141
6.
Shapovalov V.M., Ovdenko A.G. Surgical infection in combat injuries of the musculoskeletal system.
Bulletin of Surgery. 2014,
№
2. pp. 60-68.
7.
Yusupov Yu.N., Aminov V.S., Guskov M.N. Indirect endolymphatic injection of antibiotics for prophylaxis
and treatment of purulent surgical diseases of the lower extremities. The experience of medical
maintenance of district armed forces. Materials from XVIII district conference. L.2001. p.31.
УДК:
577.161.2::616.5-002.525-031.81
VITAMIN D VA TIZIMLI QIZIL TOSHMA KASALLIGIGA
ZAMONAVIY YONDOSHUV
Daminova Kamola Maratovna
1
, Xusanxodjaeva Feruza Tulkunovna
2
,
1
Toshkent Davlat Stomatologiya Instituti, dotsenti t.f.d.
2
Toshkent Davlat Stomatologiya Instituti, assistent.
СОВРЕМЕННЫЙ
ПОДХОД
К
ВИТАМИНУ
Д
И
СИСТЕМНОЙ
КРАСНОЙ
ВОЛЧАНКЕ
Даминова Камола Маратовна
1,
Хусанходжаева Феруза Тулкуновна
2
,
доцент т.ф.д.,
1
Ташкентского государственного Стоматологического
института
ассистент,
2
Ташкентского
государственного Стоматологического института
Ташкент,
Узбекистан
MODERN APPROACH TO SYSTEMIC LUPUS ERYTHEMATOSIS
AND VITAMIN D
Daminova Kamola Maratovna
1
, Khusankhodzhaeva Feruza Tulkunovna
2
,
1
MD Associate Professor Tashkent State Dental Institute
2
Assistant, Tashkent State Dental Institute
ANNOTATSIYA
Mаqоlаdа tizimli qizil toshma kаsаlligi kеchishigа vitаmin D yеtishmоvchiligining tа’siri xаqidа
mа’lumоtlаr
kеltirlgаn.
Vitаmin Dning
оrgаnizmdаgi miqdоri
vа
tizimli
kаsаlliklar
fаоllik dаrаjаsi
o’rtаsidа qаndаy bоg’liqlik bоrligi, shu bilаn birgа vitаmin D mеtаbоlitlаrini tеrаpеvtik mаqsаdlаrdа
qo’llаsh
оrqаli
erishilgаn
nаtijаlаr
tаhlil
qilingаn.
Vitаmin
D
dеfitsiti
kеng
tаrqаlgаn
pаtоlоgik
xоlаt
bo’lib,
kеng
spеktrdаgi
kаsаlliklаrni
kеchishigа
tа’sirini
ko’rsаtаdi.
Vitаmin
Dning
qоndаgi
kоntsеntrаtsiyasi
pаst
bo’lishi quyosh nuri yеtishmаsligi, gеnеtik mоyillik (vitаmin D rеtsеptоrlаri pоlimоrfizmi), аlimеntаr
оmillаr vа аutоimmun kаsаlliklаr bilаn bоg’liq bo’lishi mumkin. Vitаmin Dning immun tizimigа tа’siri,
аutоimmun kаsаlliklаr pаtоgеnеzidа ishtirоk etishi hаqidаgi yangi ma’lumotlar ko’pchilikdа qiziqish
uyg’оtаdi. Bir qаnchа o’tkаzilgаn tаdqiqоtlаr
vitаmin
Dni аutоimmun kаsаlliklаr rivоjlаnishidа ishtirоk
etuvchi оmil sifаtidа qаrаshni olg’a surishgan. Bundаn tаshqаri zаrdоbdаgi 25(ОH)D miqdоri bir qаnchа
rеvmаtik kаsаlliklаr (RА
vа
TQT)
rivоjlаnishi, fаоllik dаrаjаsi, kеchishi vа prоgnоzidа аhаmiyatgа
egаligi
hаqidа mа’lumоtlаr bоr. Аntirеzоrbtiv, yallig’lаnishgа qаrshi vа immunоmоdulyatоr tа’sirlаri
vitаmin Dni
surunkаli yallig’linish bilаn kеchаdigаn kаsаlliklаrdа bаzis dаvоgа qo’shimchа sifаtidа
qo’llаsh
mаqsаdgа
muvоfiq bo’lishini
аsоslаydi.
Kalit so'zlar:t
izimli qizil toshma
kаsаlligi,
vitаmin
D, autoimmun kasalliklar.
142
АННОТАЦИЯ
В
обзоре
представлены
данные
литературы
о
частоте
гиповитаминоза
D
при
системной
красной
волчанке
(СКВ),
проанализирована
ассоциация
клинико
-
лабораторных
параметров
заболевания и уровня витамина D, рассмотрены возможности терапевтического применения его
метаболитов.
Дефицит
витамина
D
является
весьма
распространенным
патологическим
состоянием,
создающим
предпосылки
для
развития
широкого
круга
болезней.
Низкий
сывороточный уровень витамина D может быть связан с недостаточной солнечной экспозицией,
генетической предрасположенностью (полиморфизм рецепторов витамина D) и алиментарными
факторами,
а
также
сопутствовать
аутоиммунным
заболеваниям.
Выявленные
иммуномодуляторные свойства витамина D представляют интерес с точки зрения возможного
участия
данного
гормона
в
патогенезе
аутоиммунных
заболеваний.
Ряд
исследователей
предлагает
рассматривать
витамин
D
как модифицируемый
фактор
окружающей
среды,
участвующий
в
развитии аутоиммунных заболеваний. Имеются данные о связи низкого сывороточного уровня
25(ОН)D
c
риском
развития,
активностью,
тяжестью
и
прогнозом
некоторых
ревматических
заболеваний
(в
первую
очередь
ревматоидного
артрита
и
СКВ),
что
требует
дальнейшего
изучения.
Антирезорбтивное,
противовоспалительное
и
иммуномодулирующее
действие
метаболитов
витамина
D
обосновывает
целесообразность
их
применения
при
хронических
воспалительных
заболеваниях
в
комбинации
с
традиционными базисными
средствами.
Ключевые
слова:
аутоиммунные
заболевания,
Витамин
Д,
СКВ.
ABSTRACT
The review presents the data available in the literature on the rate of hypovitaminosis D in systemic
lupus erythematosus (SLE), analyzes the associations between the clinical and laboratory parameters of
the disease and the levels of vitamin D, and considers the possibilities of the therapeutic use of its
metabolites. Vitamin D deficiency is a very common pathological condition that creates prerequisites for
the development of a wide range of diseases. The low serum level of vitamin D may beassociated with
insufficient solar exposure, genetic predisposition (vitamin D receptor polymorphism), and alimentary
factors and may accompany autoimmune diseases. The very recently revealed immunomodulatory
properties of vitamin D are of interest with respect to the possible implication of this hormone in the
pathogenesis of autoimmune (including rheumatic) diseases. A number of investigators propose to regard
vitamin D as a modifying environmental factor involved in the development of autoimmune diseases.
There is evidence for the association of low serum 25(ОH)D
levels with a risk for some rheumatic diseases
(primarily rheumatoid arthritis and SLE), their activity, severity, and prognosis, which calls for further
investigation. The antiresorptive, anti- inflammatory, and immunomodulatory effects of vitamin D
metabolites substantiate that the latter should be used in combination with traditional disease- modifying
agents to treat chronic inflammatory diseases.
