BibTex RIS Kaynak Göster

Relationship between chronic obstructive pulmonary disease and levels of vitamin D

Yıl 2015, Cilt: 42 Sayı: 2, 158 - 165, 08.07.2015
https://doi.org/10.5798/diclemedj.0921.2015.02.0551

Öz

Objective: Vitamin D deficiency may be associated with pulmonary function deterioration. The aim of this study is to assess the relationship of serum vitamin D levels with pulmonary functions, disease severity and exacerbation frequency in Chronic Obstructive Pulmonary Disease (COPD) patients.

Methods: Seventy consecutive patients with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV) who presented to our outpatient clinic and thirdty controls entered to the study. Diagnosis of COPD was confirmed according to clinical findings and pulmonary function test. Serum 25-hydroxyvitamin D (25(OH)D levels were measured by immunofluorescence method. Levels <20 ng/mL defined deficiency. Associations between Vitamin D levels and sex, age, body mass index (BMI), smoking habit, comorbidities, exacerbation frequency were examined.

Results: The mean age of patients was 60.7 years. The proportion of patients in stages 2 of GOLD was 40 %, in stages 3 was 30 % and stages 4was 30 %. There was no significant difference in serum levels of 25(OH)D between COPD patients and controls. Vitamin D level was 9.3 ±6.0 ng/mL in control group and 9.7± 8.5 ng/mL in GOLD stage 2, 9.6 ± 6.2 ng/mL in stage 3 and 5.1 ±2.4 ng/mL in stage 4. In stage 4, vitamin D levels was significantly lower statistically (p=0.03). Among the COPD patients, lower FEV1 was associated with lower levels of 25(OH)D (p= 0.03). The most frequent comorbidities were hypertension (61.4%) and heart failure (27.1%). Among the COPD patients smoking associated with significantly lower levels of serum 25(OH) D (p=0.04). We find an association with exacerbation frequency in the previous 12 months and levels of 25(OH) D (p=0.02).

Conclusion: COPD severity according to GOLD stage is also associated with low levels of 25(OH)D. Serum vitamin D levels are lower in COPD patients who are current smokers. Severe vitamin D deficiency is related to more frequent disease exacerbations. These findings indicated a relationship between serum 25(OH)D concentrations and COPD which suggests optimization of serum vitamin D levels in COPD.

