补充维生素D治疗对非酒精性脂肪性肝病及铁负荷水平的影响  

Effect of vitamin D supplementation therapy on non-alcoholic fatty liver disease and iron overload levels

作　　者：刘志平[1] 张文沙 尹会芬 赵致维 许盼 李文豪 张金华[1] LIU Zhi-ping;ZHANG Wen-sha;YIN Hui-fen;ZHAO Zhi-wei;XU Pan;LI Wen-hao;ZHANG Jin-hua(Department of Gastroenterology,Wuhan Hankou Hospital,430012 Wuhan,China)

机构地区：[1]武汉市汉口医院消化内科,湖北武汉430012

出　　处：《临床消化病杂志》2024年第3期153-157,共5页Chinese Journal of Clinical Gastroenterology

基　　金：武汉市卫健委医学科研重点项目(WX20A08)。

摘　　要：[目的]观察补充维生素D治疗对非酒精性脂肪性肝病(NAFLD)患者的临床生化指标、肝脏脂肪变性、胰岛素抵抗及铁负荷水平的影响。[方法]122例NAFLD患者随机分为维生素D组(n=62)和对照组(n=60)。所有受试者均给予饮食和运动指导及健康教育,维生素D组在此基础上给予维生素D滴剂每天800 U口服治疗,2组患者均治疗12周。观察2组患者治疗前后体质量指数(BMI)、腰围(WC)、肝功能、血糖、血脂、脂肪肝指数(FLI)、三酰甘油葡萄糖(TyG)指数及血清铁代谢指标的变化。[结果]治疗前2组各临床指标比较差异无统计学意义(P>0.05)。治疗后维生素D组BMI、WC、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、FLI、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、TyG指数、血清铁(SI)、血清铁蛋白(SF)均较治疗前降低,而25羟维生素D[25(OH)D]水平升高(P<0.05);与对照组比较,维生素D组治疗后FPG、TC、TG、TyG指数、SI、SF水平的降低及25(OH)D水平的升高更加显著(P<0.05)。将维生素D组患者进一步分为BMI异常(>24.0)组和BMI正常(≤24.0)组,分别计算2组各实验室指标治疗后与治疗前的差值,2组ALT、AST、FLI、FPG、TC、TG、LDL-C和TyG指数的差值比较差异有统计学意义(P<0.05),但2组SI、SF及TRF的差值比较差异无统计学意义(P>0.05)。[结论]补充维生素D治疗可改善NAFLD患者病情,降低血糖、血脂、胰岛素抵抗和铁负荷水平;与超重或肥胖的患者相比,BMI正常的患者补充维生素D治疗获益更多。[Objective]To observe the effects of vitamin D supplementation therapy on clinical biochemical parameters, hepatic steatosis, insulin resistance and iron overload in patients with non-alcoholic fatty liver disease(NAFLD).[Methods]The totals of 122 patients with NAFLD were randomly divided into vitamin D group(n=62)and control group(n=60).All subjects were given dietary and exercise guidance and health education, vitamin D group was additionally administered with vitamin D drops 800 units per day for treatment.Both groups were treated for 12 weeks.The changes in body mass index(BMI),waist circumference(WC),liver function, blood glucose, blood lipids, fatty liver index(FLI),triglyceride glucose(TyG)index and serum iron metabolism parameters before and after treatment were observed in the 2 groups.[Results]There was no statistically significant difference in the comparison of clinical indicators between the 2 groups before treatment(P>0.05).Compared with before treatment, BMI,WC,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),FLI,fasting glucose(FPG),total cholesterol(TC),triglycerides(TG),TyG index, serum iron(SI),and serum ferritin(SF)were lower in the vitamin D group after treatment, and the level of 25 hydroxyvitamin D[25(OH)D]was elevated(P<0.05).The decrease in FPG,TC,TG,TyG index, SI and SF levels and the increase in 25(OH)D levels after treatment were more significant in the vitamin D group compared with the control group(P<0.05).The patients in the vitamin D group were further divided into the abnormal BMI(>24.0)groupand the normal BMI(≤ 24.0)group, and the difference values between the post-treatment and pre-treatment of the laboratory indicators in the two groups were calculated separately.The comparisons of the difference values of ALT,AST,FLI,FPG,TC,TG,LDL-C and TyG index between the two groups were statistically significant(P<0.05),but there was no statistically significant difference in the comparison of SI,SF and TRF levels between the two groups(P>0

关 键 词：非酒精性脂肪性肝病 维生素D 铁代谢 脂肪肝指数 三酰甘油葡萄糖指数 

分 类 号：R575.5[医药卫生—消化系统]