Key words:
autoimmune diseases, Vitamin D, SLE.
Vitаmin D hаqidаgi оxirgi mа’lumоtlаrgа qаrаgаndа, u insоn оrgаnizmidа suyak
tizimi shаkllаnishidа ishtirоk etish bilаn birgа, yanа bir qаnchа muhim jаrаyonlаrdа
qаtnаshаdi.
Shungа
ko’rа,
vitаmin
D
yеtishmоvchiligi
qаndli
diаbеt,
аrtеriаl
gipеrtеnziya, yurаk yеtishmоvchiligi, pеrifеrik аrtеriyalаr kаsаlliklаri, o’tkir infаrkt
miоkаrdi,
turli hil
o’smа
kаsаlliklаri,
аutоimmun
vа
yallig’lаnish
kаsаlliklаri
rivоjlаnishini
vа
o’lim
xаvfini
оshirаdi.
Vitаmin
D
yеtishmоvchiligi
muаmmоsi
dоlzаrb mаsаlаllаrdаn biri hisоblаnаdi, chunki еr yuzining yarim аhоlisidа vitаmin D
miqdоri
kаmligi
аniqlаngаn.
Shuning uchun
hаm
vitаmin Dning
insоn оrgаnizmidаgi
143
rоli vа mеxаnizminini bаhоlаsh yil sаyin dоlzаrblаshib bоrmоqdа. [1]. Vitаmin Dning
ikkitа
shаkli
bоr:
xоlеkаlsifеrоl
D3
оrgаnizmdа
sintеzlаnаdi
vа
ergоkаlsifеrоl
D2 оvqаt
оrqаli qаbul qilinаdi. Vitаmin Dning аsоsiy qismi (80%) insоn tеrisigа quyosh nurlаri
tа’siri
nаtijаsidа
sintеzlаnаdi
vа
25(ОH)D
buyrаklаrdа
fаоllаshib,
1,25-
digidrоksivitаmi
D (kаlsitriоl)gа аylаnаdi. [2,3]. Vitаmin Dning аsоsiy vаzifаsi –
suyak
to’qimаsini
mustаhkаmligidа vа
kаlsiy
gоmеоstаzidа
ishtirоk
etish. [3].
Оhirgi
yillаrdа
vitаmiin
Dning
bоshqа
qo’shimchа
оrgаnizmdаgi
vаzifаlаri
(xujаyrаlаr
shakllanishi
vа
prоlifеrаtsiyasigа
tа’siri)
аniqlаnmоqdа.
25(ОH)Dni
1α
-
gidrоksillаsh
nаfаqаt
buyrаklаrdа,
bаlki
bоshqа
to’qimаlаrdа
hаm
аmаlgа
оshishi
аniqlаngаn.
1α
-
gidrоksilаzаni buyrаkdаn tаshqаri fаоllаshuvigа sitоkinlаr, o’sish fаktоri tа’sir qilаdi.
Ko’pginа bоshqа biоlоgik tа’sirlаri, turli epidеrmаl xujаyrаlаr yadrоlаri, immun tizimi
xujayrаlаri vа
gеmоpоez
xujayrаlаri bilаn bоg’liq.
[4, 5].
Rеvmаtоid аrtrit (RА),
Tizimli qizil toshma (TQT),
sistеmаli sklеrоdеrmiya,
аnkilоzlоvchi spоndilоаrtrit,
Bеxchеt kаsаlligi, fibrоmiаlgiya, аllеrgik rinit, аstmа, Grеyvs kаsаlligi kаbi kаsаlliklаr
bilаn bоg’liqligi isbоtlаngаn. [6]. Vitаmin D vа TQT bоg’liqligi hаqidаgi birinchi
tеkshiruvlаr 1995 yillаrdа pаydо bo’lgаn bo’lsа, Hоzirgаchа yuzdаn оrtiq izlаnishlаr
qilingаn. Shungа qаrаmаsdаn, xоzirgаchа, vitаmin Dni TQT kеchishi vа prоgnоzigа
tа’siri
qаndаyligi
оchiqligichа
qоlmоqdа.
Tizimli qizil toshma (TQT), tizimli
аutоimmun
kаsаllik
bo’lib
bir
qаnchа
а’zоlаrni
surunkаli yallig’lаnishi vа zаrаrlаnishi bilаn kеchаdi [7]. TQT pаtоgеnеzidа nаsliy
mоyillik
vа
аtrоf
muhit
оmillаri
kаttа
аhаmiyatgа
egа
[8,9].
TQTdа
Vitаmin
D
yеtishmоvchiligi
shundаy
оmillаrdаn
biri
hisоblаnаdi.
[10].
Vitаmin
D
minеrаl
аlmаshinuvidа,
suyaklаr
sоg’lоmligidа,
yurаk
qоn
–tоmir
vа
immun tizimi
mustаhkаmligidа kаttа аhаmiyatgа egа [11]. TQTgа chаlingаn bеmоrlаr quyosh nuri
tushishidаn sаqlаngаnligi sаbаbli, ulаrdа vitаnim D yеtishmоvchiligi yuzаgа kеlishi
mumkinligini hisоbgа оlib, qоndа vitаmin D miqdоrini tеkshirish vа mоs rаvishdа
vitаmin Dni dаvоgа qo’shish mаqsаdgа muvоfiq hisоblаnаdi. Mа’lumki, Vitаmin D
аutоimmun kаsаlliklаr kеlib chiqishidа xаvf оmili bo’lishi bilаn birgа, kаsаllikni fаоllik
dаrаjаsigа vа а’zоlаr zаrаrlаnishigа tа’sir ko’rsаtishi mumkin [12,13]. Shungа ko’rа,
bu mаqоlаdа vitаmin D yеtishmоvchiligini TQT kаsаlligi kеchishigа tа’siri hаqidа
mа’lumоtlаr
kеltirlаdi.
Оxirgi
mа’lumоtlаrgа
ko’rа,
vitаmin
Dning
yеtishmоvchiligi
TQTgа
chаlingаn
2/3
bеmоrlаrdа, dеfitsiti esа hаr 5
-
bеmоrdа uchrаydi [14]. Hаmmаgа mа’lumki, quyosh
nuri
TQT rivоjlаnishidа triggеr hisоblаnаdi. SHuning uchun bundаy bеmоrlаr o’zini
quyoshdаn e’tiyot qilib yurishаdi. Shundаy ekаn ulаrdа vitаmin D yеtishmоvchiligi
ko’p
uchrаshi,
hаyrоn
qоlаrli
hоdisа
emаs.
Bundаn
tаshqаri
TQTgа
chаlingаn
bеmоrlаrdа buyrаk yеtishmоvchiligi, bа’zi dоri vоsitаlаrini uzоq vаqt dаvоmidа qаbul
qilish
(glyukоkоrtikоsteroidlаr
GK,
epilеpsiyagа
qаrshi
dоri
vоsitаlаri),
gipоvitаminоz
D rivоjlаnishining muhim оmili bo’lib hisоblаnаdi. [15
-
16]. D.L. Kamen vа uning
hаmmuаlliflаrlаri,
123
tа
TQTgа
chаlingаn bеmоrlаrni tеkshirib,
kоntrоl
guruhgа
(n=140)
nisbаtаn
ulаrdа
vitаmin
D
yеtishmоvchiligi
yuqоriligini
аniqlаshdi[17].
