A simple proof of vitamin D deficiency and inflammation relation: single center study, over two thousand patients

Yıl 2023, Cilt: 28 Sayı: 2, 170 - 175, 23.05.2023

Ekmel Burak Özşenel , Mehmet Yavuz Gürler

https://doi.org/10.21673/anadoluklin.1228064

Öz

Aim: Vitamin D deficiency is a very common condition in the world. Although vitamin D appears to be effective mainly on calcium and bone metabolism, it is an important molecule that also affects immune functions and inflammation. In our study, we tried to evaluate the contribution of vitamin D deficiency to inflammation by examining the platelet indices of patients with low and normal vitamin D levels.

Methods: Healthy patients who applied to internal medicine outpatient clinics of our hospital for routine control in 2017 were included in our study. Patients are included in the study by following needed criteria; creatinine <1.3 mg/dl, hemoglobine >12 gr/dl, vitamin B12 >150 pg/dl, red cell distribution width <14 fL, thyroid stimulating hormone (TSH) between 1-5 IU/L and C-reactive protein (CRP) <10 mg/dl. Patients were divided into two groups, those with vitamin D less than 10 ng/ml as the study group and those above 30 ng/ml as the control group.

Results: A total of 2179 patients, 644 male and 1535 female, were included in the study. 797 patients constituted the study group (27.1% male), and 1382 patients constituted the control group (31% male). When the two groups were compared in terms of platelet indices, we found that mean platelet volume (MPV) and plateletcrit (PCT) were significantly higher in the study group (p<0.001, p<0.001).

Conclusion: In our study, we found that MPV and PCT values increased significantly with vitamin D deficiency. We attributed this result to the absence of the anti-inflammatory activity of vitamin D. As a result, treating a patient’s vitamin D deficiency can also protect patients from cardiovascular or autoimmune diseases through the anti-inflammatory effect of vitamin D.

Anahtar Kelimeler

Inflammation, mean platelet volume, platelet, Vitamin D, vitamin D deficiency

Vitamin D eksikliği ve inflamasyon ilişkisinin basit bir kanıtı: tek merkezli çalışma, iki binin üzerinde hasta

Öz

Amaç: D vitamini eksikliği dünyada çok yaygın bir durumdur. D vitamini esas olarak kalsiyum ve kemik metabolizması üzerinde etkili gibi görünse de, bağışıklık fonksiyonlarını ve inflamasyonu da etkileyen önemli bir moleküldür. Çalışmamızda D vitamini düzeyi düşük ve normal olan hastaların platelet indekslerini inceleyerek D vitamini eksikliğinin inflamasyona etkisini değerlendirmeye çalıştık.

Yöntemler: Çalışmamıza 2017 yılında hastanemiz dahiliye polikliniklerine rutin kontrol için başvuran sağlıklı hastalar dahil edildi. Hastalardan tetkik sonuçları şu kriterleri sağlayanlar çalışmaya dahil edildi; kreatinin <1,3 mg/dl, hemoglobin >12 gr/dl, vitamin B12 >150 pg/dl, kırmızı hücre dağılım genişliği (RDW) <14 fL, tiroit uyarıcı hormon (TSH) 1-5 IU/L arası ve C-reaktif protein (CRP) <10 mg/dl. Hastalar D vitamini 10 ng/ml’nin altında olanlar çalışma grubu ve 30 ng/ml’nin üzerinde olanlar kontrol grubu olarak 2 gruba ayrıldı.

Bulgular: Çalışmaya 644 erkek, 1535 kadın olmak üzere toplam 2179 hasta dahil edildi. 797 hasta çalışma grubunu (%27,1 erkek), 1382 hasta kontrol grubunu (%31 erkek) oluşturdu. Platelet indeksleri açısından iki grup karşılaştırıldığında çalışma grubunda ortalama trombosit hacmi (MPV) ve plateletokrit (PCT) anlamlı olarak daha yüksek olduğu saptandı (p<0,001, p<0,001).

Sonuç: Çalışmamızda, MPV ve PCT değerlerinin d vitamini eksikliğinde önemli ölçüde arttığını tespit ettik. Sonuç olarak, bir hastanın d vitamini eksikliğinin tedavi edilmesi, d vitamininin anti-inflamatuar etkisi ile hastayı kardiyovasküler veya otoimmün hastalıklardan da koruyabilir.

