血清中25-羟基维生素D水平在慢性乙型肝炎诊治中的临床价值

郝昆 纪玉红

[摘要] 目的 探討血清中25-羟基维生素D含量对诊治慢性乙型肝炎患者的临床价值。 方法 选取2018年5月至2019年9月在大连市金州区第一医院进行诊断并接受治疗的100例慢性乙型肝炎患者做为研究组，100例在我院体检健康的居民为对照组。研究组分为复制组与无复制组。血清中25-羟基维生素D的含量通过荧光免疫层析法测定。比较两组血清25-羟基维生素D的含量及含量的占比率。 结果 复制组血清25-羟基维生素D[（26.21±7.65）ng/mL]明显低于无复制组[（46.43±6.64）ng/mL]，差异有统计学意义（P<0.05）。研究组血清25-羟基维生素D含量[无复制组（46.43±6.64）ng/mL，复制组（26.21±7.65）ng/mL）]明显高于对照组[（22.38±5.47）ng/mL]，差异有统计学意义（P<0.05）。研究组血清25-羟基维生素D>30 ng/mL的占比率（45.00%）明显高于对照组>30 ng/mL（26.00%），差异有统计学意义（P<0.05）。对照组血清25-羟基维生素D 0～20 ng/mL（25.00%）与21～30 ng/mL（49.00%）的占比率明显高于与复制组[0～20 ng/mL（14.28%）与21～30 ng/mL（35.71%）]，对照组血清25-羟基维生素D[0～20 ng/mL（25.00%）、21～30 ng/mL（49.00%）、31～100 ng/mL（24.00%）、>100 ng/mL（2.00%）]各含量占比率明显高于无复制组[0～20 ng/mL（26.67%）、21～30 ng/mL（40.00%）、31～100 ng/mL（23.33%）、>100 ng/mL（10.00%）]，差异均有统计学意义（P<0.05）。 结论 血清中25-羟基维生素D含量与慢性乙型肝炎有紧密的联系，对于临床慢性乙型肝炎的诊治有一定的参考，此法可在临床中推广应用。

[关键词] 慢性乙型肝炎;25-羟基维生素D;病毒复制;荧光免疫层析法

[中图分类号] R512.6          [文献标识码] B          [文章编号] 1673-9701（2021）07-0136-03

Clinical value of serum 25-hydroxyvitamin D level in diagnosis and treatment of chronic hepatitis B

HAO Kun1   JI Yuhong2

1.Department of Physical Examination， the First People′s Hospital of Jinzhou District in Dalian， Dalian  116100， China; 2.Department of Clinical Laboratory， the Second Hospital of Chaoyang City in Liaoning Province， Chaoyang  122000， China

[Abstract] Objective To explore the clinical value of serum 25-hydroxyvitamin D（25（OH）D） level in diagnosis and treatment of patients with chronic hepatitis B（CHB）. Methods A total of 100 patients with CHB diagnosed and treated in our hospital from May 2018 to September 2019 and 100 healthy residents underwent physical examination in First Hospital of Jinzhou District in Dalian hospital were selected as the objects. Healthy residents underwent physical examination in our hospital were taken as the control group（n=100）， while CHB patients were taken as the study group（n=100）. Meanwhile， the study group could also be divided into the replication group and the non-replication group. The content of 25（OH）D in serum was determined by fluorescence immunochromatography. The content of serum 25（OH）D and its proportion in the control group and the study group were analyzed. Results The serum 25（OH）D in the replication group was （26.21±7.65）ng/mL， which was significantly lower than （46.43±6.64）ng/mL in the non-replication group， and the difference was statistically significant（P<0.05）. The level of serum 25（OH）D in the study group was （46.43±6.64） ng/mL （the non-replication group） and （26.21±7.65）ng/mL （the replication group）， which were significantly higher than（22.38±5.47） ng/mL in the control group， and the differences were statistically significant （P<0.05）. The proportion of serum 25（OH）D （>30 ng/mL） in the study group was 45.00%， which was significantly higher than 26.00% in the control group， and the difference was statistically significant （P<0.05）. The proportions of serum 25（OH）D （0-20 ng/mL∶25.00%， 21-30 ng/mL∶49.00%） of the control group were significantly higher than the replication group （0-20 ng/mL∶14.28%， 20-30 ng/mL∶35.71%）. The proportions of 25（OH）D were significantly higher than those in the non-replication group（0-20 ng/mL∶25.00% vs. 26.67%， 21-30 ng/mL∶49.00% vs. 40.00%， 31-100 ng/mL∶24.00% vs. 23.33%， >100 ng/mL∶2.00% vs. 10.00%） and the differences were statistically significant （P<0.05）. Conclusion The content of 25（OH）D in serum is closely related to CHB， which has certain reference for its clinical diagnosis and treatment，and it can be promoted and applied in clinic.

[Key words] Chronic hepatitis B; 25-hydroxyvitamin D; Virus replication; Fluorescence immunochromatography

25-羟基维生素D[25（OH）D]是肝脏羟基化维生素D形成的，因其含量在血清中的维持稳定的时间较长，故临床中维生素D含量测定的重要标准为25（OH）D[1]。维生素D具有抗炎作用、免疫调节作用、钙磷调节作用、抗纤维化作用等，其生物学功能需要与维生素D抗体（Vitamin D antibody，VDR）结合发挥作用。慢性乙型肝炎是因乙型肝炎病毒感染所致，且患病时间至少6个月，可导致肝功能异常、胆道疾病、脾脏肿大等，大多数其他慢性肝病，包括肝硬化和肝细胞癌（HCC），也由慢性HBV感染进展而来，急剧发病的急性乙型肝炎很少慢性化;生存下来的暴发性乙型肝炎几乎均可完全恢复。少数慢性乙型肝炎由急性乙型肝炎迁延转化;绝大多数由慢性无症状HbsAg携带者（AsC）发展而来，就这一点而言，可以认为慢性无症状携带是慢性乙型肝炎的“潜伏期”;但也有发病即是慢性乙型肝炎表现的所谓原发性慢性乙型肝炎。因此……