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Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 ve IL-10 Düzeylerinin Klinik ile İlişkisi

Year 2019, Volume: 11 Issue: 1, 16 - 21, 10.01.2019

Abstract

Amaç: Nekrotizan enterokolit (NEK) yenidoğanlarda gastrointestinal sistemin en sık görülen acil durumudur. NEK doğum ağırlığı <1500 g olan bebeklerin %5-10’unu etkiler. Günümüzde, modern yenidoğan yoğun bakım ünitelerinin kurulması ve yenidoğan bakımının artmasıyla, çok küçük preterm bebeklerin yaşam şansı artmıştır; ancak NEK insidansı ve uzun süreli morbiditeleri değişmemiştir. Prematüre ve düşük doğum ağırlığı, hastalığın en yaygın iki nedeni olmakla birlikte; NEK patofizyolojisi multifaktöriyeldir ve kesin olarak tanımlanmamıştır. NEK patofizyolojisinde temel faktörün yenidoğan bağırsağının olgunlaşmamış olması ve abartılı inflamatuvar yanıt sonucu olduğu bildirilmektedir. Çalışmalar, inflamatuvar kaskat reaksiyonunun NEK'in sadece başlangıç faktörü değil, aynı zamanda NEK'in evrelerindeve prognozunda da önemli bir rol oynadığını göstermektedir. Hayvan çalışmalarında, trombosit aktive edici faktörün (PAF), interlökinlerin (IL-8, IL-10) ve immunog-lobulinlerin NEK patofizyolojisinde rol oynadığı gösterilmiştir. Çalışmamızın ama-cı NEK tanısı alan hastalarda IgA, IgG, PAF, IL-8, IL-10 düzeylerini ve bunların kli-nik rollerini belirlemektir.                                                                                      

Materyal ve metod: Hastanemizde izlenen ve NEK tanısı almış 36 hasta, Bell evrelemesine uygun klinik, laboratuvar ve radyolojik bulgulara dayanarak üç gruba ayrıldı. Birinci grup; şüpheli NEK (NEK-I), ikinci grup kesin NEK (NEK-II), üçüncü grup ise ilerlemiş NEK (NEK-III) olarak belirlendi. Kontrol grubu olarak 17 sağlam yenidoğan çalışmaya alındı.  Hasta ve kontrol grubunda serum PAF, IL-8, IL-10, IgA ve IgG düzeyleri ölçülerek istatistiksel olarak karşılaştırıldı. p<0,05 istatistiksel olarak anlamlı kabul edildi.

Bulgular: NEK gruplarında serum PAF, IL-8 ve IL-10 düzeylerinin kontrol grubuna göre anlamlı derecede yüksek olduğu tespit edildi (p<0.001). İmmunglobulin seviyeleri istatistiksel olarak karşılaştırıldığında serum IgA düzeyi; NEK grubunda,kontrol grubuna göre anlamlı yüksek iken (p<0.001), serum IgG düzeyi; kontrol gru-bunda, tüm NEK gruplarına göre anlamlı yüksek bulundu (p<0.05). NEK-1, NEK-2 ve NEK-3 gruplarının serum PAF, IL-8, IgG ve IgA seviyelerinde anlamlı ilişkisaptanırken IL-10 seviyeleri arasında istatistiksel olarak anlamlı fark saptanmadı.

Sonuç: Premature bebeklerde proinflamatuvar ve antiinflamatuvar mediatörler arasında denge olmadığı zaman NEK gelişimi kolaylaşmakta ve daha ağır seyredebilmektedir. Ça-lışmamızda NEK’li hastalarda serum PAF, IL-8, IL-10 ve IgA düzeylerinin kontrol grubuna göre anlamlı derecede yüksek olduğu, IgG düzeylerinin daha düşük olduğu ve bunların klinikle korele olarak belirginleştiği tespit edilmiştir. Bu belirteçlerin NEK’in tanı ve klinik izleminde kullanılabilmesi için daha geniş çalışmalara ihtiyaç vardır.

