vicky3 2009-11-25 11:27
維他命D對於慢性HCV感染有好處
作者：Megan Brooks
出處：WebMD醫學新聞
【24drs.com】November 5, 2009 (波士頓) — 根據美國肝病研究協會(American Association for the Study of Liver Diseases，AASLD)第60屆年會、2009肝臟會議中，一篇最新報告的結果摘要，以長效型干擾素-alfa2b和ribavirin治療時，每天補充維他命D可增加病毒性反應率。
第一研究者、以色列Hillel Yaffe醫學中心肝臟科的Saif M. Abu-Mouch醫師等人在摘要中指出，維他命D是強力的免疫調節劑，對於以干擾素為基礎之慢性C型肝炎治療的病毒性反應影響則未知。
Abu-Mouch醫師向與會聽眾表示，這個初步結果確認了將維他命D加入慢性HCV病患之傳統抗病毒治療的好處。
該研究中，確認慢性HCV(基因型1)的58名病患被隨機指派接受長效干擾素-alfa2b (1.5μg/kg、每週一次)加ribavirin (1000-2000 mg/天)。其中31名病患還接受維他命D(1000-4000 IU/天；血清值>32 ng/mL)。
維他命D組的身體質量指數(27 vs 24 kg/m2；P< .01)、病毒載量(68% vs 58%；P< .01)、纖維化(Metavir評分> F2，55% vs 18%；P< .001)，都比未接受維他命D組高。兩研究組的人口統計學資料、疾病特徵、種族、開始時的生化參數、對治療的遵從性都相似。
四週時的快速病毒反應，維他命D組為44%，控制組為18%。12週時，Abu-Mouch醫師向Medscape Gastroenterology表示，根據逆轉錄聚合酶連鎖反應分析，維他命D組有96%(27名病患中有26人)為HCV RNA陰性，控制組為48%(31名病患中有15人)，達到顯著差異(P<.001)。
研究者在會議摘要中解釋，併用長效型干擾素與ribavirin是慢性HCV的標準照護，基因型1、未曾治療過的病患有40%至50%可達持續的病毒性反應。Abu-Mouch醫師表示，維他命D併用長效型干擾素與ribavirin，可能會有協同效應。
未參與該研究的與會聽眾、法國de Melun大學醫學中心的Laurent Tsakiris醫師向Medscape Gastroenterology表示，該研究令人驚訝且帶來希望，因為維他命D容易使用而且無毒性。
他表示，這也是個有趣的研究，研究中，維他命D組的疾病嚴重度比控制組嚴重。我認為，這可以加強此一小型研究的結果。
該研究並未接受商業補助。Abu-Mouch醫師與Tsakiris醫師皆宣告沒有相關財務關係。
美國肝病研究協會(AASLD)第60屆年會、2009肝臟會議：摘要LB20。發表於2009年11月2日。
Vitamin D Has Benefits in Chronic HCV Infection
By Megan Brooks
Medscape Medical News
November 5, 2009 (Boston, Massachusetts) — Supplementing pegylated interferon-alfa2b and ribavirin with a daily dose of vitamin?D might increase virologic response rates, according to results of a late-breaking abstract reported here at The Liver Meeting 2009, the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).
"Vitamin?D is a potent immunomodulator whose impact on virologic response rates of interferon-based treatment of chronic HCV [hepatitis?C] is unknown," lead investigator Saif M. Abu-Mouch, MD, from the Department of Hepatology, Hillel Yaffe Medical Center, in Hadera, Israel, and colleagues note in their abstract.
"This preliminary study confirms the benefit of adding vitamin?D to conventional antiviral therapy in patients with chronic HCV," Dr. Abu-Mouch told meeting attendees.
In the study, 58 patients with confirmed chronic HCV (genotype?1) were randomly assigned to peginterferon-alfa2b (1.5?μg/kg once weekly) plus ribavirin (1000 to 2000?mg/day). Thirty-one patients also received vitamin?D (1000 to 4000?IU/day; serum level >32?ng/mL).
The vitamin?D group had a higher mean body mass index (27 vs 24?kg/m2; P?< .01), viral load (68% vs 58%; P?< .01), and fibrosis (Metavir scores > F2, 55% vs 18%; P?< .001) than the group that did not receive vitamin?D. Demographics, disease characteristics, ethnicity, baseline biochemical parameters, and adherence to treatment were similar in the 2 study groups.
A rapid virologic response was seen at week 4 in 44% of the vitamin?D group and in 18% of the control group. At week 12, Dr. Abu-Mouch told Medscape Gastroenterology, 96% of the vitamin?D group (26 of 27 patients) were HCV RNA-negative, as assessed by reverse-transcriptase polymerase chain reaction, as was 48% of the control group (15 of 31 patients), which was a significant difference (P?< .001), he said.
The combination of peginterferon and ribavirin, the standard of care for chronic HCV, achieves a sustained virologic response in 40% to 50% of naive patients with genotype?1, the investigators explain in a meeting abstract. Vitamin?D in combination with peginterferon-ribavirin "may have synergistic effects," Dr. Abu-Mouch said.
Meeting attendee Laurent Tsakiris, MD, from the Centre Hospitalier Universitaire de Melun in France, who was not involved in the study, told Medscape Gastroenterology that "the study is surprising and promising because vitamin?D is something very easy to use and there is no toxicity."
"It's also interesting," he said, "that the group treated with vitamin?D had more severe disease than the control group. I think this can be considered a strong result from a small study.
The study did not receive commercial support. Dr. Abu-Mouch and Dr. Tsakiris have disclosed no relevant financial relationships.
The Liver Meeting 2009: 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD): Abstract LB20. Presented November 2, 2009.