Clinical Analysis Of Fat-soluble Vitamin Deficiency And Malnutrition In Patients With Primary Biliary Cholangitis

Objective:Primary biliary cholangitis(PBC)is a chronic cholestatic liver disease,can accompanied by a lack of fat-soluble vitamins and malnutrition.There is a lack of research on fat-soluble vitamin levels and malnutrition in patients with primary biliary cholangitis.The purpose of this study was to assess the level of fat-soluble vitamins and malnutrition in patients with primary biliary cholangitis,and to analyze the relationship between the level of fat-soluble vitamins and age,sex distribution,clinical characteristics and therapeutic effect.Method:(1)The medical records of patients diagnosed with primary biliary cholangitis from the first hospital of Jilin University from October 1,2012 to October 1,2018 were collected.According to the inclusion and exclusion criteria,583 cases were used CONUT(controlling nutritional status)to assess the incidence and degree of malnutrition.The above patients were grouped according to malnutrition,and statistical analysis was carried out on age and gender distribution,laboratory indicators,complications,disease severity,and efficacy.The incidence of malnutrition was also assessed in 55 patients using the psoas muscle index(PMI),total psoas area(TPA),and transversal psoas thickness index(TIPI).(2)72 patients with PBC were included to test the level of fat-soluble vitamins A,D,and E.The relationship between age and gender distribution,laboratory indicators,malnutrition and other levels of fat-soluble vitamins was analyzed.All patients chose whether to supplement the corresponding oral vitamin preparation according to their own wishes,and the relevant laboratory indicators were reviewed after 6 months to evaluate the efficacy.Result:In this study,vitamin A deficiency rate was 29.17%,vitamin D deficiency rate was 73.61%,vitamin D deficiency rate was 22.22%,vitamin E deficiency rate was 2.78%.There was no significant difference in age and sex distribution of fat-soluble vitamin levels(P>0.05).The levels of total protein and albumin were lower in patients with fatsoluble vitamin deficiency,while the levels of bilirubin and bile acid were higher(P<0.05).Fat-soluble vitamin deficiency was not associated with malnutrition(P>0.05).The complete response rate of the patients who received fat-soluble vitamin supplementation was higher than that of the patients who did not(P<0.05).In this study,the incidence of malnutrition in PBC patients was 63.64%~76.67% according to the different evaluation methods.The subjects were divided into normal group,mild malnutrition group,moderate malnutrition group and severe malnutrition group according to CONUT score.The incidence of edema and gastrointestinal bleeding was higher in severe malnutrition group(P<0.05).The degree of ascites and hepatic encephalopathy increased with the severity of malnutrition(P<0.05).The proportion of cirrhosis increased with the severity of malnutrition(P<0.05).Child grade and MELD score increased with the severity of malnutrition(P<0.05).Multivariate logistic regression analysis showed that male,ascites,edema,splenomegaly and gastrointestinal bleeding were independent factors for malnutrition in PBC patients(P<0.05).There was no significant difference in the level of fat-soluble vitamins between normal group and malnutrition group(P>0.05).According to the situation of vitamin deficiency,there was no significant difference in CONUT score among groups(P>0.05).Conclusion:(1)Fat-soluble vitamin deficiency and malnutrition are common in PBC patients.(2)Supplementation of fat-soluble vitamins may improve the efficacy of PBC patients.(3)Male,ascites,edema,splenomegaly and gastrointestinal bleeding may be independent factors for malnutrition in PBC patients.(4)The level of fat-soluble vitamins in PBC patients may not be associated with malnutrition.