Patients with end-stage liver disease such as liver cirrhosis and acute-on-chronic liver failure (ACLF) often have abnormal intake or absorption of trace elements and vitamins, but the relevant tests have not been popularized in clinic, the exact level of vitamins and trace elements and their relationship with disease in end-stage liver disease have not been clear, and the clinical intervention of trace elements and vitamins lacks pertinence.

To detect and analyze the levels of trace elements and vitamins in peripheral blood of patients with liver cirrhosis and ACLF and their relationship with the cause (alcoholic or non-alcoholic liver disease) and severity of the disease, providing basis for clinical targeted intervention in patients with end-stage liver disease.

From September 2020 to May 2021, 21 patients with ACLF hospitalized in the Fourth Department of Liver Disease, Beijing You'an Hospital, Capital Medical University were enrolled as the ACLF group by continuous fixed-point sampling. Nine patients with compensated liver cirrhosis who were hospitalized at the same time for elective endoscopic treatment or reexamination were enrolled as the liver cirrhosis group, and the patients were all in the compensatory period. Five healthy controls were enrolled as healthy control group. ACLF patients and liver cirrhosis patients were divided into alcoholic liver disease subgroup and non-alcoholic liver disease subgroup according to the cause of disease. The mass spectrometry was used to detect the levels of vitamin B₁, vitamin B₆, 25-hydroxyvitamin D, 25-hydroxyvitamin D₃ and trace elements (zinc, manganese, selenium ) in peripheral blood, in order to analyze the relationship between the levels of vitamins and trace elements in patients with liver cirrhosis and liver failure and the cause and severity of the disease〔total bilirubin (TBiL) , serum albumin (ALB) , international normalized ratio (INR) , Child-Pugh and MELD scores〕.

The levels of TBiL, INR, scores of Child-Pugh and MELD in ACLF group were significantly higher than those in liver cirrhosis group, ALB was significantly lower than that in liver cirrhosis group (P<0.05) . The levels of 25-hydroxyvitamin D, 25-hydroxyvitamin D₃ and blood selenium in ACLF group were significantly lower than those in healthy control group and liver cirrhosis group (P<0.05) , the difference in the above indicators between liver cirrhosis groupand healthy control groupwas not statistically significant. The blood manganese in ACLF group and liver cirrhosis group was significantly higher than that in control group (P<0.05) . There was no significant difference in vitamin B₁, vitamin B₆, 25-hydroxyvitamin D, 25-hydroxyvitamin D₃, blood manganese and blood zinc between alcoholic liver disease subgroup and nonalcoholic liver disease subgroup (P>0.05) ; the blood selenium in alcoholic liver disease subgroup was significantly lower than that in nonalcoholic liver disease subgroup (P<0.05) . The levels of 25-hydroxyvitamin D, 25-hydroxyvitamin D₃ were positively correlated with TBiL, INR, Child-Pugh score and MELD score, and positively correlated with ALB level (P<0.05) . The levels of 25-hydroxyvitamin D and 25-hydroxyvitamin D₃ in Child-Pugh grade C patients were lower than those in Child-Pugh grade A patients (P<0.05) .

In patients with liver cirrhosis and ACLF, 25-hydroxyvitamin D and 25-hydroxyvitamin D₃ are reduced, which is obviously related to the severity of the disease; patients with liver cirrhosis and ACLF, especially those with alcoholic disease, have a significant decrease in blood selenium, which can be supplemented as appropriate in clinical treatment.

肝硬化和慢加急性肝衰竭（ACLF）等终末期肝病患者常存在微量元素和维生素的摄入或吸收异常，但相关检测在临床尚未普及，终末期肝病微量元素和维生素的确切水平及其与疾病的关系尚未完全明确，临床微量元素和维生素的干预缺乏针对性。

检测分析肝硬化、ACLF患者外周血微量元素和维生素水平及其与病因（酒精性或非酒精性肝病）、疾病严重程度的关系，为终末期肝病患者的针对性干预提供依据。

2020年9月至2021年5月采用连续定点抽样方法选择在首都医科大学附属北京佑安医院肝病中心四科住院的ACLF（含前期）患者共21例为ACLF组。选择同期住院进行择期内镜下治疗或复查的肝硬化患者9例为肝硬化组，患者均为代偿期。选择5例健康对照者为健康对照组。根据病因将ACLF患者和肝硬化患者分为酒精性肝病亚组和非酒精性肝病亚组。应用质谱方法检测研究对象的外周血维生素B₁、维生素B₆、25-羟维生素D、25-羟维生素D₃及微量元素血锌、血锰、血硒水平，分析肝硬化和肝衰竭患者维生素和微量元素水平与病因和疾病严重程度〔总胆红素（TBiL）、血清白蛋白（ALB）、国际标准化比值（INR）、Child-Pugh评分和分级及终末期肝病模型（MELD）评分〕的关系。

ACLF组TBiL、INR、Child-Pugh评分和分级、MELD评分均高于肝硬化组，ALB低于ACLF组（P<0.05）。ACLF组25-羟维生素D、25-羟维生素D₃、血硒水平低于健康对照组和肝硬化组（P<0.05），肝硬化组上述指标与健康对照组比较，差异无统计学意义（P>0.05）；ACLF组和肝硬化组血锰水平高于对照组（P<0.05）。酒精性肝病亚组和非酒精性肝病亚组维生素B₁、维生素B₆、25-羟维生素D、25-羟维生素D₃、血锰、血锌水平比较，差异均无统计学意义（P>0.05）；酒精性肝病亚组血硒水平低于非酒精性肝病亚组（P<0.05）。25-羟维生素D、25-羟维生素D₃与TBiL、INR、Child-Pugh评分和分级与MELD评分呈相关，与ALB水平呈正相关（P<0.05）。Child-Pugh C级患者25-羟维生素D、25-羟维生素D₃水平低于Child-Pugh A级患者（P<0.05）。

肝硬化和ACLF患者25-羟维生素D、25-羟维生素D₃降低，且与疾病严重程度明显相关；肝硬化和ACLF患者，尤其是酒精性肝病患者，血硒明显降低，临床治疗中可酌情予以补充。