Febril konvülsiyonda Dvitamini ile pro-enflamatuvar ve anti-enflamatuvar sitokinlerin rolü
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmayla febril konvülsiyonlu çocuklarda D vitamin düzeyininin, Sinir
Büyüme Faktörü (Nerve Growth Factor = NGF)düzeyi ve febril konvülsiyon (FK)
patogenezinde yer alan pro-enflamatuvar [interlökin(IL)-1β, IL-17] ve anti-enflamatuvar
(IL-10) sitokindüzeyleri ve bu sitokinlerin 25-OH-D3 vitamini ve NGF ile ilişkisinin
değerlendirilmesi amaçlandı.
Yöntem: Çalışmaya Temmuz 2020 ile Nisan 2021 tarihleri arasında Necmettin Erbakan
Üniversitesi Meram Tıp Fakültesi Çocuk Nöroloji Poliklinikleri ile Çocuk Acil Servisine
ilk kez basit febril konvülsiyon geçirme nedeniyle başvuran [Hasta grubu (HG)], akut ateş
şikayeti ile başvurup konvülsiyon geçirmeyen [ateşli kontrol grubu (AKG)] ve konvülsiyon
geçirme öyküsü olmayıp kronik hastalığı olmayan [sağlıklı kontrol grubu (SKG)]6 ay ile
60 ay arası hastalar dahil edildi. HG’da 34, AKG’da 35 ve SKG’da 36 hasta olmak üzere
toplam 105 hasta çalışmaya dahil edildi. Hastalardan tam kan sayımı ile kanda glukoz,
sodyum (Na), potasyum (K), kalsiyum (Ca), fosfor (P), magnezyum (Mg), kreatinin (Cr),
alanin aminotransferaz (ALT), aspartat aminotransferaz (AST), alkalen fosfataz (ALP),
parathormon (PTH) ve 25-OH-D3 vitamini düzeyleri çalışıldı. Alınan kanlardan kalan
numuneler, çalışma sonunda toplu olarak çalışılmak üzere, IL-1β, IL-10, IL-17 ve NGF
çalışılması için santrifüj edilip eppendorf tüplerine aktarılarak çalışılana kadar -80oC’de
saklandı. İstatistiksel analizler için SPSS 22.0 programı kullanıldı ve p<0,05 olan değerler
anlamlı kabul edildi.
Bulgular: Katılımcıların 61’i (% 58,1) erkek, 44’ü (% 41,9) kızdı. Yaş, cinsiyet, kilo, boy,
baş çevresi, D vitamini desteği alma durumu ve güneş ışığına maruziyet süresi açısından
gruplar arasında istatistiksel açıdan anlamlı fark saptanmadı (p>0,05).Ortalama beyaz küre
sayısı (WBC) değeri, hem HG’de (p=,041) hem AKG’de(p=0,006), SKG’ye kıyasla
anlamlı derecede daha yüksekti. SKG’nin ortalama platelet (PLT) değeri, HG’ye kıyasla
anlamlı derecede daha yüksek saptandı (p=0,035). Medyan nötrofil/lenfosit (NLR) ve
platelet/lenfosit oranları (PLR), AKG (sırasıyla p<0,01 ve p=0,02) ve HG’ye (sırasıyla
p<0,01 ve p<0,01) kıyasla SKG’de anlamlı derecede daha düşüktü. Rutin biyokimya
tetkikleri incelendiğinde, HG’nin ortalama glukoz değeri, hem AKG’den (p=0,009) hem de
SKG’den (p<0,001) anlamlı derece daha yüksekti. Ayrıca AKG’nin ortalama glukoz değeri
SKG’den anlamlı derecede daha yüksek saptandı (p<0,001). SKG’nin ortalama serum Na
değeri, HG’den (p<0,001) ve AKG’den (p<0,001) anlamlı derecede daha yüksek bulundu.
