Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
Aliment Pharmacol Ther. 2015 Jul;42(2):221-30. doi: 10.1111/apt.13244. Epub 2015 May 18.
Serum vitamin D levels are associated with bone complications in patients with primary biliary cirrhosis (PBC). Increasing evidence suggests a nonskeletal role of vitamin D in various autoimmune and liver diseases.
To investigate the clinical relevance of vitamin D levels in PBC, especially their association with the therapeutic effects of ursodeoxycholic acid (UDCA).
Consecutive PBC patients were retrospectively reviewed. 25-hydroxyvitamin D [25(OH)D] levels were determined in frozen serum samples collected before initiation of UDCA treatment. Response to UDCA was evaluated by Paris-I and Barcelona criteria. Logistic regressions were performed to identify the treatment response-associated parameters.
Among 98 patients, the mean serum 25(OH)D concentration was 17.9 ± 7.6 ng/mL. 25(OH)D levels decreased with increasing histological stage (P = 0.029) and were negatively correlated with bilirubin and alkaline phosphatase levels. After 1 year of UDCA therapy, 31 patients failed to achieve complete response according to Paris-I criteria. The baseline 25(OH)D level was significantly lower in nonresponders (14.8 ± 6.4 vs. 19.3 ± 7.6 ng/mL, P = 0.005). Vitamin D deficiency at baseline was associated with an increased risk of incomplete response independent of advanced stages (OR = 3.93, 95% CI = 1.02-15.19, P = 0.047). Similar results were obtained when biochemical response was evaluated by Barcelona criteria. Furthermore, 25(OH)D levels were lower in patients who subsequently suffered death or liver transplantation (12.1 ± 4.6 vs. 18.4 ± 7.6 ng/mL, P = 0.023).
25(OH)D level is associated with biochemical and histological features in PBC. Pre-treatment vitamin D status is independently related to subsequent response to UDCA. Our results suggest that vitamin D status may have important clinical significance in PBC.
血清维生素 D 水平与原发性胆汁性肝硬化（PBC）患者的骨骼并发症有关。越来越多的证据表明，维生素 D 在各种自身免疫性和肝脏疾病中具有非骨骼作用。
探讨维生素 D 水平在 PBC 中的临床意义，特别是其与熊去氧胆酸（UDCA）治疗效果的关系。
回顾性分析连续 PBC 患者。在开始 UDCA 治疗前，采集冷冻血清样本测定 25-羟维生素 D [25(OH)D]水平。根据巴黎-I 和巴塞罗那标准评估 UDCA 治疗反应。采用逻辑回归确定与治疗反应相关的参数。
98 例患者中，血清 25(OH)D 浓度平均为 17.9 ± 7.6ng/mL。25(OH)D 水平随组织学分期增加而降低（P = 0.029），与胆红素和碱性磷酸酶水平呈负相关。UDCA 治疗 1 年后，根据巴黎-I 标准，31 例患者未达到完全缓解。未缓解组患者的基线 25(OH)D 水平明显较低（14.8 ± 6.4 vs. 19.3 ± 7.6ng/mL，P = 0.005）。基线时维生素 D 缺乏与非完全缓解独立相关，与晚期阶段无关（OR = 3.93，95%CI = 1.02-15.19，P = 0.047）。根据巴塞罗那标准评估生化反应时，也得到了类似的结果。此外，随后发生死亡或肝移植的患者 25(OH)D 水平较低（12.1 ± 4.6 vs. 18.4 ± 7.6ng/mL，P = 0.023）。
25(OH)D 水平与 PBC 的生化和组织学特征相关。治疗前维生素 D 状态与 UDCA 治疗后的后续反应独立相关。我们的结果表明，维生素 D 状态在 PBC 中可能具有重要的临床意义。
