Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
Hepatology. 2014 Nov;60(5):1541-50. doi: 10.1002/hep.27281. Epub 2014 Sep 29.
There is growing evidence that vitamin D is related to chronic hepatitis C (CHC) pathogenicity. We analyzed the relationship of vitamin D status with advanced liver fibrosis (ALF) in CHC treatment-naïve patients and sustained virologic response (SVR) in CHC patients on pegylated interferon alpha plus ribavirin (pegIFNα/ribavirin) therapy. We performed a meta-analysis of all eligible studies published to date (April, 2014) in PubMed, SCOPUS, LILACS, and the Cochrane Library, assessing plasma/serum vitamin D levels related to ALF and/or SVR. Pooled odds ratios (ORs) were estimated by either fixed or random effects models. Fourteen studies were selected from the literature search, seven for ALF (1,083 patients) and 11 for SVR (2,672 patients). For liver fibrosis, low vitamin D status was related to a diagnosis of ALF, with the cutoffs of 10 ng/mL (OR=2.37, 95% confidence interval [CI]=1.20, 4.72) and 30 ng/mL (OR=2.22, 95% CI=1.24, 3.97) being significant, and a near-significance for 20 ng/mL (OR=1.44, 95% CI=0.99, 2.12). Regarding SVR, a significant heterogeneity among studies was found (P<0.001), and we only found a significant association with SVR for a vitamin D cutoff of 20 ng/mL (OR=0.53, 95% CI=0.31, 0.91). When meta-analysis was performed excluding the outliers, significant pooled ORs were found for all patients (10 ng/mL [OR=0.48, 95% CI=0.34, 0.67] and 20 ng/mL [OR=0.58, 95% CI=0.45, 0.76]) and GT1/4 patients (10 ng/mL [OR=0.53, 95% CI=0.34, 0.81] and 20 ng/mL [OR=0.54, 95% CI=0.39, 0.74]).
Low vitamin D status in CHC patients is associated with a higher likelihood of having ALF and lower odds of achieving SVR following pegIFNα/ribavirin therapy.
越来越多的证据表明维生素 D 与慢性丙型肝炎（CHC）的发病机制有关。我们分析了维生素 D 状态与 CHC 初治患者的晚期肝纤维化（ALF）和聚乙二醇干扰素 α 加利巴韦林（pegIFNα/利巴韦林）治疗的 CHC 患者持续病毒学应答（SVR）之间的关系。我们对截至 2014 年 4 月在 PubMed、SCOPUS、LILACS 和 Cochrane 图书馆发表的所有符合条件的研究进行了荟萃分析，评估了与 ALF 和/或 SVR 相关的血浆/血清维生素 D 水平。通过固定或随机效应模型估计合并优势比（OR）。从文献检索中选择了 14 项研究，其中 7 项用于 ALF（1083 例患者），11 项用于 SVR（2672 例患者）。对于肝纤维化，低维生素 D 状态与 ALF 的诊断有关，截断值为 10ng/ml（OR=2.37，95%置信区间[CI]=1.20，4.72）和 30ng/ml（OR=2.22，95%CI=1.24，3.97）具有统计学意义，20ng/ml（OR=1.44，95%CI=0.99，2.12）具有接近统计学意义。关于 SVR，研究之间存在显著的异质性（P<0.001），我们仅发现维生素 D 截断值为 20ng/ml 时与 SVR 有显著相关性（OR=0.53，95%CI=0.31，0.91）。当排除异常值进行荟萃分析时，我们发现所有患者（10ng/ml[OR=0.48，95%CI=0.34，0.67]和 20ng/ml[OR=0.58，95%CI=0.45，0.76]）和 GT1/4 患者（10ng/ml[OR=0.53，95%CI=0.34，0.81]和 20ng/ml[OR=0.54，95%CI=0.39，0.74]）均存在显著的合并 OR。
CHC 患者的维生素 D 状态较低与发生 ALF 的可能性增加和接受 pegIFNα/利巴韦林治疗后 SVR 的可能性降低相关。
