Vitamin D supply in children with chronic viral hepatitis B
DOI:
https://doi.org/10.15574/SP.2021.117.23Keywords:
chronic viral hepatitis B, children, vitamin D, hepatitis activity, stage of fibrosisAbstract
Purpose — to investigate the vitamin D supply in children with chronic viral hepatitis B (HBV) depending on the activity of hepatitis and the stage of liver fibrosis.
Materials and methods. Fifty children with HBV were examined. All children underwent a comprehensive examination according to the recommendation and elastography of the shear wave of the liver parenchyma to determine the stage of fibrosis. Serum 25(OH)D concentration was determined to verify the diagnosis of vitamin D deficiency. The peculiarities of vitamin D supply in children with HBV, depending on gender, age, hepatitis activity and stage of liver fibrosis, were evaluated. The study included children who did not receive calcium and vitamin D for 6 months.
Results. Children of senior scholl age predomnanted among the surveyed. HBV was more often registered in boys 66.0% (n=33), while in girls — only 34.0% (n=17) (χ2=10.24; p=0.01). Among the examined children significantly more often 66.0% (n=33) we observed HBeAg-positive chronic hepatitis, 18.0% (n=9) children were diagnosed with HBeAg-positive chronic infection, HBeAg-negative chronic infection were determined in 14.0% (n=7) of children. In the vast majority (70.0%) of patients with HBV, the concentration of vitamin D in the serum was reduced (χ2=16.0; p=0.01). The average concentration of 25(OH)D was 59.85 [13.4–181] nmol/l and was in the zone of insufficiency. The optimal concentration of 25(OH)D was found in 30.0% (n=15) of children, insufficiency in 42.0% (n=21), vitamin D deficiency was diagnosed in 14 children (28.0%). Gender, age and biochemical activity of hepatitis do not affect the level of vitamin D in the examined children with HBV (p>0.05). The analysis of vitamin D supply depending on the stage of fibrosis did not reveal differences in the median concentration of 25(OH)D between groups of children, but in all groups the number of patients with low concentrations of vitamin D prevailed.
Conclusions. HBV in children is characterized mainly by a chronic course, with a predominance of the parenteral route of infection. In most patients with HBV, the concentration of 25(OH)D in the serum is reduced. There was no statistically significant difference between the levels of vitamin D in children with HBV depending on gender, age, and biochemical activity of hepatitis. All children with cirrhosis of the liver were deficient in vitamin D.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
References
Abramovitch S, Dahan-Bachar L, Sharvit E, Weisman Y, Ben Tov A, Brazowski E, Reif S. (2011, Dec). Vitamin D inhibits proliferation and profibrotic marker expression in hepatic stellate cells and decreases thioacetamide-induced liver fibrosis in rats. Gut. 60 (12): 1728-1737. https://doi.org/10.1136/gut.2010.234666; PMid:21816960
Andersen SB, Ewertsen C, Carlsen JF, Henriksen BM, Nielsen MB. (2016, Oct). Ultrasound Elastography Is Useful for Evaluation of Liver Fibrosis in Children-A Systematic Review. J Pediatr Gastroenterol Nutr. 63 (4): 389-399. https://doi.org/10.1097/MPG.0000000000001171; PMid:26925609
Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. (2010, Aug). Vitamin D: modulator of the immune system. Curr Opin Pharmacol. 10 (4): 482-496. https://doi.org/10.1016/j.coph.2010.04.001; PMid:20427238
Berezenko VS, Tkalyk OМ, Dyba MB, Krat VV, Mykhayluk KZ. (2018). Features of vitamin D status in children with chronic hepatitis C. Perinatologiya i pediatriya. 3 (75): 76-81. doi 10.15574/PP.2018.75.76.
Berezenko VS. (2007). Kliniko-patohenetychni osoblyvosti fibrohenezu pechinky pry khronichnykh hepatytakh u ditei ta shliakhy yoho medykamentoznoi korektsii. Dysertatsiia na zdobuttia naukovoho stupenia doktora medychnykh nauk. In-t pediatrii, akusherstva i hinekolohii AMN Ukrainy. Kyiv.
