维生素D水平低的初治患者的HBV流行

StephenW

Low vitamin D levels prevalent in untreated patients with HBV

Chan HL-Y, et al. J Hepatol. 2015;doi:10.1016/j.jhep.2015.06.025.
August 31, 2015


In a new study, researchers found that untreated patients with chronic hepatitis B virus infection had significantly low levels of vitamin D.

“Given the paucity of information on the role of vitamin D in [chronic hepatitis B], along with recent data suggesting vitamin D may contribute to interferon-stimulated gene expression, we evaluated the baseline serum vitamin D levels and their association with baseline clinical parameters and clinical outcomes among a large population of patients with treatment-eligible [chronic hepatitis B] infection,” the researchers wrote.

Researchers, including Henry Lik-Yuen Chan, MD, of Prince of Wales Hospital in Hong Kong, randomly assigned 740 patients with chronic HBV without advanced liver disease to either 48 weeks of tenofovir disoproxil fumarate (TDF) plus pegylated interferon alfa-2a (PEG-IFN alfa-2a); TDF plus PEG-IFN alfa-2a for 16 weeks followed by TDF for 32 weeks; PEG-IFN alfa-2a for 48 weeks; or TDF for 120 weeks. Fifty-eight percent of the cohort were positive for hepatitis B e antigen (HBeAg); 66% were male; and were all randomly assigned therapy at 139 clinical sites.

The primary outcome was to determine associations between vitamin D, baseline factors, and week 48 clinical outcome, according to the researchers.

Of 737 patients in the final analysis, 58% had deficient levels (less than 20 ng/mL) of vitamin D, and 35% had insufficient levels (at least 20 ng/mL but less than 31 ng/mL) of vitamin D.

Younger age, lower uric acid levels, HBeAg-positive status, lower calcium levels, blood drawn in winter or autumn and HBV genotype D to be baseline parameters were associated with lower vitamin D levels, according to the univariate analysis. In contrast, multivariate analysis only showed HBV genotype, season of blood drawn, calcium level and age as associated parameters.

High baseline vitamin D was associated with low HBV DNA, normal alanine aminotransferase (ALT) levels and hepatitis B surface antigen at 48 weeks independent of treatment groups. However, this association was no longer significant after adjusting for age, gender and HBeAg and HBV genotype, with the exception of ALT serum levels.

“Low baseline vitamin D level was associated with lower baseline ALT level and a lower tendency to normalize ALT after 48 weeks of treatment,” the investigators wrote. “Although the effect of vitamin D on virologic treatment outcomes were largely confounded by different clinical and virologic factors in this study. Whether a low vitamin D level contributes to unsuccessful immune clearance and active hepatitis warrants further study.” – by Melinda Stevens

Disclosure: Chan reports advising and speaking for AbbVie, Bristol-Myers Squibb, Gilead Sciences, Roche, MSD and Novartis; serving as a speaker for GlaxoSmithKline and Echosens; and receiving unrestricted grants for HBV research from Roche. Please see the full study for a list of all other authors’ relevant financial disclosures.

StephenW

维生素D水平低的初治患者的HBV流行

陈HL-Y。，等人。肝脏病学杂志。 2015年，DOI：10.1016 / j.jhep.2015.06.025。
2015年8月31日，


在一项新研究中，研究人员发现，未经治疗的慢性乙肝病毒感染过的维生素D.显著低水平

“鉴于有关在[慢性乙型肝炎]维生素D的作用缺乏，再加上最近的数据表明维生素D可能有助于干扰素刺激基因的表达，我们评估基线血清维生素D水平与基线临床参数的关联而人口众多的患者在治疗资格[慢性乙型肝炎]感染者的临床结果，“研究人员写道。

研究人员，其中包括亨利·沥，袁赞威尔斯亲王医院，医学博士，在香港，随机分配740例慢性HBV无晚期肝病要么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 -IFNα-2a）的; TDF加PEG-IFNα-2a中16周后TDF 32周; PEG-IFNα-2A共48周;或TDF 120周。队列的百分之五十八为阳性乙肝e抗原（HBeAg）; 66％为男性;并且都随机分为治疗139临床试验点。

主要成果是确定维生素D，基本因素，而48周临床结果之间的关联，根据研究人员。

737例患者在最后的分析中，有58％的水平不足的维生素D（低于20毫微克/毫升），和35％的水平不足（至少20纳克/毫升但小于31毫微克/毫升）维生素D

低龄，低级尿酸水平，HBeAg阳性状态，低级血钙，抽血在冬季或秋季和HBV基因D为基线参数具有较低的维生素D水平相关联，根据单变量分析。与此相反，多因素分析仅表现为HBV基因型，血赛季画，钙水平与年龄相关的参数。

高基线的维生素D，用低的HBV DNA，正常丙氨酸转氨酶（ALT）水平和B型肝炎表面抗原相关在48周独立处理组。不过，该协会已不再调整了年龄，性别和HBeAg和HBV基因型，除ALT血清后显著。

“低基线维生素D水平与较低的基线ALT水平较低的倾向，治疗48周后，ALT正常化相关，”研究者写道。 “尽管维生素D对病毒学治疗结果的影响在很大程度上混淆不同的临床和病毒学因素在本研究中。无论是低维生素D水平有助于不成功免疫清除和活动性肝炎需要进一步的研究。“ - 由梅琳达·史蒂文斯

披露：陈报告建议和发言艾伯维，施贵宝，Gilead Sciences公司，罗氏，MSD和诺华;作为一个扬声器，葛兰素史克和Echosens;和接收不受限制的补助金从罗氏乙肝病毒的研究。请参阅完整的研究对于所有其他作者的相关财务信息披露的名单。