Brusellozlu çocuklarda serum hepsidin-25 ve anjiogenin (RNASE-5) düzeyleri
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Tarih
2023
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Bruselloz, brusella cinsi bakterilerin neden olduğu enfekte inek, keçi, koyun, domuz gibi hayvanların idrarı, doğum materyalleri, vücut sıvıları ile temas veya bu hayvanların iyi pişirilmemiş et, süt ve süt ürünlerinin tüketilmesiyle insanlara bulaşabilen, dünya çapında en sık karşılaşılan zoonotik hastalıklardandır. Mortalitesi düşük bir hastalık olmasına rağmen özellikle bruselloz açısından endemik olan ülkemizde ve gelişmekte olan ülkelerde hem hayvanlarda hem de insanlarda morbiditesi yüksek olması ve gıda güvenliğini etkilemesinden dolayı önemli bir halk sağlığı sorunu ve ekonomik kayıp sebebi olmaya devam etmektedir. Bu çalışma ile antibakteriyel, antifungal, antiviral, antiprotozoal ve antisepsi özelliklerine sahip olan, anjiyogenez, inflamatuar tepkiler, hücre sinyalleşmesi ve yara iyileşmesi gibi hücre içi süreçlerde, yeni ilaçların araştırılmasında ve geliştirilmesinde yeni adaylar olarak görülen antimikrobiyal peptitlerden (AMP) olan hepsidin-25 ve anjiogeninin (Rnase-5) brusellozlu çocuk hastalarda, sağlıklı çocuklara göre serum düzeylerinde değişiklik olup olmadığını belirlemek ve bu antimikrobiyal peptitlerin brusellozdaki rolünün araştırılması amaçlandı.
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Çalışmamıza Kasım 2021-Eylül 2022 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Enfeksiyon Hastalıkları ile Çocuk Sağlığı ve Hastalıkları polikliniklerine başvuran hastalarda yapılan tetkikler sonucu bruselloz olduğu tespit edilen (hasta grubu) ve kronik herhangi bir hastalığı olmayan, herhangi bir sebeple rutin kan alınacak (kontrol grubu) 36-216 ay arası çocuklar dahil edildi. Hasta grubunda 50 brusellozlu çocuk, kontrol grubunda 40 sağlıklı çocuk olmak üzere toplam 90 çocuk çalışmaya dahil edildi. Hastalardan bu testler için ayrıca kan alınmamıştır. Eğer hastanın tetkiklerinden artan serum örneği yoksa ekstra kan alınmayıp bu hastalar çalışma dışı bırakılmıştır. Tüm hastaların yaş ve cinsiyeti sorgulandı, bunlara ek olarak hasta grubundaki hastaların başvuru şikayetleri, ailede brusella enfeksiyonu varlığı, hayvancılıkla uğraş, almış olduğu brusella enfeksiyonunun tanısı, verilen tedavinin süresi ve tedavi planı incelendi. Hastaların serumlarından hepsidin-25 ve anjiogenin düzeyleri çalışıldı, enfeksiyonun olduğu hastalarda tam kan sayımı, alanin aminotransferaz (ALT), aspartat aminotransferaz (AST), C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH) ile bu antimikrobiyal peptit düzeyleri arasındaki ilişkinin değerlendirilmesi amaçlandı. Alınan kanlardan kalan serumlar, çalışma sonunda toplu olarak çalışılmak üzere, hepsidin-25 ve anjiogenin çalışılması için santrifüj edilip eppendorf tüplerine aktarılarak çalışılana kadar -80°C’de saklandı. İstatistiksel analizler için SPSS for Windows version 18.0 programı kullanıldı ve istatistiksel anlamlılık için tip-1 hata düzeyi %5 olarak kabul edildi.
