Elazığ Bölgesinin 25 Hidroksivitamin D Düzeylerinin Değerlendirilmesi ve Populasyona Dayalı Yeni Referans Aralıklarının Belirlenmesi

Amaç: Son zamanlarda vitamin D eksikliğinin birçok ciddi hastalıkla ilişkili olabileceği tartışılmaktadır. Bu çalışmada amacımız, Elazığ populasyo-nuna ait vitamin D seviyelerini değerlendirmek ve indirek metodla populasyona dayalı yeni referans aralıklarını belirlemektir. Gereç ve Yöntem: Bu retrospektif çalışmaya 2013 Temmuz ayı itibariyle yaklaşık olarak 2 yıl süreyle Elazığ Eğitim Araştırma Hastanesine başvuran ve 25(OH)vit D testi çalışılmış olan hastalar dahil edildi. 25(OH)vitD düzeyleri anlaşmalı laboratuvarda Siemens ADVIA Centaur XP sistemi kullanı-larak CLIA yöntemi ile analiz edildi. Laboratuvar bilgi sisteminden retrospektif olarak elde edilen veriler dışlama kriterlerine göre düzenledikten sonra analiz edildi. Hastalar yaş, cinsiyet ve mevsimlere göre gruplara ayrıldı. Referans aralığı non-parametrik yöntemle hesaplandı. Bulgular: Vitamin D eksikliği için cut-off değeri 20 ng/ml olarak kabul edildiğinde genel populasyonun %78.2’sinde vitamin D eksikliği belirlendi. 2,5-97,5 persentil aralığı için 5,20-35,20 ng / ml olarak belirlenen referans aralıklarının üretici firma tarafından önerilen referans aralıklarından daha düşük olduğu gözlendi. Sonuç: Bu çalışmada, Elazığ bölgesinde geniş bir populasyonun 25(OH)vitD seviyeleri değerlendirildi. Aynı zamanda, klinik tanı ve tedavi üzerine olumlu katkı sağlayacağına inandığımız yeni referans aralıkları belirlendi. Yine de bu çalışmanın sağlıklı populasyonda da yapılması gerektiğini düşünüyoruz.

Evaluation of 25 Hydroxyvitamin D Levels and Determination of the New Population-Based Reference Ranges in the Elazığ Region

Objective: Recently, it is discussed that deficiency of vitamin D may be related to a variety of serious diseases. Our aim in this study is to evaluate 25(OH)vitD levels of Elazig population and to determine new reference values based on the population with indirect methods. Material and Method: As of July 2013 for a period of approximately two years, 25 (OH)vitD test studied patients admitted to Elazig Education and Research Hospital were included in this study. The 25(OH)vitD levels were analyzed using the Siemens ADVIA Centaur XP system by CLIA method in the contracted laboratory. Retrospectively obtained data from the laboratory information system were analyzed after editing according to the exclu-sion criteria. Patients were divided into groups according to age, sex and season. The reference range was calculated by non-parametric method. Results: When the cut-off value for 25(OH)vitD deficiency is accepted as 20 ng/ml, it was observed that vitamin D deficiency was present in %78.2 of general population. The determined reference intervals for 2.5-97.5 th percentil range were 5.20-35.20 ng/ml which are lower than the recommen-ded reference intervals by manufacturer. Conclusion: In this study, 25(OH)vitD levels were assessed in the a large population of Elazığ region. At the same time, new reference ranges were determined which we believe will make a positive contribution on the clinical diagnosis and treatment. Nevertheless, we believe that this work should be carried out also in the healthy population.

