Clinical Study Of Levels On Serum25-hydroxyvitamin D In Patients With Chronic Liver Disease

Background and Objective: Chronic liver disease (CLD) is defined as theprocess of long-term progressive destruction and regeneration of the liver, andwith advancing disease, cirrhosis frequently occur. Progression of CLD anddeterioration of liver function are associated with various hepaticcomplications such as chronic liver failure, and hepatocellular carcinoma(HCC). And there is a large population of chronic liver disease in our country.Vitamin D is a group of fat-soluble steroid derivatives, While its keyregulatory role in calcium and bone homeostasis is well established, recentlythere is increasing recognition that vitamin D also regulates cell proliferationand differentiation, and has immunomodulatory, anti-inflammatory andantifibrotic properties. Vitamin D also plays an important role in many dieases,such as cardiovascular, endocrine and immune system dieases. Recently,foreign studies have shown that vitamin D may play a role in the developmentof chronic liver disease, but domestic related research is less. The study is toinvestigate the characteristic of serum25-hydroxyvitamin D[25(OH)D] levelsin patients with chronic liver disease.Methods: A total of227resident patients were admitted to the First Hospitalof Jilin University from June2012to December2013.300healthy peoplewere enrolled as controls. The levels of serum25-hydroxyvitamin D was testby liquid chromatography tandem mass spectrometry (LC-MS/MS). Chronic liver disease patients divided into non cholestasis liver disease group(non-cirrhotic and cirrhotic patients), primary biliary cirrhosis (PBC) andHCC group. Aslo, patients with chronic hepatitis B(CHB) were divided intonon-cirrhotic patients, cirrhosis group and HCC group. Child–Pughclassification (CP) was determined in cirrhotic patients. Comparing thecharacteristic of serum25(OH)D levels in patients between differencesgroups.Results: Of the227patients,25(OH)D was lower than normal (<30ng/ml) in183patients, and the percentage was81.1%, higher than the control group of204cases,68.0%(P<0.05). Among183cases, the cases of vitamin Dinsufficiency (20-30ng/ml), deficiency (10-20ng/ml) and severe deficiency(<10ng/ml) were53cases,85cases,46cases, and the percentage were23.4%,37.4%,20.3%respectively. The percentage of vitamin D deficiency and severe deficiencywere higher in cirrhotic(49cases,24cases) versus non-cirrhotic(11cases,9cases) and primary biliary cirrhosis patients(4cases,4cases),(41.11%,23.1%vs.25.6%,14.0%and20.0%,20.0%, P<0.05). The serum25(OH)D levels inthe chronic liver disease patients was lower compared to thecontrols(20.10±11.86vs.27.61±12.52ng/ml, P<0.01). There was nosignificant difference of serum25(OH)D levels between non cholestasis liverdisease group and PBC group(19.95±11.77vs.23.55±13.79ng/ml，P>0.05).The serum25(OH)D levels in the patients with cirrhosis was lower comparedto the patients without cirrhosis (18.59±11.66vs.23.24±11.49ng/ml, P<0.01).Cirrhotic patients with CP stage C had markedly lower mean25(OH)D serum levels compared to patients with CP stage B and CP stage A(13.58±8.89vs.20.59±12.45å'Œ21.25±12.14ng/ml，P<0.05). But no significant difference wasfound between HCC and chronic liver disease without HCC(P>0.05). Of the123patients with CHB,25(OH)D was lower than normal (<30ng/ml) in98patients, and the percentage was79.7%. The serum25(OH)D levels in theCHB patients was lower compared to the controls(20.89±12.16vs.27.61±12.52ng/ml，P<0.01).25(OH)D levels in the cirrhotic patientswaslower compared to the non-cirrhotic patients (19.13±12.39vs.25.34±11.47ng/ml, P<0.01). Among patients with CHB, Cirrhotic patientswith CP stage C had lower mean25(OH)D serum levels compared to patientswith CP stage B and CP stage A.There was no significant difference betweenHCC and CHB without HCC either.Conclusion: vitamin D deficiency is common in patients with chronic liverdisease, and vitamin D levels in cirrhotic patients was obviously lower thannon-cirrhotic patients, especially in Child-Pugh class C patients. Thecharacteristic of serum25(OH)D levels in patients with chronic liver diseaseshould be paid more attention.