Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Dig Dis Sci. 2010 Sep;55(9):2624-8. doi: 10.1007/s10620-009-1069-9. Epub 2009 Dec 4.
Vitamin D deficiency has been associated with cholestatic liver disease such as primary biliary cirrhosis. Some studies have suggested that cirrhosis can predispose patients to development of osteoporosis because of altered calcium and vitamin D homeostasis. The aim of this study was to determine the prevalence of vitamin D deficiency in patients with chronic liver disease.
One hundred and eighteen consecutive patients (43 with hepatitis C cirrhosis, 57 with hepatitis C but no cirrhosis, 18 with nonhepatitis C-related cirrhosis) attending the University of Tennessee Hepatology Clinic had their 25-hydroxyvitamin D level measured. Severity of vitamin D deficiency was graded as mild (20-32 ng/ml), moderate (7-19 ng/ml) or severe (<7 ng/ml), normal being >32 ng/ml.
Of patients, 109/118 (92.4%) had some degree of vitamin D deficiency. In the hepatitis C cirrhosis group, 16.3% (7/43) had mild, 48.8% (21/43) had moderate, and 30.2% (13/43) had severe vitamin D deficiency. In the hepatitis C noncirrhotic group, 22.8% (19/57) had mild, 52.6% (30/57) had moderate, and 14% (8/57) had severe vitamin D deficiency. In the nonhepatitis C-related cirrhosis group, 38.9% (7/18) had mild, 27.8% (5/18) had moderate, and 27.8% (5/18) had severe vitamin D deficiency. Severe vitamin D deficiency (<7 ng/ml) was more common among patients with cirrhosis compared with noncirrhotics (29.5% versus 14.1%, P value=0.05). Female gender, African American race, and cirrhosis were independent predictors of severe vitamin D deficiency in chronic liver disease.
Vitamin D deficiency is universal (92%) among patients with chronic liver disease, and at least one-third of them suffer from severe vitamin D deficiency. African American females are at highest risk of vitamin D deficiency.
确定慢性肝病患者维生素 D 缺乏的发生率。
田纳西大学肝病诊所连续收治的 118 例患者（43 例丙型肝炎肝硬化患者、57 例丙型肝炎但无肝硬化患者、18 例非丙型肝炎相关肝硬化患者）测量了其 25-羟维生素 D 水平。维生素 D 缺乏程度分为轻度（20-32ng/ml）、中度（7-19ng/ml）或重度（<7ng/ml），正常为>32ng/ml。
118 例患者中，109/118（92.4%）存在不同程度的维生素 D 缺乏。在丙型肝炎肝硬化组中，16.3%（7/43）为轻度、48.8%（21/43）为中度、30.2%（13/43）为重度维生素 D 缺乏。在丙型肝炎无肝硬化组中，22.8%（19/57）为轻度、52.6%（30/57）为中度、14%（8/57）为重度维生素 D 缺乏。在非丙型肝炎相关肝硬化组中，38.9%（7/18）为轻度、27.8%（5/18）为中度、27.8%（5/18）为重度维生素 D 缺乏。肝硬化患者重度维生素 D 缺乏（<7ng/ml）较非肝硬化患者更为常见（29.5%比 14.1%，P 值=0.05）。女性、非裔美国人种族和肝硬化是慢性肝病患者重度维生素 D 缺乏的独立预测因素。
慢性肝病患者普遍存在维生素 D 缺乏（92%），至少三分之一的患者存在重度维生素 D 缺乏。非裔美国女性维生素 D 缺乏风险最高。
