Covid-19 enfeksiyonu geçiren çocuk hastalarda asimetrik dimetil arjinin düzeyinin incelenmesi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Koronavirüs hastalığı 2019 (COVID-19) çocuklarda daha hafif semptomlarla kendini gösterir. Hastaneye yatış ve hayatı tehdit eden komplikasyon riski daha düşüktür. Bununla birlikte, çocuklarda post-enfeksiyöz multisistem inflamatuar sendrom (MIS-C) adı verilen ve mortal seyredebilen, ciddi hastalık vakaları tanımlanmıştır. Ağır seyreden COVID-19 vakalarında agresif immün yanıtın sonucu olarak endotel hasarı gelişir. Endotel hasarı sonucunda koagülasyon faktörleri artar. Hastaların solunum sıkıntısının esas olarak endotel hasarından dolayı olduğu düşünülmektedir. Endotel aktivasyonu ve disfonksiyonu, COVID-19'un ciddi komplikasyonlarında kritik rol alır.
Asimetrik dimetilargininin (ADMA), endotelyal hücrelerde sentezlenen ve insan idrar, plazma ve dokularında bulunan, arginine benzeyen bir maddedir. Nitrik oksit sentazın (NOS) endojen bir inhibitörü olan ADMA, nitrik oksit (NO) sentezini azaltarak endotel bağımlı vazodilatasyonun bozulmasına neden olur.
Literatürü incelediğimizde ADMA’nın çocuklarda COVID-19 ve MIS-C hastalığıyla ilişkisine dair bir çalışma bulamadık. Çalışmamızda patogenezlerinde endotel hasarının etkili olduğu COVID-19 ve MIS-C hastalıklarında endotel disfonksiyonunun bir biyobelirteci olan ADMA’nın serum düzeyinin prognozu ve klinik gidişatı öngörmede kullanılıp kullanılamayacağını araştırmayı amaçladık.
Çalışmaya Temmuz 2021- Ocak 2022 tarihleri arasında COVID-19 tanısı alan 98 hasta, MIS-C tanısı alan toplam 21 hasta alındı. Kontrol grubu olarak 42 vaka çalışmaya dahil edildi. COVID-19 tanısı alan hastalar ayaktan takip edilenler, servise yatırılanlar ve yoğun bakım ihtiyacı olanlar olarak ayrıldı. MIS-C tanılı hastalarımız ayrı bir grup olarak değerlendirildi.
Çalışmamızda ayaktan COVID-19 tanısıyla takipli hastaların ortanca ADMA düzeyi 8097,0 ng/L, servise yatırılarak takip edilen COVID-19 hastalarının ortanca ADMA
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düzeyi 13195,6 ng/L, MIS-C ile takip edilen hastaların ortanca ADMA düzeyi 15735,5 ng/L, yoğun bakımda takipli COVID-19 hastalarının ortanca ADMA düzeyi 19361,4 ng/L ve kontrol hastalarının ortanca ADMA düzeyi 4081,0 ng/L idi. Çalışma grupları arasında ölçülen ADMA düzeyleri açısından anlamlı fark vardı (p<0,001). Yoğun bakımda yatan COVID-19 hastalarının ve MIS-C hastalarının ADMA düzeyleri ayaktan ve servise yatırılarak takip edilen COVID-19 hastalarına göre anlamlı olarak yüksekti. Ayrıca tüm hasta gruplarında serum ADMA düzeyi kontrol grubuna göre anlamlı olarak yüksek bulundu.
Sonuç olarak, çalışmamız COVID-19 ve MIS-C’li çocuklarda ADMA seviyelerini araştıran ilk çalışmadır. ADMA düzeylerinin yoğun bakım ihtiyacı olan COVID-19 hastalarında ve MIS-C hastalarında anlamlı olarak yüksek olduğunu tespit ettik. Serum ADMA seviyesinin 6135,15 ng/L üstünde olmasının endotelyal disfonksiyonu göstermede bir sınır olarak kullanılabileceğini düşünüyoruz. Bu konuda daha kesin yargılara ulaşmak için daha geniş kapsamlı çalışmalara ihtiyaç vardır.
