Johnson Coplen D, Stevens Christopher M, Bennett Matthew R, Litch Adam B, Rodrigue Eugenie M, Quintanilla Maria D, Wallace Eric, Allahyari Massoud
School of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
Department of Radiology, Louisiana State University Health Sciences Center-Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
Nutrients. 2024 Nov 23;16(23):4007. doi: 10.3390/nu16234007.
Hepatic encephalopathy (HE) is a neuropsychiatric condition frequently associated with cirrhosis and portosystemic shunting (PSS). It imposes a significant clinical and economic burden, with increasing attention toward identifying modifiable factors that could improve outcomes. Emerging evidence suggests that vitamin D deficiency (VDD), prevalent in patients with cirrhosis, may contribute to the development and severity of HE. This review explores the association between VDD and HE by analyzing the underlying pathophysiology, including oxidative stress, ammonia accumulation, and impaired hepatic function. Additionally, we summarize recent studies highlighting the correlation between low serum 25-hydroxy vitamin D (25-OHD) levels and worsening grades of HE. Despite strong observational data, interventional studies on vitamin D (VD) supplementation for HE remains limited. Current evidence suggests that VD's antioxidant properties may alleviate oxidative stress in HE, with potential benefits in mitigating disease severity. Future research should focus on longitudinal studies and randomized controlled trials to evaluate the clinical impact of VD supplementation on HE outcomes and explore VD's role in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures. Understanding the therapeutic potential of VD could lead to improved management strategies for HE and cirrhotic patients at large.
肝性脑病（HE）是一种常与肝硬化和门体分流（PSS）相关的神经精神疾病。它带来了重大的临床和经济负担，人们越来越关注识别可改善预后的可改变因素。新出现的证据表明，肝硬化患者中普遍存在的维生素D缺乏（VDD）可能导致HE的发生和严重程度。本综述通过分析潜在的病理生理学，包括氧化应激、氨积累和肝功能受损，探讨了VDD与HE之间的关联。此外，我们总结了最近的研究，这些研究强调了低血清25-羟维生素D（25-OHD）水平与HE病情加重分级之间的相关性。尽管有强有力的观察数据，但关于补充维生素D（VD）治疗HE的干预性研究仍然有限。目前的证据表明，VD的抗氧化特性可能减轻HE中的氧化应激，对减轻疾病严重程度有潜在益处。未来的研究应侧重于纵向研究和随机对照试验，以评估补充VD对HE预后的临床影响，并探讨VD在接受经颈静脉肝内门体分流术（TIPS）的患者中的作用。了解VD的治疗潜力可能会为HE和广大肝硬化患者带来更好的管理策略。
