Assessment of the influence of vitamin D level on the course of chronic hepatitis C in comorbidity with chronic pancreatitis

Abstract

Background. Chronic hepatitis C (СHC) is often complicated by the presence of concomitant gastrointestinal diseases, one of which is chronic pancreatitis (CP). This has a negative impact on the clinical course of both diseases, contributes to nutrient deficiencies, in particular vitamin D, and worsens the quality of life of patients. The aim of the research was to study the features of the clinical course of CHC in comorbidity with CP and to evaluate the quality of life in patients with different levels of vitamin D in blood serum. Materials and methods. The study included 120 patients who were divided into 2 groups: group 1 — 72 patients with CHC and CP and group 2 — 48 patients with CHC. In turn, patients of group 1, depending on the enzymatic activity of the pancreas, were divided into group 1a (n = 52), which included patients with CHC and CP with exocrine insufficiency (EI), and group 1b (n = 20) — patients with CHC and CP with preserved exocrine function of the pancreas. In all patients, fecal coproscopy was performed, the level of fecal elastase (FE-1), vitamin D, viral load was determined, and the degree of fibrosis and necroinflammatory activity was evaluated using FibroTest and ActiTest. Situational anxiety was assessed according to the Spielberger-Hanin method, and quality of life using the SF-12 questionnaire. The analysis and processing of the results of the examination of patients was carried out using the computer program Jamovi 2.3.2.1, Microsoft Office Excel for Windows 2016 using the Kruskal-Wallis method, the Mann-Whitney-Wilcoxon criterion and the Pearson correlation coefficient. The difference was considered to be statistically significant at p < 0.05. Results. A significantly lower level of vitamin D was found in patients of group 1a than in patients of groups 1b and 2. Patients of group 1 with higher stages of fibrosis (F2–3 and F3–4), a higher degree of necroinflammatory activity in the liver (> A2) and a high viral load have lower levels of vitamin D than those with initial stages of fibrosis and less severe necroinflammatory process in the liver. Patients with CHC, CP and exocrine insufficiency complained of mood changes, increased anxiety, rapid fatigue, and muscle weakness significantly more often than those with preserved exocrine function and patients with CHC. The level of vitamin D in people with CHC, CP and exocrine insufficiency positively correlates with the level of FE-1. In all patients with CHC in comorbidity with CP, a negative effect of low levels of vitamin D on indicators of quality of life and anxiety was found. Conclusions. A reduced level of vitamin D in the blood of patients with CHC and CP worsens the course of the disease and is associated with a decrease in quality of life.