Coronavirus disease 2019 (COVID-19) manifests itself with milder symptoms in children. Hospitalization rates and risk of life-threatening complications is lower. However, cases of a serious disease called post-infectious multisystem inflammatory syndrome in children (MIS-C), which can be fatal, have been described. In severe cases of COVID-19, endothelial damage develops as a result of an aggressive immune response. As a result of endothelial damage, coagulation factors increase. The respiratory distress of patients is supposed to be mainly due to endothelial damage. Endothelial activation and dysfunction have a critical role in the serious complications of COVID-19. Asymmetric dimethylarginine (ADMA) is an arginine-like substance synthesized in endothelial cells and found in human urine, plasma and tissues. ADMA, an endogenous inhibitor of nitric oxide synthase (NOS), causes disruption of endothelium-dependent vasodilation by reducing nitric oxide (NO) synthesis. When we reviewed the literature, we could not find any study on the relationship of ADMA with MIS-C disease and COVID-19 in children. In our study, we aimed to investigate whether the serum level of ADMA, a biomarker of endothelial dysfunction, can be used to predict prognosis and clinical course in COVID-19 and MIS-C diseases in which endothelial damage is effective in their pathogenesis. The study group included 98 patients diagnosed with COVID-19 and 21 patients diagnosed with MIS-C who admitted between June 2021 and January 2022, to our pediatric emergency clinic. The control group consisted of forty two people. Patients diagnosed with COVID-19 were divided into three groups as; outpatients, hospitalized patients in pediatric infectious disease department and those in need of intensive care. Patients diagnosed with MIS-C, were evaluated as a separate group. The median ADMA levels of the outpatient COVID-19 group, hospitalized COVID-19 group, COVID-19 patients followed up the intensive care unit, and MIS-C group were 8097.0 ng/L, 13195.6 ng/L, 19361.4 ng/L, 15735.5 ng/L, respectively. Median ADMA levels of control group was 4081.0 ng/L. ADMA levels of COVID-19 patients hospitalized in the intensive care unit and MIS-C patients were significantly higher than the outpatients and COVID-19 patients hospitalized in pediatric infectious disease v department (p<0.001). In addition, serum ADMA level was found to be significantly higher in all patient groups compared to the control group. In conclusion, our study is the first to investigate ADMA levels in children with COVID-19 and MIS-C. We found that ADMA levels were significantly higher in patients with MIS-C and COVID-19 patients who needed intensive care. We think that a serum ADMA level above 6135,15 ng/L can be used as a limit for demonstrating endothelial dysfunction. More comprehensive studies are needed to reach more precise judgments on this issue.
Coronavirus disease 2019 (COVID-19) manifests itself with milder symptoms in children. Hospitalization rates and risk of life-threatening complications is lower. However, cases of a serious disease called post-infectious multisystem inflammatory syndrome in children (MIS-C), which can be fatal, have been described. In severe cases of COVID-19, endothelial damage develops as a result of an aggressive immune response. As a result of endothelial damage, coagulation factors increase. The respiratory distress of patients is supposed to be mainly due to endothelial damage. Endothelial activation and dysfunction have a critical role in the serious complications of COVID-19. Asymmetric dimethylarginine (ADMA) is an arginine-like substance synthesized in endothelial cells and found in human urine, plasma and tissues. ADMA, an endogenous inhibitor of nitric oxide synthase (NOS), causes disruption of endothelium-dependent vasodilation by reducing nitric oxide (NO) synthesis. When we reviewed the literature, we could not find any study on the relationship of ADMA with MIS-C disease and COVID-19 in children. In our study, we aimed to investigate whether the serum level of ADMA, a biomarker of endothelial dysfunction, can be used to predict prognosis and clinical course in COVID-19 and MIS-C diseases in which endothelial damage is effective in their pathogenesis. The study group included 98 patients diagnosed with COVID-19 and 21 patients diagnosed with MIS-C who admitted between June 2021 and January 2022, to our pediatric emergency clinic. The control group consisted of forty two people. Patients diagnosed with COVID-19 were divided into three groups as; outpatients, hospitalized patients in pediatric infectious disease department and those in need of intensive care. Patients diagnosed with MIS-C, were evaluated as a separate group. The median ADMA levels of the outpatient COVID-19 group, hospitalized COVID-19 group, COVID-19 patients followed up the intensive care unit, and MIS-C group were 8097.0 ng/L, 13195.6 ng/L, 19361.4 ng/L, 15735.5 ng/L, respectively. Median ADMA levels of control group was 4081.0 ng/L. ADMA levels of COVID-19 patients hospitalized in the intensive care unit and MIS-C patients were significantly higher than the outpatients and COVID-19 patients hospitalized in pediatric infectious disease v department (p<0.001). In addition, serum ADMA level was found to be significantly higher in all patient groups compared to the control group. In conclusion, our study is the first to investigate ADMA levels in children with COVID-19 and MIS-C. We found that ADMA levels were significantly higher in patients with MIS-C and COVID-19 patients who needed intensive care. We think that a serum ADMA level above 6135,15 ng/L can be used as a limit for demonstrating endothelial dysfunction. More comprehensive studies are needed to reach more precise judgments on this issue.
Açıklama
Anahtar Kelimeler
COVID-19, ADMA, Endotel hasarı, MIS-C, SARS-CoV-2, COVID-19, ADMA, Endothelial damage, MIS-C, SARS-CoV-2
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sarı, M. (2023). Covid-19 enfeksiyonu geçiren çocuk hastalarda asimetrik dimetil arjinin düzeyinin incelenmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
