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9ASSESSMENT OF VITAMIN D AVAILABILITY IN WOMEN OF REPRODUCTIVE AGE WITH
CONNECTIVE TISSUE DYSPLASIA
Smetanin M.
Candidate of medical sciences, ultrasound diagnostics doctor of the Republican clinical and diagnostic center, Izhevsk, Russia
Pimenov L.
Doctor of medical sciences, head of the Department of General Practice and Internal Medicine with the Course of Emergency Medicine,
Izhevsk State Medical Academy, Izhevsk, Russia
Chernyshova T.
Doctor of medical sciences, professor of the Department of General Practice and Internal Medicine with the Course of Emergency Medicine,
Izhevsk State Medical Academy, Izhevsk, Russia
Abstract
The problem of undifferentiated connective tissue dysplasia (UCTD) has been actively discussed among the medical community in Russia in recent years. In the English-language literature, the term "hereditary collagen diseases" (non-Hereditary Disorders of Collagen) or "genetic collagen diseases" (Genetic Disorders of Collagen) is used to refer to quantitative and qualitative disorders of biosynthesis and degradation of collagen, which determine the range of clinical symptoms of diseases. Connective tissue dysplasia (CTD) is considered an important medical and social problem due to its widespread prevalence among the population, in particular, among women of childbearing age, the increasing costs of the health system for the treatment of this pathology, as well as a high rating among the reasons for primary disability. The latter is particularly relevant not only in medical terms, but also in social terms.
Vitamin D supplementation - in terms of the metabolite 25(OH) D (calcidiol) - in women with UCTD is currently receiving special attention. It was established that patients with UCTD are at risk for obstetric and perinatal pathology, since the prevalence of this syndrome in women of reproductive age reaches 80%. UCTD can have adverse effects on pregnancy and childbirth, perinatal morbidity and mortality of newborns. In the available literature, there are isolated studies examining the status of vitamin D in women of reproductive age with UCTD. It should be noted that studies to assess vitamin D have been conducted mainly in children and adolescents. At the same time, this problem remains almost unexplored in women of reproductive age.
Keywords: women of childbearing age, undifferentiated connective tissue dysplasia, vitamin D, calcidiol, vitamin D lack and deficiency.
Background: The problem of UCTD is currently very relevant due to the high prevalence of this pathology in the population (the frequency of its individual manifestations according to different authors varies from 26 to 80%), the variety and severity of its clinical manifestations, and the tendency to accumulate signs of CTD in the population [1]. Despite the fact that the variant of differentiated CTD carries a risk of severe complications, in practice, the doctor most often has to deal with UCTD. The presence of connective tissue (CT) in all organs and systems, its versatility, suggest the possibility of dysplastic changes in any organ [2].
It is known that vitamin D takes part in the most important physiological processes. According to modern concepts, vitamin D deficiency plays an important role not only in the violation of calcium-phosphorus metabolism, but also in the pathogenesis of a number of systemic autoimmune diseases, immune and cyto-kine dysfunctions, and in the persistence of autoimmune complicated infections, in particular, tuberculosis [3]. The only metabolite of vitamin D that is used to determine its position in the human body is 25 (OH) D (calcidiol), since the half-life of vitamin 25(OH)D is about 2-3 weeks, and the vitamin D metabolite (calcit-riol)is 1.25(OH) 2D - only 4 hours. Thus, the calcidiol
content is 25(OH)D in both serum and plasma is an informational indicator of the body's vitamin D supply [3, 4].
There are numerous publications on vitamin D-de-ficient conditions, but we have not found any studies on the availability of vitamin D in women of childbearing age with UCTD.
The aim of current research was to evaluate the status of vitamin D in peripheral blood in women with UCTD by the level of the 25(OH)D (calcidiol) metabolite.
Methods: a laboratory assessment of the plasma content of 25(OH)D (calcidiol) was performed in 87 women of childbearing age from 19 to 37 years (the average age was 25.0±6.5 years), mainly with visceral, skin and bone-joint manifestations of UCTD. Patients with monogenic hereditary syndromes were not included in the study.
