PDF(Pubmed)
Abstract：
OBJECTIVE: Vitamins and homocysteine (Hcy) are involved in liver metabolism and related to the pathogenesis of autoimmune liver disease (AILD), but consensus is lacking. This study aims to systematically summarize relevant evidence to clarify the association of serum vitamins and Hcy levels with AILD.
METHODS: The English and Chinese literature was searched until August 29, 2023. Studies were included if they were observational studies of investigating serum vitamins and Hcy levels in patients with AILD and their healthy comparisons. Quality assessment was performed by using the Newcastle-Ottawa Scale, and a meta-analysis was conducted using ReviewManager 5.3. The protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42023455367.
RESULTS: A total of 25 case-control studies comprising 3487 patients (1673 patients and 1814 healthy controls) were included for analysis. There were 548 autoimmune hepatitis (AIH) cases, 1106 primary biliary cholangitis (PBC) cases, and 19 primary sclerosing cholangitis (PSC) cases. We found that serum A and E were decreased in both AIH and PBC/PSC; but vitamin C was reduced only in patients with PBC, not AIH. In addition, decreased content of 25(OH)D3 was found in both AIH and PBC. However, levels of 25(OH)D did not differ between the patients and controls, and were independent of disease types and the country. Only one study that met the inclusion criteria reported vitamin B6, B9, B12, and Hcy changes, and found that vitamin B6 and B9 were significantly decreased in patients with PBC, while serum vitamin B12 and Hcy levels were significantly elevated in them. One eligible study each confirmed a reduction in plasma vitamin K1 and 1,25(OH)2D3 in patients with PBC.
CONCLUSIONS: Most vitamins are deficient in AILD, so appropriate vitamin supplementation should be necessary. Further studies with larger sample sizes are needed to validate these findings.
METHODS: The English and Chinese literature was searched until August 29, 2023. Studies were included if they were observational studies of investigating serum vitamins and Hcy levels in patients with AILD and their healthy comparisons. Quality assessment was performed by using the Newcastle-Ottawa Scale, and a meta-analysis was conducted using ReviewManager 5.3. The protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42023455367.
RESULTS: A total of 25 case-control studies comprising 3487 patients (1673 patients and 1814 healthy controls) were included for analysis. There were 548 autoimmune hepatitis (AIH) cases, 1106 primary biliary cholangitis (PBC) cases, and 19 primary sclerosing cholangitis (PSC) cases. We found that serum A and E were decreased in both AIH and PBC/PSC; but vitamin C was reduced only in patients with PBC, not AIH. In addition, decreased content of 25(OH)D3 was found in both AIH and PBC. However, levels of 25(OH)D did not differ between the patients and controls, and were independent of disease types and the country. Only one study that met the inclusion criteria reported vitamin B6, B9, B12, and Hcy changes, and found that vitamin B6 and B9 were significantly decreased in patients with PBC, while serum vitamin B12 and Hcy levels were significantly elevated in them. One eligible study each confirmed a reduction in plasma vitamin K1 and 1,25(OH)2D3 in patients with PBC.
CONCLUSIONS: Most vitamins are deficient in AILD, so appropriate vitamin supplementation should be necessary. Further studies with larger sample sizes are needed to validate these findings.
摘要：
目的：维生素和同型半胱氨酸（Hcy）参与肝脏代谢，与自身免疫性肝病（AILD）的发病机制有关，但缺乏共识。本研究旨在系统总结相关证据，以阐明血清维生素和Hcy水平与AILD的关系。
方法：检索到2023年8月29日的英文和中文文献。如果是调查AILD患者血清维生素和Hcy水平及其健康比较的观察性研究，则纳入研究。使用纽卡斯尔-渥太华量表进行质量评估，并使用ReviewManager5.3进行荟萃分析。该协议已在国际前瞻性系统评价登记册（PROSPERO）中注册，注册号为CRD42023455367。
结果：共纳入25项病例对照研究，包括3487例患者（1673例患者和1814例健康对照）进行分析。548例自身免疫性肝炎(AIH),1106例原发性胆汁性胆管炎（PBC），原发性硬化性胆管炎(PSC)19例。我们发现AIH和PBC/PSC患者的血清A和E均降低；但维生素C仅在PBC患者中降低。不是AIH.此外,在AIH和PBC中均发现25（OH）D3的含量降低。然而,25（OH）D的水平在患者和对照组之间没有差异，与疾病类型和国家无关。只有一项符合纳入标准的研究报告了维生素B6，B9，B12和Hcy的变化，发现PBC患者的维生素B6和B9明显下降，而血清维生素B12和Hcy水平显著升高。一项符合条件的研究均证实了PBC患者血浆维生素K1和1,25（OH）2D3的减少。
结论：大多数维生素缺乏AILD，所以适当补充维生素应该是必要的。需要更大样本量的进一步研究来验证这些发现。
方法：检索到2023年8月29日的英文和中文文献。如果是调查AILD患者血清维生素和Hcy水平及其健康比较的观察性研究，则纳入研究。使用纽卡斯尔-渥太华量表进行质量评估，并使用ReviewManager5.3进行荟萃分析。该协议已在国际前瞻性系统评价登记册（PROSPERO）中注册，注册号为CRD42023455367。
结果：共纳入25项病例对照研究，包括3487例患者（1673例患者和1814例健康对照）进行分析。548例自身免疫性肝炎(AIH),1106例原发性胆汁性胆管炎（PBC），原发性硬化性胆管炎(PSC)19例。我们发现AIH和PBC/PSC患者的血清A和E均降低；但维生素C仅在PBC患者中降低。不是AIH.此外,在AIH和PBC中均发现25（OH）D3的含量降低。然而,25（OH）D的水平在患者和对照组之间没有差异，与疾病类型和国家无关。只有一项符合纳入标准的研究报告了维生素B6，B9，B12和Hcy的变化，发现PBC患者的维生素B6和B9明显下降，而血清维生素B12和Hcy水平显著升高。一项符合条件的研究均证实了PBC患者血浆维生素K1和1,25（OH）2D3的减少。
结论：大多数维生素缺乏AILD，所以适当补充维生素应该是必要的。需要更大样本量的进一步研究来验证这些发现。