Key words: Pulmonary functions, Vitamin D, COPD

Kaynakça

  • Holick MF.Vitamin D deficiency. N Engl J Med 2007;
  • :266-281.
  • Cosio BG, Agusti A. Update in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 181:655-660.
  • Penna G, Adorini L. 1 Alpha, 25-dihydroxyvitamin D3 inhibits differentiation, maturation, activation, and survival of dendritic cells leading to impaired alloreactive T cell activation. J Immunol 2000; 164: 2405-2411.
  • Lemire JM, Adams JS, Kermani-Arab V, et al. 1,25-Dihy droxyvitamin D3 suppresses human T helper/inducer lymphocyte activity in vitro. J Immunol 1985; 134:3032-3035.
  • Adams JS, Hewison M. Unexpected actions of vitamin D:
  • new perspectives on the regulation of innate and adaptive
  • immunity. Nat Clin Pract Endocrinol Metab 2008; 4:80-90.
  • Hansdottir S, Monick MM, Hinde SL, et al. Respiratory
  • epithelial cells convert inactive vitamin D to its active
  • form: potential effects on host defense. J Immunol 2008;
  • :7090-7099.
  • Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA.
  • Relationship between exacerbation frequency and lung
  • function decline in chronic obstructive pulmonary disease.
  • Thorax 2008; 57:847-852.
  • Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 1998; 8:261-267.
  • Dursun A. D vitamininin kemik metabolizması dışındaki
  • etkileri. Beslenmede Yenilikler I-II, Katkı Pediatri Dergisi
  • ; 28:225-234.
  • Timms PM, Mannan N, Hitman GA, et al. Circulating
  • MMP9, vitamin D and variation in the TIMP-1 response
  • with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 2002; 95:787-796.
  • Banerjee A, Panettieri RJr. Vitamin D modulates airway
  • smooth muscle function in COPD. Curr opin Pharmacol 2012.
  • Wright RJ. Make no nounes about it: epidemiologic evidence links vitamin D to pulmonary function and COPD. Chest 2005;128: 3871-3873.
  • Sundar IK, Rahman I. Vitamin D and susceptibility of
  • chronic lung disease: role of epigenetics. Front Pharmacol
  • ; 2:50.
  • Erkkola M, Kaila M, Nwaru BI, et al. Maternal vitamin D
  • intake during pregnancy is inversely associated with asthma
  • and allergic rhinitis. Clin Exp Allergy 2009; 39:875-882.
  • Janssens W, Bouillon R, Claes B, et al. Vitamin D deficien
  • cy is highly prevalent in COPD and correlates with variants
  • in the vitamin D-binding gene. Thorax 2010; 65:215-220.
  • Janssens W, Mathieu C, Boonen S, Decramer M. Vitamin
  • D deficiency and chronic obstructive pulmonary disease: a
  • vicious circle. Vitam Horm 2011; 86:379-99.
  • Heulens N, Decramer M, Janssens W. Severe vitamin D
  • deficiency: a biomarker of exacerbation risk? Am J Respir
  • Crit Care Med. 2013; 187:214-215.
  • Holick MF.Vitamin D deficiency. N Engl J Med 2007;
  • :266-281.
  • Murray CJ, Lopez AD. Alternative projections of mortalityand disability by cause 1990-2020: Global Burden of Disease Study.Lancet 1997; 349:1498-1504.
  • Strassels SA, Smith DH, Sullivan SD, Mahajan PS.The
  • costs of treating COPD in the United States. Chest
  • ;119:344-352.
  • Global Initiative for Chronic Obstructive Lung Disease.
  • Global strategy for the diagnosis, management and prevention of COPD, 2015 (update) www.goldcopd.com.
  • Norman AW, Bouillon R, Whiting SJ, et al. 13th Workshop
  • consensus for vitamin D nutritional guidelines. J Steroid
  • Biochem Mol Biol 2007; 103:204-205.
  • Dawson-Hughes B, Heaney RP, Holick MF, et al. Estimates
  • of optimal vitamin D status. Osteoporos Int 2005; 16:713-716.
  • Alagöl F, Shihadeh Y, Boztepe H, et al. Sunlight exposure
  • and vitamin D deficiency in Turkish Women. J Endocrinol
  • Invest 2000; 23:173-177.
  • Pehlivan İ, Hatun Ş, Aydoğan M, et al. Maternal serum vitamin D levels in the third trimester of pregnancy. Turk J Med
  • Sci 2002; 32:237-241.
  • Malabanan A, Veronikis IE, Holick MF.Redefining vitamin
  • D insufficiency.Lancet 1998; 351:805-806.
  • Vitamin D: extraskeletal health.Holick MF. Rheum Dis Clin
  • North Am. 2012 Feb; 38:141-160.
  • Kunisaki KM, Niewoehner DE, Singh RJ, Connett JE. Vitamin D status and longitudinal lung function decline in the Lung Health Study. Eur Respir J 2011; 37:238-243.
  • Black PN, Scragg R. Relationship between serum 25-hydroxyvitamin D and pulmonary function in the third national health and nutrition examination survey.Chest 2005;
  • :3792-3798.
  • Ringbaek T, Martinez G, Durakovic A, et al. Vitamin D status in patients with chronic obstructive pulmonary disease who participate in pulmonary rehabilitation. J Cardiopulmonary Rehab Prevention 2011; 31:261-267.
  • Franco CB, PazFillho G, Gomes PE, et al. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int 2009;20:1881-1887.
  • Persson LJP, Aanerud M, Hiemstra PS, et al. COPD is associated with low levels of vitamin D. PLoS One 2012;7:6.
  • Celli BR, MacNee W. ATS/ERS Task Force. Standards for
  • the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932-946.
  • Semba RD, Chang SS, Sun K, et al.Serum 25-Hydroxyvitamin D and Pulmonary Function in Older Disabled Community-Dwelling Women. J Gerontol A Biol Sci Med Sci
  • ; 67:683-689.
  • Shaheen SO, Jameson KA, Robinson SM, et al.Relationship
  • of vitamin D status to adult lung function and COPD. Thorax 2011; 66:692-698.
  • Ampikaipakan SN, Hughes DA, Hughes JC, et al. Vitamin
  • D and COPD: seasonal variation is important. Thorax 2011;
  • :541-542.
  • Jenkins CR, Celli B, Anderson JA, et al. Seasonality and
  • determinants of moderate and severe COPD exacerbations
  • in the TORCH study.Eur Respir J. 2012; 39:38-45.
  • Lange NE, Sparrow D, Vokonas P, Litonjua AA.Vitamin
  • D deficiency, Smoking, and Lung Function in the Normative Aging Study. Am J Respir Crit Care Med. 2012 Oct 1;186:616-621.
  • Hughes DA, Norton R. Vitamin D and respiratory health.
  • Clin Exp Immunol 2009; 158:20-25.
  • Lee JH, O’Keefe JH, Bell D. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk
  • factor? J Am Coll Cardiol 2008; 52:1949-1956.
  • Forman JP, Williams JS, Fisher ND.Plasma 25-hydroxyvitamin D and regulation of the renin angiotensin system in humans. Hypertension 2010; 55:1283-1288.
  • Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;
  • :690-693.
  • Mathieu C, Gysemans C, Giulietti A, Bouillon R. Vitamin D
  • and Diabetes. Diabetologia 2005; 48:1247-1257.
  • McGill AT, Stewart JM, Lithander FE, et al. Relationships
  • of low serum vitamin D3 with anthropometry and markers
  • of the metabolic syndrome and diabetes in overweight and
  • obesity. Nutr J 2008; 28:4-7.
  • Agusti A, Soriano JB.COPD as a systemic disease. COPD
  • ; 5:133-138.
  • Marquis K, Debigare R, Lacasse Y, et al. Midthigh muscle
  • crosssectional area is a better predictor of mortality than
  • body mass index in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002; 166:809-813.
  • Cannell JJ, Vieth R, Umhau JC, et al. Epidemic influenza
  • and vitamin D. Epidemiol Infect 2006;134: 1129-1140.
  • Wang TT, Nestel FP, Bourdeau V, et al. Cutting edge:
  • ,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol 2004; 173:2909-2912.
  • Lehouck A, Mathieu C, Carremans C, et al. High doses of
  • vitamin D to reduce exacerbations in chronic obstructive
  • pulmonary disease: a randomized trial. Ann Intern Med
  • ; 156:105-114.