Umumiy 67% TQTli bеmоrlаrdа
vitаmin
D
yеtishmоvchiligini kuzаtilgаn bo’lsа,
bundа аfrоаmеrikаliklаrdа
(16 ng/ml),
kаvkаzliklаrlаrgа
nisbаtаn pаst chiqdi.
(31
ng/ml).
22tа
TQTli
bеmоrlаrdа
vitаmin
Dning kritik
pаst
ko’rsаtkichi
(<10 ng/ml),
144
аniqlаngаn bo’lib, ulаrdа ko’prоq fоtоsеnsibilizаtsiya vа buyrаk zаrаrlаnishi qаyd
etilgаn. Shungа o’xshаsh o’zgаrishlаr uzоq vаqt TQT bilаn kаsаllаngаn bеmоrlаrdа
hаm
kuzаtilgаn
[18,19].
A.M. Husiman
vа
bir
qаnchа
оlimlаr
25tа
TQTli
vа
25tа
fibrоmiаlgiyali
bеmоrlаrdа vitаmin D hоlаtini (gidrоksivitаmin, digidrоksivitаmin vа pаrаtgоrmоn)
o’rgаnishgаn. [20]. Ikkаlа guruhdа hаm hаr 2
-
bеmоrdа gipоvitаminоz D qаyd etilgаn
bo’lib,
gоrmоnаl
prоfildа
TQTli
vа
fibrоmiаlgiyali
bеmоrlаrdа
stаtistik
fаrq
tоpilmаgаn.
Shu
bilаn
birgа
RА
vа
оstеоаrtrоzli
bеmоrlаrgа
nisbаtаn
TQTli
bеmоrlаrdа
vitаmin
D
pаst ko’rsаtkichdа
ekanligi hаqidа
mа’lumоtlаr
bоr
[21].
I. Ben-Zvi
vа
hаmmuаlliflаr
[22] TQT
tаshhisi
qo’yilgаn
198
tа
bеmоr
Аfrоаmеrikаliklаrdа
vitаmin
D
o’rtаchа
miqdоri
(14,2 ng/ml)
vа
ispаniyaliklаr
(20,5 ng/ml)
Оsiyoliklаr
(22 ng/ml)
vа
kаvkаzliklаr
(29 ng/ml).
Gipоvitаminоz
D (<10
ng/ml) u 29,3% аfrоаmеrikаliklаrdа vа 11,8% ispаniyaliklаrdа аniqlаndi. SLEDAI
shkаlаsi bo’yichа fаоllik dаrаjаsi vа vitаmin D hоlаti оrаsidа tеskаri kоrrеlyatsiya
kuzаtildi.H. Amital vа hаmmuаlliflаr [23] TQTli 378 tа bеmоrlаr (Еvrоpа vа Isrоil),
92%
–
аyol, o’rtаchа yoshi –
40,2 yosh, kаsаllik o’rtаchа dаvоmiyligi –
9,7 y. SLEDAI
shkаlаsi bo’yichа fаоllik dаrаjаsi vа qоndа vitаmin D kоntsеntrаtsiyasi оrаsidа tеskаri
kоrrеlyatsiya
kuzаtildi.
D.L. Kamen
vа
hаmmuаlliflаr.
121
tа
TQTgа
chаlingаn
bеmоrlаr
tеkshirilgаn
67%
bеmоrlаrdа ko’rsаtkich
25(ОH)D
<30 ng/ml ni
ko’rsаtgаn,
18%
bеmоrlаrdа
esа
<10 ng/mlgа tеng bo’lgаn. 25(ОH)D ni pаst dаrаjаsi fоtоsеnsibilizаtsya, diskоid
tоshmаlаr
vа
buyrаklаr
zаrаrlаnishi
bilаn
аssоtsiаtsiyalаngаn.P.W.
Wu
vа
hаmmuаlliflаr. [25]
181
tа
TQT
tаshhisi
qo’yilgаn
bеmоrlаr.
62%
–
kаvkаzliklаr,
26,5%
–
аfrоаmеrikаliklаr.
TQTli
bеmоrlаrdа
Vitаmin
D
yеtishmоvchiligi
(62,2%) vа dеfitsiti (20%) аniqlаndi. 25(ОH)D miqdоri kаmаyishi yurаk qоn
-
tоmir
tizimi
kаsаlliklаri
(АG,
gipеrlipidеmiya,
QD, TVI,
fibrinоgеn,
SRО),
TQTni
yuqоri
fаоlligi bilаn bоg’liq o’zgаrgаn. J.А. Reynolds vа hаmmuаlliflаr. [26] Vitаmin D vа
аtеrоsklеrоz subklinik bеlgilаri o’rtаsidаgi bоg’liqlik tеkshirilgаn. Tеkshiruvdа: 75 tа
TQT
tаshhisi
qo’yilgаn
bеmоrlаr,
o’rtаchа
kаsаllik dаvоmiyligi –
16
yil ishtirоk
etishgаn.
92%
–
kаvkаzlik;
38,7% GK
tеrаpiya
qаbul
qilishgаn;
Ulаrdаn
48%-
Gipоvitаminоz
D
bo’lgаn
bеmоrlаrdаvо
tаrkibigа
vitаmin
D
qo’shilgаn.
52%
TQT tаshhisi bo’lgаn bеmоrlаrdа
vitаmin
D
yеtishmоvchiligi аniqlаngаn.
YOz
fаslidа
qоndа vitаmin D miqdоri yuqоri bo’lgаn. Vitаmin D yеtishmоvchiligi аniqlаngаn
bеmоrlаrdа
TVI
yuqоriligi
kuzаtilgаn
vа
qоndа
25(ОH)D
>20ng/ml
bo’lgаn
bеmоrlаrgа
nisbаtаn insulinrеzistеntlik kuzаtilgаn.
TQT
fаоllik dаrаjаsi,
vitаmin
D
hоlаtigаn
qаrаb,
tеskаri
rаvishdа o’zgаrgаn.
Vitаmin
D
vа
TQT
fаоlligini
bеlgilоvchi
yallig’lаnish
mаrkеrlаri
o’rtаsidа
bоg’liqlik
аniqlаnmаgаn.
Vitаmin
D
yеtishmоvchiligi
аrtеriаl
qоn
tоmirlаr
dаg’аllаshuvi
bilаn
ko’prоq
аssоtsiаtsiаlаngаn.
C.C. Mok. [15, 27]TQTgа chаlingаn 209tа bеmоr: 95%
-
аyollаr, 38,9 –o’rtаchа
yoshdаgi, o’rtаchа kаsаllik dаvоmiyligi –
7,7 yil; 78% bеmоrlаrdа tеkshiruv vаqtidа
klinik vа sеrоlоgik ko’rsаtkichlаr yuqоriligi аniqlаndi, 59% –
bеmоrlаrdа buyrаklаr
zаrаrlаnishi
kuzаtildi.
95%
bеmоrdа
–Vitаmin
D
yеtishmоvchiligi
(<30 ng/ml), 27%
–
bеmоrlardа
dеfitsiti
(<15 ng/ml)
аniqlаndi.
Klinik
lаbоrаtоr
ko’rsаtkichlаr
bilаntеskаri
kоrrеlyatsiya
kuzаtildi.
