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Section 7. Medical science
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Alyeva Nigora Rustamovna, Senior scientific assistant, applicant of the Department of Tashkent Pediatric Medical Institute E-mail: mbshakur@mail.ru Kamilova Altinoy Tursunbayevna, Republican specialized scientific-practical medical center of pediatrics, chief, Professor, DM.
Amount of vitamin D and phosphorus-calcium exchange in children with pathology of small intestine
Abstract: We determined a high percent of vitamin D deficit in the children with pathologies of small intestine, more expressed in celiacia and chronic enterocolitis. Vitamin D deficit in this category of patients can serve to be a marker of alkali phosphotase and parathormone level. The revealed vitamin D deficit in the patients with malabsorption syndrome dictates the necessity of vitamin d supplementation in the patients with celiacia and severe forms of enterocolitis.
Keywords: pathology of small intestine, vitamin D, phosphorus-calcium exchange, children.
Pathology of intestine, manifested by maldigestion and as celiacia, chronic post-infectious enterocolitis, and allergic
malabsorption, is one of the actual problems of clinical pediatrics. The importance of that problem is determined by the fact that, intestinal diseases are chronic, tend to relapse and formation of severe disorders of substance exchange with development of complex dysfunctions of the whole digestive system [1; 2; 6].
Status of vitamin D in the organism is of great importance in the pathogenesis of intestinal diseases with malabsorption and maldigestion, as the absorption of vitamin D mostly occurs in duodenum and jejunum with bile acids. Further it is transported by lymphatic system of intestine in the form of chylomicrons of cholecalciferol omolate formed in the interrelation of vitamin D3 with taurocholic acid [3; 7].
Scientific data about the metabolism ofvitamin D obtained during the last years led to the change of opinion that it was just usual vitamin. In the modern time it is common to speak about integral vitamin-D-endocrine system, providing not only regulation of phosphorus-calcium exchange, but also maintaining functioning of many organs and systems [4]. Receptors to calcitriol, which is hormonal active form of vitamin D, were detected at least in 36 various tissues of organism [5; 6].
In relation with the widening of understanding of vitamin D importance in the genesis of many diseases, it is necessary to study its impact on the progress of diseases, accompanied with the maldigestion and malabsorption syndromes such
enterocolitis.
Objective: to define the status of phosphorus-calcium exchange and amount ofvitamin D in the diseases of small intestine in children.
Materials and methods of the research: the study was based on the results of checking of 160 children with pathologies of small intestine. The examined children composed three groups: 60 children with celiacia (C) in the age from 3 to 16 years old (1st group); 60 with chronic enterocolitis from 2 to 12 years old (2nd group); 40 children with allergic enterocolitis from 0 to 4 years old (3rd group). The diagnosis of the diseases was verified on the basis of carefully collected anamnesis, complex clinical-laboratory, immune genetic and instrumental checking.
For the study of vitamin D status in organism we determined the following values in blood serum: 25 (OH)D3, calcium, phosphorus, parathormone, alkali phosphotase. The tests were performed according to common method.
Allergic enterocolitis was determined on the basis of careful collection of anamnesis, definition of immunoglobulin E, and basophile test to allergens (Shelly's reaction).
The control group involved 25 practically healthy children.
The results of the studies underwent statistic analysis with traditional methods of mathematic analysis. The calculations were performed using EXCELL software.
Amount of vitamin D and phosphorus-calcium exchange in children with pathology of small intestine
Results of the research: among the clinical manifestations of metabolic disorders most often mineral exchange disorders are observed. Diminishing of ionized calcium amount occurs in all forms of the disease, and statistically reliable decrease of its level was noted in the patients with celiacia and chronic enterocolitis. Concentration of total calcium in children differed little from the normal value (2.33±0.02 mol/l, 2.36±0.02 mol/l, 2.25±0.08 mol/l corresponding to the groups, and 2.35±0.02 mol/l in the control group). All patients tended to have hypocalciumemia, it means ionized calcium was equal to 1.05±0.06 mmol/l, 1.03±0.2 mmol/l and 1.05±0.1 mmol/l respectively in the groups versus 2.35±0.2 mmol/l in the control group.
Phosphorus is essential anion of a cell, its deficit leads to various disorders of cellular metabolism. The level of phosphorus in comparison with the normal value had a tendency for decrease in all groups, more expressed in children with celiacia to 0.38 mol/l (P<0.05).
