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Vitamin D Eficiency Are Associated With Subjective

Disease Severity in Chinese patients with
Chronic Rhinosinusitis with Nasal Polyps

Stase Ilmu THT Dokter Pembimbing :

RS Umum Daerah Sayang Cianjur dr. Eman Sulaeman, Sp.THT-KL
Universitas Muhammadiyah Jakarta
Oleh :
2019
Dwinur Syafitri Choirunisa (2014730022)
INTRODUCTION

Evidence suggests that chronic rhinosinusitis without

nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal
polyps (CRSwNP) are unique disease entities associated with
separate and distinct inflammatory milieu

Furthermore, CRSwNP in Western is most closely associated

with Th2 cytokine skewing; Chinese patients with CRSwNP
showed a Th1/Th17 cell pattern instead. These observations
indicate immunologic heterogeneity among different regions
within the same disease phenotype
INTRODUCTION

Vitamin D is a potent steroid hormone involved in the

regulation of bone mineralization and calcium homeostasi

it’s synthesized in the skin and then undergoes hydroxylation

to produce biologically active 1α, 25-dihydroxyvitamin D3
 INTRODUCTION

In addition, vitamin D
recognized as a key regulator of the deficiency increases
immune system due to the regulation of a sinus mucosa dendritic
variety of cell types, such as dendritic cells, cells in pediatric
CRSwNP
monocytes, macrophages, and T cells

It can reduce the proliferation of

it can augment innate immunity
nasal polyp fibroblasts and its
through the modulation of cathelicidin
secretion of matrix
production by the sinonasal mucosa
metalloproteinases and cytokine
OBJECTIVE

To evaluate the serum vitamin D level in patients

with chronic rhinosinusitis with nasal polyps and its
correlation with the disease severity.
 Demographic information
MATERIALS AND METHODS including :
• Age
• Gender
• Body mass index
• Smoke History
Scoring • Atopic status
Location: • Lund Mackay (LM) CT score
Hospital of Zhejiang University, China • Asthma status
• Sinonasal Outcome Test 22 score (SNOT-22)

Inclusion criteria:
• patients who underwent ESS
Exclusion criteria :
Sample: (endoscopic sinus surgery)
• Use of daily vitamin D supplements, use
A total of 88 patients were sampled • Diagnose of:
of oral steroids or immunomodulatory
i. CRSwNP
agents within 30 days before admission
ii. CRSsNP
• Other systemic disorders that affect the
iii. As Control ( patients with nasal
absorbing and metabolism of vitamin D
septum deviation & free of
• Pregnancy
inflammantory sinus disease)
RESULTS
Characteristics Patients

There were no significant differences between three groups regarding age, gender,
BMI, smoke history, atopic status and asthma.
RESULTS
Distribution of circulating VD3 status in three groups

1. Serum 25VD3 level in patients with CRSwNP was significantly lower than those in patients with
CRSsNP or control
2. However, the difference of serum VD3 levels between CRSsNP and control group was not significant
RESULTS
Correlations between serum 25VD3 level and disease severity in CRSwNP group

In patients with CRSwNP, serum

25VD3 level was not significantly
associated with LM score
(R=−0.240, p=0.126)
RESULTS
Correlations between serum 25VD3 level and disease severity in CRSwNP group

Preoperative SNOT-22 score

Result : significantly
(R=−0.378, p=0.013)
RESULTS
Correlations between serum 25VD3 level and disease severity in CRSwNP group

Improvement of SNOT-22 score

postoperatively was significantly
correlated with 25VD3 level
(R=0.567, p < 0.001)
 DISCUSSION

Vitamin D is apotent immunomodulator that has been implicated in the development of respiratory
health

High therapeutic dose of vitamin D may effectively reduce the nasal polyp size and restore the nasal
mucosa near its normal state

In our study, 25VD3 deficiency was present in : Meanwhile, 25VD3 insufficiency was present in :
• 93% of CRSwNP group • 7% of CRSwNP
• 56% of CRSsNP group • 44% of CRSsNP
• 38% of the control • 52% of control
 DISCUSSION

Pinto, et al. Mostafa & Schlosser Turki

Showed significantly lower Also found significantly lower Two studies in Turkey showed
serum VD3 levels in African VD3 levels in African American the circulating levels of 25VD3
Americans with CRS compared patients with CRSwNP were equivalent between
with race and sex-matched compared with race-matched patients with CRSwNP and
controls control subjects control

• the above studies along with our investigation highlight the fact that there are still many controversies regarding
vitamin D status in CRS.
• Further carefully controlled epidemiological studies should be performed to clarify the association between the 25VD3
level and CRS.
DISCUSSION

Effects of vitamin D on immune system, its potential role in mucus overproduction, antiangiogenic
and antiproliferative  its rational to hypothesize that vitamin D may have impact on the
treatment result after ESS

 To our knowledge, however, to date no published study has examined the influence of serum vitamin D
on the symptom improvement after ESS.
 In our study, the improvement of SNOT-22 scoring was found to be positively correlated with 25VD3 level.
 The result from ourstudy supports that serum vitamin D levels could be added to the routine work up of
patients performing ESS and these data could be used to potentially help determine symptom
improvement after surgery.
Conclusions

 Chinese patients with CRSwNP have reduced circulating 25VD3 levels compared to
CRSsNP and control subjects
 Levels of 25VD3 are associated with subjective disease severity. Furthermore,
systematic VD3 may be a predictor for symptom improvement after ESS.
 Further carefully controlled investigation is warranted to elucidate the complex
interplay between VD3 and CRS before recommending widespread therapeutic
protocols
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