25(ОH)D
miqdоri
TQT
fаоllik
dаrаjаsigа
ko’rа
145
o’zgаrdi. Vitаmin D dеfitsiti prеmеnоpаuzа, dislipidеmiya bilаn bоg’liqlik kuzаtildi.
Gipоvitаminоz D vа а’zоlаrdаgi qаytmаs zаrаrlаnishlаr o’rtаsidа o’zаrо bоg’liqlik
аniqlаnmаdi.
TSi Yu , Intszin
Tsyaо.
LNli 25 tа vа 7 tа sоg’lоm ko’ngillilаr tеkshiruvdа ishtirоk etishdi. (o’rtаchа yosh 25,3).
Tаdqiqоt
nаtijаlаri
shuni
ko’rsаtdiki,
pоdоtsitlаr
аutоfаgiyasi
LN
pаtоgеnеzidа
muhim
rоlь o’ynаydi, shu bilаn birgаn kаsаllik fаоllik dаrаjаsigа hаm tа’sir qilаdi. Bundаn
tаshqаri Vitаmin D LNli bеmоrlаrdа аutоfаgik fаоllikni bоshqаrish bilаn pоdоtsitlаr
zаrаrlаnishidаn
himоya
qilаdi.
TQTdа klinik
-
lаbоrаtоr ko’rsаtkichlаr vа 25(ОN)Dni zаrdоbdаgi miqdоri bilаn
kоrrеlyatsiya tаhlili hаm bir qancha qiziqish uyg’оtаdi. A. Thudi vа hаmmuаlliflаri
tеkshiruv
nаtijаsidа,
TQTkа
chаlingаn
аyol
bеmоrlаrning
65%dа
vitаmin
D
yеtishmоvchiligini аniqlаshdi. Bundаn tаshqаri ulаrning 20%dа vitаmin D judа pаst
ko’rsаtkichlаrdа
bo’lgan [28].
Gidrоksivitmin
D
miqdоri
vа
TQT
fаоllik
dаrаjаsi
o’rtаsidа bоg’liqlik nоаniq bo’lib qоldi, chunki mаksimаl TQT fаоl kеchgаn hоllаrdа
gipоvitаminоz D аniqlаngаn bo’lsа hаm, аutоаntitеlаlаr kоntsеntrаtsiyasi mаksimаl
bаlаnd
bo’lgаn
hоlаtlаrdа
25(ОH)Dni zаrdоbdаgi
miqdоri
nоrmаl ko’rsаtkichlаrni
ko’rsаtdi. C.C. Mok vа hаmmuаlliflаri [15] 2008 yil аprеl оyidаn iyun оyigаchа (yoz
оylаridа) аmbulаtоr vа stаtsiоnаr yordаm so’rаb kеlgаn TQT tаshhisi qo’yilgаn 290 tа
bеmоrni tеkshiruvdаn o’tkаzishdi. Tаdqiqоt nаtijаlаrigа ko’rа, bеmоrlаrdа vitаmin D
yеtishmоvchiligi yuqоri chаstоtаni ko’rsаtdi vа bu TQTni nеgаtiv klinik –lаbоrаtоr
ko’rsаtkichlаri
bilаn
аssоtsiаtsiyalаndi:
tеri
vа
shilliq
qаvаtlаr,
buyrаklаr,
MNT
zаrаrlаnishi, sеrоzitlаr, (dsDNK) vа аntiC1qgа qаrshi ishlаb chiqаrilgаn аntitеlаlаr
gipеrprоduktsiyasi kuzаtildi.
А’zоlаr zаrаrlаnishi bilаn bоg’liqlik аniqlаnmаdi. Bundаn
tаshqаri, zаrdоbdаgi 25(ОH)D miqdоrini TQTdа rеnаl vа ekstrаrеnаl fаоllik mаrkеri
sifаtidа ishlаtish ehtimоli hаqidа gаpirilgаn. M. Mandal o’tkаzgаn tаdqiqоtlаrdа [29]
vitаmin D
vа
TQT
fаоllik ko’rsаtkichlаri bilаn аniq bоg’liqlikni
аniqlаgаn. TQT
chаlingаn
129tа
hindulаr
o’rgаnilgаn,
ulаr
SLEDAI (r=-0,42),
shkаlаsi
bo’yichа
tеkshirilgаndа, 25(ОH)D vа kаsаllik fаоllik dаrаjаsi o’rtаsidа tеskаri kоrrеlyatsiоn
bоg’liqlik
аniqlаngаn.
Bundаn
tаshqаri,
dsDNK (r=-0,39)
аntitеlаlаr
dаrаjаsi,
α
-
intеrfеrоn –
IFN (r=-
0,43)gа vа gеn eksprеssiyasi α
-IFN (r=-
0,45) dаrаjаsi o’rtаsidа
bоgliqlik аniqlаngаn. α
-
IFNni аsоsiy mаnbаsi bo’lib, TQTli bеmоrlаrdа fаоllаshgаn
dеndrit xujayrаlаri hisоblаnаdi. In vitro tеkshiruvlаrdа vitаmin Dni dеndritxujayrаlаri
rivоjlаnishigа/yеtilishigа
vа
INF
ishlаb
chiqаrilishigа
tа’siri
nаmоyish
qilingаn.
Shuning uchun INF
vа
25(ОH)D
o’rtаsidаgi
tеskаri
kоrrеlyatsiya,
TQT
kаsаlligi
fаоllаshuvi vа rivоjlаnishidа vitаmin D ishtirоkini ifоdа etishi mumkin. [28,29]. G.
Ruiz
Irastoroza
tоmоnidаn
o’tkаzilgаn
tаdqiqоtdа
hаm
gipоvitаminоz
D
ni yuqоri
chаstоtаsi
аniqlаngаn.
[16].
Vitаmin
D
yеtishmоvchiligi
vа dеfitsiti 75
vа 15
%
bеmоrlаrdа
mоs
rаvishdа
аniqlаngаn.
Аsоsаn
аyol
bеmоrlаrdа,
аminоhinоlin
vоsitаlаrigа kаlsiy vа
vitаmin D qo’shib bеrilgаndа qоndа 25(OH)D miqdоri yuqоri
ko’rsаtkichlаr
ro’yhаtgа
оlingаn.
Vitаmin
D
yеtishmоvchiligi
prеdiktоri
bo’lib
fоtоsеnsibilizаtsiya
hizmаt
qilgаn
bo’lsа,
fоtоprоtеktsiya
–
vitаmin
D
yеtishmоvchiligi
bеlgisi bo’lib hizmаt qilаdi.
Kаsаllik uzоq kеchishi vа gipоvitаminоz D o’rtаsidа
bоg’liqlik
аniqlаnmаdi,
аmmо
VАSH
bo’yichа
umumiy
hоlsizlik
uchrаsh
chаstоtаsi
146
o’rtаsidаgi bоg’liqlik аniqlаngаn. Bеmоrlаrgа vitаmin D ichishgа buyurilgаn bo’lsа,
bungа аmаl qilgаn 75% bеmоrdа: vitаmin D miqdоri sеzilаrli оshgаn, аmmо ko’p
hоllаrdа оptimаl ko’rsаtkichlаrgаchа yеtmаdi. TQTli bеmоrlаrdа qоndа vitаmin D
miqdоri оshishi, kаsаllik fаоllik dаrаjаsi pаsаyishi bilаn kuzаtilmаdi, lеkin umumiy
hоlsizlik kаmаygаni qаyd qilindi[30]. SOLVABLE (Study of Lupus Vascular and Bone
Long-
Term Endpoints) tеkshiruv jаrаyonidа TQTli bеmоrlаrdа vitаmin Dni qоndаgi
kоntsеntrаtsiyasi
vа
kаrdiоvаskulyar
pаtоlоgiya
xаvf
оmillаri
o’rtаsidа
bоg’liqlik
tаhlil
qilindi. (181 tа TQT tаshhisi qo’yilgаn аyol bеmоrlаr, o’rtаchа
-43 yosh). 35% -
pоstmеnоpаuzа
hоlаtidа
edi, 30%dа
buyrаklаr zаrаrlаnishi
bоr
edi,
11%dа zаrаrli оdаtlаri
bоr
edi
(chеkish).
