Dikkat Eksikliği Hiperaktivite Bozukluğu Olan Olgularda Monosit / Yüksek Yoğunluklu Lipoprotein (HDL) Oranı

Öz

Amaç: Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB), dikkatsizlik, hiperaktivite ve dürtüsellik ile karakterize yaygın bir nörogelişimsel bozukluktur. Son çalışmalar, immün disregülasyon ve inflamasyonun DEHB’nin patofizyolojisinde rol oynayabileceğini öne sürmektedir. Monosit-yüksek yoğunluklu lipoprotein (HDL) oranı (MHR), yeni bir enflamatuar belirteç olarak önerilmiştir. Bu çalışmanın amacı, DEHB ve MHR arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışmaya, DEHB tanısı almış 67 çocuk ve ergen ile yaş ve cinsiyet açısından eşleştirilmiş 75 sağlıklı kontrol dahil edilmiştir. Tıbbi kayıtlar incelenerek hemogram ve lipid paneli parametreleri değerlendirilmiş ve her katılımcı için MHR hesaplanmıştır. Monosit düzeyleri, HDL seviyeleri ve MHR değerleri DEHB ve kontrol grupları arasında karşılaştırılmıştır. Bulgular: DEHB grubunda monosit seviyeleri kontrol grubuna kıyasla anlamlı derecede yüksek bulunmuştur (p = 0,028). Ancak, gruplar arasında HDL seviyeleri (p = 0,783) veya MHR (p = 0,076) açısından anlamlı bir fark saptanmamıştır. Sonuç:Bulgular, sistemik inflamasyonun, yüksek monosit düzeyleriyle gösterildiği gibi, DEHB'nin patofizyolojisine katkıda bulunabileceğini düşündürmektedir. Ancak, MHR’de anlamlı bir farkın olmaması, lipid metabolizması değişikliklerinin DEHB ile ilişkili inflamasyonda birincil bir rol oynamayabileceğini göstermektedir. DEHB'de immün disregülasyonun rolünü açıklığa kavuşturmak için daha büyük örneklem ve daha fazla sayıda inflamatuar belirtecin değerlendirildiği daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

• DEHB
• inflamasyon
• Monosit/HDL oranı
• bağışıklık sistemi
• lipid metabolizması

Monocyte/High Density Lipoprotein (HDL) Ratio in Children and Adolescents with Attention Deficit Hyperactivity Disorder

Abstract

Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Recent studies suggests that immune dysregulation and inflammation may play a role in its pathophysiology. The monocyte-to-high-density lipoprotein (HDL) ratio (MHR) has been proposed as a novel inflammatory marker. This study aimed to investigate the relationship between ADHD and MHR. Material and Methods: This retrospective, single-center study included 67 children and adolescents diagnosed with ADHD and 75 age- and sex-matched healthy controls. Hemogram and lipid panel parameters were retrieved from medical records, and MHR was calculated for each participant. Monocyte levels, HDL levels, and MHR values were compared between the ADHD and control groups. Results: Monocyte levels were significantly higher in the ADHD group compared to the controls (p = 0.028). However, no significant differences were found between the groups in terms of HDL levels (p = 0.783) or MHR (p = 0.076). Conclusions: The findings suggest that systemic inflammation may contribute to the pathophysiology of ADHD, as indicated by elevated monocyte levels. However, the lack of a significant difference in MHR suggests that lipid metabolism alterations may not play a primary role in ADHD-related inflammation. Further studies with larger samples and more inflammatory markers are needed to clarify the role of immune dysregulation in ADHD.

Keywords

• ADHD
• inflammation
• monocyte -to -HDL ratio
• immune system
• lipid metabolism

