| Abstract | Kronična reakcija davatelja protiv primatelja (cGVHD) osnovni je uzrok kasnog morbiditeta i mortaliteta
nakon alogenične transplantacije krvotvornih matičnih stanica (alo-TKMS). Režim kondicioniranja, imunosupresivna terapija
te komplikacije cGVHD-a mogu negativno utjecati na status vitamina D, kao i na nutritivni i funkcionalni status bolesnika.
Ovo je prvo prospektivno istraživanje utjecaja nadomjesne terapije vitaminom D na nutritivni i funkcionalni status alo-TKMS
ispitanika, kao i na karakteristike cGVHD-a. U istraživanje su bila uključena ukupno 102 alo-TKMS bolesnika (spol: 54 M i
48 Ž; dob 50 (39-59)), od kojih je bilo 65 cGVHD i 37 kontrolnih bolesnika koji nisu razvili cGVHD. Svim ispitanicima je na
prvom i kontrolnom pregledu određen nutritivni i funkcionalni status, status vitamina D i ostali laboratorijski parametri te im
je, ovisno o inicijalnim serumskim vrijednostima, propisana nadomjesna terapija vitaminom D. Rezultati ovog istraživanja
pokazali su da je malnutricija, prema subjektivnoj globalnoj procjeni bolesnika (PG-SGA), prisutna u oko 40 %, narušenost
funkcionalnog statusa prema snazi stiska šake (HGS) i PG-SGA procjeni u oko 50 %, a nedostatak (<50 nmol/L) i manjak
vitamina D (<75 nmol/L) kod oko 50 i 30 % ispitanika bez obzira na prisutnost cGVHD-a. U istraživanju je nađena snažna
povezanost nutritivnog i funkcionalnog statusa (P<0,0005). Niski HGS (30,2 % cGVHD, 10,8 % kontrole) i blagi gubitak
mišićne mase kod ispitanika ukazuju na povišen rizik za razvoj sarkopenije. Zahvaćenost probavnog sustava cGVHD-om bio
je čimbenik rizika umjerene i teške malnutricije prema PG-SGA-u (B+C), a malnutricija, prisutnost cGVHD-a, zahvaćenost
probavnog sustava, jetre i pluća cGVHD-om čimbenici rizika niskog HGS-a. Nije pronađena povezanost serumskih vrijednosti
vitamina D s nutritivnim i funkcionalnim statusom, kao ni s njihovom promjenom nakon nadomjesne terapije vitaminom D.
Ispitanici koji su primali najvišu dozu nadomjesne terapije vitaminom D (2000 IU) imali su i najveću promjenu njegovih
serumskih vrijednosti. Niske vrijednosti vitamina D bile su povezane s cGVHD-om jetre (P<0,05). Čimbenik rizika nedostatka
vitamina D kod svih ispitanika bilo je mijeloablativno kondicioniranje, a kod cGVHD bolesnika aktivnost bolesti. Rezultati
pokazuju da alo-TKMS bolesnici, neovisno o prisutnosti cGVHD-a, imaju narušen nutritivni i funkcionalni status, kao i
nedostatak vitamina D, ne samo u prvim mjesecima nakon alo-TKMS-a nego i godinama nakon toga. Nadomjesna terapija
vitaminom D utjecala je na oporavak serumskih vrijednosti, ali ne i na promjenu mišićne mase i snage. |
| Abstract (english) | Chronic graft versus host disease (cGVHD) is the underlying cause of late morbidity and mortality after
allogeneic hematopoietic stem cell transplantation (allo-HSCT). Conditioning regimen, immunosuppressive therapy, and
complications of cGVHD may affect vitamin D status as well as the nutritional and functional status of patients. This is the
first prospective study of the impact of vitamin D replacement therapy on the nutritional and functional status of allo-TKMS
subjects as well as on the characteristics of cGVHD. A total of 102 allo-HSCT patients (gender: 54 M and 48 F; age 50 (39-
59)) were included in the study, of whom 65 were cGVHD and 37 were control patients. In all participants, nutritional and
functional status, vitamin D levels and other laboratory parameters were assessed at the first and control examinations, and
depending on the initial serum values, they were prescribed vitamin D replacement therapy.The results of this study showed
an incidence of malnutrition aassessed with patient generated subjective global assessment (PG-SGA) in about 40%, impaired
functional status assessed with hand grip strength (HGS) and PG-SGA in about 50% and vitamin D deficiency (<50nmol / L)
in about 50% and insuficiency (<75nmol / L) in about 30% of all subjects regardless of the presence of cGVHD. A strong
correlation between nutritional and functional status was found in the study (P <0.0005). Low HGS (30.2% cGVHD, 10.8%
control) and mild loss of muscle mass in out participants indicate an increased risk of developing sarcopenia. Gastrointestinal
cGVHD was a risk factor for moderate and severe malnutrition as assessed by PG-SGA (B + C) and malnutrition, cGVHD and
cGVHD of the digestive system, liver, and lungs risk factors for low muscle strength. were. We did not find an association of
serum vitamin D values with nutritional and functional status or with their change after vitamin D supplementation. The most
significant change in serum vitamin D values was present in patients receiving the highest dose of vitamin D supplementation
(2000IU). In cGVHD patients, low vitamin D levels were associated with liver cGVHD (P <0.05). Risk factors for vitamin D
deficiency in all subjects was myeloablative conditioning, and in cGVHD patients, disease activity. Our results showed that
allo-HSCT patients, regardless of the presence of cGVHD, have impaired nutritional and functional status as well as vitamin
D deficiency not only in the first months but also in the years after allo-HSCT. Vitamin D supplementation affected the recovery
of vitamin D serum values, but not the change in muscle mass and strength. |