Campana L, Iredale PJ. (2017). Regression of Liver Fibrosis. Semin Liver Dis. 37: 1-10. https://doi.org/10.1055/s-0036-1597816; PMid:28201843
Castera L. (2015). Noninvasive Assessment of Liver Fibrosis. Dig Dis. 33: 498-503. https://doi.org/10.1159/000374097; PMid:26159265
D'Aldebert E, Biyeyeme Bi Mve M J, Mergey M, Wendum D, Firrincieli D, Coilly A, Fouassier L, Corpechot C, Poupon R, Housset C, Chignard N. (2009, Apr). Bile salts control the antimicrobial peptide cathelicidin through nuclear receptors in the human biliary epithelium. Gastroenterology. 136 (4): 1435-1443. https://doi.org/10.1053/j.gastro.2008.12.040; PMid:19245866
Gascon-Barre M, Demers C, Mirshahi A, Neron S, Zalzal S, Nanci A. (2003, May). The normal liver harbors the vitamin D nuclear receptor in nonparenchymal and biliary epithelial cells. Hepatology. 37 (5): 1034-1042. https://doi.org/10.1053/jhep.2003.50176; PMid:12717384
Grossmann RE, Zughaier SM, Liu S, Lyles RH, Tangpricha V. (2012, Sep). Impact of vitamin D supplementation on markers of inflammation in adults with cystic fibrosis hospitalized for a pulmonary exacerbation Eur J Clin Nutr. 66 (9): 1072-1074. https://doi.org/10.1038/ejcn.2012.82; PMid:22805498 PMCid:PMC3638806
Han S, Li T, Ellis E, Strom S, Chiang JY. (2010, Jun). A novel bile acid-activated vitamin D receptor signaling in human hepatocytes. Mol Endocrinol. 24 (6): 1151-1164. https://doi.org/10.1210/me.2009-0482; PMid:20371703 PMCid:PMC2875805
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 96 (7): 1911-1930. https://doi.org/10.1210/jc.2011-0385; PMid:21646368
Lampertico P, Agarwal K, Berg T, Buti M, Janssen HL, Papatheodoridis G, Tacke F. (2017). EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Journal of Hepatology. 67 (2): 370-398. https://doi.org/10.1016/j.jhep.2017.03.021; PMid:28427875
Mora JR, Iwata M, von Andrian UH. (2008, Sep). Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 8 (9): 685-698. https://doi.org/10.1038/nri2378; PMid:19172691 PMCid:PMC2906676
MOZ Ukrainy. (2021). Standarty medychnoi dopomohy Virusnyi hepatyt B u ditei. Nakaz MOZ Ukrainy vid 15.01.2021 No. 48.
Neeman R, Abramovitch S, Sharvit E, Elad-Sfadia G, Haklai R, Kloog Y, Reif S. (2014, Oct). Vitamin D and S-farnesylthiosalicylic acid have a synergistic effect on hepatic stellate cells proliferation. Dig Dis Sci. 59 (10): 2462-1469. https://doi.org/10.1007/s10620-014-3207-2; PMid:24942325
Papatheodoridis GV, Chan HL, Hansen BE, Janssen HL, Lampertico P. (2015). Risk of hepatocellular carcinoma in chronic hepatitis B: assessment and modification with current antiviral therapy. J Hepatol. 62 (4): 956-967. https://doi.org/10.1016/j.jhep.2015.01.002; PMid:25595883
Petta S, Camma C, Scazzone C, Tripodo C, Di Marco V, Bono A, Cabibi D, Licata G, Porcasi R, Marchesini G, Craxi A. (2010, Apr). Low vitamin D serum level is related to severe fibrosis and low responsiveness to interferon-based therapy in genotype 1 chronic hepatitis C. Hepatology. 51 (4): 1158-1167. https://doi.org/10.1002/hep.23489; PMid:20162613
Ragazzo GT, Paranagua-Vezozzo D, Lima FR. (2017, Sep). Accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C/Clinics (Sao Paulo). 72 (9): 516-525. https://doi.org/10.6061/clinics/2017(09)01
Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, Kao JH. (2015). Asian-Pacific clinical practice guidelines on the management of hepatitis B: A 2015 update. Hepatology International. 10 (1): 1-98. https://doi.org/10.1007/s12072-015-9675-4; PMid:26563120 PMCid:PMC4722087
Tacke F, Zimmermann HW. (2014). Macrophage heterogeneity in liver injury and fibrosis. J Hepatol. 60: 1090-1096. https://doi.org/10.1016/j.jhep.2013.12.025; PMid:24412603
Terrault NA, Lok AS, Mcmahon BJ, Chang K, Hwang JP, Jonas MM, Wong JB. (2018). Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 67 (4): 1560-1599. https://doi.org/10.1002/hep.29800; PMid:29405329 PMCid:PMC5975958
Tsarova OV. (2017). Kliniko-diahnostychni kryterii prohresuvannia khronichnykh virusnykh hepatytiv V ta S u ditei. Avtoreferat dysertatsii na zdobuttia naukovoho stupenia kandydata medychnykh nauk. Kyiv.
WHO. (2019, Feb 19). Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. URL: https://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/.
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