维生素D是人体重要的免疫调节剂，在肝炎及代谢性肝病中扮演一个重要的角色，其中也包括丙肝病毒。然而，维生素D和乙型肝炎病毒之间并没有很好的特征性关系。 因此，我们对我们203名乙型肝炎初治患者血浆维生素D水平进行定量，并与相关乙型肝炎临床指标进行对比。在这203名患者中，有69名（34%）维生素D缺乏（ <10ng/mL ），95名患者（47%）维生素D不足（ ≥10ng/mL and <20ng/mL ），39名患者（19%）维生素D是充足的（≥20ng/mL） 。在多变量分析和变量分析中，乙型肝炎病毒载量是低维生素D水平的一个强烈预示，反之亦然。同时，乙型肝炎病毒水平<2000 IU/mL 与≥2000 IU/mL 的患者血浆维生素D水平相比为17:11.此外，乙肝病毒核心抗原阳性患者比阴性患者维生素D水平更低。 血浆维生素D水平和乙肝病毒DNA血浆浓度显示出一个反向关系。低维生素D血浆浓度与慢性乙肝患者高水平病毒复制是有关的。这和丙肝肝炎有很大不同，在以前大量的研究中没有发现丙肝病毒与维生素D水平有关。维生素D水平与乙肝病毒水平之间的这种反向关系是这两个变量的函数关系。
吉林大学第一医院肝病科 张悦 摘译
本文首次发表于[Hepatology. 2013 May 22]
Low vitamin D serum concentration is associated with high levels of hepatitis B virus (HBV) replication inchronically infected patients
Abstract
Vitamin D is an important immune modulator which plays an emerging role in inflammatory and metabolic liver diseases, including infection withhepatitis C virus (HCV). In contrast, the relationship between vitamin D metabolism and chronic hepatitis B is less well characterized. Therefore, we quantified 25-hydroxyvitamin D [25(OH)D3 ] serum levels in a cohort of 203 treatment-naïve patients with chronic hepatitis B virus (HBV) infection and tested for their association with clinical parameters of chronic hepatitis B. 69 (34%), 95 (47%), and 39 (19%) out of 203 patients had severe vitamin Ddeficiency [25(OH)D3 <10ng/mL], vitamin D insufficiency [25(OH)D3 ≥10ng/mL and <20ng/mL], or adequate vitamin D serum levels [25(OH)D3≥20ng/mL], respectively. In both uni- and multivariate analyses, HBV DNA viral load (log10 IU/mL) was a strong predictor of low 25(OH)D3 serumlevels (p=0.0007 and p=0.000048, respectively), and vice versa. Mean 25(OH)D3 serum concentrations in patients with HBV DNA <2000 IU/mL vs. ≥2000 IU/mL were 17 vs. 11 ng/mL, respectively (p<0.00001). In addition, hepatitis B early antigen (HBeAg) positive patients had lower 25(OH)D3serum levels than HBeAg negative patients (p=0.0013). Finally, 25(OH)D3 and HBV DNA serum levels showed inverse seasonal fluctuations. Conclusions: Low 25(OH)D3 serum levels are associated with high levels of HBV replication in patients with chronic hepatitis B. This represents a major difference to chronic hepatitis C, were numerous previous studies have shown a lacking correlation between HCV viral load vitamin D serumlevels. Inverse seasonal fluctuations of 25(OH)D3 and HBV DNA serum levels are suggestive for a functional relationship between both variables. (HEPATOLOGY 2013.).
