Araştırma Makalesi
Yıl 2018,
Cilt: 43 Sayı: 2, 450 - 456, 30.06.2018
Öz
Purpose: Vitamin D is a hormone that plays an important role in the regulation of calcium homeostasis and bone health. Vitamin D also has many functions other than skeletal health. The liver is one of the main organs involved in vitamin D metabolism. Recent studies have demonstrated a very high prevalence of vitamin D deficiency and/or insufficiency in patients with chronic liver disease. However, studies in this subject are scarce in children.
Materials and Methods: Vitamin D levels and treatment response of children with chronic liver disease diagnosed were evaluated retrospectively. A total of 50 patients, including 17 (34%) female and 33 (66%) male patients, who were being followed for 4 years, were recruited.
Results: Vitamin D deficiency or insufficiency was detected in 29 (48%) of 50 patients with a mean age of 7.83 (± 3.70) years at the time of diagnosis. Mean 25-OH vitamin D level was 12.79 (± 4.63) ng/ml ). In 24 (82.8%) patients with vitamin D deficiency or insufficiency vitamin D level was recovered after treatment, whereas in 5 patients (17.2%) there was insufficient response. In the presence of cholestasis, the response to treatment was observed to decrease.
Conclusion: Since vitamin D levels in patients with chronic liver disease may be low, patients should be examined and treated in this respect. This would also provides support for the current disease.
Anahtar Kelimeler
Kaynakça
- 1. Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008;8(9):685–698.
- 2. Cantorna MT, Mahon BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Exp Biol Med (Maywood). 2004;229(11):1136–1142.
- 3. Hollick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancer and cardiovascular disease. Am J Clin Nutr 2004;80(Suppl 6):1678-1688.
- 4. Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J 2005;98:1024-1027.
- 5. Lim LY, Chalasani N. Vitamin d deficiency in patients with chronic liver disease and cirrhosis. Curr Gastroenterol Rep. 2012 Feb;14(1):67-73.
- 6. Holick MF. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets 2011;12:4-18.
- 7. Health Quality Ontario. Clinical utility of vitamin d testing: an evidence-based analysis. Ont Health Technol Assess Ser 2010;10:1-93.
- 8. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr. 2016;85(2):83-106.
- 9. Hernandez-Gea V, Friedman SL. Pathogenesis of liver fibrosis. Annu Rev Pathol 2011; 6: 425–456.
- 10. Chen EQ, Shi Y, Tang H. New insight of vitamin D in chronic liver diseases. Hepatobiliary Pancreat Dis Int. 2014;13(6):580-585.
- 11. Stokes CS, Volmer DA, Grunhage F, Lammert F. Vitamin D in chronic liver disease. Liver Int 2013;33:338-352.
- 12. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–281.
- 13. Arteh J, Narra S, Nair S. Prevalence of vitamin D defi ciency in chronic liver disease. Dig Dis Sci 2010;55:2624-2628.
- 14. Targher G, Bertolini L, Scala L, et al. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2007;17:517-524.
- 15. Konstantakis C, Tselekouni P, Kalafateli M, Triantos C. Vitamin D deficiency in patients with liver cirrhosis. Ann Gastroenterol. 2016;29(3):297-306.
- 16. Putz-Bankuti C, Pilz S, Stojakovic T, et al. Association of 25-hydroxyvitamin D levels with liver dysfunction and mortality in chronic liver disease. Liver Int 2012;32:845-851.
- 17. Venu M, Martin E, Saeian K, Gawrieh S. High prevalence of vitamin A defi ciency and vitamin D defi ciency in patients evaluated for liver transplantation. Liver Transpl 2013;19:627-633.
- 18. Stokes CS, Krawczyk M, Reichel C, Lammert F, Grunhage F. Vitamin D defi ciency is associated with mortality in patients with advanced liver cirrhosis. Eur J Clin Invest 2014;44:176-183.
- 19. Savic Z, Damjanov D, Curic N, et al. Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis. Bratisl Lek Listy 2014;115:573-578.
- 20. Garcia-Alvarez M, Pineda-Tenor D, Jimenez-Sousa MA, Fernandez-Rodriguez A, Guzman-Fulgencio M, Resino S. Relationship of vitamin D status with advanced liver fi brosis and response to hepatitis C virus therapy: a meta-analysis. Hepatology 2014;60:1541-1550.