Kronik obstruktif akciğer hastalığı ile vitamin D düzeyi arasındaki ilişki

Yıl 2015, Cilt: 42 Sayı: 2, 158 - 165, 08.07.2015
https://doi.org/10.5798/diclemedj.0921.2015.02.0551

Öz

Amaç: Vitamin D eksikliği, solunum fonksiyonlarında bozulma ile ilişkili olabilir. Çalışmamızda Kronik Obstruktif Akciğer Hastalığı (KOAH) hastalarında solunum fonksiyonları, hastalığın şiddeti ve alevlenme sıklığı ile serum Vitamin D düzeyi arasındaki ilişkiyi belirlemeyi amaçladık. Yöntemler: Polikliniğimize başvuran 70 KOAH hastası (GOLD Sınıflaması Evre II-IV) çalışmaya alındı. 30 sağlıklı gönüllü kontrol grubunu oluşturdu. Klinik bulgular ve solunum fonksiyon testine göre KOAH tanısı kondu. Serum 25-hidroksi vitamin D (25(OH)D) seviyesi immünofloresan yöntemi ile ölçüldü. 20 ng/mL altındaki değerler eksiklik olarak kabul edildi. Vitamin D düzeyi ile cinsiyet, yaş, Vücut Kitle İndeksi (VKİ), sigara içme durumu, komorbiditeler, alevlenme sıklığı arasındaki ilişki araştırıldı.Bulgular: Hasta grubunun yaş ortalaması 60,7 yıldı. Hastaları GOLD sınıflamasına göre ayırdığımızda %40’ı Evre II, %30’u Evre III, %30’u Evre IV KOAH’tı. Hasta ve kontrol grupları arasında serum 25(OH)D düzeyi bakımından anlamlı farklılık görülmedi. Vitamin D düzeyi kontrol grubunda 9,3 ±6,0 ng/mL, Evre II KOAH’da 9,7± 8,5 ng/mL, Evre III’te 9,6 ± 6,2 ng/mL ve Evre IV’te 5,1 ±2,4 ng/mL olarak belirlendi. Evre IV te Vitamin D düzeyi düşüklüğü istatistiksel olarak anlamlıydı (p=0.03).Hasta grubunda düşük FEV1, düşük 25(OH)D ile ilişkili bulundu (p=0.03). En sık görülen komorbidite hipertansiyon (%61,4) ve kalp yetmezliği idi (%27,1). Sigara içenlerde 25(OH)D düzeyi daha düşüktü (p=0,004). Son 12 aydaki alevlenme sıklığı ile serum 25(OH)D düzeyi düşüklüğü arasında ilişki saptandı (p=0.02).Sonuç: GOLD evrelemesine göre KOAH şiddeti ile 25(OH)D düzeyi düşüklüğü arasında ilişki vardır. Sigara içen KOAH hastalarında 25(OH)D düzeyi daha düşüktür. Ciddi Vitamin D eksikliği alevlenme sıklığında artış ile ilişkilidir. 25(OH)D düzeyi ile KOAH arasındaki ilişki, KOAH hastalarında Vitamin D düzeyini iyileştirmek gerektiğini düşündürmektedir

