胆汁淤积性肝病患儿的维生素D水平及临床特点

郭紫云; 杜丽娜; 谢晓暄; 杨燕

doi:10.12449/JCH250115

胆汁淤积性肝病患儿的维生素D水平及临床特点

DOI: 10.12449/JCH250115

国家儿童医学中心，首都医科大学附属北京儿童医院中医科，北京 100045

基金项目:

国家自然科学基金 (82205184);

北京市属医院科研培育计划 (PZ2022027)

伦理学声明：本研究方案于2022年10月27日经由首都医科大学附属北京儿童医院医学伦理委员会审批，批号：［2022］-E-181-Y，患儿家属均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：郭紫云负责数据分析，文章撰写；谢晓暄负责数据收集、整理和分析；杜丽娜和杨燕负责文章的构思、设计及修改。

详细信息

通信作者:
杨燕， yy2303@sina.com （ORCID： 0000-0003-1070-9614）

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出版历程
- 收稿日期: 2024-04-15
- 录用日期: 2024-05-29
- 出版日期: 2025-01-25

Level of vitamin D in children with cholestatic liver disease and its clinical features

Department of Traditional Chinese Medicine，Beijing Children’s Hospital，Capital Medical University，National Center for Children’s Health，Beijing 100045，China

Research funding:

National Natural Science Foundation of China (82205184);

Beijing Municipal Administration of Hospital Incubating Program (PZ2022027)