Anahtar Kelimeler

İnflamasyon, platelet, ortalama trombosit hacmi, Vitamin D, Vitamin D eksikliği

Kaynakça

• Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab. 2010;95:471-8.
• Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81:353-73.
• Heaney RP. Vitamin D in health and disease. Clin J Am Soc Nephrol . 2008;3:1535-41.
• Anderson PH, Turner AG, Morris HA. Vitamin D actions to regulate calcium and skeletal homeostasis. Clin Biochem. 2012;45(12):880-6.
• Bikle DD. Vitamin D regulation of immune function. Vitam Horm. 2011;86:1-21.
• Samuel S, Sitrin MD. Vitamin D’s role in cell proliferation and differentiation. Nutr Rev. 2008;66(10 Suppl 2):S116-S124.
• Koyama T, Hirosawa S. Anticoagulant effects of synthetic retinoids and activated vitamin D3. Semin Thromb Hemost. 1998;24(3):217-26.
• Krishnan AV, Feldman D. Mechanisms of the anti-cancer and anti-inflammatory actions of vitamin D. Annu Rev Pharmacol Toxicol. 2011;51:311-36.
• Pilz S, Tomaschitz A, Ritz E, Pieber TR. Vitamin D status and arterial hypertension: a systematic review. Nat Rev Cardiol. 2009;6(10):621-30.
• Gotsman I, Shauer A, Zwas DR, et al. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail. 2012;14(4):357-66.
• Llewellyn DJ, Lang IA, Langa KM, Melzer D. Vitamin D and cognitive impairment in the elderly U.S. population. J Gerontol A Biol Sci Med Sci. 2011;66(1):59-65.
• Di Rosa M, Malaguarnera M, Nicoletti F, Malaguarnera L. Vitamin D3: a helpful immuno-modulator. Immunology. 2011;134(2):123-39.
• Wang Y, Andrews M, Yang Y, et al. Platelets in thrombosis and hemostasis: old topic with new mechanisms. Cardiovasc Hematol Disord Drug Targets. 2012;12(2):126-32.
• Li N. CD4+ T cells in atherosclerosis: regulation by platelets. Thromb Haemost. 2013;109(6):980-90.
• Semple JW, Freedman J. Platelets and innate immunity. Cell Mol Life Sci . 2010;67(4):499-511.
• Rondina MT, Weyrich AS, Zimmerman GA. Platelets as cellular effectors of inflammation in vascular diseases. Circ Res. 2013;112(11):1506-19.
• Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357(24):2482-94.
• Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 2002;13(5-6):301-6.
• Khode V, Sindhur J, Kanbur D, Ruikar K, Nallulwar S. Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study. J Cardiovasc Dis Res. 2012;3(4):272-5.
• Bulur S, Önder HI, Aslantas Y, et al. Relation between indices of end-organ damage and mean platelet volume in hypertensive patients. Blood Coagul Fibrinolysis. 2012;23(5):367-9.
• Kodiatte TA, Manikyam UK, Rao SB, et al. Mean platelet volume in Type 2 diabetes mellitus. J Lab Physicians. 2012;4(1):5-9.
• Lombarts AJ, Koevoet AL, Leijnse B. Basic principles and problems of haemocytometry. Ann Clin Biochem. 1986;23 ( Pt 4):390-404.
• Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc. 2010;85(8):752-8.
• Park YC, Kim J, Seo MS, Hong SW, Cho ES, Kim JK. Inverse relationship between vitamin D levels and platelet indices in Korean adults. Hematology. 2017;22(10):623-9.
• Sivritepe R, Basat S, Ortaboz D. Association of vitamin D status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems in patients with type 2 diabetes mellitus. Aging Male. 2019;22(2):156-62.
• Kebapcilar AG, Kulaksizoglu M, Ipekci SH, et al. Relationship between mean platelet volume and low-grade systemic coagulation with vitamin D deficiency in primary ovarian insufficiency. Arch Gynecol Obstet. 2013;288(1):207-12.
• Gur EB, Karadeniz M, Genc M, et al. Relationship between mean platelet volume and vitamin D deficiency in gestational diabetes mellitus. Arch Endocrinol Metab. 2015;59(5):448-54.