Solunum Cihazına Bağlı Pnömonili Hastalarda Soluk Havasındaki Nitrik Oksit ve Hidrojen Peroksitin Tanısal Değerleri

Yıl 2022, Cilt: 5 Sayı: 1, 1 - 11, 30.06.2022

Amine Aktar Karakaya , Yusuf Türköz , Ünsal Özgen

Öz

Serbest radikallerin özellikle nitrik oksitin (NO), akciğer hastalıklarının takibinde önemi giderek artmaktadır. Çalışmada, hasta için herhangi bir risk taşımayan, örneklemesi kolay bir yöntemle, enflamatuvar parametrelerin ölçülmesi planlandı. Solunum cihazına bağlı 37 olgu alındı ( 27 hasta, 10 kontrol). Olguların birinci ve üçüncü günlerde soluk hava yoğunlaştırıcısı ile ekspiryum hava numunesi alınarak, NO, hidrojen peroksit (H2O2) ayrıca serumdan C-reaktif protein (CRP) düzeyleri ölçüldü. Birinci gün; pnömoni grubunun NO düzeyi kontrol grubundan istatistiksel olarak daha yüksekti (p <0,0001). Birinci gün H2O2 düzeyi açısından gruplar arasında anlamlı bir farklılık yoktu (p> 0,05). Pnömoni grubunun birinci ve üçüncü gün arasındaki NO düzeyindeki düşüş istatistiksel olarak anlamlı bulundu. (p<0,05). Birinci gün bakılan serum CRP ve ekspiryum hava NO düzeyleri pnömoni grubunda anlamlı derecede yüksekti, ancak H2O2 düzeyleri arasında fark bulunmadı. Yapılan çalışmada, enflamasyonu göstermede NO ölçümünün oldukça anlamlı olduğu, özellikle solunum cihazına bağlı pnömonide erken tanıda değerli olabileceği düşünülmektedir.

Anahtar Kelimeler

Soluk havası, H2O2, Solunum cihazı, Nitrik oksit, Pnömoni

Proje Numarası

This study is İnönü University Scientific Research Projects Management Unit Supported by the 2005-12 project number.

Dıagnostıc Values of Nıtrıc Oxıde and Hydrogen Peroxıde Content ın Inspıred Aır ın Patıents wıth Pneumonıa Under Respıratory Device

Öz

Free radicals, especially nitric oxide (NO), are of increasing importance in the management of lung diseases. In this study, we aimed to measure the inflammatory parameters with a method that is easy to sample and does not carry any risk to the patient. 37 cases connected to ventilator were included (27 patients, 10 controls). The first day and the third day, expiratory air was removed with an exhaled breath condenser and NO, hydrogen peroxide (H2O2) and serum C-reactive protein (CRP) were examined. First day; The NO level of the pneumonia group was statistically higher than the control group (p <0,0001). No significant difference was found between the patients in terms of hydrogen peroxide level at the first day (p> 0,05).The decrease in NO level between the first and third days of the pneumonia group was found to be statistically significant. (p<0,05). Serum CRP and exhaled air NO levels were significantly higher in the pneumonia group on the first day compared to the control group, but no difference was found between the H2O2 values. In our study, it is thought that NO is very significant in showing inflammation and may be valuable in early diagnosis, especially in respiratory device-associated pneumonia.

Anahtar Kelimeler

Exhaled air, H2O2, Mechanical ventilation, Nitric oxide, Pneumonia

Proje Numarası

This study is İnönü University Scientific Research Projects Management Unit Supported by the 2005-12 project number.

