Rode A, Fourlanos S, Nicoll A
Department of Gastroenterology, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3050, Melbourne, Australia.
Gastroenterol Clin Biol. 2010 Nov;34(11):618-20. doi: 10.1016/j.gcb.2010.07.009.
BACKGROUND & AIMS: End-stage chronic liver disease is associated with vitamin D deficiency but the prevalence across a broad-spectrum of liver disease is unknown. This study prospectively examines prevalence of vitamin D deficiency and response to replacement in chronic liver disease.
One hundred and fifty-eight outpatients with chronic liver disease were enrolled. Serum 25-hydroxyvitamin D (25[OH]D) levels were classified as: severely deficient less than 25 nmol/l, deficient 25-54 nmol/l or replete greater than 54 nmol/l. Sixty-five of 158 (41%) had cirrhosis.
25[OH]D was suboptimal in 101/158 (64%), including severe deficiency in 24 patients (15%). Vitamin D deficiency occurred in liver disease of all aetiologies, including patients with only mild liver disease. 25[OH]D increased by 60.0% (19.11 ± 13.20 nmol/l) in patients with deficiency after vitamin D replacement and decreased by 25.2% (-18.33 ± 12.02 nmol/l) in non-treated initially replete patients over a median of 4 months.
Vitamin D deficiency improves with oral vitamin D supplementation and levels fall without supplementation. Chronic liver disease patients are at very high risk of vitamin D deficiency regardless of etiology or severity.
终末期慢性肝病与维生素D缺乏有关,但在广泛的肝病范围内其患病率尚不清楚。本研究前瞻性地调查了慢性肝病中维生素D缺乏的患病率及补充治疗后的反应。
纳入158例慢性肝病门诊患者。血清25-羟维生素D(25[OH]D)水平分为:严重缺乏(低于25 nmol/l)、缺乏(25 - 54 nmol/l)或充足(高于54 nmol/l)。158例中有65例(41%)患有肝硬化。
101/158例(64%)患者的25[OH]D水平未达最佳,其中24例(15%)为严重缺乏。各种病因的肝病患者均有维生素D缺乏,包括仅有轻度肝病的患者。维生素D缺乏的患者经补充维生素D后,25[OH]D水平升高60.0%(19.11±13.20 nmol/l),而最初充足且未接受治疗的患者在中位4个月期间25[OH]D水平下降25.2%(-18.33±12.02 nmol/l)。
口服补充维生素D可改善维生素D缺乏,不补充则水平下降。无论病因或严重程度如何,慢性肝病患者维生素D缺乏风险都非常高。