Mohamed A A, Al-Karmalawy A A, El-Kholy A A, El-Damas D A, Abostate H M, Mostafa S M, Hamada M, Khalik Elkady M A, Hassan Y, Al-Hussain E, Khalil M G, Badawy I, Elebeedy D, Alsfouk B A, Shaheenl M M
Biochemistry, Molecular Biology and Biochemistry Department, National Hepatology and Tropical Medicine Research Institute, Egypt.
Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):6908-6919. doi: 10.26355/eurrev_202111_27239.
Spontaneous Bacterial Peritonitis (SBP) is one of the most serious liver cirrhosis with ascites complications. Vitamin D (Vit D) deficiency has been associated with a high risk of infection and mortality in cirrhotic patients. Herein, the assessment of Vit D level as a prognostic marker in SBP patients and the impact of Vit D supplementation on their treatment plan was studied as well.
Ascetic patients with SBP and Vit D deficiency were divided randomly into treatment and control groups. The control group received standard treatment without Vit D and the treatment group received standard treatment plus Vit D. Clinical monitoring of Vit D was done over 6 months.
At baseline, all patients in both groups revealed an elevated serum and ascetic TLC, AST, ALT, total and direct bilirubin, in addition to elevation in INR and procalcitonin (PCT) level. Univariate regression analysis confirmed that deficiency of Vit D was an independent predictor of infection and mortality (p < 0.01; Crude Hazard Ratio: 0.951). Over 6 months, the study revealed significant improvement in serum Vit D level in the treatment group (34.6 ± 9.2 and 18.3 ± 10.0 ng/mL; p < 0.001). Moreover, a statistically significant increase in survival rate (64% vs. 42%; p < 0.05) and duration (199.5 days vs. 185.5 days; p < 0.05) were recorded as well. Univariate and multivariate regression analysis confirmed that Vit D supplementation was positively correlated to survival over 6 months (p < 0.001; Adjusted Hazard Ratio: 0.895).
Vit D deficiency is prevalent in SBP cirrhotic patients and is used as an independent predictor of infection and death. Therefore, Vit D supplementation revealed improvement in their response to treatment.
自发性细菌性腹膜炎（SBP）是肝硬化腹水最严重的并发症之一。维生素D（Vit D）缺乏与肝硬化患者的高感染风险和死亡率相关。本文还研究了评估Vit D水平作为SBP患者的预后标志物以及补充Vit D对其治疗方案的影响。
将患有SBP且Vit D缺乏的腹水患者随机分为治疗组和对照组。对照组接受不含Vit D的标准治疗，治疗组接受标准治疗加Vit D。对Vit D进行了6个月的临床监测。
基线时，两组所有患者的血清和腹水白细胞总数、谷草转氨酶（AST）、谷丙转氨酶（ALT）、总胆红素和直接胆红素均升高，此外国际标准化比值（INR）和降钙素原（PCT）水平也升高。单因素回归分析证实，Vit D缺乏是感染和死亡的独立预测因素（p < 0.01；粗风险比：0.951）。在6个月的时间里，研究显示治疗组的血清Vit D水平有显著改善（34.6 ± 9.2和18.3 ± 10.0 ng/mL；p < 0.001）。此外，生存率（64%对42%；p < 0.05）和生存时间（199.5天对185.5天；p < 0.05）也有统计学意义的增加。单因素和多因素回归分析证实，补充Vit D与6个月以上的生存率呈正相关（p < 0.001；调整后风险比：0.895）。
Vit D缺乏在SBP肝硬化患者中普遍存在，可作为感染和死亡的独立预测因素。因此，补充Vit D显示出其对治疗反应的改善。
