The relationship between idiopathic chest pain, Vitamin D deficiency and insufficiency in school children and adolescents

Yıl 2014, Cilt: 41 Sayı: 1, 41 - 46, 01.03.2014

Emel Torun Türkay Sarıtaş Feyza Ustabaş Kahraman Nurcan Keskinoğlu Faruk Öktem

https://doi.org/10.5798/diclemedj.0921.2014.01.0370

Cited By: 2

Öz

Objective: The aim of this study is to determine an association between vitamin D status and idiopathic chest pain in school children and adolescents. Methods: Included in the study were a control group of 60 healthy children for comparison with 120 school children and adolescents referred to our pediatric cardiology department, after being diagnosed with idiopathic chest pain. A patient\'s examination included taking a history and doing a physical examination, chest radiograph, electrocardiogram, echocardiogram complete blood count, and 25-hydroxyvitamin D and troponin I levels. Results: Age, gender distribution, and body mass index were not statistically different between the control and study groups (p=0.7, p=0.2 and p=0.3, respectively). Histories of the patients with idiopathic chest pain revealed 22% with heart disease and 6% with recent death in the family. Chest pain was present for 1 month in 19.2%, and for

Anahtar Kelimeler

Idiopathic chest pain, vitamin D deficiency, child

The relationship between idiopathic chest pain, Vitamin D deficiency and insufficiency in school children and adolescents

Öz

Amaç: Okul çocuğu ve ergenlerde, nedeni bilinmeyen göğüs ağrısı ile vitamin D düzeyinin ilişkisini belirlemek amaçlanmıştır. Yöntemler: Çalışmamıza, nedeni bilinmeyen göğüs ağrısı şikayeti ile pediatrik kardiyoloji birimimize başvuran 120 okul çocuğu ve ergen ile genel polikliniğimize başvuran 60 sağlıklı kontrol hastası alındı. Öykü alınması ve fizik muayenenin ardından, biyokimyasal testler (tam kan sayımı, kan biyokimyası, troponin I ve vitamin D düzeyi) akciğer grafisi, elektrokardiyogram, ekokardiyogram tüm hastalarda değerlendirildi. Bulgular: Çalışma grubu ile kontrol grubu arasında yaş, cinsiyet dağılımı ve vücut kitle indeksi açısından anlamlı fark saptanmadı (sırasıyla, p=0,7, 0,2 ve 0,3). Çalışma grubunda %22 hastanın aile öyküsünde kalp hastalığı, %6 &lsquo;sında ani ölüm olduğu saptandı. Çalışma grubunda, göğüs ağrısının %19,2 hastada 1 aydır, %79,2 hastada 1 aydan uzun sürdüğü; %64\'ünde sol prekordiyumda, %32\'sinde sağ prekordiyumda, %18\'inde midsternal alanda olduğu öğrenildi. Göğüs ağrısı sıklığı ve süresi değişkendi. Serum vitamin D düzeyi çalışma grubunda kontrol hastalarına göre anlamlı derecede düşüktü (p< 0,0001). Alkalen fosfataz dışında biyokimyasal parametrelerde iki grup arasında fark saptanmadı. Göğüs ağrısı süresi ve ağrı sıklığı serum vitamin D düzeyi düşüklüğü ile ilşikili bulundu (r= 0,621, p=0,002 ve r=0,213, p=0,02). Sonuç: Çocukluk çağında sebebi bilinmeyen göğüs ağrısının süresi ve sıklığı ile serum vitamin D eksiliği ve yetersizliği arasında ilişki saptanmıştır.