References

  • Kaynaklar 1. Alison Chu, Joseph R. Hageman and Michael S. Caplan. Necro-tizing Enterocolitis: Predictive Markers and Preventive Strate-gies. NeoReviews 2013;14:113. 2. Kriston G, Meng Di, Rautava S, Lu L, Walker WA, NanthakumarN. Probiotics prevent necrotizing enterocolitis by modulating en-terocyte genes that regulate innate immune –mediated inflamma-tion. Am J PhysiolGastrointest Liver Physiol. 2013;304:132-41. 3.Al Tawil, K, Sumaily H, Ahmed İA. et al. Risk factors, characte-ristics and outcomes of necrotizing enterocolitis in late pretermand term infants. Journal of Neonatal-Perinatal Medicine 2013;6:125-130. 4. Zhang C, Michael P. Sherman, Lawrence S.Prince. et al. Panethcell ablation in the presence of Klebsiella pneumoniae induces nec-rotizing enterocolitis (NEC)-like injury in the small intestine of im-mature mice. Disease Models &Mechanisms 2012;4:522-532 5.Rose M.Viscardi, Nancy H. Lyon, Chen- Chih J. et al. Inflamma-tory cytokine mRNAs in surgical specimens of necrotizing ente-rocolitis and normal newborn intestine. Pediatric Pathology &Laboratory Medicine: Journal of the Society for Pediatric Pat-hology, Affiliated with the International Paediatric Pathology As-sociation 1996;17,:547-559. 6. Edelson M.B., Bagwell C.E. and RozyckiH.J. Circulating pro- andcounter inflammatory cytokine levels and severity in necrotizingenterocolitis. Pediatrics 1999;4:766-771. 7. Isabelle G De Plaen., Xiao-Di Tan, Hong Chang. et al. Lipopoly-saccharide activates nuclear factor kappaB in rat intestine: roleof endogenous platelet-activating factor and tumour necrosis fac-tor. British Journal of Pharmacology. 2000;129:307-314. 8. Benkoe T, Baumann S, Weninger M et al. Comprehensive evalua-tion of 11 cytokines in premature infants with surgical necroti-zing enterocolitis. PLoS ONE 8 2013;58:720 9.Rentea RM. Early enteral stressors in newborns increase inflamma-tory cytokine expression in a neonatal necrotizing enterocolitis rat mo-del. European Journal of Pediatric Surgery 2012;23(1):39-47. 10.ErikaC.Claud. Neonatal Necrotizing Enterocolitis –Inflammati-on and Intestinal ImmaturitAntiinflammAntiallergy Agents MedChem. 2009; 8(3): 248–259. 11.Nanthakumar NN, Fusunyan. RD, Sanderson I, Walker AW. Inflam-mation in the developing human intestine: a possible pathophy-siologic contribution to necrotizing enterocolitis. Proceedings ofthe National Academy of Sciences of the United States of Ame-rica 2000;97: 6043-6048. 12.Afrazi A, Sodhi CP, Richardson W, Neal M, Good M, Siggers Rand Hackam DJ: New insights into the pathogenesis and treat-ment of necrotizing enterocolitis: Toll-like receptors and beyond.Pediatr Res. 2011;69:183–188. 13.Akhil Maheshweri, Robert L Schelonka, Reed A Dimmit et al.Cyto-kines Associated with Necrotizing Enterocolitis in Extremely LowBirth Weight Infants . Pediatr Res 2014;76(1):100-108. 14.Sankararaman S, Yanamandra K, Napper D, Caldito G , DhanireddyR.The prevalence of platelet activating factor acetylhydrolase singlenucleotide polymorphisms in relationship to necrotizing enterocoli-tis in Northwest Louisiana infants. Springerplus 2013 2:294. 15..Col R andDurgun Z: Effect of recombinant interleukin-10 on somehaematological and biochemical parameters in a rat endotoxae-micmodel. Acta Vet Hung 2011;59:237–245. 16. Claudia N, Ema Cmi,Choski, N, Hunter C. Role of interleukin-10in the pathogenesis of NEC. Am J Surg 2012:4:428-435. 17.Foster J.P., Seth R and Cole M.J. Oral immunoglobulin for preven-ting necrotizing enterocolitis in preterm and low birth weight neo-nates. Cochrane Database of Systematic Reviews. 2016; 4:1816. 18.Ohlsson A. and Lacy J.B. Intravenous immunoglobulin for pre-venting infection in preterm and/or low birth weight infants. Coch-rane Database of Systematic Reviews. 2013;7:361. 19. Rubaltelli FF, Benini F, Sala M. Prevention of necrotizing ente-rocolitis in neonates at risk by oral administration of monome-ric IgG. Developmental Pharmacology & Therapeutics1990;17:138-143.