Kaynakça

  • Holick MF.Vitamin D deficiency. N Engl J Med 2007;
  • :266-281.
  • Cosio BG, Agusti A. Update in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 181:655-660.
  • Penna G, Adorini L. 1 Alpha, 25-dihydroxyvitamin D3 inhibits differentiation, maturation, activation, and survival of dendritic cells leading to impaired alloreactive T cell activation. J Immunol 2000; 164: 2405-2411.
  • Lemire JM, Adams JS, Kermani-Arab V, et al. 1,25-Dihy droxyvitamin D3 suppresses human T helper/inducer lymphocyte activity in vitro. J Immunol 1985; 134:3032-3035.
  • Adams JS, Hewison M. Unexpected actions of vitamin D:
  • new perspectives on the regulation of innate and adaptive
  • immunity. Nat Clin Pract Endocrinol Metab 2008; 4:80-90.
  • Hansdottir S, Monick MM, Hinde SL, et al. Respiratory
  • epithelial cells convert inactive vitamin D to its active
  • form: potential effects on host defense. J Immunol 2008;
  • :7090-7099.
  • Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA.
  • Relationship between exacerbation frequency and lung
  • function decline in chronic obstructive pulmonary disease.
  • Thorax 2008; 57:847-852.
  • Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 1998; 8:261-267.
  • Dursun A. D vitamininin kemik metabolizması dışındaki
  • etkileri. Beslenmede Yenilikler I-II, Katkı Pediatri Dergisi
  • ; 28:225-234.
  • Timms PM, Mannan N, Hitman GA, et al. Circulating
  • MMP9, vitamin D and variation in the TIMP-1 response
  • with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 2002; 95:787-796.
  • Banerjee A, Panettieri RJr. Vitamin D modulates airway
  • smooth muscle function in COPD. Curr opin Pharmacol 2012.
  • Wright RJ. Make no nounes about it: epidemiologic evidence links vitamin D to pulmonary function and COPD. Chest 2005;128: 3871-3873.
  • Sundar IK, Rahman I. Vitamin D and susceptibility of
  • chronic lung disease: role of epigenetics. Front Pharmacol
  • ; 2:50.
  • Erkkola M, Kaila M, Nwaru BI, et al. Maternal vitamin D
  • intake during pregnancy is inversely associated with asthma
  • and allergic rhinitis. Clin Exp Allergy 2009; 39:875-882.
  • Janssens W, Bouillon R, Claes B, et al. Vitamin D deficien
  • cy is highly prevalent in COPD and correlates with variants
  • in the vitamin D-binding gene. Thorax 2010; 65:215-220.
  • Janssens W, Mathieu C, Boonen S, Decramer M. Vitamin
  • D deficiency and chronic obstructive pulmonary disease: a
  • vicious circle. Vitam Horm 2011; 86:379-99.
  • Heulens N, Decramer M, Janssens W. Severe vitamin D
  • deficiency: a biomarker of exacerbation risk? Am J Respir
  • Crit Care Med. 2013; 187:214-215.
  • Holick MF.Vitamin D deficiency. N Engl J Med 2007;
  • :266-281.
  • Murray CJ, Lopez AD. Alternative projections of mortalityand disability by cause 1990-2020: Global Burden of Disease Study.Lancet 1997; 349:1498-1504.
  • Strassels SA, Smith DH, Sullivan SD, Mahajan PS.The
  • costs of treating COPD in the United States. Chest
  • ;119:344-352.
  • Global Initiative for Chronic Obstructive Lung Disease.
  • Global strategy for the diagnosis, management and prevention of COPD, 2015 (update) www.goldcopd.com.
  • Norman AW, Bouillon R, Whiting SJ, et al. 13th Workshop
  • consensus for vitamin D nutritional guidelines. J Steroid
  • Biochem Mol Biol 2007; 103:204-205.
  • Dawson-Hughes B, Heaney RP, Holick MF, et al. Estimates
  • of optimal vitamin D status. Osteoporos Int 2005; 16:713-716.
  • Alagöl F, Shihadeh Y, Boztepe H, et al. Sunlight exposure
  • and vitamin D deficiency in Turkish Women. J Endocrinol
  • Invest 2000; 23:173-177.
