Инфекция и иммунитет. 2021;
Связь низкого статуса витамина D с тяжестью детской пневмонии у госпитализированных болгарских пациентов
https://doi.org/10.15789/2220-7619-AAB-1765Аннотация
Инфекции нижних дыхательных путей являются одной из наиболее важных причин заболеваемости и детской смертности во всем мире. Несмотря на успехи в лечении и профилактике, детская пневмония является основной причиной госпитализации и остается основной причиной смерти, унеся примерно 800 000 жизней детей в 2018 году. Во всем мире более 1,23 миллиона детей умерли от пневмонии, не дожив до своего 5-летия, что эквивалентно более 3.400 смертей в день во всем мире. Появляется все больше свидетельств того, что витамин D играет важную роль в иммунной системе, модулируя как врожденный, так и адаптивный иммунитет. Витамин D является дополнительным фактором регуляции воспалительной реакции. Его действие опосредуется рецептором витамина D (VDR), который присутствует практически во всех типах иммунных клеток, включая активированные клетки CD4 + и CD8 +, В-клетки, макрофаги, нейтрофилы и дендритные клетки. Дефицит витамина D связан со снижением защиты хозяина от инфекций. Целью был анализ низкого уровня витамина D как фактора риска осложнений пневмонии, использования нескольких антибиотиков и длительного пребывания в больнице среди госпитализированных педиатрических пациентов с внебольничной пневмонией. Всего в исследование были включены 200 детей (102 здоровых контроля и 98 с тяжелой пневмонией) в возрасте от 11 дней до 17 лет. Электрохемилюминесцентный иммуноанализ использовали для измерения уровней 25-гидроксивитамина D. Средние уровни витамина D у всех обследованных детей находились в недостаточном диапазоне 51,4-68,9 нмоль / л. Контрольная группа показала более низкие значения, чем основная. группа. Больные случаи с осложненной пневмониех имели значительно более низкие уровни в диапазоне 29,7-68,0 нмоль / л по сравнению с больными без осложнений в диапазоне 49,1-88,6 нмоль / л. Была обнаружена значимая отрицательная корреляция между концентрацией витамина D и продолжительностью пребывания в больнице, количеством антибиотиков, используемых для лечения, и уровнями маркеров воспаления в сыворотке крови. Низкий уровень витамина D связан с тяжестью заболевания, но не связан с заболеваемостью / частотой заболевания. Дети с низким уровнем витамина D могут подвергаться более высокому риску развития опасных для жизни осложнений, госпитализации с реанимацией и более выраженной воспалительной реакции.
Список литературы
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7. Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zügel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RL. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006, vol. 24, pp 1770-1773. doi: 10.1126/science.1123933.
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9. Mamani M, Muceli N, Ghasemi Basir HR, Vasheghani M, Poorolajal J. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study. Int J Gen Med. 2017, vol 10, pp 423-429. doi: 10.2147/IJGM.S149049.
10. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020, vol 12, no 4, pp 988. doi: 10.3390/nu12040988.
11. Pletz MW, Terkamp C, Schumacher U, Rohde G, Schütte H, Welte T, Bals R; CAPNETZ-Study Group. Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2 D are associated with disease severity. Respir Res. 2014, vol 15, no 1, pp 53. doi: 10.1186/1465-9921-15-53.
12. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011, vol 96, no 1, pp 53-58. doi: 10.1210/jc.2010-2704.
13. Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012, vol 24, no 3, pp 69-71.
14. Holick MF. Vitamin D: extraskeletal health. Rheum Dis Clin North Am. 2012, vol 38, no 1, pp 141-160. doi: 10.1016/j.rdc.2012.03.013.
15. Hossein-nezhad A, Holick MF. Optimize dietary intake of vitamin D: an epigenetic perspective. Curr Opin Clin Nutr Metab Care. 2012, vol 15, no 6, pp 567-579. doi: 10.1097/MCO.0b013e3283594978.
16. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014, vol 144, pp 38-45. doi: 10.1016/j.jsbmb.2013.11.003.
17. Holick MF. Vitamin D deficiency. N Engl J Med. 2007, vol 357, no 3, pp 266-281. doi: 10.1056/NEJMra070553
18. Şişmanlar T, Aslan AT, Gülbahar Ö, Özkan S. The effect of vitamin D on lower respiratory tract infections in children. Turk Pediatri Ars. 2016, vol 51, no 2, pp 94-99. doi: 10.5152/TurkPediatriArs.2016.3383.
19. Pilz S, Rutters F, Dekker JM. Disease prevention: vitamin D trials. Science. 2012, vol 338, no 6109, pp 883. doi: 10.1126/science.338.6109.883-c.
20. Esposito S, Lelii M. Vitamin D and respiratory tract infections in childhood. BMC Infect Dis. 2015, vol 15, pp 487. doi: 10.1186/s12879-015-1196-1.
