Avaliação dos níveis séricos de vitamina D e hormônio para tireoidiano em pacientes cirróticos

Dissertação (mestrado profissional) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Cuidados Intensivos e Paliativos, Florianópolis, 2013.Introdução: Níveis mais baixos de 25-hidroxivitamina D [25(OH)D] têm sido observados em pacientes cirróticos e foram relacionados à maior gravidade da doença e pior prognóstico. No entanto, a maioria dos estudos prévios incluiu uma grande proporção de pacientes com doença hepática muito avançada, sem o adequado controle para outras variáveis que podem se associar aos níveis de vitamina D. Objetivos: Investigar a prevalência de hipovitaminose D em portadores de cirrose hepática acompanhados ambulatorialmente e investigar a associação entre baixos níveis de vitamina D com parâmetros clínicos, nutricionais, laboratoriais e de avaliação do eixo cálcio-PTH-vitamina D.Material e Métodos: Estudo transversal que incluiu pacientes cirróticos ambulatoriais. Os níveis séricos de 25(OH)D e PTH foram determinados por quimioluminescência. Os pacientes foram submetidos à avaliação clínica, laboratorial e nutricional. Análises bivariada e multivariada foram realizadas para investigação de fatores associados a níveis de vitamina D abaixo do tercil inferior.Resultados: Foram incluídos 133 pacientes com média de idade de 53,93 ± 12,13 anos, 72,2% homens, 67,7% Child-Pugh A. Os níveis de 25(OH)D foram menores que 30 ng/mL em 69,9% e menores que 20 ng/mL em 14,3% da amostra. Níveis de 25(OH)D abaixo do tercil inferior (Abstract : Introduction: Lower levels of 25-hidroxyvitamin D [25(OH)D] have been observed in cirrhotic patients and were related to disease severity and worse prognosis. However, most previous studies included a large proportion of patients with very advanced liver disease, without an adequate control for other variables that may be associated with the levels of vitamin D. Objectives: To investigate the prevalence of hypovitaminosis D in outpatients with liver cirrhosis and the association between low vitamin D levels with clinical, nutritional, and laboratory variables, including evaluation of calcium-PTH-vitamin D axis. Material and methods: This cross-sectional study included cirrhotic outpatients. The serum levels of 25(OH)D and PTH were determined by chemiluminescence. Patients underwent clinical, laboratory and nutritional evaluation. Bivariate and multivariate analyses were performed to determine factors associated with 25(OH)D levels below the lowest tertile. Results: One hundred and thirty-three patients with a mean age of 53.93 ± 12.13 years were included in the study. Male gender was observed in 72.2% of the subjects and 67.7% were classified as Child-Pugh A. The levels of 25(OH)D were less than 30 ng/mL in 69.9% and less than 20 ng/mL in 14.3% of the sample. Levels of 25(OH)D below the lowest tertile (< 24 ng/mL) were independently associated with higher values of triceps skinfold (OR 1.041, 95% CI 1.003 to 1.081, P = 0.034) and with non-white skin color (OR 4.056, 95% CI 1.005 to 16.369, P = 0.049). The 25(OH)D levels were not associated with variables related to the severity of liver disease. PTH above 65 pg/mL was found in 24.6% of patients without association with 25(OH)D levels or severity of liver disease. Conclusions: In this sample of cirrhotic patients with relatively preserved hepatic function, the prevalence of hypovitaminosis D was high and was associated with adiposity and non-white skin color, but not with the severity of liver disease