Çalışmaya 90 hasta dahil edilmiş olup olguların %60.0’ı erkek (n=54) ve %40.0’ı kız (n=36) idi. Bruselloz tanısı olan hastaların yaş ortalaması 146,56±53,36 aydı. Grupların yaş dağılımı benzer olarak tespit edildi (p=0,074). Hastaların en sık başvuru şikayetleri eklem ağrısı (%76), ateş (%32), kilo kaybı (%18) ve baş ağrısı (%18) idi. Elli bruselloz hastasının %50,0’ında ailede brusella enfeksiyonu öyküsü vardı, %90,0’ının ailesi hayvancılıkla uğraşmaktaydı. Kan kültürü alınan 32 bruselloz hastasının %31,3’ünde (n=10) üreme saptandı. Hastalarda görülen komplikasyonlar %4 (n=2) nörobruselloz, %14 (n=7) relaps, %2 (n=1) epididimoorşit, %2 (n=1) sakroileit idi. Hastaların %80,0’ına (n=40) ikili, %20,0’ına (n=10) üçlü tedavi verildi. Üçlü antibiyotik tedavisi verilen hastalar nörobruselloz, sakroileit ve relapsı olan hastalardı. Nörobrusellozu olan (n=7) hastaların
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tedavisine seftriakson da ilave edildi. Hastaların tedavi süreleri %76,0’ısında (n=38) 6 hafta, %18,0’ında (n=9) 8 hafta, %6,0’ında (n=3) 3 aya kadar uzatıldı. Hasta ve kontrol gruplarının hepsidin-25 düzeyleri (p=0,295) ve anjiogenin düzeyleri (p=0,742) arasında istatistiksel olarak anlamlı fark tespit edilmedi. Hepsidin-25 ve anjiogenin düzeyleri ile yaş ve laboratuvar parametreleri arasında da istatistiksel olarak anlamlı ilişki tespit edilmedi (p>0,05). Çalışmamızdaki komplikasyonu olan (nörobruselloz, epididimoorşit ve sakroileit) dört hasta ile diğer hastalar arasındaki hepsidin-25 (p=0,618) ve anjiogenin (p=0,681) düzeyleri benzerdi. Aynı şekilde relaps olan yedi hasta ile diğer hastaların hepsidin-25 (p=0,614) ve anjiogenin (p=0,815) düzeyleri arasında istatistiksel anlamlı bir fark saptanmadı.
Çalışmamızda sentez yerlerinden birisi karaciğer olan hepsidin-25 ve anjiogenin düzeylerinin brusellozlu ve sağlıklı çocuklar arasında anlamlı bir farkının olmadığı görülmüştür. Bruselloz patogenezinin daha iyi anlaşılmasına yönelik daha fazla hasta sayısının yer aldığı ve diğer antimikrobiyal peptitlerin dahil edildiği daha kapsamlı prospektif çalışmaların yapılması gerektiği kanaatindeyiz.