Ayrıca AKG’nin ortalama serum Na değeri HG’den anlamlı olarak daha yüksek saptandı
iii
(p=0,024). HG’nin ortalama serum K değerinin SKG’yekıyasla anlamlı derecede daha
düşük olduğu saptandı (p=0,002). Ortalama Cl ve Cr değerleri ile medyan AST ve ALT
değerleri açısından gruplar arasında anlamlı farklılık yoktu (p>0,05). SKG’nin ortalama
serum Ca ve P değerlerinin HG’ye (p<0,001) ve AKG’ye(p<0,001) kıyasla anlamlı
derecede daha yüksek olduğu saptandı. AKG’nin ortalama 25-OH-D3 vitamini değerinin
SKG’ye kıyasla anlamlı derecede daha düşük olduğu saptandı (p=0,033). Medyan PTH
değeri ile ortalama ALP değeri açısından gruplar arasında anlamlı farklılık izlenmedi
(p>0,05). Çalışılan sitokinler incelendiğinde; ortalama serum IL-10 değerinin
SKG’deAKG’ye kıyasla anlamlı derecede daha yüksek olduğu görüldü (p=0,019). Diğer
sitokinlerde gruplar arasında anlamlı farklılık izlenmedi. Ayrıca yapılan korelasyon
analizinde 25-OH-D3 vitamini ile sitokinler ve NGF arasında korelasyon saptanmaz iken,
IL-1β, IL-10, IL-17 ve NGF arasında anlamlı düzeyde pozitif korelasyon saptandı.
Sonuç: Çalışmamızda bakılan serum sitokinleri ve D vitamini düzeyleri normaldi ve
çalışılan sitokinler ile NGF’nin 25-OH-D3 ile korelasyonu yoktu. Bu bulgular, febril
konvülsiyon gelişiminde pro-enflamatuvar ve anti-anflamatuvar sitokinlerin dengede
olduğunu ve D vitamininin anlamlı bir etkisi olmadığnı göstermektedir. Ancak, FK
patogenezinin daha iyi anlaşılmasına yönelik daha fazla hasta sayısının ve çalışılan
parametrelerin hem serum hem de beyin omurilik sıvısı düzeylerinin dahil edildiği daha
kapsamlı prospektif çalışmaların yapılması gerektiği kanaatindeyiz.
Objective: With this study, it was aimed to evaluate vitamin D levels, serum Nerve Growth Factor (NGF) levels, levels of pro-inflammatory [interleukin(IL)-1β, IL-17] and anti-inflammatory (IL-10) cytokines that are involved in pathogenesis of febrile seizure (FS), and association of these cytokines with vitamin 25-OH-D3 and NGF in children with FS. Method: A total of 105 patients aged 6-60 months who admitted to Necmettin Erbakan University Meram Faculty of Medicine Pediatric Neurology Outpatient Clinics and Pediatric Emergency Department with first simple febrile seizure (febrile seizure, FS; n=34) group, an acute febrile illness(febrile control, FC; n=35) group and for routine child health examination (healthy control, HC; n=36) group between July 2020 and April 2021 were included in the study. Blood samples for a complete blood count, as well as for blood glucose, sodium (Na), potassium (K), calcium (Ca), phosphorus (P), magnesium (Mg), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), parathormone (PTH) and vitamin 25-OH-D3 levels were obtained. The left-over blood samples were centrifuged, transferred to eppendorfs and the stored at -80oC for later assay of IL-1β, IL-10, IL-17 ve NGF. For statistical analyses, SPSS 22.0 program was used and a p<0.05 was considered significant. Results: Of the participants; 61 (58.1%) were male and 44 (41.9%) female. There were no statistically significant difference between the groups in terms of age, gender, weight, height, head circumference, status of vitamin D supplementation and duration of exposure to sunlight (p>0.05). Mean white cell count (WBC) was higher in both FS group (p=.041) and FC group (p=0,006) compared to the HC group. Mean platelet count (PLT) of the HC group was found to be significanlty higher compared to the FS group (p=0.035). Median neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were significantly lower in the HC group compared to the FC group (p<0.01 and p=0.02, respectively) and the patient group (p<0.01 and p<0.01, respectively). When routine biochemical tests were examined, mean glucose level of the FS group was found to be significantly higher compared to both FC group (p=0.009) and HC group (p<0.001). Moreover, mean glucose level of the FC group was determined to be significantly higher compared to the HC group (p<0.001). Mean serum Na level of the HC group was found to be significantly higher compared to both FS group (p<0.001) and FC group (p<0.001). Moreover, mean serum Na level of the FC group was determined to be significantly higher v compared to the FS group (p=0.024). Mean serum K level of the FS group was found to be significantly lower compared to the HC group (p=0.002). There were no significant differences between the groups in terms of mean Cl and Cr levels, as well as median AST and ALT levels (p>0.05). Mean serum Ca and P levels of the HC group was determined to be significantly higher compared to both patient group (p<0.001) and FC group (p<0.001). Mean vitamin 25-OH-D3 level of the febrile control FC group was found to be significantly lower compared to the HC group (p=0.033). No significant differences in median PTH and mean ALP levels were observed between the groups (p>0.05). When the investigated cytokines were examined mean serum IL-10 level of the HC group was found to be significantly higher compared to the FC group (p=0.019). There were no significant differences in other cytokines between the groups. Conclusion: Serum levels of cytokines, NGF and vitamin D investigated in our study were normal and there was no correlation of the investigated cytokines, NGF and with 25-OHD3. These results suggests that pro-inflammatory and anti-inflammatory cytokines are in a balance and vitamin D has no significant impact in pathogenesis of FS. However, we are in thought of conduction of more extensive prospective studies in which higher number of patients, all types of febrile seizures and both serum and CSF levels of the investigated parameteresare included is needed.
