目的 探讨乙肝肝硬化患者维生素 D水平与小肠细菌过度生长关系及与 TLR4 表达的关系.方法 检测乙肝肝硬化患者及健康体检者维生素 D水平、小肠细菌生长情况及外周血单个核细胞表面 TLR4 表达,比较不同组维生素 D 水平及其与 SIBO 关系和 TLR4 表达相关性.结果 乙肝肝硬化患者维生素 D 不足或缺乏率为 93.3%(56/60),与健康体检者 76.2%(16/21)比较,差异有统计学意义(χ2=4.63,P<0.05),且不同肝功能分级的肝硬化患者维生素 D 不足或缺乏率不同,Child-Pugh A 级与 Child-Pugh B/C级比,差异有统计学意义(χ2=4.6,P<0.05).肝硬化患者维生素 D 水平较健康体检者明显降低(t=3.3,P<0.01),且肝硬化SIBO阳性患者维生素 D水平显著低于 SIBO阴性组(t=2.45,P<0.05),而肝硬化 SIBO阴性患者维生素 D水平与健康体检者相比,差异无统计学意义(t=1.96,P>0.05).肝硬化 SIBO阳性患者维生素 D水平与外周血单个核细胞 TLR4 表达呈负相关(r=-0.57,P<0.01),而健康对照组、肝硬化 SIBO阴性组维生素 D水平与外周血单个核细胞 TLR4 表达无相关性(P>0.05).结论 乙肝肝硬化患者广泛存在维生素 D不足或缺乏,维生素 D水平与 SIBO密切相关,且维生素 D水平降低与 TLR4 表达上调相关,维生素 D 通过与 TLR4 的作用在肝硬化病情进展中发挥作用.
The relationship between vitamin D levels and small intestinal bacterial overgrowth and correlation with TLR4 expression in patients with hepatitis B cirrhosis
Objective To investigate the relationship between vitamin D levels and small intestinal bacterial over-growth and correlation with TLR4 expression in patients with hepatitis B cirrhosis.Methods Vitamin D levels,small intestinal bacterial growth and TLR4 expression on the surface of peripheral blood mononuclear cells were detected in pa-tients with hepatitis B cirrhosis and healthy medical check-ups,and vitamin D levels and their relationship with SIBO and correlation with TLR4 expression were compared between different groups.Results The rate of vitamin D insuffi-ciency or deficiency in patients with hepatitis B cirrhosis was 93.3% (56/60),which was statistically significant when compared with 76.2% (16/21)of healthy individuals(χ2=4.63,P<0.05),and the rate of vitamin D insufficiency or deficiency was different in cirrhosis patients with different liver function classifications,with a statistically significant difference in the comparison of Child-Pugh A with Child-Pugh B/C(χ2=4.6,P<0.05).Vitamin D levels were signifi-cantly lower in cirrhosis patients compared to healthy individuals(t=3.3,P<0.01)and significantly lower in cirrhosis SIBO-positive patients than in the SIBO-negative group(t=2.45,P<0.05),whereas there was no statistically signifi-cant difference in vitamin D levels in cirrhosis SIBO-negative patients compared to healthy individuals(t=1.96,P>0.05).Vitamin D levels were negatively correlated with TLR4 expression in peripheral blood mononuclear cells in cir-rhosis SIBO-positive patients(r=-0.57,P<0.01),whereas there was no correlation between vitamin D levels and TLR4 expression in peripheral blood mononuclear cells in the healthy control group and cirrhosis SIBO-negative group(P>0.05).Conclusion Vitamin D insufficiency or deficiency is widespread in patients with hepatitis B cirrhosis.Vitamin D levels are strongly correlated with SIBO,and reduced vitamin D levels are associated with up-regulation of TLR4 expression.Vitamin D plays a role in the progression of cirrhosis through its interaction with TLR4.
Hepatitis B cirrhosisVitamin DSmall intestinal bacterial overgrowthToll-like receptor 4
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