Brucellosis is one of the most common zoonotic diseases worldwide which can be transmitted to humans by contact with urine, birth materials, body fluids of animals such as infected cows, goats, sheep and pigs due to brucella bacteria, or by consuming undercooked meat, milk and dairy products of these animals. Although it is a disease with low mortality, it continues to be an important public health problem and cause of economic loss, especially in our country which is endemic in terms of brucellosis, and in developing countries, as it has high morbidity in both animals and humans and affects food safety. The aim of this study is to determine whether there is a change in serum levels of Hepcidin-25 and angiogenin in pediatric patients with brucellosis compared to healthy children, which are antimicrobial peptides (AMP), which have antibacterial, antifungal, antiviral, antiprotozoal and antisepsis properties, seen as new candidates in the research and development of new drugs in intracellular processes such as angiogenesis, inflammatory responses, cell signaling and wound healing, and to investigate the role of these antimicrobial peptides in brucellosis. In our study, as a result of the examinations performed on patients who applied to Necmettin Erbakan University Meram Medical Faculty, Department of Pediatric Diseases and Pediatric Infectious Diseases and Pediatric Health and Diseases polyclinics between viii November 2021 and September 2022, children aged 36 to 216 months who were found to have brucellosis (case group) and who did not have any chronic disease and would give routine blood for any reason (control group) were included in our study. A total of 90 children, including 50 children with brucellosis in the case group and 40 healthy children in the control group, were included in the study. No blood was taken from the patients for these tests. If there is no residual serum sample from the patient's tests, extra blood was not taken and these patients were excluded from the study. Age and gender of all patients were questioned, in addition to these, complaints of patients in the case group, presence of brucella infection in the family, dealing with animal husbandry, diagnosis of brucella infection, duration of treatment and treatment plan were examined. Hepcidin-25 and angiogenin levels in the serum of the patients were studied, complete blood count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), erythrocyte sedimentation rate (ESH) and the relationship between these antimicrobial peptide levels were evaluated. The residual Serum from the collected blood were transferred to eppendorf tubes after centrifugation to study hepcidin-25 and angiogenin collectively at the end of the study and stored at -80°C. SPSS for Windows version 18.0 program was used for statistical analysis and type-1 error level was accepted as 5% for statistical significance. 90 patients were included in the study and 60.0% of the cases were male (n=54) and 40.0% were female (n=36). The mean age of the patients diagnosed with brucellosis was 146.56±53.36 months. The age distribution of the groups was found to be similar (p=0.074). The most common complaints of the patients were joint pain (76%), fever (32%), weight loss (18%) and headache (18%). Of 50 brucellosis patients, 50.0% had a family history of brucella infection, 90.0% of them were engaged in animal husbandry. Reproduction was detected in 31.3% (n=10) of 32 brucellosis patients whose blood cultures were taken. Complications in the patients were 4% (n=2) neurobrucellosis, 14% (n=7) relapse, 2% (n=1) epididymo orchitis, 2% (n=1) sacroiliitis. Patients given triple antibiotic therapy were those with neurobrucellosis, sacroiliitis and relapse. Ceftriaxone was also added to the treatment of patients with neurobrucellosis (n=7). The duration of treatment was extended to 6 weeks in 76.0% (n=38), 8 weeks in 18.0% (n=9), and up to 3 months in 6.0% (n=3). There was no statistically significant difference between hepcidin-25 levels (p=0.295) and angiogenin ix levels (p=0.742) of the case and control groups. No statistically significant correlation was found between hepcidin-25 and angiogenin levels and age and laboratory parameters (p>0.05). Hepcidin-25 (p=0.618) and angiogenin (p=0.681) levels were similar between the four patients with complications (neurobrucellosis, epididymo orchitis, and sacroiliitis) and the other patients in our study. Similarly, there was no statistically significant difference between hepcidin-25 (p=0.614) and angiogenin (p=0.815) levels of seven patients who had relapse and the other patients. In our study, it was observed that hepcidin-25 and angiogenin levels, one of the synthesis sites of which is liver, did not differ significantly between healthy children and those with brucellosis. We believe that more comprehensive prospective studies with a larger number of patients and inclusion of other antimicrobial peptides should be conducted to better understand the pathogenesis of brucellosis.
