Менеджмент дефіциту вітаміну D у пацієнток з дисгормональними поєднаними проліферативними захворюваннями репродуктивних органів

Abstract

The lack of vitamin D, according to WHO, is a pandemic. Studies conducted in different countries show the problem of vitamin D deficiency regardless of geographical latitudes in people of different age, nationality, vitamin D intake with food, even in those countries where there is no shortage of sunny days. Low level of vitamin D is considered as an independent predictor of the formation and progression of obesity, insulin resistance, PCOS, increased risk of endometriosis, uterine leiomyoma. Along with the influence on many vital processes in the human body, vitamin D plays a very important role in regulating the reproductive function of women. D-hormone affects the reproductive organs both directly, by binding to receptors (VDR), and mediated, through stimulation of the synthesis of steroid hormones and other effects. The objective: to study the effectiveness of clinical management of vitamin D deficiency in women with combined dyshormonal proliferative diseases of the reproductive organs. Materials and methods. The study involved 350 women of active and late reproductive age, residents of the Lviv region, who applied for preventive examination or with complaints of menstrual irregularity, infertility, miscarriage, chronic pelvic pain. The complex examination included ultrasonographic screening of the pelvic organs, mammary glands, thyroid gland, for hysteroscopy, endometrial needle biopsy, diagnostic / operative laparoscopy. Level 25(OH)D in the serum was determined by the enzyme immunoassay. I group consisted of 50 women without gynecological and concomitant pathology at the time of enrollment, group II – 300 patients with dyshormonal proliferative pathology of the reproductive organs. Results. Level 25(OH)D in the blood serum averaged 33.8±2.5 ng/ml occurred in 62.0% of women without gynecological pathology and only in 21.6% of women with dyshormonal pathology of the reproductive organs, lack of vitamin D(25(OH)D 22.3±1.5 ng/ml) was detected in 24.0% and 37.7%, respectively. Deficiency of vitamin D(25(OH)D 13.8±4.6 ng/ml) in women without gynecological and somatic pathology was diagnosed in 5.0% of cases and in 36.3% of women with benign proliferative pathology of reproductive organs (p<0.0001), with a severe deficit of vitamin D(25(OH)D in the serum from 4 to 9 ng/ml occurred in 73.7% of the latter.) A differential correction of vitamin D deficiency and deficiency with the use of preventive and curative doses of cholecalciferol Сonclusion. The dose of cholecalciferol (vitamin D3) 2000 IU/day is a sufficient preventive dose with an initial adequate level of vitamin D, but insufficient to eliminate its deficiency. Admission cholecalciferol in a daily dose of 100 mcg (4000 IU) with vitamin D deficiency allows after 3 months to reach 25–28 ng/ml 25(OH)D in the blood serum, but does not result in the level of 25(OH)D 40–50 ng/ml. Admission of 6000 IU/day cholecalciferol with severe vitamin D deficiency allows to reach 25(OH)D 40–50 ng/ml on average after 2.8±1.2 months in the absence of undesirable effects. Key words: vitamin D, vitamin D deficiency, combined dyshormonal proliferative diseases of the reproductive organs, cholecalciferol.