Influence of vitamin D deficiency on fibrosis-4 index and disease severity in patients with nonalcoholic steatohepatitis

Quan ZHOU; Jinqiang LI; Xiaowu LI

doi:10.3969/j.issn.1001-5256.2022.06.015

Volume 38 Issue 6

Jun. 2022

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Influence of vitamin D deficiency on fibrosis-4 index and disease severity in patients with nonalcoholic steatohepatitis

DOI: 10.3969/j.issn.1001-5256.2022.06.015

Department of Infectious Diseases, The First Hospital of Changsha, Changsha 410000, China

Research funding:

Scientific Research Plan Project of the Science and Technology Bureau of Changsha (kq1907016)

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Corresponding author: LI Jinqiang, leejy2020@163.com (ORCID:0000-0001-7403-1844); LI Xiaowu, lxwdp@163.com (ORCID:0000-0001-9913-1622)
Received Date: 2021-10-10
Accepted Date: 2021-11-12
Published Date: 2022-06-20

Abstract

Abstract

Objective To investigate the influence of vitamin D deficiency on nonalcoholic steatohepatitis (NASH). Methods The patients with NASH who were hospitalized in Department of Infectious Diseases, The First Hospital of Changsha, from January 2020 to October 2021 were enrolled, and according to the serum level of 1, 25(OH)₂D₃, they were divided into group A with 1, 25(OH)₂D₃ deficiency (< 20 ng/mL), group B with 1, 25(OH)₂D₃ insufficiency (20-30 ng/mL), and group C with sufficient 1, 25(OH)₂D₃ (> 30 ng/mL). The three groups were compared in terms of the serum levels of 1, 25(OH)₂D₃, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total cholesterol (TC), triglyceride (TG), interleukin-18 (IL-18), and interleukin-37 (IL-37) and liver pathological grade, and fibrosis-4 (FIB-4) index was calculated. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. A Pearson correlation analysis was also performed. Results A total of 120 NASH patients were enrolled, with 40 patients in each group. Compared with group A, groups B and C had significant increases in the levels of 1, 25(OH)₂D₃ and IL-37 and significant reductions in FIB-4 index and the levels of ALT, AST, TBil, TC, TG, and IL-18 (all P < 0.05). Compared with group B, group C had significant increases in the levels of 1, 25(OH)₂D₃ and IL-37 and significant reductions in FIB-4 index and the levels of ALT, AST, TC, TG, and IL-18 (all P < 0.05). The correlation analysis showed that 1, 25(OH)₂D₃ was negatively correlated with ALT (r=-0.84, P < 0.001), AST (r=-0.77, P < 0.001), TBil (r=-0.32, P < 0.001), TC (r=-0.45, P < 0.001), TG (r=-0.42, P < 0.001), IL-18 (r=-0.40, P < 0.001), and FIB-4 index (r=-0.62, P < 0.001), and it was positively correlated with IL-37 (r=0.59, P < 0.001). Compared with group A, groups B and C had significant reductions in the proportion of patients with severe steatosis (χ²=51.46, P < 0.001), bridging fibrosis and early liver cirrhosis (χ²=36.59, P < 0.001), or bridging necrosis and large-scale necrosis (χ²=37.28, P < 0.001). Light microscopy showed that group A had extensive ballooning degeneration of hepatocytes, a large number of lipid droplets (mainly macrovesicular lipid droplets), disordered arrangement of the liver plate, lymphocyte infiltration, and focal bridging fibrosis; group B mainly had spotted focal necrosis, periportal fibrosis, lipid droplets with various sizes, a small amount of neutrophil infiltration, and ballooning degeneration of some hepatocytes; group C had ballooning degeneration of a small number of hepatocytes, focal perisinusoidal fibrosis, a small number of lesions with spotted focal necrosis, and a small number of lipid droplets in the cytoplasm of hepatocytes. Conclusion The degree of liver injury and fibrosis increases with the reduction in vitamin D level, and vitamin D measurement helps to evaluate the progression of NASH.
- Non-alcoholic Fatty Liver Disease,
- Vitamin D,
- FIB-4 Index,
- Interleukins

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References

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Influence of vitamin D deficiency on fibrosis-4 index and disease severity in patients with nonalcoholic steatohepatitis

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Influence of vitamin D deficiency on fibrosis-4 index and disease severity in patients with nonalcoholic steatohepatitis

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