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婴儿胆汁淤积性肝病严重程度与血清维生素D水平的关系
Correlation of severity of infantile cholestatic liver disease with serum vitamin D level
文章发布日期:2019年07月05日  来源:  作者:黄彩芝,聂波丽,唐莲,等  点击次数:445次  下载次数:75次

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【摘要】: 目的 探讨血清25羟基维生素D[25(OH)D]水平与婴儿胆汁淤积性肝病(ICH)患儿病情严重程度的关系。 方法 选取2015年7月-2017年12月收入或转入湖南省儿童医院肝病中心的121例ICH患儿作为研究对象,根据是否发生肝硬化分为肝硬化组(26例)和无肝硬化组(95例),对2组患儿的年龄、性别比、25(OH)D、肝功能指标(TBil、DBil、总蛋白、Alb、ALT、AST、GGT、ALP、总胆汁酸、PT)、肝纤维化血清学指标[Ⅲ型前胶原氨基端肽、层粘连蛋白、透明质酸(HA)、Ⅳ型胶原(CⅣ)]以及与维生素D代谢有关的指标(Ca、P)等进行比较。计量资料两组间比较采用独立样本t检验或Mann-Whitney U非参数秩和检验,计数资料组间比较采用χ2检验。应用二分类logistic回归分析与肝硬化发生有关的因素。 结果 ICH患儿中维生素D缺乏者占88.43%(107/121),肝硬化患儿中维生素D缺乏者占100%(26/26);与无肝硬化组比较,肝硬化组血清25(OH)D(Z=3.029,P=0.002)、Alb水平明显降低(t=2.294,P=0.024),DBil(Z=3.032,P=0.002)、AST(Z=2.026,P=0.043)、GGT(Z=3.439,P=0.001)、HA(Z=3.143,P=0.002)、CⅣ(Z=2.247,P=0.025)水平明显升高,其他各指标在2组间差异均无统计学意义(P值均>0.05)。logistic多因素回归分析表明,与ICH患儿发生肝硬化有关的因素包括25(OH)D[比值比(OR)=0.865,95%可信区间(95%CI):0.755~0.922,P=0.038]、GGT(OR=1.002,95%CI:1.000~1.004,P=0.039)和HA(OR=1.004,95%CI:1.000~1.008,P=0.034)。 结论 血清25(OH)D对于预测ICH患儿肝细胞受损严重程度及早期肝硬化的发生具有一定的临床价值。
【Abstract】: Objective To investigate the correlation of serum 25-hydroxy vitamin D[25(OH)D] level with the severity of infantile cholestatic hepatopathy (ICH). Methods A total of 121 infants with ICH who were admitted or referred to Liver Research Center in our hospital from July 2015 to December 2017 were enrolled, and according to the presence or absence of liver cirrhosis, these infants were divided into liver cirrhosis group with 26 infants and non-liver cirrhosis group with 95 infants. The two groups were compared in terms of age, sex ratio, 25(OH)D, liver function parameters [total bilirubin (TBil), direct bilirubin (DBil), total protein (TP), albumin (Alb), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), total bile acid (TBA), and prothrombin time (PT)], serological markers of liver fibrosis [procollagen Ⅲ peptide (PⅢNP), laminin (LN), hyaluronic acid (HA), and type Ⅳ collagen (C-Ⅳ)], and indices associated with vitamin D metabolism (Ca and P). The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A binary logistic regression analysis was used to investigate the factors associated with the development of liver cirrhosis. Results Of all 121 infants, 107 (88.43%) had vitamin D deficiency, and all 26 infants with liver cirrhosis had vitamin D deficiency. Compared with the non-liver cirrhosis group, the liver cirrhosis group had significant reductions in the serum levels of 25(OH)D and Alb (Z=3.029, t=2.294, P<0.05) and significant increases in the levels of DBil, AST, GGT, HA, and C-Ⅳ(Z=3.032, 2.026, 3.439, 3.143, and 2.247, P<0.05), while there were no significant differences in the other indices between the two groups (all P>0.05). The multivariate logistic regression analysis showed that 25(OH)D (odds ratio [OR]=0.865, 95% confidence interval [CI]: 0.755-0.922, P=0.038), GGT(OR=1.002, 95%CI: 1.000-1.004, P=0.039), and HA (OR=1.004, 95%CI: 1.000-1.008, P=0.034) were associated with liver cirrhosis in infants with ICH. Conclusion Serum 25(OH)D has a certain clinical value in predicting the severity of hepatocyte damage and the development of early liver cirrhosis in infants with ICH.
【关键字】:胆汁淤积; 维生素D; 婴儿
【Key words】:cholestasis; vitamin D; infant
【引证本文】:HUANG CZ, NIE BL, TANG L, et al. Correlation of severity of infantile cholestatic liver disease with serum vitamin D level[J]. J Clin Hepatol, 2019, 35(8): 1782-1785. (in Chinese)
黄彩芝, 聂波丽, 唐莲, 等. 婴儿胆汁淤积性肝病严重程度与血清维生素D水平的关系[J]. 临床肝胆病杂志, 2019, 35(8): 1782-1785.

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