Воспалительные заболевания кишечника у детей: уровень обеспеченности витамином D и особенности течения болезни при его недостаточности

Abstract

Objctive. To substantiate and assess the efficacy of using vitamin D and polyunsaturated fatty acids in basic treatment of inflammatory bowel disease (IBD) in children. Patients and methods. We examined 108 patients aged 1 to 17 years with IBD, among them 59 boys (54.6%), 49 girls (45.4%). After assessment of vitamin D status, children with IBD were randomised into two groups, comparable by age, gender and nosological forms. Group D– comprised 54 patients who received only basic IBD therapy, group D+ consisted of 54 patients who received basic treatment and a combination of cholecalciferol and polyunsaturated fatty acids (PUFAs). The children were examined at 1 and 6 months after the beginning of therapy. The comparison group included 62 children of the corresponding age who belonged to the 1st–2nd health status groups. Results. As has been found, more than 90% of children with IBD have an insufficient vitamin D status (average level 17.9 ± 7.9 ng/ml, in the comparison group – 25.03 ± 8.2 ng/ml, р > 0.05). A quarter of children have a significant vitamin deficiency (levels of 25(ОН)D <10 ng/ml), a moderate negative correlation was found between blood vitamin D levels and IBD activity as assessed by PUCAI and PCDAI scores. After 1 month of treatment we noted a tendency of blood vitamin D levels to increase, while the calprotectin levels and IBD activity indices tended to decrease, but the differences from the initial values were not significant. After 6 months of therapy, vitamin D levels (25.03 ± 8.2 ng/ml) and IBD activity indices significantly differed from those at baseline in group D+ (PUCAI 15.09 ± 3.92; PCDAI 14.12 ± 4.06). In the group that did not receive cholecalciferol with PUFAs, vitamin D levels did not change significantly, and the reduction of the inflammatory activity was less evident. Conclusion. The study demonstrated a high incidence of vitamin D insufficiency among children with IBD. A better clinical and laboratory dynamics of IBD was found in the group of patients who received supplements with cholecalciferol and PUFAs, which substantiates the necessity of using vitamin D in comprehensive therapy of IBD. Key words: vitamin D, inflammatory bowel disease, children, polyunsaturated fatty acids