Background: The use of vitamin D in the treatment of depressive disorders in patients with chronic obstructive pulmonary disease (COPD) is justified by its pathophysiology, but it is not always feasible in clinical practice. This may be related to the lack of guidelines for implementation for this patient group, as well as to the inadequate sample of patients with baseline high vitamin D levels or mild psychoemotional distress.Objective: To assess the changes of psychoemotional status over time in COPD patients against the maintenance of vitamin D levels at>34.3 ng/ml for one year.Materials and methods: The study included 264 COPD patients randomized into the treatment and control groups (135 and 129 patients, respectively). The patients in both groups were divided into 4 subgroups according to their forced expiratory volume in 1 second (FEV1) values and vitamin D levels. All the patients were administered an inactive vitamin D (colecalciferol): in the main group, according to the scheme ensuring maintenance of the micronutrient value above the goal for 12 months, and in the control group according to the standard scheme of correction of vitamin D deficiency. Depression symptoms were assessed in Geriatric Depression Scale (GDS-15) at the beginning of the study and at its end.Results: After 12 months of vitamin D treatment, the main group showed a statistically significant decrease in the rate of severe depression (14.8% vs 6.7%, χ2=4.67, p=0.04) and an increase in the proportion of patients with normal psychoemotional status (28.2% vs 49.6%, χ2=13.11, p=0.03). In addition, there was a significant difference between the rates of severe depression in the main and control groups after 12 months of treatment: 6.7% vs 14.7% (χ2=4.52, p=0.02).Conclusion: Maintenance of vitamin D levels above 34.3 ng/ml in COPD patients for 12 months reduces the proportion of patients with severe depression.
Aim. To assess the dynamics of the main echocardiographic parameters in patients with chronic obstructive pulmonary disease (COPD) and early-stage chronic kidney disease (CKD) taking native vitamin D.Material and methods. The study included 264 patients, which were divided into two groups: experimental group (n=135) — patients with stage 2-4 COPD (men, mean age — 72,2±3,8 years, mean disease duration — 23,1±3,4 years); control group (n=136) — patients with stage 2-4 COPD, comparable in age and sex. Patients of both groups were divided into 4 subgroups depending on forced expiratory volume in 1 second and vitamin D levels. In the experimental group, native vitamin D therapy was performed according to regimen that maintains its level >34,3 ng/ml during the year; in the control group — according to the Russian Association of Endocrinologists guidelines. Echocardiography was performed for all patients at the beginning and end of the study.Results. In all subgroups of the experimental group, a statistically significant increase in the left ventricular ejection fraction was revealed (p<0,05); in patients with moderate COPD (GOLD 2) and vitamin D deficiency and patients with severe and very severe COPD (GOLD 3,4) and vitamin D insufficiency of the experimental group, we observed a significant decrease in the end-systolic dimension, average left atrial size and increase in stroke volume and stroke volume index, as well as normalization of the left ventricular geometry (p<0,05). In the control group after 12 months, no significant changes were detected.Conclusion. Maintaining of vitamin D level >34,3 ng/ml for 12 months in patients with COPD and early-stage CKD was associated with a significant improvement in myocardial remodeling. This indicates an improvement in cardiovascular adaptation and function.
Целью работы стала оценка динамики ультразвуковых параметров почечного кровотока у больных ХОБЛ, имеющих начальные стадии хронической болезни почек (ХБП), на фоне лечения препаратами неактивного витамина D . В исследование включены 264 пациента с ХОБЛ II-IV степени тяжести в сочетании с ХБП I-II стадии: 135 пациентов основной группы и 129 - контрольной. Каждая группа была разделена на четыре подгруппы по величине объема форсированного выдоха (ОФВ) и уровню витамина D . В основной группе был назначен препарат нативного витамина D по схеме, обеспечивающей поддержание уровня >34,3 нг/мл в течение года, в контрольной - согласно рекомендациям Российской ассоциации эндокринологов. Всем пациентам на этапе включения в исследование и после его окончания проводили УЗИ почек с расчетом индекса резистентности Пурсилота ( RI ), исследование уровня альбуминурии. У 16 (24,1%) пациентов основной группы выявлено уменьшение тяжести альбуминурии с А3 до А2, ау 58 (42,9%) - повышение СКФ. Статистически значимое снижение значения индекса резистентности почечных артерий зафиксировано у пациентов основной группы со среднетяжелым течением ХОБЛ ( GOLD 2) и дефицитом витамина D ( р <0,05). Поддержание уровня витамина D более 34,3 нг/мл в течение 12 мес у пациентов с ХОБЛ в сочетании с ХБП I-II стадии ассоциировано с уменьшением тяжести альбуминурии, повышением СКФ, статистически значимым снижение индекса резистентности почечных артерий у пациентов основной группы со среднетяжелым течением ХОБЛ ( GOLD 2) и дефицитом витамина D . The aim of the work was to assess the dynamics of ultrasound parameters of renal blood flow in patients with chronic obstructive pulmonary disease (COPD)and initial stages of chronic kidney disease (CKD) during treatment with inactive vitamin D . The study included 264 patients with COPD of 2-4 degrees of severity in combination with CKD of 1-2 stages: 135 patients of the main group and 129 patients of the control group. Each group was divided into 4 subgroups according to the value of FEVand vitamin D level. In the main group, the native vitamin D was prescribed according to the scheme providing maintenance of vitamin D level >34,3 ng/ml during the year, in the control group - according to the recommendations of the Russian Association of Endocrinologists. An ultrasound of the kidneys with the calculation of the resistance index ( RI ) and albuminuria level were carried out in all patients at inclusion into the study and after its completion. A decrease in the severity of albuminuria from A3 to A2 was revealed in 24,1 % (16), and an increase in GFR - in 42,9 % (58) patients of all patients in the main group. A statistically significant decrease in the renal artery resistance index was recorded in the group of patients with moderate COPD ( GOLD 2) and vitamin D deficiency in the main group ( p <0,05). The maintaining of vitamin D levels more than 34,3 ng/ ml over 12 months in patients with COPD in combination with CKD stage 1-2 was associated with a decrease in the severity of albuminuria, with an increase in GFR, and statistically significant decrease of resistance index in renal arteries of patients with moderate clinical course of COPD ( GOLD 2) and lack of vitamin D .
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