Laboratuvar ve Klinik Bakış Açısıyla: Vitamin D
Özet
Gamze Avcıoğlu tarafından kaleme alınan bu çalışma, D vitamininin biyokimyasal metabolizması, fizyolojik işlevleri, laboratuvar ölçüm teknikleri ve çeşitli kronik veya akut hastalıklarla olan ilişkisini ayrıntılı biçimde ele almaktadır. Yağda çözünen ve sekosteroid yapıda hormon benzeri bir bileşik olan D vitamini; güneş ışınları vasıtasıyla deride üretilen kolekalsiferol (D3) ve bitkisel gıdalardan alınan ergokalsiferol (D2) biçiminde vücuda girmektedir. Karaciğerde 25-hidroksilaz ve böbreklerde 1-alfa-hidroksilaz enzimlerinin etkisiyle aktif formu olan 1,25(OH)2D'ye dönüştürülen D vitamini, kalsiyum ve fosfor metabolizmasının dengelenmesinde, kemik mineralizasyonunda ve bağışıklık yanıtlarının düzenlenmesinde temel rol üstlenmektedir. Klinik tanı ve değerlendirmelerde yarı ömrünün uzunluğu sebebiyle majör dolaşım formu olan 25(OH)D seviyeleri esas alınmakta, LC-MS/MS yöntemi yüksek hassasiyet ve özgüllüğü sayesinde altın standart kabul edilmektedir. D vitamini eksikliği çocuklarda raşitizme ve yetişkinlerde osteomalaziye sebebiyet verirken; literatürde kanser türleri, tip 1 ve tip 2 diyabet, otoimmün bozukluklar ile COVID-19 klinik tablosu ve sitokin fırtınası riskleri ile de yakından ilişkilendirilmektedir. Tedavi yaklaşımında ise serum 25(OH)D düzeyinin 30-50 ng/mL seviyesine ulaştırılması hedeflenerek uygun dozda D3 vitamini replasmanı uygulanması önerilmektedir.
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