Objective: With this study, it was aimed to evaluate vitamin D levels, serum Nerve Growth Factor (NGF) levels, levels of pro-inflammatory [interleukin(IL)-1β, IL-17] and anti-inflammatory (IL-10) cytokines that are involved in pathogenesis of febrile seizure (FS), and association of these cytokines with vitamin 25-OH-D3 and NGF in children with FS. Method: A total of 105 patients aged 6-60 months who admitted to Necmettin Erbakan University Meram Faculty of Medicine Pediatric Neurology Outpatient Clinics and Pediatric Emergency Department with first simple febrile seizure (febrile seizure, FS; n=34) group, an acute febrile illness(febrile control, FC; n=35) group and for routine child health examination (healthy control, HC; n=36) group between July 2020 and April 2021 were included in the study. Blood samples for a complete blood count, as well as for blood glucose, sodium (Na), potassium (K), calcium (Ca), phosphorus (P), magnesium (Mg), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), parathormone (PTH) and vitamin 25-OH-D3 levels were obtained. The left-over blood samples were centrifuged, transferred to eppendorfs and the stored at -80oC for later assay of IL-1β, IL-10, IL-17 ve NGF. For statistical analyses, SPSS 22.0 program was used and a p<0.05 was considered significant. Results: Of the participants; 61 (58.1%) were male and 44 (41.9%) female. There were no statistically significant difference between the groups in terms of age, gender, weight, height, head circumference, status of vitamin D supplementation and duration of exposure to sunlight (p>0.05). Mean white cell count (WBC) was higher in both FS group (p=.041) and FC group (p=0,006) compared to the HC group. Mean platelet count (PLT) of the HC group was found to be significanlty higher compared to the FS group (p=0.035). Median neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were significantly lower in the HC group compared to the FC group (p<0.01 and p=0.02, respectively) and the patient group (p<0.01 and p<0.01, respectively). When routine biochemical tests were examined, mean glucose level of the FS group was found to be significantly higher compared to both FC group (p=0.009) and HC group (p<0.001). Moreover, mean glucose level of the FC group was determined to be significantly higher compared to the HC group (p<0.001). Mean serum Na level of the HC group was found to be significantly higher compared to both FS group (p<0.001) and FC group (p<0.001). Moreover, mean serum Na level of the FC group was determined to be significantly higher v compared to the FS group (p=0.024). Mean serum K level of the FS group was found to be significantly lower compared to the HC group (p=0.002). There were no significant differences between the groups in terms of mean Cl and Cr levels, as well as median AST and ALT levels (p>0.05). Mean serum Ca and P levels of the HC group was determined to be significantly higher compared to both patient group (p<0.001) and FC group (p<0.001). Mean vitamin 25-OH-D3 level of the febrile control FC group was found to be significantly lower compared to the HC group (p=0.033). No significant differences in median PTH and mean ALP levels were observed between the groups (p>0.05). When the investigated cytokines were examined mean serum IL-10 level of the HC group was found to be significantly higher compared to the FC group (p=0.019). There were no significant differences in other cytokines between the groups. Conclusion: Serum levels of cytokines, NGF and vitamin D investigated in our study were normal and there was no correlation of the investigated cytokines, NGF and with 25-OHD3. These results suggests that pro-inflammatory and anti-inflammatory cytokines are in a balance and vitamin D has no significant impact in pathogenesis of FS. However, we are in thought of conduction of more extensive prospective studies in which higher number of patients, all types of febrile seizures and both serum and CSF levels of the investigated parameteresare included is needed.
Açıklama
Anahtar Kelimeler
Çocuk, D Vitamini, Febril Konvülsiyon, Sinir büyüme faktörü, Child, Febrile Seizure, Nerve growth factor, Vitamin D
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Karakaş, E. (2021). Febril konvülsiyonda Dvitamini ile pro-enflamatuvar ve anti-enflamatuvar sitokinlerin rolü. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