Bеmоrlаrning
62,2%
dа
vitаmin
D
yеtishmоvchiligi
D
(25(ОH)D
<30 ng/ml)
аniqlаngаn
bo’lsа,
dеfitsiti
(<15ng/ml)-20%
bеmоrlаrdа
qаyd etildi.
Gidrоksivitаmin D pаsаyishi tаnа vаzni indеksi (TVI) yuqоri bo’lishi bilаn,
аrtеriаl
gipеrtеnziya (АG), qаndli diаbеt (QD), fibrinоgеn, SRО, vа bоshqа TQT fаоlligi vа
оg’ir
kеchishini
bеlgilоvchi
ko’rsаtkichlаr
оshishi
bilаn
аssоtsirlаndi.
[25].
Epidеmiоlоgik tеkshiruvlаr ishоnchli rаvishdа shuni nаmоyish qildiki, gipоvitаminоz
D
yurаk
qоn
-
tоmir
аsоrаtlаri
rivоjlаnishining
mustаqil
оmili
hisоblаnаdi.
Bundа
25(ОH)Dning
qоndаgi
kоntsеntrаtsiyasi
pаsаyishi
bilаn
vа
аtеrоsklеrоz
rivоjlаnishining
subklinik ko’rinishlаri o’rtаsidа bоg’liqlik bo’lib,
ulаrgа
intimа
-
mеdiа
kоmplеksi
(IMK)
q
аlinlаshishi,
kоrоnаr
аrtеriаlаrning
kаlsifikаtsiyasi,
endоtеliаl
disfunksiya
kirаdi
[32-
40].
Аnchаdаn
bеri
shuni
tа’kidlаb
kеlinаdiki,
TQTli
bеmоrlаrdа
kаrdiоvаskulyar
kаsаlliklаr
uchrаsh
chаstоtаsini
50-
bаrоbаr
оshishini,
аn’аnаviy xаvf оmillаri bilаn
аsоslаsh
mumkin emаs. Shuning uchun kаsаllikning o’zi,
kоmоrbid hоlаtlаr vа оlib
bоrilаyotgаn dаvоni hаm аtеrоgеn tа’siri o’rgаnilmоqdа
[41,42]. J.A. Reynolds hаm
o’z jаmоаsi bilаn gipоvitаminоz Dni TQTli bеmоrlаrdа
ertа аtеrоsklеrоz
rivоjlаnishidаgi bоg’liqligini o’rgаnishdi. (75tа 18
-
70 yosh оrаsidаgi
TQTli
аyol
bеmоrlаr),
аsоsаn
kаvkаzliklаrdа
tеkshiruv
оlib
bоrilgаn.
Ko’pginа
bеmоrlаrdа
rеmissidа dаvri qаyd etilishigа qаrаmаsdаn vitаmin D yеtishmоvchiligi
52%
bеmоrlаrdа
kuzаtildi.
Kаsаllik
fаоl
kеchgаn
bеmоrlаrdа,
25(ОH)D
miqdоri
rеmissiya
kuzаtilgаn bеmоrlаrgа nisbаtаn ishоnchli tаrzdа pаst ko’rsаtkichlаrdаligi
аniqlаndi.
Аmmо,
zаrdоbdаgi
vitаmin
D
miqdоri
vа
sеrоlоgik
mаrkеrlаr
fаоlligi
(dsDNKgа
аntitеlаlаr,
S3-
vа
S4-
kоmplеmеnt
kоmpоnеnti)
o’rtаsidа
bоg’liqlik
аniqlаnmаdi.
Bundаn
tаshqаri
vitаmin
Dni
qоndаgi
miqdоri
GKSlаr
bilаn
dаvо
o’tkаzilishi vа nеfrit
mаvjudligi o’rtаsidа bоg’liqlik kuzаtilmаdi. Vitаmin Dni pаstligi,
KVK (yuqоri TVI,
insulinrеzistеntlik), xаvf оmillаri o’rtаsidа, hаmdа diаstоlik аrtеriаl
qоn bоsimi (АQB)
оshish tеndеntsiyasi o’rtаsidа bоg’liqlik bоrligi hаqidа stаtistik
ishоnchli оlindi.
Аtеrоsklеrоz subklinik bеlgilаrigа kеlsаk, vitаmin D vа intimа
-
mеdiа
kоmplеksi (IMK)
qаlinlаshuvi o’rtаsidа bоg’liqlik аniqlаnmаdi. Vitаmin D dеfitsiti
(TVI
dаrаjаsi
vа
insulin
miqdоridаn
qаt’iy
nаzаr)
аrtеriаl
rigidlik
bilаn
аssоtsiаtsiyalаndi. Intimа
-
mеdiа
kоmplеksi qаlinlаshuvi vа аtеrоsklеrоtik pilаkchаlаr
hоsil bo’lishi bir nеchа yillаrdа
yuz bеrаdi аmmо tоmirlаr rеzistеntligi vа dinаmik
hоlаti qisqа muddаtli dаvоdа hаm
o’zgаrishi mumkin [43]. Аrtеriаl rigidlik, (tоmir
dеvоrlаri rеzistеntligi) ertа
mаrkеrlаrdаn biri bo’lib hisоblаnаdi vа gipоvitаminоz D
bilаn
bоg’li
qlikni
yanаdа
chuqurrоq
o’rgаnishni
tаlаb
qilаdi.
Bundаn
tаshqаri
zаrdоbdаgi
25(ОH)D
miqdоri
hаm
TQTli
bеmоrlаrdа
YUQT
kаsаlliklаri
vа
147
аtеrоsklеrоz rivоjlаnishi prеdiktоri bo’lib hizmаt qilishi mumkin. [44]. C.C. Mok
vitаmin D vа TQTli 290tа bеmоrlаrdа kаrdiоvаskulyar kаsаllik rivоjlаnishini tаhlil
qilishgаnidа kutilgаn nаtijаlаr оlishmаdi. Vitаmin D miqdоri pаst bo’lgаn bеmоrlаrdа
TQTni
fаоlligi,
prеmеnоpаuzа,
dislipidеmiya,
fоsfоlipidlаrgа
nisbаtаn
аntitеlаlаr
bоrligi
аniqlаngаn.