- 21. Kitson MT, Dore GJ, George J, et al. Vitamin D status does not predict sustained virologic response or fi brosis stage in chronic hepatitis C genotype 1 infection. J Hepatol 2013;58:467-472.
- 22. Han YP, Kong M, Zheng S, et al. Vitamin D in liver diseases: from mechanisms to clinical trials. J Gastroenterol Hepatol 2013;28(Suppl 1):49-55.
- 23. Kitson MT, Roberts SK. D-livering the message: the importance of vitamin D status in chronic liver disease. J Hepatol 2012;57:897-909.
- 24. Petta S, Camma C, Scazzone C, et al. Low vitamin D serum level is related to severe fi brosis and low responsiveness to interferonbased therapy in genotype 1 chronic hepatitis C. Hepatology 2010;51:1158-1167.
- 25. Anty R, Tonohouan M, Ferrari-Panaia P, et al. Low levels of 25-Hydroxy vitamin D are independently associated with the risk of bacterial infection in cirrhotic patients. Clin Transl Gastroenterol 2014;5:e56.
- 26. Finkelmeier F, Kronenberger B, Koberle V, et al. Severe 25-hydroxyvitamin D defi ciency identifi es a poor prognosis in patients with hepatocellular carcinoma - a prospective cohort study. Aliment Pharmacol Th er 2014;39:1204-1212.
- 27. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015;63:971-1004.
- 28. Efe C, Kav T, Aydin C, et al. Low serum vitamin D levels are associated with severe histological features and poor response to therapy in patients with autoimmune hepatitis. Dig Dis Sci 2014;59:3035-3042.
- 29. Luong KV, Nguyen LT. Th e role of vitamin D in autoimmune hepatitis. J Clin Med Res 2013;5:407-415.
- 30. Hepner GW, Roginsky M, Moo HF. Abnormal vitamin D metabolism in patients with cirrhosis. Am J Dig Dis 1976;21:527-532.
- 31. Long RG, Skinner RK, Wills MR, Sherlock S. Serum-25-hydroxyvitamin-D in untreated parenchymal and cholestatic liver disease. Lancet 1976;2:650-652.
- 32. Malham M, Jorgensen SP, Ott P, Agnholt J, Vilstrup H, Borre M, Dahlerup JF. Vitamin D deficiency in cirrhosis relates to liver dysfunction rather than aetiology. World J Gastroenterol 2011;17:922-925.
- 33. Chen CC, Wang SS, Jeng FS, Lee SD. Metabolic bone disease of liver cirrhosis: Is it parallel to the clinical severity of cirrhosis? J Gastroenterol Hepatol 1996; 11: 417–421.
- 34. Crawford BAL, Kam C, Donaghy AJ, Mccaughan GW. The heterogeneity of bone disease in cirrhosis: A multivariate analysis. Osteoporos Int 2003; 14: 987–994.
- 35. Menon KV, Angulo P, Weston S, Dickson ER, Lindor KD. Bone disease in primary biliary cirrhosis: independent indicators and rate of progression. J Hepatol 2001; 35:316–23. 36. Collier JD, Ninkovic M, Compston JE. Guidelines on the management of osteoporosis associated with chronic liver disease. Gut. 2002;50 Suppl 1:1–9.
- 37. Shiomi S, Masaki K, Habu D, et al. Calcitriol for bone loss in patients with primary biliary cirrhosis. J Gastroenterol 1999; 34: 241–245.
- 38. Bitetto D, Fattovich G, Fabris C, et al. Complementary role of vitamin D deficiency and the interleukin-28B rs12979860 C/T polymorphism in predicting antiviral response in chronic hepatitis C. Hepatology 2011; 53:1118–1126.
- 39. Vidot H, Potter A, Cheng R, Allman-Farinelli M, Shackel N. Serum 25-hydroxyvitamin D deficiency and hepatic encephalopathy in chronic liver disease. World J Hepatol. 2017 Apr 8;9(10):510-518.
Yıl 2018,
Cilt: 43 Sayı: 2, 450 - 456, 30.06.2018
Öz
Amaç: D vitamini kalsiyum metabolizması ve iskelet sağlığında önemli rol oynayan bir hormondur. Ayrıca D vitamininin iskelet sağlığı dışı birçok fonksiyona sahip olduğu bilinmektedir. Karaciğer, vitamin D metabolizmasına katılan başlıca organlardan biridir. Son yıllarda yapılan çalışmalar kronik karaciğer hastalığına sahip hastalarda vitamin D eksikliğinin ve yetersizlik prevalansının yüksek olduğunu ortaya koymuştur. Ancak çocukluk çağında bu konuda az sayıda çalışma mevcuttur.
