MULTİPL SKLEROZ HASTALARINDA VİTAMİN D, PARATHORMON, CİNSİYET, İNTERLÖKİN 10 VE TÜMÖR NEKROZ FAKTÖR ALFA İLİŞKİSİ
Giriş: Güneş ışığına maruziyetin fazla olduğu bölgelerde Multipl Skleroz’un daha az sıklıkla görülmesinde D vitamininin rolü olduğu düşünülmektedir. Vitamin D’nin klinik özellikler ile ilişkisi ve bu etkisinin kadın hastalarda daha belirgin olduğu görüşü tartışmalıdır. Bu çalışmada relapsing-remitting multipl skleroz hastalarında vitamin D, sitokin ve cinsiyet arasındaki ilişki araştırıldı. Gereç ve yöntem: Çalışmaya remisyon döneminde olan 74 Relapsing-remitting multiple skleroz hastası alındı. Kontrol grubu benzer yaş ve cinsiyette 50 sağlıklı bireyden oluşturuldu. Hasta ve kontrol gruplarında serum vitamin D, interlökin-10, tümör nekroz faktör-α ve parathormon düzeyleri ölçüldü. Vitamin D’nin cinsiyet ve klinik özellikler ile ilişkisi araştırıldı. Bulgular: Ortalama vitamin D düzeyi hasta grubunda 14.4 ng/ml, kontrol grubunda 16 ng/ml olarak saptandı. Hasta ve kontrol gruplarında vitamin D (p:0.206), Interlökin-10 (p:0.081), tümör nekroz faktör-α (p: 0,340) ve parathormon (p:0.107) düzeyleri benzer bulundu. Klinik ağırlaştıkça vitamin D düzeyinin düşme eğiliminde olduğu gözlendi ise de bu ilişki istatistiksel anlamlılığa ulaşmadı. Kadınlarda vitamin D düzeyi daha düşük saptandı. Sonuç: Hem hasta hem de kontrol grubunda vitamin D düzeyi düşüktü ve vitamin D klinik özellikler ile ilişkili bulunmadı.
VITAMIN D, PARATHORMONE, GENDER, INTERLEUKIN 10 AND TUMOR NECROSIS ALPHA RELATIONSHIP IN MULTIPLE SCLEROSIS PATIENTS
Introduction: Vitamin D is thought to have a role on multiple sclerosis hence MS cases are less frequent in theareas where exposure to sunlight is high. The idea that vitamin D is related to clinical features and this effect ismore prominent in female patients is controversial. In this study, the relationship between vitamin D levels, proand anti-inflammatory cytokine levels and gender in relapsing-remitting multiple sclerosis patients wereinvestigated. Materials and Methods: 74 patients with relapsing-remitting multiple sclerosis who were in the remission periodwere included in the study. The control group consisted of 50 healthy individuals with similar age and gender.Serum vitamin D, parathormone, interleukin-10 and tumor necrosis factor-α levels were tested in the patient andcontrol groups. The relationship of vitamin D with gender, clinical features and cytokine levels was alsoinvestigated.Results: The mean vitamin D level was 14.4 ng/ml in the patient group and 16 ng/ml in the control group. Thelevels of vitamin D (p: 0,206), Interleukin-10 (p: 0,081), Tumor necrosis factor-α (p: 0,340) and parathormone (p:0,107) were similar in the patient and control groups. Although vitamin D values tended to decrease as clinicalseverity was worsening, this relationship was not statistically significant. Vitamin D levels found to be lower infemale .Conclusion: Vitamin D levels were low in both the patient and control group. There was no correlation betweenvitamin D levels and clinical features.
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- 1. Ascherio A, Munger KL, White R, Köchert K, Simon KC, Polman CH, et al. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol 2014; 71(3): 306-14.
- 2. Mowry EM, Waubant E, Mc Culloch CE, Okuda DT, Evangelista AA, Lincoln RR et al. Vitamin D predicts new brain MRI activity in multiple sclerosis. Ann Neurol 2012; 72(2): 234-40
- 3. Pierrot-Deseilligny C, Souberbielle J. Vitamin D and multiple sclerosis: An update. Mult Scler Relat Disor 2017; 14: 35-45.
- 4. Runia TF, Hop WC, de Rijke YB, Buljevoc D, Hintzen RQ. Lower serum vitamin D levels are associated with a higher relapse risk in multiple sclerosis. Neurology 2012; 79(3): 261-6.
- 5. Sintzel MB, Rametta M, Reder AT. Vitamin D and multiple sclerosis: A comprehensive review. Neurol Ther 2018; 7: 59-85
- 6. Sellner J, Kraus J, Awad A, Milo R, Henner B, Stüve O. The increasing incidence and prevalence of female multiple sclerosis – A critical analysis of potential environmental factors. Autoimmun Rev 2011; 10(8): 495-502.
- 7. Eskandari G, Ghajarzadeh M, Yekaninejad MS, Sahraian MA, Gorji R, Rajaei F, et al. Comparison of serum vitamin D level in multiple sclerosis patients, their siblings, and healthy controls. Iran J Neurol 2015; 14(2): 81-5.
- 8. Gelfand JM, Cree BA, McElroy J, Okseberg J, Green R, Mowry EM, et al. Vitamin D in African Americans with multiple sclerosis. Neurology 2011; 76(21): 1824-30.
