Afifi Mohamed Abd Ellatif, Hussein Ahmed Mohamed, Rizk Mahmoud
Internal Medicine Department, Hepatology and Gastroenterology Unit, Benha University, Egypt.
Int J Hepatol. 2021 Feb 12;2021:6669527. doi: 10.1155/2021/6669527. eCollection 2021.
Patients with liver cirrhosis experience a large variety of metabolic disorders associated with more hepatic decompensation. Hepatic encephalopathy (HE) is a significant complication in liver cirrhosis patients, presenting a wide spectrum of neuropsychological symptoms. A deficiency of 25-hydroxy vitamin D (25-OHD) in the general population is associated with a loss of cognitive function, dementia, and Alzheimer's disease. . Our study aims to check the relationship between low serum 25-OHD and HE in patients with HCV-related liver cirrhosis and assess its link with patient mortality. . This study was observationally carried out on 100 patients with HCV-related liver cirrhosis. The patients were divided into 2 groups: Group A-included 50 HCV-related cirrhotic patients with HE, and Group B-included 50 HCV-related cirrhotic patients without HE. Assessment of disease severity using the end-stage liver disease (MELD) model and Child Turcotte Pugh (CTP) scores were done, and 25-OHD levels were measured. Comparison of vitamin D levels in different etiologies and different CTP categories was made using one-way ANOVA. Pearson's correlation between the level of vitamin D and other biomarkers was applied.
There was a statistically significant Vitamin D level difference between the two groups. A lower level of vitamin D was observed in the HE group where the severe deficiency was 16%, while it was 6% in the other group and the moderate deficiency was 24% in HE group as compared to 10% in the other group. The insufficient vitamin D level represented 46% of the non-HE group while none of the HE group falls in this category. Vitamin D level was statistically higher in Grade 1 HE than in Grade 2 which is higher than in Grades 3 to 4. Vitamin D level was also significantly higher in those who improved from HE as compared to those who died.
The lower levels of 25-OHD were associated with the higher incidence of HE in cirrhotic HCV patients. The worsening vitamin D deficiency was associated with increased severity of the liver disease, so vitamin D may be considered a prognostic factor for the severity of liver cirrhosis and high mortality rate in HE patients.
肝硬化患者会出现多种与肝脏失代偿相关的代谢紊乱。肝性脑病（HE）是肝硬化患者的一种重要并发症，表现出广泛的神经心理症状。普通人群中25-羟维生素D（25-OHD）缺乏与认知功能丧失、痴呆和阿尔茨海默病有关。我们的研究旨在检查丙型肝炎病毒（HCV）相关肝硬化患者血清25-OHD水平低与HE之间的关系，并评估其与患者死亡率的关联。本研究对100例HCV相关肝硬化患者进行了观察性研究。患者分为两组：A组包括50例患有HE的HCV相关肝硬化患者，B组包括50例无HE的HCV相关肝硬化患者。使用终末期肝病（MELD）模型和Child Turcotte Pugh（CTP）评分评估疾病严重程度，并测量25-OHD水平。使用单因素方差分析比较不同病因和不同CTP分类中的维生素D水平。应用维生素D水平与其他生物标志物之间的Pearson相关性分析。
两组之间维生素D水平存在统计学显著差异。HE组中维生素D水平较低，其中严重缺乏率为16%，而另一组为6%；HE组中度缺乏率为24%，而另一组为10%。维生素D水平不足在非HE组中占46%，而HE组中无患者属于这一类别。1级HE患者的维生素D水平在统计学上高于2级，2级高于3至4级。与死亡患者相比，从HE中改善的患者维生素D水平也显著更高。
25-OHD水平较低与HCV肝硬化患者HE的较高发病率相关。维生素D缺乏的恶化与肝病严重程度增加相关，因此维生素D可被视为肝硬化严重程度和HE患者高死亡率的一个预后因素。