Gereç ve Yöntem: Kronik karaciğer hastalığı tanısı ile izlenen çocukların vitamin D düzeyleri ve tedavi yanıtları geriye dönük olarak dosyalarından değerlendirilmiştir. Dört yıllık dönemde izlenen 17 (%34) kız, 33 (%66) erkek olmak üzere toplam 50 hastanın dosya kaydı verilerine ulaşıldı.
Bulgular: Çalışmaya alınan 50 hastanın tanı anındaki yaş ortalamaları 7,83 (±3,70) yıl olup 29’unda (%48) D vitamin düzeylerinde eksiklik veya yetersizlik saptandı (ortalama 25-OH vitamin D: 12,79 (± 4,63) ng/ml). Tedavi sonrası vitamin D düzeyi eksik veya yetersiz olan hastaların %82,8’inde düzelme sağlanırken, 5 hastada (%17,2) yeterli cevap yoktu. Kolestaz durumunda tedaviye verilen cevabın azaldığı görüldü.
Sonuç: Kronik karaciğer hastalığı nedeniyle izlenen hastalardaki vitamin D düzeyleri düşük olabileceğinden, bu açıdan hastaların incelenmesi ve tedavi edilmesi gerekmektedir. Bu durum mevcut hastalığı için de bir destek sağlamaktadır.
Anahtar Kelimeler
Kaynakça
- 1. Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008;8(9):685–698.
- 2. Cantorna MT, Mahon BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Exp Biol Med (Maywood). 2004;229(11):1136–1142.
- 3. Hollick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancer and cardiovascular disease. Am J Clin Nutr 2004;80(Suppl 6):1678-1688.
- 4. Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J 2005;98:1024-1027.
- 5. Lim LY, Chalasani N. Vitamin d deficiency in patients with chronic liver disease and cirrhosis. Curr Gastroenterol Rep. 2012 Feb;14(1):67-73.
- 6. Holick MF. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets 2011;12:4-18.
- 7. Health Quality Ontario. Clinical utility of vitamin d testing: an evidence-based analysis. Ont Health Technol Assess Ser 2010;10:1-93.
- 8. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr. 2016;85(2):83-106.
- 9. Hernandez-Gea V, Friedman SL. Pathogenesis of liver fibrosis. Annu Rev Pathol 2011; 6: 425–456.
- 10. Chen EQ, Shi Y, Tang H. New insight of vitamin D in chronic liver diseases. Hepatobiliary Pancreat Dis Int. 2014;13(6):580-585.
- 11. Stokes CS, Volmer DA, Grunhage F, Lammert F. Vitamin D in chronic liver disease. Liver Int 2013;33:338-352.
- 12. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–281.
- 13. Arteh J, Narra S, Nair S. Prevalence of vitamin D defi ciency in chronic liver disease. Dig Dis Sci 2010;55:2624-2628.
- 14. Targher G, Bertolini L, Scala L, et al. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2007;17:517-524.
- 15. Konstantakis C, Tselekouni P, Kalafateli M, Triantos C. Vitamin D deficiency in patients with liver cirrhosis. Ann Gastroenterol. 2016;29(3):297-306.
- 16. Putz-Bankuti C, Pilz S, Stojakovic T, et al. Association of 25-hydroxyvitamin D levels with liver dysfunction and mortality in chronic liver disease. Liver Int 2012;32:845-851.
- 17. Venu M, Martin E, Saeian K, Gawrieh S. High prevalence of vitamin A defi ciency and vitamin D defi ciency in patients evaluated for liver transplantation. Liver Transpl 2013;19:627-633.
- 18. Stokes CS, Krawczyk M, Reichel C, Lammert F, Grunhage F. Vitamin D defi ciency is associated with mortality in patients with advanced liver cirrhosis. Eur J Clin Invest 2014;44:176-183.
- 19. Savic Z, Damjanov D, Curic N, et al. Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis. Bratisl Lek Listy 2014;115:573-578.