More Information

Corresponding author: YANG Yan， yy2303@sina.com （ORCID： 0000-0003-1070-9614）

摘要

摘要: 目的分析胆汁淤积性肝病患儿的维生素D水平，为该病患儿补充维生素D治疗提供理论依据。方法选取2022年1月—2024年1月于首都医科大学附属北京儿童医院中医科初次就诊的胆汁淤积性肝病患儿116例，按照性别、年龄、补充维生素D剂量、病程、病因分别进行分组比较，并收集患儿的血清25-羟基维生素D（25-OH-D）水平及相关生化指标，分析维生素D水平与生化指标的相关性。计数资料组间比较采用χ²检验或Fisher精确概率法。相关分析采用Spearman秩相关。结果 116例患儿中76例（65.5%）存在维生素D缺乏或不足。维生素D缺乏或不足在男性中占65.7%（46/70），在女性中占65.2%（30/46），差异无统计学意义（χ²=0.003，P=0.956）。维生素D缺乏或不足在从未补充过维生素D患儿中占83.3%（25/30），在每日补充500 IU者中占58.7%（27/46），在每日补充700 IU者中占64.3%（18/28），在每日补充>700 IU者中占50.0%（6/12），差异无统计学意义（χ²=6.460，P=0.091）。不同病因比较结果显示，维生素D缺乏或不足在感染性疾病组占57.7%（15/26），在遗传代谢性疾病组占66.7%（10/15），在药物性肝损伤组占66.7%（6/9），在胆道系统结构异常组占100.0%（8/8），在病因未明组占63.8%（37/58），差异无统计学意义（χ²=5.304，P=0.252）。不同病程比较结果显示，维生素D缺乏或不足在<1个月组占78.4%（29/37），在1～3个月组占54.3%（25/46），在>3～6个月组占53.3%（8/15），在>6个月组占77.8%（14/18），差异无统计学意义（χ²=7.432，P=0.059）。不同年龄段比较结果显示，儿童组维生素D缺乏或不足占比明显高于婴儿组（82.5% vs 52.5%，χ²=9.504，P=0.018）。相关性分析结果显示，血清AST、ALT与25-OH-D无显著相关性（P值均>0.05）；血清ALP（r=-0.286，P=0.002）、GGT（r=-0.248，P=0.007）、TBil（r=-0.353，P<0.001）、DBil（r=-0.299，P=0.001）、总胆汁酸（r=-0.236，P=0.011）与25-OH-D均呈负相关；血清钙（r=0.263，P=0.004）、磷（r=0.385，P<0.001）与25-OH-D均呈正相关。结论大部分胆汁淤积性肝病患儿存在维生素D缺乏或不足；血清ALP、GGT、TBil、DBil或总胆汁酸水平升高，钙或磷水平降低，对维生素D缺乏或不足具有提示作用。
- 胆汁淤积 /
- 维生素D /
- 儿童
Abstract: Objective To investigate vitamin D level in children with cholestatic liver disease， and to provide a theoretical basis for vitamin D supplementation therapy in children with this disease. Methods A total of 116 children with cholestatic liver disease who attended Department of Traditional Chinese Medicine， Beijing Children’s Hospital， Capital Medical University， for the first time from January 2022 to January 2024 were enrolled and divided into groups for comparison based on sex， age， vitamin D supplementation dose， course of the disease， and etiology. The data on the serum level of 25-hydroxyvitamin D （25-OH-D） and related biochemical parameters were collected to assess the correlation between vitamin D level and biochemical parameters. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups， and the Spearman rank correlation test was used for correlation analysis. Results Among the 116 children， 76 （65.5%） had vitamin D deficiency or insufficiency. The children with vitamin D deficiency or insufficiency accounted for 65.7% （46/70） among boys and 65.2% （30/46） among girls， with no significant difference between boys and girls （χ²=0.003， P=0.956）. The children with vitamin D deficiency or insufficiency accounted for 83.3% （25/30） among the children who had never received vitamin D supplementation， 58.7% （27/46） among the children with a daily supplementation dose of 500 IU， 64.3% （18/28） among the children with a daily supplementation dose of 700 IU， and 50.0% （6/12） among the children with a daily supplementation dose of>700 IU， and there was no significant difference between these groups （χ²=6.460， P=0.091）. Comparison between the groups with different etiologies showed that the children with vitamin D deficiency or insufficiency accounted for 57.7% （15/26） in the infectious disease group， 66.7% （10/15） in the inherited metabolic disease group， 66.7% （6/9） in the drug-induced liver injury group， 100.0% （8/8） in the group with abnormal structure of the biliary system， and 63.8% （37/58） in the group with unknown etiology， and there was no significant difference between these groups （χ²=5.304， P=0.252）. Comparison between the groups with different courses of the disease showed that the children with vitamin D deficiency or insufficiency accounted for 78.4% （29/37） in the<1 month group， 54.3% （25/46） in the 1‍ — ‍3 months group， 53.3% （8/15） in the 3‍ — ‍6 months group， and 77.8% （14/18） in the>6 months group， with no significant difference between these groups （χ²=7.432， P=0.059）. Comparison between different age groups showed that compared with the infant group， the children group had a significantly higher proportion of children with vitamin D deficiency or insufficiency （χ²=9.504， P=0.018）. The correlation analysis showed that serum aspartate aminotransferase and alanine aminotransferase had no significant correlation with 25-OH-D （P>0.05）； serum alkaline phosphatase （ALP）（r=-0.286， P=0.002）， gamma-glutamyl transpeptidase （GGT）（r=-0.248， P=0.007）， total bilirubin （TBil）（r=-0.353， P<0.001）， direct bilirubin （DBil）（r=-0.299， P=0.001）， and total bile acid （r=-0.236， P=0.011） were negatively correlated with 25-OH-D， while serum calcium （r=0.263， P=0.004） and phosphorus （r=0.385， P<0.001） were positively correlated with 25-OH-D. Conclusion Most children with cholestatic liver disease have vitamin D deficiency or insufficiency， and the increase in serum ALP， GGT， TBil， DBil or total bile acid and the reduction in calcium or phosphorus may suggest vitamin D deficiency or insufficiency.
- Cholestasis /
- Vitamin D /
- Child

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表 1 不同年龄组患儿维生素D缺乏或不足的比较

Table 1. Comparison of vitamin D deficiency or insufficiency in different age groups

组别	例数	维生素D缺乏或不足［例（%）］
婴儿组	61	32（52.5）
幼儿组	5	4（80.0）
儿童组	40	33（82.5）^1）
青春期组	10	7（70.0）
χ²值		10.209
P值		0.012
注：与婴儿组比较，1）P<0.05。

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表 2 不同病程患儿维生素D缺乏或不足的比较

Table 2. Comparison of vitamin D deficiency or insufficiency in different disease course groups

组别	例数	维生素D缺乏或不足［例（%）］
<1个月组	37	29（78.4）
1～3个月组	46	25（54.3）
>3～6个月组	15	8（53.3）
>6个月组	18	14（77.8）
χ²值		7.432
P值		0.059

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表 3 不同病因患儿维生素D缺乏或不足的比较

Table 3. Comparison of vitamin D deficiency or insufficiency in different etiologic groups

组别	例数	维生素D缺乏或不足［例（%）］
感染性疾病组	26	15（57.7）
遗传代谢性疾病组	15	10（66.7）
药物性肝损伤组	9	6（66.7）
胆道系统结构异常组	8	8（100.0）
病因未明组	58	37（63.8）
χ²值		5.304
P值		0.252

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