AASLD2018[2096]严重的维生素D缺乏症识别贫困 慢性乙型肝炎患者

StephenW

2096
Severe Vitamin D Deficiency Identifies a Poor
Prognosis in Patients with Chronic Hepatits B
Infection
Zhang Xi1, An Xiaocui1, Liu Xiaojing1, Shi Lei1, Xueliang
Yang2, Kai Zhang1, Chen Yunru1, Li Jianzhou1, Jia Haijuan1,
Zhu Ruixue1, Pan Tiantian3, Ye Feng1 and Lin Shumei1, (1)
Department of Infectious Diseases, The First Affiliated
Hospital, Medical School of Xi’an Jiaotong University, (2)
Department of Infectious Disease, The First Affiliated
Hospital, Medical School of Xi’an Jiaotong University, (3)
The First Affiliated Hospital, Medical School of Xi’an Jiaotong
University, Department of Infectious Diseases
Background: Vitamin D is an important immune modulator
that involves in the metabolic and inflammatory diseases
of the liver. The role of vitamin D in patients with chronic
hepatitis C has been discussed on many forums. However,
studies on the potential interaction between vitamin D level
and chronic hepatitis B (CHB) are still limited. This study
aimed to assess the prevalence of vitamin D deficiency
in patients with chronic hepatitis B virus infection and
evaluate serum vitamin D as progression and prognostic
in chronic hepatitis B virus infection patients. Methods:
Serum vitamin D levels were determined in a cohort of 373
chronic HBV-infected patients (including chronic hepatitis,
compensated liver cirrhosis, decompensated liver cirrhosis,
HCC and acute-on-chronic liver failure). Biochemical
parameters (ALT,AST,ALP,GGT,ALB,TBIL,PT),tumor markers
(AFP),HBV DNA load, blood routine, surface antigen
(HBsAg) and hepatitis B e antigen (HBeAg ) level were
tested .Computed tomography (CT) or ultrasound image
(USG) used for radiological assessment. The association of
the vitamin D levels and chronic hepatitis B was assessed
in uni- and multivariate analysis. Results: The mean
serum level of vitamin D in CHB patients was significantly
lower than that for healthy controls(14.28±7.19ng/ml vs
23.60±6.20ng/ml, P < 0.05). Vitamin D deficiency (<20ng/
ml) was highly prevalent in chronic hepatitis B patients
(76.1%, 283/373). The percentage of patients with vitamin
D deficiency were 68.9%,64.3%,88.4%,83.1% and 72.7%
in chronic hepatitis, compensated cirrhosis, decompensated
cirrhosis, hepatocellular carcinoma and liver failure patients,
respectively(P<0.05). Vitamin D levels were significantly
related to ALT (r = 0.228, P< 0.05), AST(r=0.123,P<0.05),
ALB (r=0.289, P <0.05), GGT (r=0.19,P<0.05),AFP(r=0.159,
P<0.05), and Child-Pugh score(r=-0.221,P<0.05), while no
significant association was found between HBV-DNA and
Vitamin D status(r=0.103,P=0.05). In addition, vitamin D levels
were significantly lower in Child-Pugh score C patients (11.65
±6.76ng/ml), compared to Child-Pugh score B patients(14.08±
7.42ng/ml, P =0.022) and Child-Pugh score A patients (15.57
± 6.95ng/ml, P<0.001) . Based on the multivariate analysis,
serum vitamin D deficiency (<20ng/ml) were independently
predictors associated with progression of CHB patients.
Conclusion: Vitamin D deficiency is prevalent in chronic
hepatitis B patients. Vitamin D deficiency is strongly related to
the severity and progression of chronic HBV infection, it may
be a potential prognostic indicator for HBV related diseases

StephenW

2096
严重的维生素D缺乏症识别贫困
慢性乙型肝炎患者的预后
感染
张曦1，安小翠1，刘晓静1，石磊1，薛良
Yang2，张凯1，陈云如1，李建宙1，贾海娟1，
朱瑞雪1，潘天天3，叶锋1，林淑梅1，（1）
第一附属传染病科
西安交通大学医学院附属医院，（2）
第一附属传染病科
西安交通大学医学院附属医院，（3）
西安交通大学附属第一医院
大学，传染病系
背景：维生素D是一种重要的免疫调节剂
涉及代谢和炎症性疾病
肝脏维生素D在慢性乙型肝炎患者中的作用
许多论坛都讨论过丙型肝炎。然而，
研究维生素D水平之间的潜在相互作用
和慢性乙型肝炎（CHB）仍然有限。这项研究
旨在评估维生素D缺乏症的患病率
在慢性乙型肝炎病毒感染和
评估血清维生素D作为进展和预后
在慢性乙型肝炎病毒感染患者中。方法：
血清维生素D水平在373的队列中确定
慢性HBV感染患者（包括慢性肝炎，
代偿性肝硬化，肝硬化失代偿期，
HCC和急性慢性肝功能衰竭）。生化
参数（ALT，AST，ALP，GGT，ALB，TBIL，PT），肿瘤标志物
（AFP），HBV DNA载量，血常规，表面抗原
（HBsAg）和乙型肝炎e抗原（HBeAg）水平均为
测试。计算机断层扫描（CT）或超声图像
（USG）用于放射性评估。协会
评估维生素D水平和慢性乙型肝炎
在单变量和多变量分析中。结果：平均值
CHB患者血清维生素D水平显着升高
低于健康对照组（14.28±7.19ng / ml vs.
23.60±6.20ng / ml，P <0.05）。维生素D缺乏症（<20ng /
ml）在慢性乙型肝炎患者中非常普遍
（76.1％，283/373）。维生素患者的百分比
D缺乏率分别为68.9％，64.3％，88.4％，83.1％和72.7％
在慢性肝炎，代偿性肝硬化，失代偿期
肝硬化，肝细胞癌和肝衰竭患者，
分别（P <0.05）。维生素D水平显着
与ALT相关（r = 0.228，P <0.05），AST（r = 0.123，P <0.05），
ALB（r = 0.289，P <0.05），GGT（r = 0.19，P <0.05），AFP（r = 0.159，
P <0.05）和Child-Pugh评分（r = -0.221，P <0.05），而没有
HBV-DNA与HBV-DNA之间存在显着相关性
维生素D状态（r = 0.103，P = 0.05）。此外，维生素D水平
Child-Pugh评分C患者显着降低（11.65
与Child-Pugh评分B患者相比（±6.76ng / ml）（14.08±
7.42ng / ml，P = 0.022）和Child-Pugh评分A患者（15.57
±6.95ng / ml，P <0.001）。基于多变量分析，
血清维生素D缺乏症（<20ng / ml）是独立的
与CHB患者进展相关的预测因子。
结论：维生素D缺乏症在慢性病中很常见
乙型肝炎患者。维生素D缺乏与强烈相关
慢性HBV感染的严重程度和进展，可能
是HBV相关疾病的潜在预后指标