Phillips J R, Angulo P, Petterson T, Lindor K D
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 2001 Sep;96(9):2745-50. doi: 10.1111/j.1572-0241.2001.04134.x.
To determine the occurrence of fat-soluble vitamin deficiencies and to identify clinical factors that may predict vitamin deficiency in patients with primary biliary cirrhosis (PBC).
Review of our data from a randomized, placebo-controlled trial that evaluated the efficacy of UDCA in 180 patients with PBC. We use the first available measurements of vitamin levels in each study participant. Vitamin levels for A, D, and E were measured in serum. The prothrombin time (PT) was used as a surrogate marker for vitamin K.
The proportion of patients with fat-soluble vitamin deficiencies in the treatment and placebo groups was similar and the data sets were combined. The proportion with vitamin A, D, E or K deficiency was 33.5%, 13.2%, 1.9%, and 7.8%, respectively. In multivariate analysis, the Mayo risk score, advanced histological stage, and total cholesterol were independently associated with vitamin A deficiency whereas serum albumin levels was independently associated with vitamin D deficiency. No factors were associated with vitamin E or K deficiency in multivariate analysis owing to the few vitamin E and K deficient patients. Factors predictive of vitamin K deficiency by univariate analysis included Mayo risk score, advanced histological stage, HDL, total bilirubin, AST, and albumin. The cut-off value of the Mayo risk score with the highest sensitivity and specificity for vitamin A deficiency was 5.0.
Other than deficiency of vitamin A, deficiency of fat-soluble vitamins occurs uncommonly in patients with PBC. A Mayo risk score > or = 5 helps in selecting patients with PBC for surveillance for vitamin A deficiency.
确定原发性胆汁性肝硬化（PBC）患者中脂溶性维生素缺乏的发生率，并识别可能预测维生素缺乏的临床因素。
回顾我们一项随机、安慰剂对照试验的数据，该试验评估了熊去氧胆酸（UDCA）对180例PBC患者的疗效。我们采用了每个研究参与者首次可得的维生素水平测量值。血清中测量了维生素A、D和E的水平。凝血酶原时间（PT）用作维生素K的替代标志物。
治疗组和安慰剂组中脂溶性维生素缺乏患者的比例相似，因此将数据集合并。维生素A、D、E或K缺乏的比例分别为33.5%、13.2%、1.9%和7.8%。在多变量分析中，梅奥风险评分、高级组织学分期和总胆固醇与维生素A缺乏独立相关，而血清白蛋白水平与维生素D缺乏独立相关。由于维生素E和K缺乏的患者较少，多变量分析中没有因素与维生素E或K缺乏相关。单变量分析中预测维生素K缺乏症的因素包括梅奥风险评分、高级组织学分期、高密度脂蛋白、总胆红素、谷草转氨酶和白蛋白。对维生素A缺乏症敏感性和特异性最高的梅奥风险评分临界值为5.0。
除维生素A缺乏外，PBC患者中脂溶性维生素缺乏并不常见。梅奥风险评分≥5有助于选择PBC患者进行维生素A缺乏监测。
