维生素A水平反映了肝硬化患者的疾病严重程度和门脉高压

StephenW

Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

    Benedikt Simbrunner, Georg Semmler, Alexander Stadlmann, Bernhard Scheiner, Philipp Schwabl, Rafael Paternostro, Theresa Bucsics, David Bauer, Ernst Eigenbauer, Matthias Pinter, Albert-Friedrich Stättermayer, Peter Quehenberger, Rodrig Marculescu, Michael Trauner, Mattias Mandorfer & Thomas Reiberger

Hepatology International volume 14, pages1093–1103(2020)Cite this article

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Abstract
Background and Aims

The liver plays a key role in the storage, metabolism and homeostasis of fat-soluble vitamins. We investigated the relation of Vitamin(Vit)A/D/E serum levels with severity of liver disease and portal hypertension (PHT).
Methods

VitA/D/E serum levels were assessed in 234 patients with advanced chronic liver disease (ACLD, i.e. hepatic venous pressure gradient [HVPG] ≥ 6 mmHg). Patients with hepatocellular carcinoma, pre-/post-hepatic PHT, TIPS or liver transplantation were excluded.
Results

Most patients were male (n = 153; 65%) with a median age of 57.6 (49.7–64.5) years. Thirty-two (14%) patients had HVPG 6–9 mmHg, 66 (28%) 10-15 mmHg, and 136 (58%) ≥ 16 mmHg, respectively. VitD deficiency (25-OH-vitamin-D <50 nmol/L) was found in 133 (57%) with higher prevalence in Child-Turcotte-Pugh (CTP)-C: 85% vs. B: 66% vs. A: 47% (p < 0.001). VitD levels displayed significant but weak correlations with hepatic dysfunction and PHT. VitE levels were normal in 227 (97%) patients and displayed no relevant association with hepatic dysfunction or PHT. Only 63 (27%) patients had normal (>1.05 µmol/L) VitA levels, while 58 (25%) had mild (0.70–1.04 µmol/L), 71 (30%) moderate (0.35–0.69 µmol/L), and 42(18%) severe(<0.35 µmol/L) VitA deficiency. VitA correlated with HVPG (Rho = −0.409), CTP score (Rho = −0.646), and serum bile acid levels (Rho = −0.531; all p < 0.001). The prevalence of decompensated ACLD (dACLD) continuously increased with severity of VitA deficiency (no: 40% vs. mild: 51% vs. moderate: 67% vs. severe: 91% had dACLD; p < 0.001). CTP score (per point; OR 2.46; 95%CI 1.80–3.37; p <0.001), age (per year; OR 0.95; 95%CI 0.92–0.98; p = 0.001) and elevated bile acid levels(>10 µmol/L; OR 3.62; 95%CI 1.61–8.14; p = 0.002) were independently associated with VitA deficiency.
Conclusion

VitA and VitD but not VitE deficiencies are highly prevalent in ACLD. VitA deficiency strongly correlates with hepatic dysfunction, PHT and bile acid levels and is associated with decompensated ACLD.
Trial registration number

NCT03267615.

StephenW

维生素A水平反映了肝硬化患者的疾病严重程度和门脉高压

    Benedikt Simbrunner，Georg Semmler，Alexander Stadlmann，Bernhard Scheiner，Philipp Schwabl，Rafael Paternostro，Theresa Bucsics，David Bauer，Ernst Eigenbauer，Matthias Pinter，Albert-FriedrichStättermayer，Peter Quehenberger，Rodrig Marculesia和Michael Tradorfer

国际肝病杂志第14卷，1093-1103（2020）页

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抽象
背景和目标

肝脏在脂溶性维生素的储存，代谢和体内平衡中起着关键作用。我们调查了维生素（Vit）A / D / E血清水平与肝病严重程度和门脉高压（PHT）的关系。
方法

在234例晚期慢性肝病（ACLD，即肝静脉压梯度[HVPG]≥6mmHg）中评估了VitA / D / E血清水平。排除肝细胞癌，肝前/后PHT，TIPS或肝移植的患者。
结果

大多数患者是男性（n = 153，65％），中位年龄为57.6（49.7-64.5）岁。三十二（14％）例患者的HVPG为6–9 mmHg，66（28％）为10-15 mmHg，136（58％）≥16mmHg。在133（57％）中发现了VitD缺乏症（25-OH-维生素D <50 nmol / L），Child-Turcotte-Pugh（CTP）-C的患病率更高：相对于B：85％；相对于A：66％ ：47％（p ＜0.001）。 VitD水平与肝功能障碍和PHT表现出显着但微弱的相关性。 227名患者（97％）的VitE水平正常，与肝功能不全或PHT没有相关性。只有63（27％）患者的VitA水平正常（> 1.05 µmol / L），而58（25％）患者的轻度（0.70–1.04 µmol / L），71（30％）中度（0.35–0.69 µmol / L）和42（18％）严重（<0.35 µmol / L）的VitA缺乏症。 VitA与HVPG（Rho = -0.409），CTP评分（Rho = -0.646）和血清胆汁酸水平（Rho = -0.531；所有p <0.001）相关。失代偿ACLD（dACLD）的发生率随VitA缺乏症的严重程度而持续增加（否：40％vs.轻度：51％vs.中度：67％vs.重度：91％患有dACLD； p <0.001）。 CTP评分（每分； OR 2.46； 95％CI 1.80-3.37； p <0.001），年龄（每年； OR 0.95； 95％CI 0.92-0.98； p = 0.001）和胆汁酸水平升高（> 10 µmol / L； OR 3.62； 95％CI 1.61-8.14； p = 0.002）独立于VitA缺乏症。
结论

VitA和VitD，但不是VitE缺陷在ACLD中非常普遍。 VitA缺乏症与肝功能障碍，PHT和胆汁酸水平密切相关，并与代偿性ACLD相关。
试用注册号

NCT03267615。

StephenW

https://link.springer.com/articl ... c_springer_20210113