Patients of the 1st and 2nd groups had increased level of the alkali phosphotase values. The values of alkali phosphotase activity in the patients of the 1st and 2nd groups were increased. The level of alkali phosphotase activity in the patients of the 3rd group was not significantly raised. Thus, in the 1st group it was 2.1 folds higher in comparison with the control group (P<0.05; 195.8±15.9 U/l and 95.5±1.4 U/l respectively), in the second group to 1.8 fold (P<0.05; 175.3±8.8 U/l and 95.5±1.4 U/l respectively); in the third group that value was insignificantly different from the values of the control group and was equal to 102.2±2.5 U/l versus 95.5±1.4 U/l.
Optimal mean for the evaluation of vitamin D status was definition of 25-hydroxivitamin D [25 (OH) D] amount in blood serum. Under the term of vitamin D deficit we understand decrease of 25 (O) D concentration in blood serum less than 20 ng/ml (50 nmol/l); sufficient vitamin D is the status when the concentration of 25 (O) D in blood serum is above 30 ng/ml (75 nmol/l), while in case of deficiency the level of vitamin D in blood is preserved in the range from 21 to 29 nanogram/ml. [4; 5].
Vitamin D deficit was revealed in 48 (80%) patients with celiacia, among them in 15 below 10 ng/ml. Insufficient amount of vitamin D was revealed in 12 patients (20%).
In chronic enterocolitis the deficit of vitamin D was revealed in 34 patients (57%), and it is 1.4 fold rarer than in the patients with celiacia. Insufficient amount of vitamin D was registered in 26 (43%) patients, and it was 2 folds more often than in the patients with celiacia.
Among the children with allergic enterocolitis vitamin D deficit was revealed in 10 children (25%), and it was more than 3 times rarer than in the patients with celiacia. Insufficient amount of vitamin D was revealed in 27 (62%) children
from the 3rd group.
Average level of vitamin D decreased in all group of the children, more expressed in the 1st and 2nd groups (P<0.05). In the 1st group the average values of vitamin D was 14.78±1.04 ng/mg, and it was almost 3 folds below the average values of the control group (45.1±0.9 ng/mg). In the 2nd group the average values of vitamin D were higher than in the 1st group (18.6±0.77 ng/mg versus 14.8±1.04; P<0.05), but 2.4 folds below the control group results (18.6±0.77 ng/mg versus 45.1±0.9; P<0.05). In the third group the amount of vitamin D was 22.8±0.6 ng/mg, and it was above the average level in the second group, but 2 folds lower than the control values (22.8±0.6 ng/mg versus 45.1±0.9; P<0.05).
We observed increased level of parathormone in all groups. More expressed increase was observed in children with celiacia (29.3±1.9 pg/ml versus 9.1±0.5 pg/ml in the control group; P<0.05) and chronic enterocolitis (27.2±1.4 pg/ml versus 9.1±0.5 pg/ml in the control group; P<0.05). In the third group that value was 1.7 fold increased in comparison with the control group (15.6±1.3 pg/ml versus 9.1±0.5 pg/ml; P<0.05) and 1.9 fold lower than in the 1st group (15.6±1.3 pg/ml versus 29.3±1.9 pg/ml).
The analysis of correlation link of vitamin D showed strong correlation interrelation with the value of alkali phosphotase (r=+0.721) and strong correlation feedback with parathormone (r=-0.659).
Thus, we determined high percent of vitamin D deficit in the patients with pathologies of small intestine in the region with high insolation, and it was more expressed in children with celiacia and chronic enterocolitis. The level of alkali phosphotase and parathormone can serve to be a marker of vitamin D deficit in the patients with chronic diseases of intestine. The revealed deficit of vitamin D in the patients with malabsorption syndrome dictates the necessity of vitamin D supplementation in the patients with celiacia and severe forms of enterocolitis.
Conclusions:
1. Decrease of the ionized calcium amount occurs in all forms of the disease, and statistically reliable decrease of its level was noted in the patients with C and CE.
2. We determined high percent of vitamin D deficit in the patients with diseases of small intestine in the region with high insolation; 80% in the patients with celiacia, 57% in children with chronic enterocolitis, and 25% in the children with allergic enterocolitis.
3. The obtained results will serve the basis for the designing of the complex of therapeutic-diagnostic measures aiming normalization of the status of vitamin D and phosphorus-calcium exchange in organism with chronic diseases of small intestine.
References:
1. Avdeyev V. Diagnostics and therapy of celiakia//Doctor. - 2010. - № 4. - P. 16-19.
2. Averkin N. A., Roslavtseva Y. A., Potapov A. S., Borovik T. E. Morphometric values of small intestine in children with ce-liakia in catamnesis//Materials of the XIII Congress of pediatric gastroenterologists of Russia.-M., 2006. - P. 289-290.
