Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2012;7(2):e27144. doi: 10.1371/journal.pone.0027144. Epub 2012 Feb 16.
In animal models and human cross-sectional studies, vitamin D deficiency has been associated with liver disease progression. Vitamin D supplementation has been suggested as a treatment to prevent disease progression. We sought to evaluate the role of vitamin D levels in predicting chronic liver disease development. We conducted a nested case-control study of vitamin D levels in subjects with (cases) and without (controls) liver histologic progression or clinical decompensation over the course of the HALT-C Trial. Vitamin D levels were measured at 4 points over 45 months. 129 cases and 129 aged-matched controls were included. No difference in baseline vitamin D levels were found between cases and controls. (44.8 ng/mL vs. 44.0 ng/mL, P = 0.74). Vitamin D levels declined in cases and controls over time (P = 0.0005), however, there was no difference in the level of decline (P = 0.37). Among study subjects with diabetes mellitius, baseline vitamin D levels were higher in cases, 49.9 ng/mL, than controls, 36.3 ng/mL. (P = 0.03) In addition, baseline vitamin D levels were higher in black case subjects, 32.7 ng/mL, than in black control subjects, 25.2 ng/mL (P = 0.08) No difference in vitamin D levels was found between patients with and without progression of hepatitis C-associated liver disease over 4 years. Our data do not suggest any role for vitamin D supplementation in patients with advanced chronic hepatitis C and raise the possibility that higher vitamin D levels may be associated with disease progression.
在动物模型和人类横断面研究中,维生素 D 缺乏与肝病进展有关。维生素 D 补充被认为是预防疾病进展的一种治疗方法。我们试图评估维生素 D 水平在预测慢性肝病发展中的作用。我们对 HALT-C 试验过程中肝组织学进展或临床失代偿的患者(病例)和无进展的患者(对照)的维生素 D 水平进行了嵌套病例对照研究。在 45 个月的时间内测量了 4 个时间点的维生素 D 水平。共纳入 129 例病例和 129 例年龄匹配的对照。病例和对照之间的基线维生素 D 水平无差异。(44.8ng/mL 比 44.0ng/mL,P=0.74)。病例和对照的维生素 D 水平随时间下降(P=0.0005),但下降水平无差异(P=0.37)。在患有糖尿病的研究对象中,病例的基线维生素 D 水平更高,为 49.9ng/mL,而对照组为 36.3ng/mL(P=0.03)。此外,黑人病例患者的基线维生素 D 水平高于黑人对照组患者,为 32.7ng/mL,比对照组高 25.2ng/mL(P=0.08)。在 4 年内丙型肝炎相关肝病进展的患者中,未发现维生素 D 水平有差异。我们的数据表明,补充维生素 D 对晚期慢性丙型肝炎患者没有作用,并提出了维生素 D 水平较高可能与疾病进展相关的可能性。