PDF

___

Ustaalioğlu YE, Dirican M. Plazma 25-OH Vitamin D ölçümünde HPLC, CMIA ve ECLIA yöntemlerinin karşılaştırılması. Ulu-dağ Üniversitesi Tıp Fakültesi Dergisi 2015; 41: 53-8.
Souberbielle J-C, Friedlander G, Kahan A, Cormier C. Evaluating vitamin D status. Implications for preventing and managing osteoporosis and other chronic diseases. Joint Bone Spine 2006; 73: 249-53.
Park S, Kim da S, Kang S. Vitamin D deficiency impairs glucose-stimulated insulin secretion and increases insulin resistance by reducing PPAR-gamma expression in nonobese Type 2 diabetic rats. J Nutritiol Biochem 2016; 27: 257-65.
Faridi KF, Lupton J, Martin S, Kulkarni K, Jones S, Michos E. Vitamin D deficiency and non-lipid serum markers of cardiovascular risk: The very large database of lipids study. J Am Coll of Cardiol 2016; 67: 1908.
Iniesta RR, Rush R, Paciarotti I, et al. Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients. Clin Nutr 2016; 35: 95-108.
Kuźma E, Soni M, Littlejohns TJ, et al. Vitamin D and memory decline: Two population-based prospective studies. J Alzheimer's Dis 2016; 50: 1099-108.
Williams JD, Aggarwal A, Swami S, et al. Tumor autonomous effects of vitamin D deficiency promote breast cancer metastasis. Endocrinology 2016; 157: 1341-7.
Chen Y, Kinney L, Bozovic A, et al. Performance evaluation of Siemens ADVIA Centaur and Roche MODULAR Analytics E170 Total 25-OH Vitamin D assays. Clin Biochem 2012; 45: 1485-90.
Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 2009; 19: 73-8.
Wagner D, Hanwell HE, Vieth R. An evaluation of automated methods for measurement of serum 25-hydroxyvitamin D. Clin Biochem 2009; 42: 1549-56.
Zerwekh JE. The measurement of vitamin D: analytical aspects. Ann Clin Biochem 2004; 41: 272-81.
Kaplan LA, Kazmıerczak E. Clinical chemistry: theory, analysis, correlation: Mosby, 2003: 789-90.
Flegar-Meštrić Z, Perkov S, Radeljak A. Standardization in laboratory medicine: Adoption of common reference intervals to the Croatian population. World J Methodology 2016; 6: 93.
Alpdemir M, Alpdemir MF. Determination of the reference range with the indirect methods of 25-Hydroxyvitamin D3 test in Balikesir Region, Turkey. Turk J Med Sci 2016; 46: 1504-19.
CLSI. Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline-Third Edition. CLSI Do-cument C28-A3. Wayne, PA, USA: Clinical and Laboratory Standards Institute; 2008
Lumsden J, Mullen K. On establishing reference values. Canadian J Comparative Med 1978; 42: 293.
Reed AH, Henry RJ, Mason WB. Influence of statistical method used on the resulting estimate of normal range. Clinl Chem 1971; 17: 275-84.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimati-on of optimal serum concentrations of 25-hydroxyvitamin D for multiple health out-comes. American J Clin Nutrition 2006; 84:18-28.
Mithal A, Wahl DA, Bonjour JP, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporosis internati-onal: a journal established as result of coope-ration between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2009; 20:1807-20.
Bouillon RA, Auwerx JH, Lissens WD, Pelemans WK. Vitamin D status in the elderly: seasonal substrate deficiency causes 1, 25-dihydroxycholecalciferol deficiency. American J Clin Nutr 1987; 45: 755-63.
Moan J, Porojnicu AC, Dahlback A, Setlow RB. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proceedings of the National Academy of Sciences of the United States of America. 2008; 105: 668-73.
Vurgun E, Evliyaoğlu O, Yıldırmak S. Kanıta dayalı laboratuvar: D vitamini yetersizlik sınırlarının belirlenmesi. Med Bull Haseki 2016; 54: 76-82.
Looker AC, Johnson CL, Lacher DA, Pfeiffer CM, Schleicher RL, Sempos CT. Vitamin D status: United States, 2001–2006. NCHS Data Brief 2011; 59: 1-8.
Solberg H. Approved recommendation (1986) on the theory of reference values. Part 1 The concept of reference values. J Clin Chem Clin Biochem 1987; 25: 337-42.
Baadenhuijsen H, Arts J, Somers L, Smit J. Refvalue, a software package to calculate reference intervals from total hospital patient laboratory data. Elsevier Science Publishers, Amsterdam, New York; 1984.