In Patients With Necrotizing Enterocolitis; Relationship of IgA, IgG, PAF, IL-8 and IL-10 Levels with Clinic

Year 2019, Volume: 11 Issue: 1, 16 - 21, 10.01.2019

Abstract

Necrotizing enterocolitis (NEC) is the most common
gastrointestinal emergency in preterm neonates. Modern
intensive care units and newborn care contributed towards
increased survival of the neonates over last few decades.
But the incidence and long term health problems in NEC
is unchanged due to lack of systematic preventive strategy. The pathophysiology of NEC is multifactorial and
not precisely defined. However, it is related to immature innate immunity of newborn intestine and exaggerated inflammatory response.
The aim of our study was to determine PAF, IL-8, IL10 and IgA, IgG levels and clinical roles of these inflammatory cytokines in NEC patients.
Method: Patients with necrotizing enterocolitis are divided into 3 groups according to Bell`s classification. First
group included 12 newborn infants with NEC I (suspected NEC). Second group included 11newborn infants with
NEC II (proven NEC). 3rd group included 13 newborn
infants NEC III (advanced NEC), The 4th group (control
group) 17 newborn healthy. PAF, IL-8, IL-10, IgA ve IgG
tests were carried out by the ELISA method in the ELISYS
Uno-Human full-automatic analyzer at the Immunological Laboratory Division of the Clinical Diagnostic Laboratory Department of the Scientific Research Institute. The
measurement data were presented as mean ± SD, and repeated measurement data were compared among the groups. p<0.05 was considered statistically significant.
Results: Serum PAF, IL-8 and IL-10 levels were significantly higher in NEC group than in control group (p
<0.001). When the immunoglobulin levels were compared statistically, serum IgA level was significantly higher in the NEC group compared to the control group
(p<0.001), while serum IgG levels were significantly higher in the control group than in all NEC groups (p<0.05).
No significant difference was found between IL-10 levels
and serum PAF, IL-8, IgG and IgA levels of NEK-1, NEK2 and NEK-3 groups.

Conclusion: When there is no equilibrium between
proinflammatory and anti-inflammatory mediators in premature babies, development of NEC is easier and more
severe. In our study, it was determined that serum PAF,
IL-8, IL-10 and IgA levels were significantly higher in
patients with NEC compared to the control group, IgG levels were lower, and these were correlated with the clinic. Further studies are needed to use these markers in the
diagnosis and clinical follow-up of NEC.

