Colaris Maartje J L, van der Hulst Rene R, Tervaert Jan Willem Cohen
Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40 6229 ER, Maastricht, the Netherlands.
Department of Reconstructive, Plastic and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Clin Rheumatol. 2017 May;36(5):981-993. doi: 10.1007/s10067-017-3589-6. Epub 2017 Mar 17.
The development of autoimmunity and/or autoimmune diseases is multifactorial. Vitamin D is one of the factors that might play a role. We postulated that both the presence of adjuvants and insufficient levels of vitamin D may result in the development of autoimmunity in patients with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in relation to silicone implant incompatibility. We measured vitamin D levels in 135 patients with ASIA in relation to silicone implant incompatibility and related findings to the presence of autoantibodies that are commonly used to diagnose systemic autoimmune diseases. Furthermore, we systematically reviewed the literature regarding vitamin D deficiency as a risk factor for the development of autoantibodies. Vitamin D measurements were available for analysis in 131 of 135 patients with ASIA in relation to SIIS. Twenty-three patients (18%) tested positive for autoantibodies, from which 18 patients (78%) had either a vitamin D deficiency or insufficiency (median vitamin D level 60.5 mmol/L), whereas five patients (22%) had sufficient vitamin D levels. The risk to develop autoantibodies was significantly increased in vitamin D deficient and/or insufficient patients [RR 3.14; 95% CI, 1.24-7.95; p = 0.009]. Reviewed literature suggested an association between vitamin D levels and the presence and/or titer levels of autoantibodies in different autoimmune diseases. From our current study and from our review of the literature, we conclude that vitamin D deficiency is related to the presence of autoantibodies. Whether vitamin D supplementation results in a decrease of autoimmunity needs to be studied prospectively.
自身免疫和/或自身免疫性疾病的发生是多因素的。维生素D是可能起作用的因素之一。我们推测，佐剂的存在以及维生素D水平不足可能导致因硅酮植入物不相容引发的自身免疫性/炎症综合征（ASIA）患者出现自身免疫。我们测量了135例因硅酮植入物不相容而患ASIA的患者的维生素D水平，并将相关结果与常用于诊断全身性自身免疫性疾病的自身抗体的存在情况进行关联。此外，我们系统回顾了有关维生素D缺乏作为自身抗体产生风险因素的文献。在135例因硅酮植入物不相容引发的ASIA患者中，有131例的维生素D测量结果可供分析。23例患者（18%）自身抗体检测呈阳性，其中18例患者（78%）存在维生素D缺乏或不足（维生素D水平中位数为60.5 mmol/L），而5例患者（22%）维生素D水平充足。维生素D缺乏和/或不足的患者产生自身抗体的风险显著增加[相对危险度3.14；95%可信区间，1.24 - 7.95；p = 0.009]。回顾的文献表明，维生素D水平与不同自身免疫性疾病中自身抗体的存在和/或滴度水平之间存在关联。基于我们目前的研究以及对文献的回顾，我们得出结论，维生素D缺乏与自身抗体的存在有关。维生素D补充是否会导致自身免疫性降低需要进行前瞻性研究。
