目的：分析丙型肝炎（简称丙肝）患者血清25羟基维生素D [25（OH）D]水平和病毒载量、肝脏纤维化程度之间的关系。方法收集271例丙肝患者和218名表面健康人（正常对照组）的血清标本，定量检测血清25（ OH） D浓度、HCV RNA病毒载量以及Fibrotest分级标准中的5项指标[包括α2巨球蛋白（α2M）、触珠蛋白（HPT）、载脂蛋白A1（apo A1）、总胆红素（TBil）和γ－谷氨酰基转移酶（GGT）]。根据Fibrotest分级标准判断丙肝患者的肝纤维化程度。比较丙肝组与正常对照组之间25（OH）D浓度的差异；比较HCV RNA阳性组与阴性组25（OH）D浓度的差异；分析HCV RNA阳性组HCV RNA载量与25（ OH） D浓度的相关性。根据25（ OH） D浓度进行四分位分组，分析25（OH）D浓度与肝脏纤维化指数（Fibrotest分级）的关系。结果丙肝组25（ OH） D浓度为（49．31±1．39） nmol／L，明显低于正常对照组[（60．42±1．34）nmol／L，P＜0．01]。丙肝组中25（OH）D缺乏（＜50 nmol／L）和严重缺乏（＜25 nmol／L）的比例为41．33％（112／271）和14．40％（39／271），明显高于正常对照组[27．98％（61／218）和3．67％（8／218）]（P＜0．01）。丙肝患者中HCV RNA阳性组与HCV RNA阴性组25（OH）D浓度分别为48．98±21．59、（49．89±25．27） nmol／L，两组比较差异无统计学意义（ P＞0．05）。线性相关分析显示HCV RNA阳性组病毒载量对数值与其25（OH）D浓度无相关性（r＝0．056，P＝0．412）。四分位25（OH）D最低浓度分位和最高浓度分位患者的Fibrotest分级F0－F1级、F1－F3级和F3－F4级的比例差异无统计学意义（P＞0．05）；无肝纤维化、轻度肝纤维化、重度肝纤维化患者25（OH）D浓度分别为49．12±5．80、48．27±4．90和（49．89±8．20） nmol／L，3组之间差异无统计学意义（P＞0．05）。结论丙肝患者体内25（OH）D浓度明显低于健康对照人群，建议对该类人群进行维生素D的补充。丙肝患者25（OH）D浓度与HCV RNA载量及肝纤维化的严重程度并不明显相关。%Objective To investigate the correlations of serum 25-hydroxyvitamin D [25(OH)D] concentrations with hepatitis C virus ( HCV ) RNA loads and cirrhosis severity in hepatitis C patients . Methods A total of 271 hepatitis C patients and 218 healthy subjects were enrolled , and their serum samples were collected .Serum 25( OH) D concentrations and HCV RNA loads were determined .Moreover, serum alpha 2-macroglobulin (α2M), haptoglobin (HPT), apolipoprotein A1 (apo A1), total bilirubin (TBil) and gamma-glutamyl transpeptidase (GGT) concentrations were determined .According to Fibrotest classification , the severity of cirrhosis was evaluated . The 25 ( OH ) D concentrations between hepatitis C and healthy control groups were compared .Furthermore, the difference of serum 25( OH) D between HCV RNA positive group and HCV RNA negative group was also evaluated .The correlation between serum 25( OH) D concentrations and HCV RNA loads in HCV RNA positive group was analyzed .Hepatitis C patients were classified according to the quartile concentrations of 25(OH)D, and the correlation between serum 25(OH)D concentrations and Fibrotest classification was investigated .Results Serum 25(OH)D concentrations were significantly higher in healthy control group than in hepatitis C group [ means were ( 60.42 ±1.34 ) nmol/L and ( 49.31 ± 1.39) nmol/L, P<0.01].The proportions of patients with the deficiency of 25(OH)D (<50 nmol/L) and the ones with severe deficiency (<25 nmol/L) in hepatitis C group were 41.33%(112/271) and 14.40%(39/271), which were significantly higher than those in healthy control group [27.98%(61/218) and 3.67% (8/218)] (P<0.01). No significant difference for serum 25(OH)D concentrations was observed between HCV RNA positive and HCV RNA negative groups [means were 48.98 ±21.59 and (49.89 ±25.27) nmol/L, P>0.05].Linearity regression revealed that there was no correlation between the logarithmic of HCV RNA loads and the concentration of 25 ( OH) D in HCV RNA positive group (r =0.056, P =0.412).Moreover, there was no statistical significance for the proportion of patients with different Fibrotest classifications (F0-F1, F1-F3 and F3-F4) between the highest quartile concentration and the lowest quartile concentration of 25(OH)D [means were 49.12 ±5.80, 48.27 ±4.90 and (49.89 ±8.20) nmol/L, P>0.05].Conclusions The hepatitis C patients are prone to encounter 25(OH)D deficiency compared with healthy subjects, which implys that these patients are suggested to uptake vitamin D supply .Furthermore, no clinical correlation is found between the logarithmic of HCV RNA loads , cirrhosis severity and the concentrations of 25(OH)D.
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