- 9. Karampoor S, Zahednasab H, Ramagopalan S, Mehrpour M, Safornejad Tameshkel F, et al. 25-hydroxyvitamin D levels are associated with multiple sclerosis in Iran: A cross-sectional study. J Neuroimmunol 2016; 290; 47-8.
- 10. Kumar RS, Syed S, Kumar AA, Kumari KNS, Sajitha K. Serum vitamin D levels in Indian patients with multiple sclerosis. Ind J Clin Biochem 2013; 28(3): 255-8.
- 11. Wawrzyniak S, Mikolajewska E, Kuczko-Piekarska E, Niezgozinska-Maciejek A, Goch A. Association of vitamin D status and clinical and radiological outcomes in a treated MS population in Poland. Brain Behav 2017;7(2):e00609.
- 12. Zhang Y, Liu G, Han X, Dong H, Geng J. The association of serum 25-hydroxyvitamin D levels with multiple sclerosis severity and progression in a case-control study from China. J Neuroimmunol 2016; 297: 127-31.
- 13. Hussain AN, Alkhenizan AH, El Shaker M, Raef H, Gabr A. Increasing trends and significance of hipovitaminosis D: a population-based study in Kingdom of Saudi Arabia. Arch Osteoporos 2014; 9: 2-5
- 14. Holick MF. High prevalance of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006; 81(3): 353-73.
- 15. Harandi AA, Shahbeigi S, Pakdaman H, Fereshteehnejad SM, Nikravesh E, Jalilzadeh R. Association of serum 25(OH) vitamin D3 concentration with severity of multiple sclerosis. Ir J Neurol 2012; 11(2): 54-8.
- 16. Becker J, Callegaro D, Lana-Peixoto MA, Talim N, Vidaletti T, de Paula Correa M,et al. Hypovitaminosis D association with disease activity in relapsing remitting multiple sclerosis in Brazil. J Neurol Sci 2016; 363: 236-9.
- 17. Niino M, Sato S, Fukazawa T, Masaki K, Miyazaki Y, Matsuse D, et al. Decreased serum vitamin D in Japanese patients with multiple sclerosis. J Neuroimmunol. 2015; 279: 40-5.
- 18. Nikanfar M, Taheri-Aghdam AA, Yazdani M, Sahaffi S, MasaudianN, Akbari H, et al. Serum 25(OH) vitamin D levels is not associated with disability in multiple sclerosis patients: A case-control study. Iran J Neurol 2015; 14(1): 17-21.
- 19. Kragt J, van Amerongen B, Killestein J, Dikjstra C, Vitdehaa B, Pohan Ch, et al. Higher levels of 25-hydroxyvitamin D are associated with a lower incidence of multiple sclerosis only in women. Mult Scler 2009; 15(1): 9-15.
- 20. Thouvenot E, Orsini M, Daures JP, Comu W. Vitamin D is associated with degree of disability in patients with fully ambulatory relapsing-remitting multiple sclerosis. Eur J Neurol 2015;22(3):564-9.
- 21. Farsani ZS, Behmanesh M, Sahraian MA. Interleukin-10 but not transforming growth factor-β1 gene expression is upregulated by vitamin D treatment in multiple sclerosis patients. J Neurol Sci 2015; 350(1-2):18-23.
- 22. Correale J, Aguirre MEB, Farez MF. Sex-specific environmental influences affecting MS development. Clin Immunol 2013; 149(2):176-81.
- 23. Correale J, Ysrraelit MC, Gaitan MI. Gender differences in 1,25 dihydroxyvitamin D3 immunomodulatory effects in multiple sclerosis patients and healthy subjects. J Immunol 2010; 185: 4948-58.
- 24. Barnes MS, Bonham MP, Robson PJ, Strain JJ, Wallace JM. Assessment of 25-hydroxyvitamin D and 1,25- dihydroxivitamin D3 concentrations in male and female multiple sclerosis patients and control volunteers. Mult Scler 2007; 13(5): 670-2.
- 25. Pascale AV, Finelli R, Giannotti R, Visco V, Fabbricatore D, Matula I, et al. Vitamin D, parathyroid hormone and cardiovascular risk: the good, the bad and the ugly. J Cardiovasc Med (Hagerstown) 2018; 19(2): 62-6.
- 26. Dadaei T, Safapoor MH, Aghdaei HA, Balaii H, Pourhoseinghali MA, Naderi N, et al. Effect of vitamin D3 supplementation on TNF-α serum level and disease activity index in Iranian IBD patients. Gastroenterol Hepatol Bed Bench 2015; 8(1): 49- 55.
- 27. Kuo YT, Kuo CH, Lam KP, Chu YT, Wang WL, Huang CH, et al. Effects of vitamin D3 on expression of tumor necrosis factor-alpha and chemokines by monocytes. J Food Sci 2010; 75(6): 200-4.
- 28. Mrad MF, El Ayoubi NK, Esmerian MO, Kajan JM, Khoury SJ. Effect of vitamin D replacement on immunological biomarkers in patients with multiple sclerosis. Clin Immunol 2017; 181: 9-15.
- 29. Van Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol 2005;97(1-2):93-101.