慢性HBV感染者血清维生素D水平及其临床意义

Objective: To assess the level of serum 25(OH)D in patients infected with chronic hepatitis B virus (HBV) at different stages so as to explore their clinical significance. Methods: We quantified the levels of serum 25(OH)D from 246 chronic HBV-infected patients (chronic hepatitis B, n=90; compensated liver cirrhosis, n=70; and decompensated liver cirrhosis, n=86) in the study. Serum 25(OH)D level, liver function, coagulation index, and HBV markers were tested in all the patients. Child-Pugh grade and FIB-4 score of liver fibrosis were calculated in patients with liver cirrhosis. Results: ① The mean serum level of vitamin D in chronic HBV infection patients was significantly lower than that in healthy controls [(14.37±7.18)ng/mL vs. (23.60±6.20)ng/mL, P<0.05]. Serum 25(OH)D level in patients with decompensated cirrhosis was obviously lower than that in patients with chronic hepatitis B [(15.22±6.84)ng/mL, P<0.001] and compensated cirrhosis [(17.16±7.55)ng/mL, P<0.001]. ② Serum 25(OH)D had a positive correlation with ALB level, but a negative correlation with PT level. Serum 25(OH)D level in liver cirrhosis patients was significant negatively correlated with FIB-4 scores. ③ Of the liver cirrhosis patients, 91.9% patients in Child-Pugh C group, 81.6% patients in Child-Pugh B group, and 67.1% patients in Child-Pugh A group had serum 25(OH)D level deficiency. Univariate and multivariate logistic regression analysis showed that CHB patients with FIB-4 score≥1.45 were more likely to develop compensated liver cirrhosis. Compensated liver cirrhosis patients with serum 25(OH) D level <20 ng/mL had the high possibility of decompensation cirrhosis and more severe hepatic injury. Conclusion: Vitamin D deficiency is prevalent in chronic HBV-infected patients, especially in those with decompensated cirrhosis. Vitamin D level can be used as an indicator to assess the severity of chronic HBV infection.