The Influence Of1,25-dihydroxy Vitamin D₃on Lung Function And Quality Of Life In Chronic Obstructive Pulmonary Disease Patients

Objective:Chronic obstructive pulmonary disease is characterized by a progressive, irreversible airflow limitation chronic lung disease, but in recent years a number of studies have shown that it is a chronic inflammatory disease involving the whole body,it is associated with a variety of diseases such as osteoporosis, cardiovascular disease. The disease progresses continuously, and there is no effective drugs can slow down the deterioration of lung function in patients with COPD. In patients with moderate and severe COPD, because of the decreases of Vitamin D absorption and synthesis, vitamin D binding protein gene mutation, the lack of vitamin D can lead to Vitamin D deficiency in COPD patients. And mounting evidences presented suggest that besides calcium, phosphorus, and bone metabolism,vitamin D is also involved in a variety of inflammatory cells, and regulate the body’s innate and adaptive immunity, then vitamin D supplements may delay the processive inflammation of COPD, improve the patients’ symptoms and quality of life.In this study,we detectated the serum1,25(OH)2D3in COPD patients (n=94), and compared with healthy control groups(n=62), then explored the COPD patients serum1,25(OH)2D3levels and the relationship between lung function and quality of life scores.Methods:In the Respiratory Ward of the4th Center Clinical College of Tianjin Medical University,94cases diagnosed as COPD patients with acute exacerbation (Acute exacerbation group of COPD)were retrospectively analyzed since September2011to August2012, after treatment they improved and discharged from hospital. After3-6months,they became COPD patients in stabilization (Stabilization group of COPD), and they were all of GOLD Class Ⅱ-Ⅳ. In the Hospital Physical Examination Center,62people whose age and sex matched with the COPD patients were selected meanwhile(Healthy control group).1. Three groups was detected in serum1,25(OH)2D3level, serum calcium, phosphorus and data of pulmonary function, and analized whether differences between groups were statistical significant.2. The COPD patients were grading with pulmonary function according to the2007edition GOLD Guide (Class Ⅱ, Ⅲ, and Ⅳ), and questionnaire survey were done. Different grading patient’s quality of life score marks (CAT), BMI, and serum1,25 (OH)2D3levels, serum calcium and phosphorus levels, lung function were measured and compared.3. In acute exacerbation period, stable period of COPD patients and healthy control group, compared the correlation of serum1,25(OH)2d3level with serum calcium, phosphorus, pulmonary function data, BMI, CAT scores, and linear correlation analyses were carried out.Results:1. In COPD patients with acute exacerbation group(n=94), the serum1,25(OH)2D3levels and the levels of serum calcium, phosphorus, SaO2, PaO2were lower than that in COPD stabilization group, and CAT score significantly higher than COPD stabilization group, the differences had statistical significance (P<0.05). In COPD patients with acute exacerbation group(n=94),the data of pulmonary function (FEV1%predicted, FVC%predicted, FEV1/FVC ratio) were lower than that of COPD stabilization group(n=94), but the differences had no statistically significance (P>0.05). In COPD acute exacerbation group, the serum1,25(OH)2D3levels and and the levels of serum calcium, phosphorus, pulmonary function data (FEV1%predicted, FVC%predicted, FEV1/FVC ratio) were lower than the healthy control group, the differences had statistical significance (P<0.01). In COPD stabilization group patients(n-94), serum1,25(OH)2D3levels, serum calcium and phosphorus levels and pulmonary function data (FEV1%predicted, FVC%predicted, FEV1/FVC ratio) were significantly lower than that of the healthy control group,and the differences had statistical significance (P<0.01).2. The clinical data of COPD stabilization group patients at GOLD class Ⅱ～Ⅳ and healthy control group:the serum1,25(OH)2D3level of healthy control group (n=62), GOLD Class Ⅱ (moderate,n=30), Ⅲ(severe,n=34) and Ⅳ(very severe,n=30) was(65.16±14.86) pmol/L, pmol/L (61.33±14.03),(40.07±9.18) pmol/L and (31.69±6.14) pmol/L respectively. In COPD stabilization group patients, as the grading increased, serum1,25(OH)2D3level decreased, and the differences between subgroups had statistical significance (P<0.01), but there was no statistically significant difference between Class Ⅱ patients and the healthy control group. Among healthy control group, Class Ⅱ, Ⅲ and Ⅳ of COPD stabilization group, blood calcium levels gradually decreased, in addition to the blood calcium levels of Class Ⅱ and health control group had no statistically significant difference, the other groups of blood calcium level difference had statistical significance. Between healthy controls and Class Ⅱ,Ⅲ and Ⅳ of COPD stabilization group, the blood phosphorus levels gradually decreased, between the healthy controls, Class Ⅱ and ClassⅢ, the differences had no statistical significance, but there were significant statistical differences between them and Class IV.3. No matter COPD patients with acute exacerbation, stabilization and healthy control groups, their levels of serum calcium, phosphorus were positively correlated with serum1,25(OH)2D3levels, data of pulmonary function (FEV1%predicted, FVC%predicted, FEV1/FVC ratio) were positively correlated with serum1,25(OH)2D3levels (P<0.01).In COPD patients with acute exacerbation and stabilization group, blood gas analysis data such as PaO2and SaO2were positively correlated with serum1,25(OH)2D3levels (P<0.01); The CAT scores with serum1,25(OH)2D3levels showed a negative correlation(P<0.01).Conclusion:1. Compared with healthy controls, patients with COPD regardless of acute exacerbation group or stabilitzation group, both had low serum1,25(OH)2D3levels and low serum calcium and phosphorus levels.2. In COPD stabilization group patients,their serum1,25(OH)2D3levels and serum calcium levels were both lower than healthy controls, in addition to GOLD class Ⅱ and healthy control group, the difference between other subgroups were statistically significant, COPD patients with severe lung function decline should complement vitamin D and calcium.3.In COPD patients with acute exacerbation, their serum1,25(OH)2D3level were positively correlated with FEV1%predicted, FVC%predicted,FEV1/FVC ratio, SaO2, and PaO2, which suggested that serum1,25(OH)2D3level may influence COPD patient’s lung function and blood gas analysis.4. In COPD patients with acute exacerbation and stabilization, their serum1,25(OH)2D3levels were negatively correlated with CAT scores, indicated that low level of serum1,25(OH)2D3may influence the quality of life of COPD patients.