Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Ann Hepatol. 2018 Oct 16;17(6):920-932. doi: 10.5604/01.3001.0012.7192.
Malnutrition is prevalent in cirrhosis. Vitamin and mineral deficiencies, including vitamin D, vitamin A, and zinc, are common and have been shown to correlate with survival. Our aim was to review the mechanisms of vitamin D, vitamin A, and zinc deficiencies in cirrhosis and the clinical assessment of affected patients, their outcomes based on the current literature, and management. This is a narrative review including the relevant literature for cirrhosis and vitamin D, vitamin A, and zinc deficiencies. Vitamin D deficiency has important effects in cirrhosis, regardless of the cause of chronic liver disease.These effects include associations with fibrosis and outcomes such as infections, hepatocellular carcinoma, and mortality. Vitamin A deficiency is associated with liver disease progression to cirrhosis and clinical decompensation, including occurrence of ascites or hepatic encephalopathy. Zinc deficiency can lead to hepatic encephalopathy and impaired immune function. Such deficiencies correlate with patient survival and disease severity. Caution should be applied when replacing vitamin D, vitamin A, and zinc to avoid toxicity. Identification and appropriate treatment of vitamin and mineral deficiencies in cirrhosis may reduce specific nutritional and cirrhosis-related adverse events. Routine monitoring of vitamin A, vitamin D and zinc levels in cirrhosis should be considered.
营养不良在肝硬化中很常见。维生素和矿物质缺乏，包括维生素 D、维生素 A 和锌，很常见，并已被证明与生存率相关。我们的目的是回顾肝硬化中维生素 D、维生素 A 和锌缺乏的机制，以及受影响患者的临床评估、根据现有文献评估他们的结局，以及管理。这是一篇叙述性综述，包括肝硬化和维生素 D、维生素 A 和锌缺乏的相关文献。维生素 D 缺乏在肝硬化中具有重要影响，无论慢性肝病的原因如何。这些影响包括与纤维化的关联以及感染、肝细胞癌和死亡率等结局。维生素 A 缺乏与肝硬化进展和临床失代偿相关，包括腹水或肝性脑病的发生。锌缺乏可导致肝性脑病和免疫功能受损。这些缺乏与患者的生存和疾病严重程度相关。在替代维生素 D、维生素 A 和锌时应谨慎，以避免毒性。识别和适当治疗肝硬化中的维生素和矿物质缺乏症可能会减少特定的营养和肝硬化相关不良事件。应考虑在肝硬化中常规监测维生素 A、维生素 D 和锌的水平。