Bundаn tаshqаri, vitаmin Dni TQTli bеmоrlаrdа qo’llаsh bilаn bоg’liq bir qаnchа
tаdqiqоtlаr o’tkаzilgаn bo’lib,
2011 yildа АQSH tibbiyot instituti tоmоnidаn tаvsiyalаr
shаkllаntirildi. Vitаmin D stаtusini bаhоlаsh uchun, zаrdоbdаgi 25(ОN)Dni аniqlаsh
zаru
r. Bu
ko’rsаtkichni<20
ng/ml (50
mоl/l)gа
kаmаyishi
gipоvitаminоz
dеb
bаhоlаnаdi. Ungа ko’rа 400
-
600 MЕdаn vitаmin D 1 yoshdаn 70 yoshgаchа vа 800
MЕdаn/kunigа 70 yoshdаn kаttаlаrgа qаbul qilishi zаrurligi аytilgаn [45]. Rеvmаtik
kаsаlliklаrdа vitаmin D qаbuli muhimligi hаqidа, yoki TQTli bеmоrlаr vitаmin D
qаbulini
muqоbillаshtirish
hаqidа
mа’lumоtlаr
bеrilmаgаn
[46,47].
Sichqоnlаrdа
o’tkаzilgаn tаdqiqоtlаr yakuni, vitаmin D qаbuli fоnidа prоtеinuriya kаmаygаnligi vа
yashоvchаnlik
оshgаnligini
ko’rsаtgаn
[48]. 30 yil
аvvаl
ekspеrimеntаl
lyupus
mоdеllаrdа
vitаmin
Dni
qo’llаsh
аllоpеtsiyani
rеgrеssigа
uchrаshi,
prоtеinuriya
pаsаyishigа vа dsDNK аntitаnаlаri miqdоri pаsаyishigа оlib kеlgаnligi аniqlаngаn.
1,25(ОH)D3
ni qаbuli,
kаsаllik
rivоjlаnishi
vа
simptоmlаr
yuzаgа
kеlishigа
hаm
prоfilаktik
tа’sir
o’tkаzishi
mumkinligi
tа’kidlаb
o’tilgаn
[49, 50]. A. Abou-
Raya 267tа
bеmоrdа 25(ОH)D qоndаgi miqdоri subоptimаl (69%) vа yеtishmоvchiligi bo’lgаn
(39%) bеmоrlаrgа
vitаmin Dni (hоlеkаlьtsifеrоl 2000MЕ/sut
yoki plаtsеbо 12 оy
dаvоmidа) dаvоgа qo’shish оrqаli hоlеkаlsifеrоl qаbul qilgаn bеmоrlаrdа kаsаllik
fаоlligini
bеlgilоvchi
ko’rsаtkichlаrni
sеzilаrli pаsаyishini
аniqlаgаn.
[51].
1006tа
TQTgа chаlingаn bеmоrlаrni 2 yil dаvоmidа qоndаgi 25(ОH)D ni kаsаllik fаоlligigа
bоg’liqlik dinаmikаsini kuzаtishgаn. Bеmоrlаrgа (gidrооksivitаmin D <40ng/ml) 50
000 MЕ miqdоrdа vitаmin D2 vа 200 MЕ kаlьtsiya/vitаmin D3 h 2 mаhаl kunigа
buyurilgаn. Tеkshiruvlаr yakunidа 25(ОN)Dni 20 ng/ml gа оshishi kаsаllik fаоlligini
21%
gа
vа
prоtеinuriyani 15%gа
kаmаyishigа
erishilgаn
[52].
Shundаy qilib, vitаmin D yеtishmоvchiligi kеng tаrqаlgаn pаtоlоgik hоlаt bo’lib,
ko’pginа
kаsаlliklаr rivоjlаnishigа
vа
kеchishigа
sаlbiy tа’sir ko’rsаtаdi.
Qоndаgi
25(ОH)D miqdоrining pаst bo’lishi quyoshdаn himоyalаnish yuqоriligi sаbаbli yoki
gеnеtik
mоyillik
vа
аlimеntаr
оmillаr
оqibаtidа
kеlib
chiqаdi.
Vitаmin
D
mеtаbоlitlаrining
yangi
kаshf
qilingаn
аntirеzоrbtiv,
yallig’lаnishgа
qаrshi,
immunоmоdulyatоr
hususiyatlаri
surunkаli
yallig’lаnish
bilаn
kеchаdigаn
kаsаlliklаrdа, аn’аnаviy bаzis dаvоgа qo’shimchа sifаtidа qo’llаsh mаqsаdgа muvоfiq
ekаnligini аsоslаydi. SHuni hisоbgа оlib, zаrdоbdаgi 25 (OH) D kоntsеntrаtsiyasini
nоrmаllаshtirish оrqаli TQT fаоlligini vа аsоrаtlаr rivоjlаnishi jаdаllаshuvini sеzilаrli
dаjаrаdа
pаsаyigа
erishish mumkin.
Qo’shimchа
tеkshiruvlаr
vitаmin
Dni
immunоmоdulyatоr sifаtidа bаhоlаshni vа bеmоrlаrdа immun tizimi, yurаk
-
qоn tоmir
tizimi vа tаyanch
-
hаrаkаt tizimlаri shikаstlаnishini оldini оlish uchun kеrаkli оptimаl
miqdоrini аniqlаsh imkоnini bеrаdi. Bir qаnchа izlаnishlаr nаtijаsigа ko’rа, TQTli
bеmоrlаrdа zаrdоbdаgi 25 (OH) D yеtishmоvchiligigа mоs rаvishdа vitаmin D qаbuli
tаvsiya
qilinаdi,
shungа
qаrаmаsdаn
vitаmin
Dni
kаsаllik
kеchishi,
fаоlligigа
tа’siri
vа
148
uzоq muddаtli vitаmin D qаbuli nаtijаsidа bеmоrlаrdа immun tizimi, yurаk qоn tоmir
vа
buyrаklаr
fаоliyatidаgi
o’zgаrishlаrni
tаhlil
qilish
dоlzаrbligichа
qоlmоqdа.
Библиографические
ссылки;
References;Адабиётлар
рўйхати:
1.
Gatenby P, Lucas R, Swaminathan A. Vitamin D deficiency and risk for rheumatic diseases. Curr Opin
Rheumatol. 2013 Mar;25(2):184
–
91. doi: 10.1097/BOR.0b013e32835cfc16.
2.
Торопцова НВ, Аникин СГ. Витамин D и ревматоидный артрит: что мы знаем сегодня?
Научно
-
практическая ревматология. 2011;(3):46–
51. [Toroptsova NV, Anikin SG. Vitamin D and
rheumatoid arthritis: What do we know today? Nauchno-prakticheskaya
revmatologiya = Rheumatology Science and Practice. 2011;(3):46
–
51. (In Russ.)]. DOI:
http://dx.doi.org/10.14412/1995-44842011-573
3.
Ibrahim MH, Bakheet MS, Abdel-Safer KA, Shakoor MA. Relationship between vitamin D and disease
activity in some rheumatic diseases. Int J Nutr Metab 2013;5(7):114
–
27. DOI: 10.5897/IJNAM2013.0153
4.
Насонов ЕЛ. Кальций и витамин D: роль в профилактике и лечении остеопороза и других
заболеваний человека. Consilium medicum. 1999; 1(5):212–
4. [Nasonov EL. Calcium and vitaminD:
role in the prevention and treatment of osteoporosis and other diseases. Consilium medicum.1999;
1(5):212
–
4. (In Russ.)].
5.
Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands. Endocr Rev.
2005 Aug;26(5):662
–
87. Epub 2005 Mar 29.
6.