  • Pehlivan İ, Hatun Ş, Aydoğan M, et al. Maternal serum vitamin D levels in the third trimester of pregnancy. Turk J Med
  • Sci 2002; 32:237-241.
  • Malabanan A, Veronikis IE, Holick MF.Redefining vitamin
  • D insufficiency.Lancet 1998; 351:805-806.
  • Vitamin D: extraskeletal health.Holick MF. Rheum Dis Clin
  • North Am. 2012 Feb; 38:141-160.
  • Kunisaki KM, Niewoehner DE, Singh RJ, Connett JE. Vitamin D status and longitudinal lung function decline in the Lung Health Study. Eur Respir J 2011; 37:238-243.
  • Black PN, Scragg R. Relationship between serum 25-hydroxyvitamin D and pulmonary function in the third national health and nutrition examination survey.Chest 2005;
  • :3792-3798.
  • Ringbaek T, Martinez G, Durakovic A, et al. Vitamin D status in patients with chronic obstructive pulmonary disease who participate in pulmonary rehabilitation. J Cardiopulmonary Rehab Prevention 2011; 31:261-267.
  • Franco CB, PazFillho G, Gomes PE, et al. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int 2009;20:1881-1887.
  • Persson LJP, Aanerud M, Hiemstra PS, et al. COPD is associated with low levels of vitamin D. PLoS One 2012;7:6.
  • Celli BR, MacNee W. ATS/ERS Task Force. Standards for
  • the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932-946.
  • Semba RD, Chang SS, Sun K, et al.Serum 25-Hydroxyvitamin D and Pulmonary Function in Older Disabled Community-Dwelling Women. J Gerontol A Biol Sci Med Sci
  • ; 67:683-689.
  • Shaheen SO, Jameson KA, Robinson SM, et al.Relationship
  • of vitamin D status to adult lung function and COPD. Thorax 2011; 66:692-698.
  • Ampikaipakan SN, Hughes DA, Hughes JC, et al. Vitamin
  • D and COPD: seasonal variation is important. Thorax 2011;
  • :541-542.
  • Jenkins CR, Celli B, Anderson JA, et al. Seasonality and
  • determinants of moderate and severe COPD exacerbations
  • in the TORCH study.Eur Respir J. 2012; 39:38-45.
  • Lange NE, Sparrow D, Vokonas P, Litonjua AA.Vitamin
  • D deficiency, Smoking, and Lung Function in the Normative Aging Study. Am J Respir Crit Care Med. 2012 Oct 1;186:616-621.
  • Hughes DA, Norton R. Vitamin D and respiratory health.
  • Clin Exp Immunol 2009; 158:20-25.
  • Lee JH, O’Keefe JH, Bell D. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk
  • factor? J Am Coll Cardiol 2008; 52:1949-1956.
  • Forman JP, Williams JS, Fisher ND.Plasma 25-hydroxyvitamin D and regulation of the renin angiotensin system in humans. Hypertension 2010; 55:1283-1288.
  • Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;
  • :690-693.
  • Mathieu C, Gysemans C, Giulietti A, Bouillon R. Vitamin D
  • and Diabetes. Diabetologia 2005; 48:1247-1257.
  • McGill AT, Stewart JM, Lithander FE, et al. Relationships
  • of low serum vitamin D3 with anthropometry and markers
  • of the metabolic syndrome and diabetes in overweight and
  • obesity. Nutr J 2008; 28:4-7.
  • Agusti A, Soriano JB.COPD as a systemic disease. COPD
  • ; 5:133-138.
  • Marquis K, Debigare R, Lacasse Y, et al. Midthigh muscle
  • crosssectional area is a better predictor of mortality than
  • body mass index in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002; 166:809-813.
  • Cannell JJ, Vieth R, Umhau JC, et al. Epidemic influenza
  • and vitamin D. Epidemiol Infect 2006;134: 1129-1140.
  • Wang TT, Nestel FP, Bourdeau V, et al. Cutting edge:
  • ,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol 2004; 173:2909-2912.
  • Lehouck A, Mathieu C, Carremans C, et al. High doses of
  • vitamin D to reduce exacerbations in chronic obstructive
  • pulmonary disease: a randomized trial. Ann Intern Med
  • ; 156:105-114.
Toplam 109 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Araştırma Yazıları
Yazarlar

