Hubungan Defisiensi Vitamin D dengan Keparahan Pemfigus Vulgaris

Rudi Chandra, Widyaningsih Oentari

Abstract

Latar Belakang: Pemfigus vulgaris (PV) merupakan penyakit bulosa autoimun kulit dan membran mukosa yang jarang, disebabkan oleh IgG-autoantibodi yang secara langsung menyerang desmoglein dan menyebabkan akantolisis. Rendahnya kadar vitamin D telah dikaitkan dengan keparahan penyakit pemfigus. Peran vitamin D pada perkembangan PV karena efek regulasi sistem imun dengan menekan fungsi sel Th1 dan menginduksi aktivitas sel Th2, sehingga meningkatkan sitokin yang berhubungan dengannya. Selain itu, vitamin D juga dapat meningkatkan populasi sel Treg yang berperan menekan sistem imun dan mencegah penyakit autoimun. Evidence-based case report ini bertujuan untuk mengetahui hubungan defisiensi vitamin D dengan keparahan penyakit PV. Metode: Penelusuran artikel dilakukan di Pubmed dan Cochrane berdasarkan pertanyaan klinis dan pemilihan artikel
sesuai kriteria inklusi dan eksklusi. Artikel yang terpilih ditelaah kritis berdasarkan aspek validity, importance, dan applicability. Hasil: Didapatkan 1 artikel cross-sectional oleh Moravvej, et al, yang melaporkan defisiensi vitamin D berhubungan dengan PAAS kutaneus yang lebih tinggi (OR 1,36 (1,11-1,66); p<0,01) dan total PAAS kutaneus yang lebih tinggi (OR 1,24 (1,08-1,41); p<0,01). Studi ini dinyatakan sahih, penting, dan dapat diterapkan pada pasien kami. Simpulan: Defisiensi vitamin D berhubungan dengan keparahan PV.

 

Background: Pemphigus vulgaris (PV) is a rare autoimmune bullous disease of the skin and mucous membranes, caused by IgG-autoantibodies that directly attack desmoglein, causing acantholysis. Low vitamin D level has been associated with PV’s severity. The role of vitamin D in the development of PV is due to its regulatory effect on the immune system by suppressing Th1-cells function and inducing Th2-cell activity, thereby increasing the associated cytokines. Vitamin D can also increase the population of Treg-cells that play a role in suppressing the immune system and preventing autoimmune diseases. This evidence-based case report aims to determine the relationship of vitamin D deficiency with the severity of PV. Method: Relevant articles were searched through Pubmed and Cochrane based on clinical questions and selected according to inclusion and exclusion criteria. Selected articles were analyzed critically based on validity, importance, and applicability. Results: One cross-sectional article by Moravvej, et al, reported vitamin D deficiency was associated with higher cutaneous PAAS (OR 1.36 (1.11-1.66); p<0.01) and total cutaneous PAAS (OR 1.24 (1.08-1.41); p<0.01). This study was valid, important, and applicable to our patients. Conclusion: Vitamin D deficiency is associated with the severity of PV.

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References

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