在合并和未合并人类免疫缺陷病毒感染的亚洲丙型肝炎患者中，通过瞬时弹性成像、纤维化4以及丙氨酸氨基转移酶/血小板比值指数评估的晚期肝纤维化：维生素D水平的作用
Advanced liver fibrosis by transient elastography, fibrosis 4, and alanine aminotransferase/platelet ratio index among Asian hepatitis C with and without human immunodeficiency virus infection: role of vitamin D levels.
作者信息
Avihingsanon Anchalee, Jitmitraparp Salyavit, Tangkijvanich Pisit, Ramautarsing Reshmie A, Apornpong Tanakorn, Jirajariyavej Supunee, Putcharoen Opass, Treeprasertsuk Sombat, Akkarathamrongsin Srunthron, Poovorawan Yong, Matthews Gail V, Lange Joep M A, Ruxrungtham Kiat
机构信息
HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Center, Bangkok, Thailand; Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
出版信息
J Gastroenterol Hepatol. 2014 Sep;29(9):1706-14. doi: 10.1111/jgh.12613.
BACKGROUND AND AIM
Vitamin D insufficiency plays an important role in liver fibrosis in hepatitis C virus (HCV)-infected patients. We assessed liver fibrosis by transient elastography and 25 hydroxy vitamin D [25(OH)D] status in HCV-infected patients, with (HIV/HCV) or without HIV co-infection (HCV) from Thailand.
METHODS
Fibrosis stage was defined as mild (< 7.1 kPa); moderate (7.2-9.4 kPa); severe (9.5-14 kPa), and cirrhosis (> 14 kPa). Hypovitaminosis D was defined as 25(OH)D < 30 ng/mL. Logistic regression analyses were used to assess predictors for significant fibrosis. Serum 25(OH) D levels, HCV genotypes (GT), interleukin-28B (IL28B) and HCV-RNA were assessed.
RESULTS
A total of 331 HCV and 130 HIV/HCV patients were enrolled (70% male, 35% people who inject drugs [PWIDs]). HCV GT distribution was as follows: GT3 47%, GT1 34%, GT6 17%. IL-28B CC genotype (rs12979860) were found in 88% of HIV/HCV and 85% of HCV. In HCV, liver fibrosis was mild in 56.5%; moderate in 18.4%; severe in 12.4%; and cirrhosis in 12.7%. In HIV/HCV, these figures were 30.6%, 27.8%, 17.6%, and 24.1%, respectively. Patients with significant fibrosis were more often male, older, with HIV infection, hypovitaminosis D, and less likely to be infected with GT6. Factors associated with significant fibrosis by multivariate analysis were HIV infection (adjusted odd ratio [95% confidential interval]: 2.67, 1.20-5.93), P = 0.016, Fib-4 score > 1.45 (6.30, 2.70-14.74), P < 0.001, and hypovitaminosis D (2.48, 1.09-5.67), P = 0.031. GT 6 was less likely to have advanced liver fibrosis (0.17, 0.05-0.65), P = 0.01.
CONCLUSIONS
HIV infection, Fib-4 score > 1.45, and hypovitaminosis D are strong and independent predictors for the presence of advanced fibrosis in our HCV-infected patients. These data highlight the urgent need of HCV treatment and vitamin D supplement in resource-limited settings.
背景与目的
维生素D不足在丙型肝炎病毒（HCV）感染患者的肝纤维化中起重要作用。我们通过瞬时弹性成像评估了来自泰国的HCV感染患者（合并或未合并人类免疫缺陷病毒（HIV）感染）的肝纤维化情况以及25羟维生素D [25(OH)D] 水平。
方法
纤维化阶段定义为轻度（<7.1kPa）；中度（7.2 - 9.4kPa）；重度（9.5 - 14kPa）和肝硬化（>14kPa）。维生素D缺乏定义为25(OH)D < 30ng/mL。采用逻辑回归分析评估显著纤维化的预测因素。检测血清25(OH)D水平、HCV基因型（GT）、白细胞介素-28B（IL28B）和HCV-RNA。
结果
共纳入331例HCV患者和130例HIV/HCV患者（70%为男性，35%为注射吸毒者[PWIDs]）。HCV GT分布如下：GT3占47%，GT1占34%，GT6占17%。在HIV/HCV患者中88%以及HCV患者中85%发现IL-28B CC基因型（rs12979860）。在HCV患者中，肝纤维化轻度占56.5%；中度占18.4%；重度占12.4%；肝硬化占12.7%。在HIV/HCV患者中，这些数字分别为30.6%、27.8%、17.6%和24.1%。显著纤维化患者更常为男性、年龄较大、合并HIV感染、维生素D缺乏，且感染GT6的可能性较小。多因素分析显示与显著纤维化相关的因素为HIV感染（调整比值比[95%置信区间]：2.67，1.20 - 5.93），P = 0.016，Fib-4评分>1.45（6.30，2.70 - 14.74），P < 0.001，以及维生素D缺乏（2.48，1.09 - 5.67），P = 0.031。GT6发生晚期肝纤维化的可能性较小（0.17，0.05 - 0.65），P = 0.01。
结论
HIV感染、Fib-4评分>1.45和维生素D缺乏是我们HCV感染患者发生晚期纤维化的强有力且独立的预测因素。这些数据凸显了在资源有限地区迫切需要进行HCV治疗和补充维生素D。
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