21. Lips P, Cashman KD, Lamberg-Allardt C, Bischoff-Ferrari HA, Obermayer-Pietsch B, Bianchi ML, Stepan J, El-Hajj Fuleihan G, Bouillon R. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol. 2019, vol 180, no 4, pp 23-54. doi: 10.1530/EJE-18-0736.
22. Ene MC., Tertiu O., Vrancianu O. , Chifiriuc M. Vitamin D status in adult and pediatric Romanian population. 2018, Roumanian Archives of Microbiology and Immunology, vol 77 no 3 pp. 198-212 doi: 10.1371/journal.pone.0128010.
23. Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R. Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab. 2003, vol 88, no 10, pp 4623-4632. doi: 10.1210/jc.2003-030358.
24. Dhungel, A., & Alam, M. Efficacy of vitamin D in children with pneumonia: a randomized control trial study. Janaki Medical College Journal of Medical Science, 2016, vol 3, no 1, 5-13. doi:10.3126/jmcjms.v3i1.15369.
25. Landry, A., Docherty, P., Ouellette, S., & Cartier, L. J. Causes and outcomes of markedly elevated C-reactive protein levels. Canadian family physician Medecin de famille canadien, 2017,vol 63, no 6, e316–e323.
26. Sakka ASE, Iman SS, Amer HA, Moustafa SA. Vitamin D deficiency and low hemoglobin level as risk factors for severity of acute lower respiratory tract infections in Egyptian children: a case-control study. Egypt Pediatr Assoc Gaz. 2014, vol 62, pp 1–7. doi:10.1016/j.epag.2013.12.001.
27. de Oliveira C, Biddulph JP, Hirani V, Schneider IJC. Vitamin D and inflammatory markers: cross-sectional analyses using data from the English Longitudinal Study of Ageing (ELSA). J Nutr Sci. 2017, vol 6, e1. doi:10.1017/jns.2016.37.
28. Inamo Y, Hasegawa M, Saito K, Hayashi R, Ishikawa T, Yoshino Y, Hashimoto K, Fuchigami T. Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children. Pediatr Int. 2011, vol 53, no 2, pp 199-201. doi: 10.1111/j.1442-200x.2010.03224.x.
Russian Journal of Infection and Immunity. 2021;
Association of low vitamin D status with Childhood Pneumonia Severity in Hospitalized Bulgarian Patients
https://doi.org/10.15789/2220-7619-AAB-1765Abstract
Lower respiratory tract infections are among the most important causes of morbidity and mortality in the pediatric population worldwide. Despite advances in treatment and prevention, childhood pneumonia is a major reason for hospital admissions and remains a leading cause of death, claiming an estimated 800,000 children’s lives in 2018. Globally, over 1.23 million children died of pneumonia before reaching their 5th birthday - the equivalent of over 3.400 deaths per day worldwide. There is growing evidence that vitamin D plays an important role in the immune system by modulating both innate and adaptive immunity. Vitamin D is an additional factor in the inflammatory response regulation. Its action is mediated via the vitamin D receptor (VDR), which is present in almost all types of immune cells, including activated CD4+ and CD8+ cells, B cells, macrophages, neutrophils and dendritic cells. Vitamin D deficiency is associated with decreased host defenses against infections. Therefore, our aim was to investigate whether low vitamin D status was a risk factor for pneumonia complications, usage of multiple antibiotics and prolonged hospital stay among hospitalized pediatric patients with community-aquired pneumonia. Total of 200 children (102 healthy controls and 98 with severe pneumonia) from 11 days to 17 years old were included in the study. Cases with severe pneumonia were subdivided into groups with and without complications (36 and 62, respectively). Electro-chemiluminescence immunoassay was used to measure the serum 25-hydroxyvitamin D levels. The control group showed lower values than the study group. Cases with complicated pneumonia had significantly lower levels 29.7-68.0 nmol/l, compared with 49.1-88.6 nmol/l in cases without complications. A significant negative correlation was found between vitamin D concentrations and duration of hospital stay, the number of antibiotics used for treatment, and serum levels of inflammatory markers. The low status of vitamin D is related to the severity of the disease, but has not been associated with the incidence/frequency of the disease. Children with low vitamin D levels may be at higher risk of developing life-threatening complications, intensive care admissions and a higher inflammatory response.
References
1. World Health Organisation (August 2, 2019). Pneumonia and diarrhea progress report, retrieved from https://www.who.int/news-room/fact-sheets/detail/pneumonia
2. WHO-UNICEF Estimates of National Immunization Coverage (WUENIC), 1980-2019. (July, 2020) report, retrieved from: https://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html
3. Martens P-J, Gysemans C, Verstuyf A, Mathieu C. Vitamin D’s Effect on Immune Function. Nutrients. 2020; vol 12 no 5, pp1248. doi:10.3390/nu12051248
4. Gois PHF, Ferreira D, Olenski S, Seguro AC. Vitamin D and Infectious Diseases: Simple Bystander or Contributing Factor? Nutrients. 2017 vol 9 no 7, pp 651. doi: 10.3390/nu9070651.
5. Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol. 2008, vol 37 no 1, pp 13-19. doi: 10.1093/ije/dym247.