References

  • Kaynaklar 1. Alison Chu, Joseph R. Hageman and Michael S. Caplan. Necro-tizing Enterocolitis: Predictive Markers and Preventive Strate-gies. NeoReviews 2013;14:113. 2. Kriston G, Meng Di, Rautava S, Lu L, Walker WA, NanthakumarN. Probiotics prevent necrotizing enterocolitis by modulating en-terocyte genes that regulate innate immune –mediated inflamma-tion. Am J PhysiolGastrointest Liver Physiol. 2013;304:132-41. 3.Al Tawil, K, Sumaily H, Ahmed İA. et al. Risk factors, characte-ristics and outcomes of necrotizing enterocolitis in late pretermand term infants. Journal of Neonatal-Perinatal Medicine 2013;6:125-130. 4. Zhang C, Michael P. Sherman, Lawrence S.Prince. et al. Panethcell ablation in the presence of Klebsiella pneumoniae induces nec-rotizing enterocolitis (NEC)-like injury in the small intestine of im-mature mice. Disease Models &Mechanisms 2012;4:522-532 5.Rose M.Viscardi, Nancy H. Lyon, Chen- Chih J. et al. Inflamma-tory cytokine mRNAs in surgical specimens of necrotizing ente-rocolitis and normal newborn intestine. Pediatric Pathology &Laboratory Medicine: Journal of the Society for Pediatric Pat-hology, Affiliated with the International Paediatric Pathology As-sociation 1996;17,:547-559. 6. Edelson M.B., Bagwell C.E. and RozyckiH.J. Circulating pro- andcounter inflammatory cytokine levels and severity in necrotizingenterocolitis. Pediatrics 1999;4:766-771. 7. Isabelle G De Plaen., Xiao-Di Tan, Hong Chang. et al. Lipopoly-saccharide activates nuclear factor kappaB in rat intestine: roleof endogenous platelet-activating factor and tumour necrosis fac-tor. British Journal of Pharmacology. 2000;129:307-314. 8. Benkoe T, Baumann S, Weninger M et al. Comprehensive evalua-tion of 11 cytokines in premature infants with surgical necroti-zing enterocolitis. PLoS ONE 8 2013;58:720 9.Rentea RM. Early enteral stressors in newborns increase inflamma-tory cytokine expression in a neonatal necrotizing enterocolitis rat mo-del. European Journal of Pediatric Surgery 2012;23(1):39-47. 10.ErikaC.Claud. Neonatal Necrotizing Enterocolitis –Inflammati-on and Intestinal ImmaturitAntiinflammAntiallergy Agents MedChem. 2009; 8(3): 248–259. 11.Nanthakumar NN, Fusunyan. RD, Sanderson I, Walker AW. Inflam-mation in the developing human intestine: a possible pathophy-siologic contribution to necrotizing enterocolitis. Proceedings ofthe National Academy of Sciences of the United States of Ame-rica 2000;97: 6043-6048. 12.Afrazi A, Sodhi CP, Richardson W, Neal M, Good M, Siggers Rand Hackam DJ: New insights into the pathogenesis and treat-ment of necrotizing enterocolitis: Toll-like receptors and beyond.Pediatr Res. 2011;69:183–188. 13.Akhil Maheshweri, Robert L Schelonka, Reed A Dimmit et al.Cyto-kines Associated with Necrotizing Enterocolitis in Extremely LowBirth Weight Infants . Pediatr Res 2014;76(1):100-108. 14.Sankararaman S, Yanamandra K, Napper D, Caldito G , DhanireddyR.The prevalence of platelet activating factor acetylhydrolase singlenucleotide polymorphisms in relationship to necrotizing enterocoli-tis in Northwest Louisiana infants. Springerplus 2013 2:294. 15..Col R andDurgun Z: Effect of recombinant interleukin-10 on somehaematological and biochemical parameters in a rat endotoxae-micmodel. Acta Vet Hung 2011;59:237–245. 16. Claudia N, Ema Cmi,Choski, N, Hunter C. Role of interleukin-10in the pathogenesis of NEC. Am J Surg 2012:4:428-435. 17.Foster J.P., Seth R and Cole M.J. Oral immunoglobulin for preven-ting necrotizing enterocolitis in preterm and low birth weight neo-nates. Cochrane Database of Systematic Reviews. 2016; 4:1816. 18.Ohlsson A. and Lacy J.B. Intravenous immunoglobulin for pre-venting infection in preterm and/or low birth weight infants. Coch-rane Database of Systematic Reviews. 2013;7:361. 19. Rubaltelli FF, Benini F, Sala M. Prevention of necrotizing ente-rocolitis in neonates at risk by oral administration of monome-ric IgG. Developmental Pharmacology & Therapeutics1990;17:138-143.
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Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section makale
Authors

Prof. Dr. Ayla Günlemez This is me

Publication Date January 10, 2019
Published in Issue Year 2019 Volume: 11 Issue: 1

Cite

APA Günlemez, P. D. A. (2019). Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 ve IL-10 Düzeylerinin Klinik ile İlişkisi. Klinik Tıp Pediatri Dergisi, 11(1), 16-21.
AMA Günlemez PDA. Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 ve IL-10 Düzeylerinin Klinik ile İlişkisi. Pediatri. January 2019;11(1):16-21.
Chicago Günlemez, Prof. Dr. Ayla. “Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 Ve IL-10 Düzeylerinin Klinik Ile İlişkisi”. Klinik Tıp Pediatri Dergisi 11, no. 1 (January 2019): 16-21.
EndNote Günlemez PDA (January 1, 2019) Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 ve IL-10 Düzeylerinin Klinik ile İlişkisi. Klinik Tıp Pediatri Dergisi 11 1 16–21.
IEEE P. D. A. Günlemez, “Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 ve IL-10 Düzeylerinin Klinik ile İlişkisi”, Pediatri, vol. 11, no. 1, pp. 16–21, 2019.
ISNAD Günlemez, Prof. Dr. Ayla. “Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 Ve IL-10 Düzeylerinin Klinik Ile İlişkisi”. Klinik Tıp Pediatri Dergisi 11/1 (January 2019), 16-21.
JAMA Günlemez PDA. Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 ve IL-10 Düzeylerinin Klinik ile İlişkisi. Pediatri. 2019;11:16–21.
MLA Günlemez, Prof. Dr. Ayla. “Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 Ve IL-10 Düzeylerinin Klinik Ile İlişkisi”. Klinik Tıp Pediatri Dergisi, vol. 11, no. 1, 2019, pp. 16-21.
Vancouver Günlemez PDA. Nekrotizan Enterokolitli Hastalarda; IgA, IgG, PAF, IL-8 ve IL-10 Düzeylerinin Klinik ile İlişkisi. Pediatri. 2019;11(1):16-21.