- 20. Garcia-Alvarez M, Pineda-Tenor D, Jimenez-Sousa MA, Fernandez-Rodriguez A, Guzman-Fulgencio M, Resino S. Relationship of vitamin D status with advanced liver fi brosis and response to hepatitis C virus therapy: a meta-analysis. Hepatology 2014;60:1541-1550.
- 21. Kitson MT, Dore GJ, George J, et al. Vitamin D status does not predict sustained virologic response or fi brosis stage in chronic hepatitis C genotype 1 infection. J Hepatol 2013;58:467-472.
- 22. Han YP, Kong M, Zheng S, et al. Vitamin D in liver diseases: from mechanisms to clinical trials. J Gastroenterol Hepatol 2013;28(Suppl 1):49-55.
- 23. Kitson MT, Roberts SK. D-livering the message: the importance of vitamin D status in chronic liver disease. J Hepatol 2012;57:897-909.
- 24. Petta S, Camma C, Scazzone C, et al. Low vitamin D serum level is related to severe fi brosis and low responsiveness to interferonbased therapy in genotype 1 chronic hepatitis C. Hepatology 2010;51:1158-1167.
- 25. Anty R, Tonohouan M, Ferrari-Panaia P, et al. Low levels of 25-Hydroxy vitamin D are independently associated with the risk of bacterial infection in cirrhotic patients. Clin Transl Gastroenterol 2014;5:e56.
- 26. Finkelmeier F, Kronenberger B, Koberle V, et al. Severe 25-hydroxyvitamin D defi ciency identifi es a poor prognosis in patients with hepatocellular carcinoma - a prospective cohort study. Aliment Pharmacol Th er 2014;39:1204-1212.
- 27. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015;63:971-1004.
- 28. Efe C, Kav T, Aydin C, et al. Low serum vitamin D levels are associated with severe histological features and poor response to therapy in patients with autoimmune hepatitis. Dig Dis Sci 2014;59:3035-3042.
- 29. Luong KV, Nguyen LT. Th e role of vitamin D in autoimmune hepatitis. J Clin Med Res 2013;5:407-415.
- 30. Hepner GW, Roginsky M, Moo HF. Abnormal vitamin D metabolism in patients with cirrhosis. Am J Dig Dis 1976;21:527-532.
- 31. Long RG, Skinner RK, Wills MR, Sherlock S. Serum-25-hydroxyvitamin-D in untreated parenchymal and cholestatic liver disease. Lancet 1976;2:650-652.
- 32. Malham M, Jorgensen SP, Ott P, Agnholt J, Vilstrup H, Borre M, Dahlerup JF. Vitamin D deficiency in cirrhosis relates to liver dysfunction rather than aetiology. World J Gastroenterol 2011;17:922-925.
- 33. Chen CC, Wang SS, Jeng FS, Lee SD. Metabolic bone disease of liver cirrhosis: Is it parallel to the clinical severity of cirrhosis? J Gastroenterol Hepatol 1996; 11: 417–421.
- 34. Crawford BAL, Kam C, Donaghy AJ, Mccaughan GW. The heterogeneity of bone disease in cirrhosis: A multivariate analysis. Osteoporos Int 2003; 14: 987–994.
- 35. Menon KV, Angulo P, Weston S, Dickson ER, Lindor KD. Bone disease in primary biliary cirrhosis: independent indicators and rate of progression. J Hepatol 2001; 35:316–23. 36. Collier JD, Ninkovic M, Compston JE. Guidelines on the management of osteoporosis associated with chronic liver disease. Gut. 2002;50 Suppl 1:1–9.
- 37. Shiomi S, Masaki K, Habu D, et al. Calcitriol for bone loss in patients with primary biliary cirrhosis. J Gastroenterol 1999; 34: 241–245.
- 38. Bitetto D, Fattovich G, Fabris C, et al. Complementary role of vitamin D deficiency and the interleukin-28B rs12979860 C/T polymorphism in predicting antiviral response in chronic hepatitis C. Hepatology 2011; 53:1118–1126.
- 39. Vidot H, Potter A, Cheng R, Allman-Farinelli M, Shackel N. Serum 25-hydroxyvitamin D deficiency and hepatic encephalopathy in chronic liver disease. World J Hepatol. 2017 Apr 8;9(10):510-518.
Toplam 38 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2018 |
| Kabul Tarihi | 17 Ocak 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 43 Sayı: 2 |
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