Kaynakça

• Reference 1 :Chang I, Schibler A. Ventilator Associated Pneumonia in Children. Paediatr Respir Rev 2016; 20: 10-6.
• 2-Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63: 575-82.
• 3-Türk toraks derneği. Erişkinlerde hastanede gelişen pnömoni. Tanı ve tedavi uzlaşı raporu 2018; 1-4.
• 4-Xu Y, Lai C, Xu G, et al. Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation. Clin Interv Aging 2019; 14: 1027-38.
• 5-Lee W, Thomas PS. Oxidative stress in COPD and its measurement through exhaled breath condensate. Clin Transl Sci 2009; 2: 150-5.
• 6-Bjermer L, Alving K, Diamant Z, etal. Current evidence and future research needs for FeNO measurement in respiratory diseases. Respir Med 2014; 108: 830-41.
• 7-Balint B, Kharitonov SA, Hanazawa T, et al. Increased nitrotyrosine in exhaled breath condensate in cystic fibrosis. Eur Respir J 2001; 17: 1201-7.
• 8-Kelekçi S, Sen V, Yolbas I, et al. FeNO levels in children with asthma and other diseases of the lung. Eur Rev Med Pharmacol Sci 2013; 17: 3078-82.
• 9-Karsten J, Krabbe K, Heinze H, Dalhoff K, Meier T, Drömann D. Bedside monitoring of ventilation distribution and alveolar inflammation in community-acquired pneumonia. J Clin Monit Comput 2014; 28: 403-8.
• 10-Ricciardolo FL, Sorbello V, Ciprandi G. FeNO as biomarker for asthma phenotyping and management. Allergy Asthma Proc 2015; 36: 1–8.
• 11-Brugiere O, Thabut G, Mal H, et al. Exhaled NO may predict the decline in lung function in bronchiolitis obliterans syndrome. Euro Res J 2005; 25: 813-9.
• 12-Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011; 184: 602-15.
• 13-Teng Y, Sun P, Zhang J, et al. Hydrogen peroxide in exhaled breath condensate in patients with asthma: a promising biomarker? Chest 2011; 140: 108-16.
• 14-Cheah FC, Darlow BA, Winterbourn CC. Problems associated with collecting breath condensate for the measurement of exhaled hydrogen peroxide from neonates on respiratory support. Biol Neonate 2003; 84: 338-41.
• 15-Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis 2010; 51: 131-5.
• 16-van Oort PM, Bos LD, Póvoa P, et al. Soluble urokinase plasminogen activator receptor for the prediction of ventilator-associated pneumonia. ERJ Open Res 2019; 5: 00212-2018.
• 17-Jungersten L, Edlund A, Petersson AS, Wennmalm A. Plasma nitrate as an index of nitric oxide formation in man: analyses of kinetics and confounding factors. Clin Physiol 1996; 16: 369–79.
• 18-Ozbek E, Turkoz Y, Gokdeniz R, Davarci M, Ozugurlu F. Increased nitric oxide production in the spermatic vein of patients with varicocele. Eur Urol 2000; 37: 172-5.
• 19-Loukides S, Horvath I, WodehouseT, Cole PJ, Barnes PJ. Elevated levels of expired breath hydrogen peroxide in bronchiectasis. Am J Respir Crit CareMed 1998; 158: 991-4.
• 20- A Essizoglu, EA Yildirim. Nitric oxide in the psychobiology of mental disorders. Dicle Med J 2009; 36:67-74.
• 21-Biban P, Zangardi T, Baraldi E, Dussini N, Chiandetti L, Zachello F. Mixed exhaled nitric oxide and plasma nitrites and nitrates in newborns infants. Life Sciences 2001; 68: 2789-97.
• 22-Adrie C, Monchi M, Dinh-Xuan AT, Dall'Ava-Santucci J, Dhainaut JF, Pinsky MR. Exhaled and nasal nitric oxide as a marker of pneumonia in ventilated patients. Am J Respir Crit Care Med 2001; 163: 1143-9.
• 23- Dikener AH, Özdemir H, Ceylan A, Ünlü A, Artaç H. Serum periostin level and exhaled nitric oxide in children with asthma. Asthma Allergy Immunology 2018; 16: 97-103.
• 24- Carraro S, Andreola B, Alinovi R, et al. Exhaled leukotriene B4 in children with community acquired pneumonia. Pediatr Pulmonol 2008; 43: 982-6.
• 25-Ueno T, Kataoka M, Hirano A, et al. Inflammatory markers in exhaled breath condensate from patients with asthma. Respirology 2008; 13: 654-63.
• 26- Kietzman D, Kahl R, Müller M, Burchardi H, Kettler D. Hydrogen peroxide in breath condensate of patients with acute respiratory failure and with ARDS. İntensive Care Med 1993; 19: 78-81.
• 27- Majewska E, Kasielski M, Luczynski R, Bartosz G, Bialasiewicz P, Nowak D. Elevated exhalation of hydrogen peroxide and thiobarbituric acid reactive substances in patients with community acquired pneumonia. Respir Med 2004; 98: 669-76.