Muñoz S J, Heubi J E, Balistreri W F, Maddrey W C
Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
Hepatology. 1989 Apr;9(4):525-31. doi: 10.1002/hep.1840090403.
In contrast to deficiencies of vitamins A, D and K, little is known of the prevalence, clinical manifestations and mechanisms of vitamin E deficiency in adult patients with cholestasis. We measured serum vitamin E levels in 45 patients with primary biliary cirrhosis, 20 with primary sclerosing cholangitis, 9 with cryptogenic cirrhosis and 12 with alcoholic cirrhosis. To correct for the hyperlipidemia often found in patients with primary biliary cirrhosis and primary sclerosing cholangitis, total serum lipids were measured and vitamin E levels were expressed as the vitamin E/total serum lipid ratio. Serum vitamin A and D levels and prothrombin time were also determined. Six of 45 patients with primary biliary cirrhosis (13%) but none of the patients with sclerosing cholangitis, cryptogenic cirrhosis or alcoholic cirrhosis and subnormal vitamin E/total serum lipids ratios. Vitamin E deficiency was found in two of eight patients with asymptomatic primary biliary cirrhosis. There was no correlation between standard liver biochemical tests, fasting serum cholylglycine and vitamin E levels. Patients with primary biliary cirrhosis and primary sclerosing cholangitis had significantly lower vitamin E/total serum lipids ratios than patients with either cryptogenic or alcoholic cirrhosis. Twenty-three percent of patients with primary biliary cirrhosis were vitamin D deficient and 14% had low vitamin A levels. Two of the six patients with vitamin E deficiency were also deficient in vitamin D, only one was vitamin A deficient and none had prolonged prothrombin time. We also investigated the gastrointestinal absorption of vitamin E in nine patients with primary biliary cirrhosis and normal vitamin E levels as well as in six normal controls.(ABSTRACT TRUNCATED AT 250 WORDS)
与维生素A、D和K缺乏不同，对于成年胆汁淤积患者维生素E缺乏的患病率、临床表现及机制了解甚少。我们测定了45例原发性胆汁性肝硬化患者、20例原发性硬化性胆管炎患者、9例隐源性肝硬化患者和12例酒精性肝硬化患者的血清维生素E水平。为校正原发性胆汁性肝硬化和原发性硬化性胆管炎患者中常见的高脂血症，测定了总血清脂质，并将维生素E水平表示为维生素E/总血清脂质比值。还测定了血清维生素A和D水平以及凝血酶原时间。45例原发性胆汁性肝硬化患者中有6例（13%）维生素E/总血清脂质比值低于正常，而硬化性胆管炎、隐源性肝硬化或酒精性肝硬化患者中无一例出现这种情况。在8例无症状原发性胆汁性肝硬化患者中有2例发现维生素E缺乏。标准肝脏生化检查、空腹血清胆酰甘氨酸与维生素E水平之间无相关性。原发性胆汁性肝硬化和原发性硬化性胆管炎患者的维生素E/总血清脂质比值显著低于隐源性或酒精性肝硬化患者。23%的原发性胆汁性肝硬化患者维生素D缺乏，14%的患者维生素A水平低。6例维生素E缺乏患者中有2例也缺乏维生素D，仅1例维生素A缺乏，无一例凝血酶原时间延长。我们还研究了9例维生素E水平正常的原发性胆汁性肝硬化患者以及6例正常对照者对维生素E的胃肠道吸收情况。（摘要截短至250字）
