维生素D水平与代谢相关脂肪性肝病患者肝纤维化的相关性

王华娟; 石书珺; 熊雪莲

doi:10.12025/j.issn.1008-6358.2025.20250074

维生素D水平与代谢相关脂肪性肝病患者肝纤维化的相关性

The correlation between vitamin D level and liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease

摘要

摘要:
目的探讨不同形式血清维生素D水平对代谢相关脂肪性肝病（metabolic dysfunction-associated fatty liver disease，MAFLD）患者肝纤维化的影响。
方法通过分析美国国家健康与营养调查数据库2021—2023年的数据，采用logistic回归模型分别分析血清总维生素D和25羟基维生素D₃水平与MAFLD患者肝纤维化的相关性。
结果本研究共纳入2 628例患者。MAFLD肝纤维化患者的年龄、吸烟史、腰围、体质量指数、高密度脂蛋白胆固醇、总胆固醇、空腹血糖、高血压史、总维生素D和25羟基维生素D₃水平与不伴肝纤维化的MAFLD患者间存在显著性差异（P＜0.05）。Logistic回归分析显示：与低水平血清总维生素D组（11.2～61.8 nmol/L）相比，高水平总维生素D组（89.1 nmol/L＜维生素D≤290 nmol/L）的MAFLD患者肝纤维化风险下降了22%（OR＝0.78，95%CI 0.64～0.94，P＝0.015）；与低水平血清25羟基维生素D₃组（4.1～57.0 nmol/L）相比，高水平血清25羟基维生素D₃组（84.7 nmol/L＜25羟基维生素D₃≤288 nmol/L）的MAFLD患者肝纤维化风险下降了23%（OR＝0.77，95%CI 0.62～0.95，P＝0.021）。调整协变量后，高水平总维生素D仍可显著降低MAFLD患者肝纤维化风险（OR＝0.63，95%CI 0.42～0.94，P＝0.036）。
结论高水平血清总维生素D以及25羟基维生素D₃是MAFLD肝纤维化的保护因素。

Abstract:
Objective To investigate the correlation between different forms of serum vitamin D levels and liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).
Methods Data from the National Health and Nutrition Examination Survey in 2021–2023 were analyzed. Logistic regression models were used to evaluate the relationship between serum total vitamin D, 25(OH)D₃ levels, and liver fibrosis in the MAFLD patients.
Results A total of 2 628 patients were included. There were significant differences between MAFLD patients with liver fibrosis and those without fibrosis in age, smoking history, waist circumference, body mass index, high-density lipoprotein cholesterol, total cholesterol, fasting plasma glucose, hypertension history, vitamin D, and 25(OH)D₃ levels (P＜0.05). Logistic regression analysis revealed that compared to the low total serum vitamin D group (11.2-61.8 nmol/L), MAFLD patients with high total vitamin D levels (89.1 nmol/L＜vitamin D≤290 nmol/L) exhibited a 22% reduced risk of liver fibrosis (OR＝0.78, 95%CI 0.64-0.94, P＝0.015). Similarly, compared to the low 25(OH)D₃ group (4.1-57.0 nmol/L), those with high 25(OH)D₃ level 84.7 nmol/L＜25(OH)D₃≤288 nmol/L showed a 23% lower risk of liver fibrosis (OR＝0.77, 95%CI 0.62-0.95, P＝0.021). After adjusting for covariates, high total vitamin D levels remained significantly associated with reduced liver fibrosis risk (OR＝0.63, 95%CI 0.42-0.94, P＝0.036).
Conclusions Elevated serum total vitamin D and 25(OH)D₃ levels are protective factors against early liver fibrosis in MAFLD patients.

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