Anahtar Kelimeler

nedeni belli olmayan göğüs ağrısı, vitamin D eksikliği, çocuk

Kaynakça

• Geggel RL. Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics 2004;114:409-417.
• Fyfe DA, Moodie DS. Chest pain in pediatric patients pre- senting to a cardiac clinic. Clin Pediatr 1984;23:321-324.
• Selbst SM. Chest pain in children. Pediatrics 1985;75:1068- 1070.
• Zavaras-Angelidou KA, Weinhouse E, Nelson DB. Review of 180 episodes of chest pain in 134 children. Pediatr Emerg Care 1992;8:189-193.
• Driscoll DJ, Glicklich LB, Gallen WJ. Chest pain in children: a prospective study. Pediatrics 1976;57:648-651.
• Pantell RH, Goodman BW. Adolescent chest pain: a prospec- tive study. Pediatrics 1983;71:881-887.
• Selbst SM, Ruddy RM, Clark BJ, et al. Pediatric chest pain: a prospective study. Pediatrics 1988;82:319-323.
• Rowe BH, Dulberg CS, Peterson RG, et al. Characteristics of children presenting with chest pain to a pediatric emer- gency department. Can Med Assoc J 1990;143:388-394.
• Tunaoglu FS, Olguntürk R, Akcaby S, et al. Chest pain in children referred to a cardiology clinic. Pediatr Cardiol 1995;16:69-72.
• Evangelista JK, Parsons M, Renneburg AK. Chest pain in children: diagnosis through history and physical examina- tion. J Pediatr Health Care 2000;14:3-8.
• Massin MM, Bourguignont A, Coremans C, et al. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr 2004;43:231-238.
• Asnes RS, Santulli R, Bemporad JR. Pshchogenic chest pain in children. Clin Pediatr 1981;20:788.
• Kashani JH, Lababidi Z, Jones RS. Depression in children and adolescents with cardiovasculer symptomatology: the significance of chest pain. J Am Acad Child Psychiatry 1982;21:187-189.
• Greenbaum LA. Rickets and hypervitaminosis D. In: Behrman RE, Kliegman RM, Jensen HB, Stanton BF, editors. Nelson textbook of pediatrics, 18th ed. Saunders, 2007:253–258.
• Heidari B, Shirvani JS, Firouzjahi A, et al. Association be- tween nonspecifi c skeletal pain and vitamin D deficiency. Int J Rheum Dis 2010;13:340–346.
• Tezer H, Sıklar Z, Dallar Y, Dogankoç S. Early and severe presentation of vitamin D deficiency and nutritional rickets among hospitalized infants and the effective factors. Turk J Pediatr 2009;51:110–115.
• Ahmed SF, Franey C, McDewitt H, et al. Recent trends and clinical features of childhood vitamin D deficiency present- ing to a children’ s hospital in Glasgow. Arch Dis Child 2011;96:694-625.
• Hussain MZ, Ishrat S, Salehuddin M, et al. Chest pain in children: an update. Mymensingh Med J 2011;20:165-170.
• Need AG, O’Loughlin PD, Morris HA, et al. Vitamin D metabolites and calcium absorption in severe vitamin D de- ficiency. J Bone Miner Res 2008;23:1859-1863.
• Sanli C, Akalin N, Kocak U, et al. Could lower bone turn- over be a cause of chest pain during childhood? Pediatr Cardiol 2010;31:991–996.
• Roberto AM, Terreri MT, Szejnfeld V, et al. Bone mineral density in children: association with musculoskeletal pain and/or joint hypermobility. J Pediatr 2002;78:523–528.
• Cesur Y, Doğan M, Ariyuca S, et al. Evaluation of children with nutritional rickets. J Pediatr Endoc Met 2011,24:35- 43.
• Plotniof GA, Quingly JM. Prevalence of severe hypovita- minosis D in patients with persistent, nonspecific musculo- skeletal pain. Mayo Clin Proc 2003;78:1463-1470.
• de Torrente de la Jara G, Pecaud A, Favrat B. Female asy- lum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D. BMC Fam Prac 2006;7:4-11.
• Hick GE, Shardell M, Miller RR, et al. Associations be- tween vitamin D status and pain in older adults: the invec- chiare in Chianti study. J am Geriatr Soc 2008;56:785-791.
• Gloth FM 3rd, Lidsay JM, Zelesnick LB, et al. Can vitamin D deficiency produce an unusual pain syndrome? Arch In- tern Med 1991;15:1662-1664.
• Arvold DS, Odeon MJ, Donfeld MP, et.al. Correlation of symptoms with vitamin D deficiency and symptoms re- sponse to cholecalciferol treatment: a randomized con- trolled trial. Endocr Pract 2009;15:203-212.
• Warner AE, Arnspiger SA. Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. J Clin Rheumatol 2008;14:12-6.
• Wagner CL, Greer FR, for the American Academy of Pedi- atrics Section on Breastfeeding; American Academy of Pe- diatrics Committee on Nutrition. Prevention of rickets and vitamin D defi ciency in infants, children and adolescents. Pediatrics 2009;123:197.