6. Rolf L, Muris AH, Hupperts R, Damoiseaux J. Vitamin D effects on B cell function in autoimmunity. Ann N Y Acad Sci. 2014, vol 1317, pp 84-91. doi: 10.1111/nyas.12440.
7. Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zügel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RL. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006, vol. 24, pp 1770-1773. doi: 10.1126/science.1123933.
8. De Smet K, Contreras R. Human antimicrobial peptides: defensins, cathelicidins and histatins. Biotechnol Lett. 2005, vol 27, no18, pp 1337-1347. doi: 10.1007/s10529-005-0936-5.
9. Mamani M, Muceli N, Ghasemi Basir HR, Vasheghani M, Poorolajal J. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study. Int J Gen Med. 2017, vol 10, pp 423-429. doi: 10.2147/IJGM.S149049.
10. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020, vol 12, no 4, pp 988. doi: 10.3390/nu12040988.
11. Pletz MW, Terkamp C, Schumacher U, Rohde G, Schütte H, Welte T, Bals R; CAPNETZ-Study Group. Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2 D are associated with disease severity. Respir Res. 2014, vol 15, no 1, pp 53. doi: 10.1186/1465-9921-15-53.
12. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011, vol 96, no 1, pp 53-58. doi: 10.1210/jc.2010-2704.
13. Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012, vol 24, no 3, pp 69-71.
14. Holick MF. Vitamin D: extraskeletal health. Rheum Dis Clin North Am. 2012, vol 38, no 1, pp 141-160. doi: 10.1016/j.rdc.2012.03.013.
15. Hossein-nezhad A, Holick MF. Optimize dietary intake of vitamin D: an epigenetic perspective. Curr Opin Clin Nutr Metab Care. 2012, vol 15, no 6, pp 567-579. doi: 10.1097/MCO.0b013e3283594978.
16. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014, vol 144, pp 38-45. doi: 10.1016/j.jsbmb.2013.11.003.
17. Holick MF. Vitamin D deficiency. N Engl J Med. 2007, vol 357, no 3, pp 266-281. doi: 10.1056/NEJMra070553
18. Şişmanlar T, Aslan AT, Gülbahar Ö, Özkan S. The effect of vitamin D on lower respiratory tract infections in children. Turk Pediatri Ars. 2016, vol 51, no 2, pp 94-99. doi: 10.5152/TurkPediatriArs.2016.3383.
19. Pilz S, Rutters F, Dekker JM. Disease prevention: vitamin D trials. Science. 2012, vol 338, no 6109, pp 883. doi: 10.1126/science.338.6109.883-c.
20. Esposito S, Lelii M. Vitamin D and respiratory tract infections in childhood. BMC Infect Dis. 2015, vol 15, pp 487. doi: 10.1186/s12879-015-1196-1.
21. Lips P, Cashman KD, Lamberg-Allardt C, Bischoff-Ferrari HA, Obermayer-Pietsch B, Bianchi ML, Stepan J, El-Hajj Fuleihan G, Bouillon R. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol. 2019, vol 180, no 4, pp 23-54. doi: 10.1530/EJE-18-0736.
22. Ene MC., Tertiu O., Vrancianu O. , Chifiriuc M. Vitamin D status in adult and pediatric Romanian population. 2018, Roumanian Archives of Microbiology and Immunology, vol 77 no 3 pp. 198-212 doi: 10.1371/journal.pone.0128010.
23. Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R. Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab. 2003, vol 88, no 10, pp 4623-4632. doi: 10.1210/jc.2003-030358.
24. Dhungel, A., & Alam, M. Efficacy of vitamin D in children with pneumonia: a randomized control trial study. Janaki Medical College Journal of Medical Science, 2016, vol 3, no 1, 5-13. doi:10.3126/jmcjms.v3i1.15369.
25. Landry, A., Docherty, P., Ouellette, S., & Cartier, L. J. Causes and outcomes of markedly elevated C-reactive protein levels. Canadian family physician Medecin de famille canadien, 2017,vol 63, no 6, e316–e323.
26. Sakka ASE, Iman SS, Amer HA, Moustafa SA. Vitamin D deficiency and low hemoglobin level as risk factors for severity of acute lower respiratory tract infections in Egyptian children: a case-control study. Egypt Pediatr Assoc Gaz. 2014, vol 62, pp 1–7. doi:10.1016/j.epag.2013.12.001.
27. de Oliveira C, Biddulph JP, Hirani V, Schneider IJC. Vitamin D and inflammatory markers: cross-sectional analyses using data from the English Longitudinal Study of Ageing (ELSA). J Nutr Sci. 2017, vol 6, e1. doi:10.1017/jns.2016.37.
28. Inamo Y, Hasegawa M, Saito K, Hayashi R, Ishikawa T, Yoshino Y, Hashimoto K, Fuchigami T. Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children. Pediatr Int. 2011, vol 53, no 2, pp 199-201. doi: 10.1111/j.1442-200x.2010.03224.x.