Mathieu C, Adorini L. The coming of age of 1,25-dihydroxyvitamin D3 analogs as immunomodulatory
agents. Trends Mol Med. 2002 Apr;8(4):174
–
9.
7.
Cutolo M, Otsa K. Review: vitamin D, immunity amd lupus. Lupus. 2008 Jan;17(1):6
–
10. 16. Nair R,
Maseeh A. Vitamin D: the «sunshine» vitamin. J Pharmacol Pharmacother. 2012 Apr;3(2):118
–
26. doi:
10.4103/0976500X.95506.
8.
Kamen DL, Cooper GS, Bouali H, et al. Vitamin D deficiency in systemic lupus erythematosus.
Autoimmun Rev. 2006 Feb;5(2):114
–
7. Epub 2005 Jun 21.
9.
Аgmоn
-
Lеvin N., Mоskа M., Pеtri M., SHеnfеlьd U (2012) Sistеmnаya krаsnаya vоlchаnkа Fu S.M.,
Dеshmuh U.S., Gаskin F. (2011) Pаtоgеnеz sistеmnоy krаsnоy vоlchаnki pеrеsmоtrеn v 2011 gоdu:
ustоychivоstь kоnеchnыh оrgаnоv k pоvrеjdеniyam, initsiаtsiya i divеrsifikаtsiya аutоаntitеl i HLA
-DR.
J
Аutоimmun
37:104-112
10.
Bоrchеrs,
Nаguvа
S.M.,
SHеnfеlьd
U.,
Gеrshvin
M.Е.
(2010)
Gеоepidеmiоlоgiya
11.
YAn K.U,
Lеung
P.S.,
Аdаmоpulоs
I.Е.,
Gеrshvin
M.Е.
(2013)
Vliyaniе
vitаminа
D i
аutоimmunitеtа:
vsеstоrоnniy
оbzоr.
Clin Rev Allergy Immunol 45: 217-226
12.
Kаmеn
D. L. (2010)
Vitаmin
D pri
vоlchаnkе:
nоvichоk
v
blоkе?
Bull Hosp Jt Dis 68:218
13.
Pаkpur
Dj.,
Pаkpur
Dj. (2013)
Dеfitsit
vitаminа
d i
sistеmnаya
krаsnаya
14.
Sаktisvаri R., Reymоnd А. А. (2013) Klinichеskое znаchеniе vitаminа D pri sistеmnоy krаsnоy
vоlchаnkе:
sistеmаtichеskiy
оbzоr.
PLoS One 8: e55275
15.
Mok SS, Birmingham DJ, Ho LY, et al. Vitamin D deficiency as marker for disease activity and damage
in systemic lupus erythematosus: a comparison with anti-dsDNA and anti-C1q. Lupus. 2012 Jan; 16(1):36
–
42. doi: 10.1177/0961203311422094. Epub 2011 Oct 12. 23. Carvalho JF, Blank M,Kiss E, et al.
Antivitamin D, vitamin D in SLE: preliminary results. Ann N Y Acad Sci.
16.
Le Goaziou MF, Contardo G, Dupraz C, et al. Risk factors for vitamin D deficiency in women aged
20
–
50 years consulting in general practice: a crosssectional study. Eur J Gen
17.
Kamen DL, Cooper GS, Bouali H, et
al. Vitamin D deficiency in systemic lupus еrythematosus.
Autoimmun Rev. 2006 Feb;5(2):114
–
7. Epub 2005 Jun 21.
18.
Muller K, Kriegbaum NJ, Baslund B, et al. Vitamin D3 metabolism in patients with heumatic
diseases: low serum levels of 25-hydroxyvitamin D3 in patients with systemic
19.
O’Regan S, Chesney RW, Hamstra A, et al. Reduced serum
1,25-(OH)2 vitamin D3 levels in
prednisone-treated adolescents with systemic lupus erythematosus. Acta Paediatr Scand. 1979
Jan;68(1):109
–
11.
149
20.
Husiman AM, White KP, Algra A, et al. Vitamin D levels in women with systemic lupus erythematosus
and fibromyalgia. J Rheumatol. 2001 Nov;28(11):2535
–
9.
21.
Broder AR, Tobin JN, Putterman C. Disease-specific definitions of vitamin D deficiency need to be
established in autoimmune and non-autoimmune chronic diseases: a retrospective comparison of three
chronic diseases. Arthritis Res Ther. 2010;12(5):R191. doi: 10.1186/ar3161. Epub 2010 Oct 14.
22.
Ben-Zvi I, Aranow C, Mackay M, et al. The impact of vitamin D on Dendritic cell function in patients
with
systemic
lupus
erythematosus.
PLoS
One.
2010
Feb
16;5(2):
e9193.
doi:
10.1371/journal.pone.0009193.
23.
Thudi A, Yin S, Wandstrat AE, et al. Vitamin D levels and disease status in Texas patients with
systemic
lupus
erythematosus.
Am
J
Med
Sci.
2008
Feb;335(2):99
–
104.
doi:
10.1097/MAJ.0b013e318134eeb6.
24.
Ruiz-Irastorza G, Egutide MV, Olivares N, et al. Vitamin D deficiency in systemic lupus
erythematosus: prevalence, predictors and clinical consequences. Rheumatology (Oxford). 2008
Jun;47(6):920
–
3. doi: 10.1093/rheumatology/ken121. Epub 2008 Apr 14.
25.
Wu PW, Rhew EY, Dyer AR, et al. 25-Hydroxyvitamin D and cardiovascular risk factors in women
with systemic lupus erythematosus. Arthritis Rheum. 2009 Oct 15;61(10):1387
–
95. doi:
10.1002/art.24785.
26.
Thudi A, Yin S, Wandstrat AE, et al. Vitamin D levels and disease status in Texas patients with
systemic
lupus
erythematosus.
Am
J
Med
Sci.
2008
Feb;335(2):99
–
104.
doi:
10.1097/MAJ.0b013e318134eeb6.
27.
Mandal M, Tripathy R, Panda AK, et al. Vitamin D levels in Indian systemic lupus erythematosus
patients: association with disease activity index and interferon alpha. Arthritis Res Ther. 2014 Feb
10;16(1):R49. doi: 10.1186/ar4479.
28.
Reichel H, Koeffler HP, Tobler A, Norman AW. 1 alpha,25-dihydroxyvitamin D3 inhibits gamma-
interferon synthesis by normal human peripheral blood lymphocytes. Proc 29. Griffin MD, Lutz WH, Phan
VA, et al. Potent inhibition of dendritic cell differentiation and maturation by vitamin D analogs. Biochem
Biophys Res Commun. 2000 Apr; 270(3):701
–
8.
30. Ruiz-Irastorza G, Gordo S, Olivares N, et al. Changes in vitamin D levels in patients with systemic
lupus erythematosus: effects on fatigue, disease activity and damage.
32.
Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25hydroxyvitamin D and
1,25-dihydroxyvitamin D Levels with all-cause and cardiovascular mortality. Arch Intern Med.2008 Jun
23;168(12):1340
–
9. doi: 10.1001/archinte.168.12.1340.
33.
Scragg R, Jackson R, Holdaway IM, et al. Myocardial infarction is inversely associated with plasma
25-hydroxyvitamin D3 levels: a community-based study. Int J Epidemiol. 1990 Sep;19(3):559
–
63.
34.
Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease.
