Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuk ve Ergenlerde İnflamasyon Göstergelerinin Değerlendirilmesi: Cinsiyet ve Alt Tipin Etkisi

Year 2020, , 84 - 90, 30.08.2020

Gülen Güler Aksu , Pelin Dağ

https://doi.org/10.18678/dtfd.690128

Cited By: 4

Abstract

Amaç: Bu çalışmada, tedavi almayan ve komorbiditesi olmayan dikkat eksikliği hiperaktivite bozukluğu (DEHB) tanılı çocuk ve ergenlerde hematolojik inflamatuar biyobelirteçlerin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Bu çalışmaya DSM-5 kriterlerine göre DEHB tanısı alan 6-18 yaş arası 169 çocuk dahil edildi. Yaş ve cinsiyet açısından eşleştirilmiş psikiyatrik ve/veya tıbbi hastalığı olmayan 59 sağlıklı çocuk kontrol grubu olarak alındı. Anlıksal yeti yitimi ve/veya otizm spektrum bozukluğu, akut, kronik veya inflamatuar bir hastalığı olan çocuklar çalışma dışı bırakıldı. Sigara kullanımı, obezite, psikotrop ilaçların kullanımı ve kayıt bilgilerinin yetersiz olması diğer dışlama kriterleri idi. DEHB ve kontrol grupları sosyodemografik özellikler, inflamatuar belirteçler ve hematolojik parametreler açısından karşılaştırıldı.

Bulgular: Ortalama platelet volümü (MPV) ve bazofil (BASO) düzeyleri DEHB grubunda kontrol grubuna göre anlamlı düzeyde yüksek idi ve bu fark sadece erkeklerde görüldü. Hiperaktif grupta eritrosit dağılım genişliği (RDW), lenfosit (LYMPH)ve monosit (MONO) daha yüksekti; dikkat eksikliği grubunda ortalama platelet volümü/lenfosit oranı (MPVLR) diğer tüm alt gruplardan ve kontrol grubundan daha yüksek idi. MPV ise üç alt grupta benzerdi ve bu grupların tümünde kontrol grubundan daha yüksekti.

Sonuç: Bu çalışma MPV ve BASO düzeylerinin DEHB grubunda, özellikle erkek çocuklarda daha yüksek olma eğiliminde olduğunu ortaya koymaktadır. Hematolojik biyobelirteçler DEHB tanısında ve DEHB alt tiplerinin belirlenmesinde faydalı olabilir ancak bu konudaki veriler henüz yetersizdir ve daha kapsamlı çalışmalara ihtiyaç vardır.

Keywords

DEHB, biyobelirteçler, çocuk, inflamasyon, cinsiyet

Evaluation of the Indicators of Inflammation in Children and Adolescents with Attention Deficit and Hyperactivity Disorder: Effect of Sex and Subtype

Abstract

Aim: It was aimed to evaluate the hematological inflammatory markers in treatment-naive and comorbidity-free children and adolescents with attention deficit and hyperactivity disorder (ADHD) in this study.

Material and Methods: One hundred sixty-nine children aged 6-18, who were diagnosed with ADHD according to DSM-5 criteria were included in the study. