Gerova Daniela Ivanova, Galunska Bistra Tzaneva, Ivanova Irina Ivanova, Kotzev Iskren Andreev, Tchervenkov Trifon Georgiev, Balev Svetlozar Petrov, Svinarov Dobrin Avramov
Department of Clinical Laboratory, Medical University - Varna "Prof. Dr. Paraskev Stoyanov" , Varna , Bulgaria.
Scand J Clin Lab Invest. 2014 Nov;74(8):665-72. doi: 10.3109/00365513.2014.930710. Epub 2014 Jul 9.
The present pilot study aimed to determine vitamin D status in Bulgarian patients with chronic HCV infection in respect to the severity of liver disease and response to interferon-ribavirin therapy.
The study encompassed 296 patients: 161 males (54.4%) aged 42.08 ± 14.87 years, 135 females (45.6%) aged 45.72 ± 14.34 years, 86.5% of them infected with HCV genotype 1. Total 25-hydroxyvitamin-D (25OHD) was determined by liquid chromatography/tandem-mass spectrometric detection.
The median 25OHD level of the studied cohort was 50.40 nmol/L (range: 29.6-71.05). 25OHD deficient (< 25 nmol/L) were 16% of patients, 33% showed profound insufficiency (25-50 nmol/L), another 33% were in the range 50-80 nmol/L (mild insufficiency), the rest 18% were 25OHD sufficient. Significantly lower 25OHD levels were registered in cases with advanced fibrosis compared to those with mild or absent fibrosis (37.10 nmol/L vs. 53.00 nmol/L, respectively, p < 0.05). This association remained unchanged by seasonal variations in 25OHD levels. Inverse relationship was found between 25OHD and HCV-RNA (p < 0.01). Patients with sustained virological response to therapy had significantly higher 25OHD levels, compared to patients who failed to achieve viral eradication (56.90 nmol/L vs. 45.00 nmol/L, p = 0.012).
More than 80% of HCV-infected patients were vitamin D-deficient and -insufficient. The inverse relationship between 25OHD levels and viral load, liver fibrosis and treatment outcomes supports the hypothesis that improvement of vitamin D status may have considerable potential to amend the host defense against HCV infection and response to therapy.
本初步研究旨在确定保加利亚慢性丙型肝炎病毒（HCV）感染患者的维生素D状态，以及其与肝脏疾病严重程度和干扰素 - 利巴韦林治疗反应的关系。
该研究纳入了296例患者：161例男性（54.4%），年龄42.08±14.87岁；135例女性（45.6%），年龄45.72±14.34岁，其中86.5%感染HCV 1型。采用液相色谱/串联质谱检测法测定血清总25 - 羟基维生素D（25OHD）水平。
研究队列的25OHD水平中位数为50.40 nmol/L（范围：29.6 - 71.05）。25OHD缺乏（<25 nmol/L）的患者占16%，33%表现为严重不足（25 - 50 nmol/L），另有33%处于50 - 80 nmol/L范围（轻度不足），其余18%的患者25OHD充足。与轻度或无纤维化患者相比，晚期纤维化患者的25OHD水平显著降低（分别为37.10 nmol/L和53.00 nmol/L，p<0.05）。这种关联不受25OHD水平季节性变化的影响。25OHD与HCV - RNA呈负相关（p<0.01）。与未实现病毒清除的患者相比，治疗获得持续病毒学应答的患者25OHD水平显著更高（56.90 nmol/L对4%5.00 nmol/L，p = 0.012）。
超过80%的HCV感染患者存在维生素D缺乏和不足。25OHD水平与病毒载量、肝纤维化及治疗结果之间的负相关支持了以下假设：改善维生素D状态可能具有相当大的潜力来改善宿主对HCV感染的防御及治疗反应。