Kaynakça

1. 1. Polanczyk, G., & Jensen, P. (2008). Epidemiologic considerations in attention deficit hyperactivity disorder: a review and update. Child and Adolescent Psychiatric Clinics of North America, 17(2), 245-260. https://doi.org/10.1016/j.chc.2007.07.002
2. 2. Polanczyk, G., De Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. American Journal of Psychiatry, 164(6), 942-948. https://doi.org/10.1176/ajp.2007.164.6.942
3. 3. Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490-499. https://doi.org/10.1007/s13311-012-0135-8
4. 4. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association. 5. Abdel Samei, A. M., Mahmoud, D. A. M., Salem Boshra, B., & Abd El Moneam, M. H. E. D. (2024). The interplay between blood inflammatory markers, symptom domains, and severity of ADHD disorder in children. Journal of Attention Disorders, 28(1), 66-76. https://doi.org/10.1177/10870547221089164
5. 6. Goldsmith, D. R., Rapaport, M. H., & Miller, B. J. (2016). A meta-analysis of blood cytokine network alterations in psychiatric patients: Comparisons between schizophrenia, bipolar disorder, and depression. Molecular Psychiatry, 21(11), 1696-1709. https://doi.org/10.1038/mp.2016.163
6. 7. Careaga, M., Rogers, S. J., Hansen, R. L., Amaral, D. G., Van de Water, J., & Ashwood, P. (2017). Immune endophenotypes in children with autism spectrum disorder. Biological Psychiatry, 81(5), 434-441. https://doi.org/10.1016/j.biopsych.2016.08.035
7. 8. Rout, U. K., Mungan, N. K., & Dhossche, D. M. (2012). Presence of GAD65 autoantibodies in the serum of children with autism or ADHD. European Child & Adolescent Psychiatry, 21(3), 141-147. https://doi.org/10.1007/s00787-012-0243-0
8. 9. Vázquez-González, D., Carreón-Trujillo, S., Alvarez-Arellano, L., Abarca-Merlin, D. M., Domínguez-López, P., Salazar-García, M., & Corona, J. C. (2023). A potential role for neuroinflammation in ADHD. Neuroinflammation, Gut-Brain Axis and Immunity in Neuropsychiatric Disorders, 327-356. https://doi.org/10.1007/978-3-031-20394-3_14

9. 10. Leffa, D. T., Torres, I. L. S., & Rohde, L. A. (2018). A review on the role of inflammation in attention-deficit/hyperactivity disorder. Neuroimmunomodulation, 25(5-6), 328-333. https://doi.org/10.1159/000493699 11. Instanes, J., Halmøy, A., Engeland, A., Haavik, J., Furu, K., & Klungsøyr, K. (2017). Attention-deficit/hyperactivity disorder in offspring of mothers with inflammatory and immune system diseases. Biological Psychiatry, 81(5), 452-459. https://doi.org/10.1016/j.biopsych.2015.11.024
10. 12. Hisle-Gorman, E., et al. (2018). Prenatal, perinatal, and neonatal risk factors of autism spectrum disorder. Pediatric Research, 84, 190-198. https://doi.org/10.1038/s41390-018-0072-3
11. 13. Liu, X., et al. (2019). Parental asthma occurrence, exacerbations and risk of attention-deficit/hyperactivity disorder. Brain, Behavior, and Immunity, 82, 302-308. https://doi.org/10.1016/j.bbi.2019.07.002
12. 14. Donfrancesco, R., et al. (2021). Serum cytokines in pediatric neuropsychiatric syndromes: Focus on attention deficit hyperactivity disorder. Minerva Pediatrica, 73(5), 398-404. https://doi.org/10.23736/S2724-5276.16.04642-9
13. 15. Oades, R. D., Myint, A. M., Dauvermann, M. R., Schimmelmann, B. G., & Schwarz, M. J. (2010). Attention-deficit hyperactivity disorder (ADHD) and glial integrity: An exploration of associations of cytokines and kynurenine metabolites with symptoms and attention. Behavioral and Brain Functions, 6, 32. https://doi.org/10.1186/1744-9081-6-32
14. 16. Oades, R. D., Dauvermann, M. R., Schimmelmann, B. G., Schwarz, M. J., & Myint, A. M. (2010). Attention-deficit hyperactivity disorder (ADHD) and glial integrity: S100B, cytokines and kynurenine metabolism – Effects of medication. Behavioral and Brain Functions, 6, 29. https://doi.org/10.1186/1744-9081-6-29
15. 17. Pardali, E., & Waltenberger, J. (2012). Monocyte function and trafficking in cardiovascular disease. Thrombosis and Haemostasis, 108(5), 804-811. https://doi.org/10.1160/TH12-04-0276
16. 18. Soran, H., Hama, S., Yadav, R., & Durrington, P. N. (2012). HDL functionality. Current Opinion in Lipidology, 23(4), 353-366. https://doi.org/10.1097/MOL.0b013e328355ca25
17. 19. Ganjali, S., Gotto, A., Ruscica, M., Atkin, S., Butler, A., Banach, M., & Sahebkar, A. (2018). Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. Journal of Cellular Physiology, 233(12), 9237-9246. https://doi.org/10.1002/jcp.27028
18. 20. Sahpolat, M., Ayar, D., Ari, M., & Karaman, M. A. (2021). Elevated monocyte-to-HDL ratios as inflammation markers for schizophrenia patients. Clinical Psychopharmacology and Neuroscience, 19(1), 112-116. https://doi.org/10.9758/cpn.2021.19.1.112
19. 21. Chang, J. P., Su, K. P., Mondelli, V., & Pariante, C. M. (2018). Omega-3 polyunsaturated fatty acids in youth with ADHD. Progress in Lipid Research, 70, 45-56.