：[email protected]。
    2Toronto肝脏中心，多伦多，安大略省，加拿大。
    3San何塞消化科，圣何塞，CA，USA。
    4Kyungpook国立大学医院，大邱，韩国。
    5Drexel大学医学院，宾夕法尼亚州费城，美国。
    6Kaohsiung医科大学附属医院，高雄医学大学，台湾高雄。
    7Seoul国立大学医院，首尔，韩国。
    8Gilead科学公司，福斯特城，加利福尼亚州，美国。
    伦敦，伦敦，英国9Queen玛丽大学。
    10HôpitalBeaujon，巴黎，法国巴黎大学。

抽象
背景与目的：

维生素D水平与慢性乙型肝炎（CHB）感染和治疗结果之间的关系不好阐明。我们测量治疗前血清维生素D（25-羟基维生素D3; 25 OHD3）水平，并确定在积极CHB患者临床指标和治疗结果的关联没有先进的肝病参加一个全球性的临床试验。
方法：

患者被随机分配到48周富马酸替诺福韦酯（TDF）加聚乙二醇干扰素α-2a干扰素（PEG-IFN），TDF加PEG-IFN 16周，然后TDF 32周，PEG-IFN 48周，或TDF 120周。单因素和多因素分析来确定维生素D，基本因素，以及48周临床结果之间的关联。
结果：

737名患者中，35％有不足（⩾20但<31毫微克/毫升）和58％的缺陷（<20毫微克/毫升）的维生素D水平。在单因素分析，较低的维生素D水平与显著以下基本参数有关：年龄小，降低尿酸水平，HBeAg阳性的状态，降低钙的水平，抽血在冬季或秋季和HBV基因型D.在多变量分析，只有HBV基因型，抽血，钙水平的季节和年龄保留了他们的关系。维生素D高的基线水平低HBV DNA，ALT正常，HBsAg与相关的48个独立的治疗组的一周，但联想 - 除ALT的 - 成为在调整了年龄，性别和HBeAg和HBV基因型后无统计学意义。
结论：

异常低维生素D水平都属于治疗，积极CHB患者非常普遍。基线维生素D水平不与治疗效果有关，但ALT正常有关联。

版权所有©2015年出版由Elsevier B.V.
关键词：

乙型肝炎;季节变化;富马酸替诺福韦酯;维生素D缺乏症

张大发财

能简单详细点吗？看不太明白

682256

结论:血液中不正常的低维生素D水平与未治疗的活动性肝炎有关，基线以上维生素D水平和治疗效果无关，但与正常ALT水平有关。直译太拗口！

682256

也就是说，转氨酶正常，则血液中维生素D含量是正常值；活动性肝炎未经治疗，转氨酶不正常时，维生素D含量低于正常基线水平？

StephenW

回复 张大发财 的帖子



异常低维生素D水平, 非常普遍在未经治疗的, 活跃的患者.
基线维生素D水平与治疗效果无关, 但与ALT正常有关联.

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
, Vincent Wai-Sun Wongcorrespondenceemail
Published Online: October 28, 2014
Article has an altmetric score of 2
DOI: http://dx.doi.org/10.1016/j.cgh.2014.09.050 |
hideArticle Info
Publication History
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)

StephenW

维生素D缺乏对患者的预后不良影响慢性乙型肝炎
格雷斯丽黄红
亨利沥，陈婉
，海韵婵
，志谢杭
，天使美泠墀呒
，安吉丽娜霭单咯
文森特围太阳Wo​​ngcorrespondenceemail
发布时间：2014年10月28日
文章有altmetric比分2
DOI：http://dx.doi.org/10.1016/j.cgh.2014.09.050 |
hideArticle信息
出版物历史
发布时间：2014年10月28日

    抽象
    全文
    图片
    参考
    补充材料

背景与目的

维生素D是可能参与在病毒肝炎的发病机制中的免疫调节剂。我们研究了维生素D缺乏症的慢性乙型肝炎（CHB）的长期结果的影响。
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，平均年龄为41±13岁），谁从1997年通过的25羟基胆钙化醇（25（OH）D3）2000年血清水平分别招收测量研究招生（基线）。随访159±46个月直到去年诊或死亡的患者;大约33％的在随访期间接收抗病毒治疗。主要成果是临床事件（肝癌，肝硬化并发症或死亡）。
结果

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

维生素D缺乏症是常见的慢性乙肝患者，并与临床不良事件相关联。
关键词：
乙肝，肝癌，死亡率，肝事件，肝癌
在本文中使用的缩写：
ALT（丙氨酸转氨酶），慢性乙型肝炎（慢性乙型肝炎），CI（置信区间），e抗原（乙型肝炎e抗原），乙肝表面抗原（乙型肝炎表面抗原），HBV（乙肝病毒），肝癌（肝细胞癌）

682256

楼主真热心，谢谢了！

张大发财

StephenW 发表于 2015-7-8 17:05
回复 张大发财 的帖子

您的意思就是 乙肝患者可以适当的补充维生素D？