| Background:Vitligo is now regarded as an autoimmune disease which badly affect patient’s social activity and psychological health。It is difficult to cure. Vitamin D is proved to be able to inhibit abnormal immune response and keep immune homeostasis. Lots of clinical studies have shown that low serum vitamin D levels could be related to the occurrence and activity of many autoimmune diseases. Oral supplementation could improve their prognosis. Vitamin D analog is applied for vitiligo patients externally for years. Its effect has been supported by both theory and practice. But it is used only as external application. Latest study in America paid attention to serum vitamin D level in vitiligo patients, indicating that low serum vitamin D levels are probably associated with vitiligo. In China, no such research has been conducted.Objectives:To find out serum vitamin D levels among Chinese vitiligo patients and influence factors. To observe the association of serum vitamin D level with disease activity. Which help to provide epidemiological data and clue for further research. Methods:280patients.50normal controls. Serum25(OH) vitamin D levels were tested. Comparison between patients and controls was developed. Univariate and multivariate analysis of the association of serum25(OH) vitamin D with related feature was performed, including gender, age, type, stage, surface area, history of other autoimmune diseases, family history, testing month.6months later,20patients were followed up, to observe the relationship between vitamin D and disease evolution.Results:The mean value is29.9±9.6nmol/L, no one reached the standard of ’sufficiency’(>75nmol/L),66.7%patients were insufficient(25-75nmol/L),33.3%were deficient(<25nmol/L). No significant difference compared with controls.23%were deficient among males, while40.5%among females. Females were at an increased risk of vitamin D deficiency (p=0.019). Among patients with vitamin D deficiency,36.2%were with thyroid abnormality when29%were with hyperthyroidism or hypothyroidism. Among those with insufficiency, thyroid abnormality accounted for25.8%, when hyperthyroidism or hypothyroidism accounted for2.9%. Patients with vitamin D deficiency were at an increased risk of thyroid disease, especially thyroid dysfunction (P=0.017). Vitamin D value was lowest in March,26.1±9.7nmol/L, then went up to the highest in September and October,45.1±14.0nmol/L-44.1±15.2nmol/L, then went down. Multivariate analysis indicated gender(p=0.035), thyroid condition(p=0.034), testing month(p=0.049) were independent factors affecting vitamin D level. In the follow-up, the3patients with disease progression after common therapy (without steroids or UV therapy) all had vitamin d values lower than month average.2of them were males,66.7%in males with lower vitamin D values then month average,1was female,16.7%in females with lower vitamin D values than month average. All3patients were lip-digit type, accounted for75%in patients with lower vitamin D levels than month average, while counterparts in higher vitamin D group had no progression. Other patients in lower-than-month-average vitamin D group had it go up as disease improved, except1with thyroid disease, whose vitamin D value didn’t go up though vitiligo improved.Conclusion:Chinese vitiligo patients generally lack vitamin D. Females have higher risk. Patients with vitamin D deficiency are more likely to have thyroid diseases. Vitamin D level reaches the peak of the year in September and October, but doesn’t reach the’sufficient’standard. Lower pretreatment vitamin D level is probably associated with autoimmunity, unsatisfied prognosis and sensitivity to treatment, especially among males and lip-digit type. Vitamin D may be valuable for judging patients’autoimmune state, determining therapy and evaluating prognosis. For Chinese vitiligo patients, adequately increasing sunshine exposure and oral supplementation of vitamin D are suggested. |
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