Livia Melo Villar, Elisabeth Lampe, Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ 210360-040, Brazil.
World J Gastroenterol. 2013 Sep 21;19(35):5917-24. doi: 10.3748/wjg.v19.i35.5917.
To evaluate the association between 25-hydroxyvitamin D [25(OH)D] and sustained virological response (SVR) in hepatitis C virus (HCV) infected individuals.
Relevant studies were identified by systematically searching MEDLINE databases up to March 2012 and abstracts of the European and American Congress of Hepatology conducted in 2011. Studies must provide information on SVR and the levels of 25(OH)D₃ and/or 25(OH)D₂ [henceforth referred to as 25(OH)D] in sera samples from HCV infected individuals. The inclusion criteria were: clinical studies that included HCV infected patients aged older than 18 years regardless of HCV genotype or ethnic group; provided information on SVR rates; and were reported in the English language as full papers. Due to the heterogeneity of studies in categorizing serum vitamin D levels, a cut-off value of 30 ng/mL of serum 25(OH)D was used. Heterogeneity was assessed using I² statistics. The summary odds ratios with their corresponding 95%CI were calculated based on a random-effects model.
Overall, 11 studies (8 observational and 3 interventional) involving 1575 individuals were included and 1117 HCV infected individuals (71%) showed low vitamin D levels. Most of the studies included mono-infected HCV individuals with the mean age ranging from 38 to 56 years. Four studies were conducted in human immunodeficiency virus/HCV infected individuals. Regarding vitamin D measurement, most of the studies employed radioimmunoassays (n = 5) followed by chemiluminescence (n = 4) and just one study employed high performance/pressure liquid chromatography (HPLC). Basal vitamin D levels varied from 17 to 43 ng/mL in the studies selected, and most of the HCV infected individuals had genotype 1 (1068/1575) with mean viral load varying from log 4.5-5.9 UI/mL. With regard to HCV treatment, most of the studies (n = 8) included HCV individuals without previous treatment, where the pooled SVR rate was 46.4%. High rates of SVR were observed in HCV individuals with vitamin D levels above 30 ng/mL (OR = 1.57; 95%CI: 1.12-2.2) and those supplemented with vitamin D (OR = 4.59; 95%CI: 1.67-12.63) regardless of genotype.
Our results demonstrated high prevalence of vitamin D deficiency and high SVR in individuals with higher serum vitamin D levels or receiving vitamin D supplementation.
评估丙型肝炎病毒（HCV）感染者 25-羟维生素 D [25(OH)D]与持续病毒学应答（SVR）之间的关系。
通过系统检索截至 2012 年 3 月的 MEDLINE 数据库和 2011 年举行的欧洲和美国肝脏病学会的摘要，确定相关研究。研究必须提供 HCV 感染者血清样本中 SVR 和 25(OH)D₃ 和/或 25(OH)D₂（下文简称 25(OH)D）水平的信息。纳入标准为：纳入年龄大于 18 岁的 HCV 感染患者的临床研究，无论 HCV 基因型或种族如何；提供 SVR 率信息；以全文形式用英文报告。由于研究中血清维生素 D 水平的分类存在异质性，故使用血清 25(OH)D 为 30ng/ml 作为截断值。采用 I² 统计评估异质性。根据随机效应模型计算汇总比值比及其相应的 95%置信区间。
总体而言，纳入了 11 项研究（8 项观察性研究和 3 项干预性研究），共涉及 1575 名参与者，其中 1117 名 HCV 感染者（71%）维生素 D 水平较低。大多数研究纳入了单纯 HCV 感染患者，平均年龄为 38 至 56 岁。有 4 项研究在人类免疫缺陷病毒/HCV 感染者中进行。关于维生素 D 的测量，大多数研究采用放射免疫分析（n=5），其次是化学发光（n=4），只有一项研究采用高效/高压液相色谱法（HPLC）（n=1）。入选研究中基础维生素 D 水平从 17 至 43ng/ml 不等，大多数 HCV 感染者为基因型 1（1068/1575），平均病毒载量为 log4.5-5.9UI/ml。关于 HCV 治疗，大多数研究（n=8）纳入未经治疗的 HCV 感染者，其 SVR 率为 46.4%。维生素 D 水平高于 30ng/ml（OR=1.57；95%CI：1.12-2.2）和接受维生素 D 补充的 HCV 感染者（OR=4.59；95%CI：1.67-12.63）的 SVR 率较高，无论基因型如何。
我们的结果表明，血清维生素 D 水平较高或接受维生素 D 补充的个体中，维生素 D 缺乏和 SVR 发生率较高。