Buket Çilingir

Hülya Günbatar Bu kişi benim

Yayımlanma Tarihi 8 Temmuz 2015
Gönderilme Tarihi 8 Temmuz 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 42 Sayı: 2

Kaynak Göster

APA Çilingir, B., & Günbatar, H. (2015). Relationship between chronic obstructive pulmonary disease and levels of vitamin D. Dicle Medical Journal, 42(2), 158-165. https://doi.org/10.5798/diclemedj.0921.2015.02.0551
AMA Çilingir B, Günbatar H. Relationship between chronic obstructive pulmonary disease and levels of vitamin D. diclemedj. Temmuz 2015;42(2):158-165. doi:10.5798/diclemedj.0921.2015.02.0551
Chicago Çilingir, Buket, ve Hülya Günbatar. “Relationship Between Chronic Obstructive Pulmonary Disease and Levels of Vitamin D”. Dicle Medical Journal 42, sy. 2 (Temmuz 2015): 158-65. https://doi.org/10.5798/diclemedj.0921.2015.02.0551.
EndNote Çilingir B, Günbatar H (01 Temmuz 2015) Relationship between chronic obstructive pulmonary disease and levels of vitamin D. Dicle Medical Journal 42 2 158–165.
IEEE B. Çilingir ve H. Günbatar, “Relationship between chronic obstructive pulmonary disease and levels of vitamin D”, diclemedj, c. 42, sy. 2, ss. 158–165, 2015, doi: 10.5798/diclemedj.0921.2015.02.0551.
ISNAD Çilingir, Buket - Günbatar, Hülya. “Relationship Between Chronic Obstructive Pulmonary Disease and Levels of Vitamin D”. Dicle Medical Journal 42/2 (Temmuz 2015), 158-165. https://doi.org/10.5798/diclemedj.0921.2015.02.0551.
JAMA Çilingir B, Günbatar H. Relationship between chronic obstructive pulmonary disease and levels of vitamin D. diclemedj. 2015;42:158–165.
MLA Çilingir, Buket ve Hülya Günbatar. “Relationship Between Chronic Obstructive Pulmonary Disease and Levels of Vitamin D”. Dicle Medical Journal, c. 42, sy. 2, 2015, ss. 158-65, doi:10.5798/diclemedj.0921.2015.02.0551.
Vancouver Çilingir B, Günbatar H. Relationship between chronic obstructive pulmonary disease and levels of vitamin D. diclemedj. 2015;42(2):158-65.