| Objective:To investigate the prevalence of vitamin D deficiency in patients with bronchiectasis, and to examine the correlation between vitamin D levels and risk factors of bronchiectasis through detecting the level of serum 25(OH)D in controls and bronchiectasis patients as well as performing correlation analysis between the level of serum 25(OH)D and the detected clinical parameters.Methods:Patients with bronchiectasis confirmed by chest High-Resolution Computed Tomography (HRCT) in respiratory department ward of Qilu Hospital of Shandong University were enrolled as patient group from April,2014 to November,2015.29 male patients and 48 female patients were included, with the average age of (57.2±1.6). During the same period,36 healthy people were recruited from the Health Examination Center of Qilu Hospital of Shandong University as control group, including 15 male and 21 female, with the average age of (52.6±2.4).Unified form was designed to collect the characteristics of all subjects, such as gender, age, height, body weight, smoking history and family history.All the subjects fasted for at least 8 hours to have venous blood sampling. All the blood samples were saved in 20? within 2 hous after sampling. The serum 25(OH)D levels of all subjects were detected in Central Laboratory of Qilu Hospital of Shandong University by using electrochemiluminescence method with 25(OH)D Assay Kit.All the subjects from patient group received examinations including HRCT (to confirm the degree of bronchiectasis), sputum microbiology, pulmonary function tset, arterial blood gas analysis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), immunoglobulin, subsets of T cells detection, as well as the modified British Medical Research Council dyspnea questionnaire (mMRC questionnaire).According to the serum 25(OH)D level, patient group was divided into 3 subgroups:vitamin D deficiency subgroup, vitamin D insufficiency subgroup and vitamin D sufficiency subgroup. The differences of general clinical characteristics, chest imaging characteristics, pulmonary function, sputum microbiology, inflammatory markers, immunoglobulin, and subsets of T cells among the 3 groups were analyzed.Statistical analysis:Quantitative data are expressed as mean ± SE. Comparison between two groups was done with independent sample T-test. Comparison among multiple groups was done with one-way analysis of variance (one-way ANOVA). Inter-group difference pairwise comparison was done with least significant difference (LSD) when the variances were equal, or with Dunnett T3 when the variances were unequal. Categorical data were presented as percentages. Chi-square test was used to analyze categorical data. When n<40, Fisher's Exact Test was applied. P<0.05 was considered statistically significant. All data analysis used SPSS 16.0 software (SPSS Inc., Chicago, IL, USA).Results:1. Patients with bronchiectasis had significantly lower BMI than the control group (p=0.006, p=0.003).2. Compared with the control group (28.46±4.75ng/ml), patients with bronchiectasis had a significantly decreased levels of 25(OH)D, which was 15.70±10.70ng/ml in general (p<0.001). Among the 36 control subjects,15 subjects were in vitamin D sufficiency (41%),20 subjects were in vitamin D insufficiency (56%), and 1 subject was in vitamin D deficiency (3%). In the bronchiectasis group, only 11% patients were in vitamin D sufficiency and 19% patient were in vitamin D insufficiency, while the percentage of vitamin D deficiency patients was as high as 70%. The distribution of vitamin D insufficiency and vitamin D deficiency in bronchiectasis had statistical difference (P=0.009).3. Among the 3 subgroups divided by 25(OH)D levels in bronchiectasis patients, the chest HRCT characteristics had significant differences. With the changes of vitamin D status, the degree of bronchiectasis among the 3 subgroups showed significantly differences (P=0.015). In the vitamin D sufficiency subgroup,50% patients were involving 1-5 pulmonary segments and anther 50% were involving 6-9 pulmonary segments, with no patients involving>9 pulmonary segments. Intriguingly, in vitamin D deficiency subgroup,46.3% patients were involving>9 pulmonary segments. In addition, the bronchiectasis patients with vitamin D sufficiency had 2.0±0.3 pulmonary lobes involved on average, while in bronchiectasis patients with vitamin D deficiency, the number of involved pulmonary lobes increased significantly (3.1±0.2, P<0.05).4. In bronchiectasis patients with vitamin D sufficiency,37.5% were with normal pulmonary function,37.5% had mild obstructive ventilation dysfunction,12.5% had moderate obstructive ventilation dysfunction, and 12.5% were with restrictive ventilation dysfunction, with no severe or extremely severe obstructive ventilation dysfunction. However, in bronchiectasis patients with vitamin D insufficiency or deficiency, the percentage of patients with normal pulmonary function decreased remarkably, while the incidence of severe or extremely severe obstructive ventilation dysfunction increased significantly, which were 26.7% and 33.3% respectively. Compared with the bronchiectasis patients with vitamin D sufficiency, bronchiectasis patients with vitamin D deficiency had obviously reduced FVC%?FEV1%? FV1/FVC(%) (p=0.012, p=0.011, p=0.019).5.The PaO2 of the arterial blood was significantly lower in bronchiectasis patients with vitamin D insufficiency and deficiency, and the PaCO2 was significantly higher in patients with vitamin D deficiency, compared with the patients with vitamin D sufficiency.6.1n bronchiectasis patients, the inflammatory biomarkers including CRP?ESR and PCT elevated significantly in all of the 3 subgroups with the decrease of vitamin D level.Conclusions:1. Compared with the controls, the bronchiectasis patients had lower 25(OH)D levels and a much higher incidence of vitamin D deficiency.2. Bronchiectasis patients with lower 25(OH)D levels had larger area of involved lung segments as shown in chest HRCT.3. Bronchiectasis patients with vitamin D deficiency had worse pulmonary function, indicating that serum vitamin D levels may reflrct pulmonary function and be positively related to the severity of bronchiectasis.4. Bronchiectasis patients with lower levels of vitamin D had a higher levels of inflammatory biomarkers and to some degree they were more likely to be susceptible. |
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