Efficacy of the Vitamin D3 in the Treatment of Generalized Periodontitis, Associated with Combined Endocrinological Pathology: Immunological Aspect

The urgency of the study is due to the high prevalence of generalized periodontitis associated with endocrine pathology, in particular, type 2 diabetes mellitus and autoimmune thyroiditis, which, in its turn, ranked among the endocrinologic diseases. The aim of study is to determine the effectiveness of using vitamin D3 in complex treatment of patients with generalized periodontitis associated with type 2 diabetes mellitus and hypothyroidism in terms of immune status. Materials and Methods. 87 patients with generalized periodontitis of the 1st and 2nd degree of severity, the acute course associated with the combined endocrine pathology, with the defined insufficient level of vitamin D3 (immune enzyme-linked quantitative determination Kit 25-OH D IDS OCTEIA (Immunodiagnostic, Bensheim and Biomedica, Vienna, Austria). The immune system - Th1-profile cytokines (INF-γ, TNF-α, IL-2, IL-6, IL-12), Th2-profile (IL-4, IL-5), IL-10 and IL-17. Vitamin D3 was included in the treatment scheme of 57 patients with GP. The results of treatment of 30 persons with GP without using vitamin D3 served to control the research. The initial level of immune status of patients with GP and type 2 diabetes mellitus and autoimmune thyroiditis indicates a significant increase in the background concentration of Th1-profile cytokines (INF-γ, TNF-α, IL-2, IL-6, IL-12) and reduction of Th2-profile (IL-4, IL-5), as well as IL-10 and IL-17. As a result we prescribed application of vitamin D3 in the complex treatment of patients with diabetes mellitus according to the scheme: two courses (for 2 months each) with an interval of not less than 3 months (except summer period) 2000-4000 IU/day, depending on the severity of the diseases and of the reference level 25 (OH) D3. The proposed scheme of vitamin D3 administration showed that it had a significant corrective effect on the balance of cytokines in the blood of patients with generalized periodontitis, associated with combined endocrine pathology. Conclusion. Including vitamin D3 into the scheme of integrated treatment in comparison with traditional therapy of generalized periodontitis provided a decrease in the concentration of proinflammatory cytokines INF-γ, TNF-α, IL-2, IL-6, IL-12 and increase of background level of IL-4, IL- 5, IL-10 and IL-17. The obtained data testify to the reliably corrective influence of vitamin D3 on the balance of cytokines in patients with GP associated with type 2 diabetes mellitus and autoimmune thyroiditis. In the context of normalizing the immune status of patients, the proposed method creates conditions for an increase in the period of remission and stabilization of the dystrophic-inflammatory process in periodontium.