Immunochemical methods were used to determine the quantitative content of 25(OH)D in blood serum. As a result of the study of women, data on different levels of vitamin D availability and high prevalence of vitamin D deficiency in women of childbearing age with UCTD were obtained. This, in turn, dictates the need for further in-depth study of vitamin D availability and individual nutritional prevention of its deficiency in young women with UCTD syndrome.
Detection of CTD in the examined women was performed using the criteria presented in the National Recommendations for the Diagnosis, Treatment and Rehabilitation of Patients with CTD [5].
The diagnosis of CTD was established on the basis of an in-depth analysis of anamnestic and anthropometric data, the results of a clinical examination, taking into account the number and severity of phenotypic signs of dysplasia. When six or more stigmas of dysembryogen-esis were detected in women, the diagnosis of UCTD was made [6].
Quantitative determination of 25(OH)D in blood serum was carried out by the immunoassay method on the analyzer "Immulite" (USA) in 87 young women aged 19 to 37 years (the average age was 25.0±6.5 years) on the basis of a day hospital of the Republican Clinical and Diagnostic Center. The calculation was carried out according to the attached instructions. The norm was taken to be level 25(OH)D > 30-100 ng / ml; lack -10-29 ng / ml; deficit - <10 ng / ml. Blood was
Vitamin D content in women of childbearing age
drawn from the vein in the morning (8-9) hours after a 12-hour fast.
The research Protocol was approved by the Ethics Committee of the Izhevsk State Medical Academy (Protocol No. 128 of 07.10.2019).
Statistical processing of the material was performed by calculating the indicator of prevalence of the sign, calculating the average values (M) and their errors (m). Evaluation of the research results included the use of generally accepted methods of variation statistics with the calculation of the Student-Fisher criterion using the program Statistica 10.0 and Excel 2016. Differences were considered reliable at p <0.05.
Results. As a result of the study, it was found that the content of the metabolite 25 (OH)D in young women ranged in a fairly wide range from 5.2 to 50.4 ng / ml, averaging 17.1±6.2 ng / ml. Normal vitamin D levels were observed in 5 women (5.7%), lack of vitamin D - in 72 women (82.8%), and deficiency - in 10 women (11.5%) (table 1).
Table 1
Indicator of vitamin D 25(OH)D Number of women, abs. (%) The average level of vitamin D D 25(OH)D
Norm (>30 ng / ml) 5 (5,7) 37,9±6,2
Lack (10-29 rn/Mrf) 72 (82,8) 17,1±4,9*
Deficit (<10 Hr/Mrf) 10 (11,5) 8,1±1,4
Note: * - p <0.05 compared to women with normal vitamin D content and serum vitamin D deficiencies.
It is interesting to study the level of vitamin D depending on the severity of UCTD. According to our research, the average content of 25 (OH)D in women with 6 stigmas of dysembryogenesis was 17.5±7.0 ng / ml, among women with 7-10 stigmas of dysembryogene-sis-16.9±6.0 ng/ml and, finally, among women with 11 or more stigmas of dysembryogenesis - 15.9±5.4 ng / ml (p>0.05).
Conclusions. Thus, as a result of the study, a high prevalence of vitamin D lack and deficit of various degrees of severity in women of reproductive age with undifferentiated connective tissue dysplasia was established. Attention is drawn to the tendency to a more pronounced decrease in the level of vitamin D in the blood serum with an increase in the number of stigmas of dysembryogenesis in the examined women.
The obtained data indicate the need to correct vitamin D lack and deficit by taking vitamin D medications in accordance with the Clinical Recommendations of the Russian Association of Endocrinologists for the Diagnosis, Treatment and Prevention of Vitamin D Deficiency in Adults (2016) [7]. Also according to prescription may require a computed tomography densitometry for the assessment of the degree of mineralization of bone tissue.
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