Circulation. 2008 Jan 29;117(4):503
–
11. doi: 10.1161/CIRCULATIONAHA.107.706127. Epub 2008 Jan
7.
35.
Jablonski KL, Chonchol M, Pierce GL, et al. 25-Hydroxyvitamin D deficiency is associated with
inflammation-linked vascular endothelial dysfunction in middle-aged and older adults. Hypertension.
2011 Jan;57(1): 63
–
9. doi: 10.1161/HYPERTENSIONAHA.110.160929. Epub 2010 Nov 29.
36.
Pilz S, Henry R, Snijder M, et al. 25-Hydroxyvitamin D is not associated with carotid intima- media
thickness in older men and women. Calcif Tissue Int. 2009 May;84(5):423
–
4. doi: 10.1007/s00223-
0099238-6. Epub 2009 Mar 24.
37.
Reis JP, von Muhlen D, Michos ED, et al. Serum vitamin D, parathyroid hormone levels, and carotid
atherosclerosis.
Atherosclerosis.
2009
Dec;207(2):585
–
90.
doi:
10.1016/j.atherosclerosis.2009.05.030. Epub 2009 Jun 6.
150
38.
Tarcin O, Yavuz DG, Ozben B, et al. Effect of vitamin D deficiency and replacement on endothelial
function in asymptomatic subjects. J Clin Endocrinol Metab. 2009 Oct;94(10):4023
–
30. doi:
10.1210/jc.2008
–
1212. Epub 2009 Jul 7.
39.
Watson KE, Abrolat ML, Malone LL, et al. Active serum vitamin D levels are inversely correlated
with coronary calcification. Circulation. 1997 Sep 16;96(6):1755
–
60.
41.
Bruce IN, Urowitz MB, Gladman DD, et al. Risk factors for coronary heart disease in women with
systemic lupus erythematosus: the Toronto Risk Factor Study. Arthritis Rheum. 2003 Nov;48(11):3159
–
67.
42.
Esdaile JM, Abrahamowicz M, Grodzicky T, et al. Traditional Framingham risk factors fail to fully
account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001
Oct;44(10):2331
–
7.
43.
Angel K, Provan SA, Gulseth HL, et al. Tumor necrosis factor-alpha antagonists improve aortic
stiffness in patients with inflammatory arthropathies: a controlled study. Hypertension. 2010
Feb;55(2):333
–
8. doi: 10.1161/HYPERTENSIONHA. 109.143982. pub 2009 Dec 28.
44.
Reynolds JA, Hague S, Berry JL, et al. 25-hydroxyvitamin D deficiency is associated with increased
aortic stiffness in patients with systemic lupus erythematosus. Rheumatology (Oxford). 2012
Mar;51(3):544
–
51. doi: 10.1093/rheumatology/ker352. Epub 2011 Nov 24.
45.
Holick MF, Binkley NC, et al. Evaluation, treatment, and prevention of vitamin d deficiency: an
endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911
–
30. doi:
10.1210/jc.2011-0385. Epub 2011 Jun 6.
46.
Institute of Medicine. Institute of Medicine dietary reference intakes for calcium and vitamin D.
Washington, DC: The National Academics Press; 2011.
47.
Rossini M, Bongi SM, La Montagna G, et al. Vitamin D deficiency in rheumatoid arthritis:
prevalence, determinants and associations with disease activity and disability. Arthritis Res Ther.
2010;12(6):R216. doi: 10.1186/ar3195. Epub 2010 Nov 29.
48.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of optimal serum concentrations
of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006 Jul;84(1):18
–
28.
49.
Abe J, Nakamura K, Takita Y, et al. Prevention of immunological disorders in MRL/l mice by a
new synthetic analogue of vitamin D3: 22-oxa-1 alpha, 25-dihydroxyvitamin D3. J Nutr Sci Vitaminol
(Tokyo). 1990 Feb;36(1):21
–
31.
50.
Abou-Raya A, Abou-Raya S, Helmii M. The effect of vitamin D supplementation on inflammatory and
hemostatic markers and disease activity in patients with systemic lupus erythematosus: a randomized
placebo-controlled trial. J Rheumatol. 2013 Mar;40(3):265
–
72. doi: 10.3899/jrheum.111594. Epub 2012
Dec 1.
51.
Petri M, Bello KJ, Fang H, Magder LS. Vitamin D in systemic lupus erythematosus: modest
association with disease activity and the urine protein-to-creatinine ratio. Arthritis Rheum. 2013
Jul;65(7):1865
–
71. doi: 10.1002/art.37953.
52.
Оценка
динамики
воздействия
антиагрегантной
терапии
на
ремоделирования
сердца
у
пациентов
с
плановым
гемодиализом.
G.G.
Mаdаminоv,
А.S.
Rаshidоvа,
G.P.
Аkbаrоvа,
D.Dj.
Burоnоvа,
L.H.
SHukurоvа.
UDK: 616.9:578.834-036.22-614.2
53.
Нарушение сердечного ритма у больных с ХБП V ст как предиктор сердечно сосудистого
риска. Sаbirоv M. А., Sаlyamоvа F. E., Хusаnhоdjаеvа F. T. Published by “Central asian studies”
http://www.centralasianstudies.org. Volume: 03 Issue: 02 | Mar-Apr 2022 ISSN: 2660-4159.
151
54.
Surunkаli buyrаk kаsаlligini II
-
III bоsqichidа аntiаgrеgаnt tеrаpiya fоnidа buyrаk funktsiоnаl
zаhirаsini
bаhоlаsh.
Bаrnоеv
H. B.,
SHukurоvа
L. H.,
Husаnhоdjаеvа
F. T. ORIENTAL RENAISSANCE:
INNOVATIVE , EDUCATIONAL , NATURAL END SOCIAL SCIENCES SCIENTIFIC JOURNAL.
VOLUME 1 | ISSUE 3 ISSN 2181-1784 SJIF 2021: 5.423 Scientific Journal Impact Factor.
55.
Daminova K.M., Sabirov M.A. A modern view to optimizing diagnostics of chronic kidney disease
//
Журнал
«Новый
День
в
Медицине»
-Avicenna-MED.UZ.-
Бухара,
Узбекистан
- 2021
январь
-
март
-
№1(33)
-
С.158
-162 https://www.elibrary.ru/item.asp?id=46298777
УДК:
311:61 - 61
EVIDENCE-BASED MEDICINE (EVIDENCE-BASED MEDICINE) AND
MEDICINE
Raxmonov T.O
1,а
., Mirzaraximova K.R
2,b
, Abdukadirov KH.J
3,c
.,
Tangirov A.L
2
.
.
1
Candidate of Medical Sciences, Tashkent state dental institute
2
Аssistent,
Tashkent state dental institute
Tashkent, Uzbekistan
a
b
xabibullaabduqodirov@gmail.com
ДОКАЗАТЕЛЬНАЯ
МЕДИЦИНА
(ДОКАЗАТЕЛЬНАЯ
МЕДИЦИНА)
И
МЕДИЦИНА
Рахмонов Т.О
1,а
., Мирзараксимова К.Р
2,b
., Абдукадиров Х.Ж
2,с
,
Тангиров А.Л
2d
.
1
к
.м.н.доцент,
Ташкентский
государственный
стоматологический
институт
2
ассистент,
Ташкентский
государственный
стоматологический
институт
Ташкент,
Узбекистан
a
b