Brucellosis is one of the most common zoonotic diseases worldwide which can be transmitted to humans by contact with urine, birth materials, body fluids of animals such as infected cows, goats, sheep and pigs due to brucella bacteria, or by consuming undercooked meat, milk and dairy products of these animals. Although it is a disease with low mortality, it continues to be an important public health problem and cause of economic loss, especially in our country which is endemic in terms of brucellosis, and in developing countries, as it has high morbidity in both animals and humans and affects food safety. The aim of this study is to determine whether there is a change in serum levels of Hepcidin-25 and angiogenin in pediatric patients with brucellosis compared to healthy children, which are antimicrobial peptides (AMP), which have antibacterial, antifungal, antiviral, antiprotozoal and antisepsis properties, seen as new candidates in the research and development of new drugs in intracellular processes such as angiogenesis, inflammatory responses, cell signaling and wound healing, and to investigate the role of these antimicrobial peptides in brucellosis. In our study, as a result of the examinations performed on patients who applied to Necmettin Erbakan University Meram Medical Faculty, Department of Pediatric Diseases and Pediatric Infectious Diseases and Pediatric Health and Diseases polyclinics between viii November 2021 and September 2022, children aged 36 to 216 months who were found to have brucellosis (case group) and who did not have any chronic disease and would give routine blood for any reason (control group) were included in our study. A total of 90 children, including 50 children with brucellosis in the case group and 40 healthy children in the control group, were included in the study. No blood was taken from the patients for these tests. If there is no residual serum sample from the patient's tests, extra blood was not taken and these patients were excluded from the study. Age and gender of all patients were questioned, in addition to these, complaints of patients in the case group, presence of brucella infection in the family, dealing with animal husbandry, diagnosis of brucella infection, duration of treatment and treatment plan were examined. Hepcidin-25 and angiogenin levels in the serum of the patients were studied, complete blood count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), erythrocyte sedimentation rate (ESH) and the relationship between these antimicrobial peptide levels were evaluated. The residual Serum from the collected blood were transferred to eppendorf tubes after centrifugation to study hepcidin-25 and angiogenin collectively at the end of the study and stored at -80°C. SPSS for Windows version 18.0 program was used for statistical analysis and type-1 error level was accepted as 5% for statistical significance. 90 patients were included in the study and 60.0% of the cases were male (n=54) and 40.0% were female (n=36). The mean age of the patients diagnosed with brucellosis was 146.56±53.36 months. The age distribution of the groups was found to be similar (p=0.074). The most common complaints of the patients were joint pain (76%), fever (32%), weight loss (18%) and headache (18%). Of 50 brucellosis patients, 50.0% had a family history of brucella infection, 90.0% of them were engaged in animal husbandry. Reproduction was detected in 31.3% (n=10) of 32 brucellosis patients whose blood cultures were taken. Complications in the patients were 4% (n=2) neurobrucellosis, 14% (n=7) relapse, 2% (n=1) epididymo orchitis, 2% (n=1) sacroiliitis. Patients given triple antibiotic therapy were those with neurobrucellosis, sacroiliitis and relapse. Ceftriaxone was also added to the treatment of patients with neurobrucellosis (n=7). The duration of treatment was extended to 6 weeks in 76.0% (n=38), 8 weeks in 18.0% (n=9), and up to 3 months in 6.0% (n=3). There was no statistically significant difference between hepcidin-25 levels (p=0.295) and angiogenin ix levels (p=0.742) of the case and control groups. No statistically significant correlation was found between hepcidin-25 and angiogenin levels and age and laboratory parameters (p>0.05). Hepcidin-25 (p=0.618) and angiogenin (p=0.681) levels were similar between the four patients with complications (neurobrucellosis, epididymo orchitis, and sacroiliitis) and the other patients in our study. Similarly, there was no statistically significant difference between hepcidin-25 (p=0.614) and angiogenin (p=0.815) levels of seven patients who had relapse and the other patients. In our study, it was observed that hepcidin-25 and angiogenin levels, one of the synthesis sites of which is liver, did not differ significantly between healthy children and those with brucellosis. We believe that more comprehensive prospective studies with a larger number of patients and inclusion of other antimicrobial peptides should be conducted to better understand the pathogenesis of brucellosis.
Açıklama
Anahtar Kelimeler
Brusella, Hepsidin-25, Anjiogenin (Rnase-5), Antimikrobiyal peptit, Çocuk, Brucella, Hepcidin-25, Angiogenin (Rnase-5), Antimicrobial peptide, Child
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Mumcu. Ü. S. (2022). Brusellozlu çocuklarda serum hepsidin-25 ve anjiogenin (RNASE-5) düzeyleri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
