维生素A缺乏与HCV慢性感染和干扰素的抗病毒治疗无应答相关
最近的数据表明，维生素A能调节I型干扰素受体的表达，增强α-干扰素抑制丙型肝炎病毒（HCV）复制效果。本研究旨在探讨慢性丙型肝炎病毒感染的患者维生素A缺乏的流行病学，评估是否维生素A缺乏症与干扰素的抗病毒治疗的无应答相关。该分析包括了199名连续治疗的初治慢性丙型肝炎患者，检测治疗前血清维生素A和25-OH维生素D; 119名健康献血者作为对照组。HCV阳性患者的血清维生素A的中位数（四分位数间距）显着低于对照组：256纳克/毫升（128-440）和742（624-942，P <0.0001）。199名患者中有122人获得了持续病毒学应答，109名病毒分型为难治型人群中有46人获得持续病毒学应答。后者中39名/104（37.5％）患者无应答。在多变量分析中，抗病毒治疗无应答的预测指标有：IL-28B基因型为T /*基因型，基线血清γGT> 60 IU/ mL，HCV RNA>600000 IU/ mL，维生素A≤100 ng / mL以及累积服用利巴韦林剂量≤80％。17例患者（9.0％），同时有血清维生素A≤100 纳克/毫升和维生素D≤20 纳克/毫升；同时具有维生素A和D缺乏被认为是抗病毒治疗无应答的一个强有力的独立预测因素。结论：目前慢性丙型肝炎病毒感染血清维生素A缺乏症的患者比例较高。这与抗病毒治疗无应答具有相关性。
吉林大学第一医院肝胆胰内科 迟秀梅 摘译
本文首次发表于[Hepatology. 2012 Dec 5]
Vitamin A deficiency is associated with HCV chronic infection and with unresponsiveness to interferon based antiviral therapy
Recent data suggest that vitamin A modulate the expression of type I interferon receptor enhancing the anti replication effect of interferon-α on hepatitis C virus (HCV). This study aimed to investigate the prevalence of vitamin A deficiency among patients with chronic HCV infection and to assess whether vitamin A deficiency could be associated with unresponsiveness to interferon based antiviral therapy. The analysis included 199 consecutive treatment-naïve chronic hepatitis C patients in whom pre-treatment serum vitamin A and 25-OH vitamin D were measured; 119 healthy blood donors were used as controls. Median (inter-quartile range) serum vitamin A in HCV positive patients was significantly lower than in controls: 256 ng/mL (128-440) Vs 742 (624-942, p<0.0001). Overall sustained viral response was achieved in 122/199 patients, 46/109 infected by difficult to treat HCV genotypes. In these latter, 39/104 (37.5%) were non responders. At multivariate analysis, non response to antiviral therapy was predicted by carriage of IL-28B T/* genotypes, baseline serum levels of γGT >60 IU/mL, of HCV RNA >600.000 IU/mL, of vitamin A ≤100 ng/mL and the cumulative dose of ribavirin ≤80%. Seventeen patients (9.0%) had both serum levels of vitamin A ≤100 ng/mL and of vitamin D ≤20 ng/mL; the presence of the combined vitamin A and D deficiency was found to be a strong independent predictor of non response to antiviral therapy. Conclusions: a high percentage of patients with chronic HCV infection present serum vitamin A deficiency. This condition is associated with non response to antiviral therapy. 
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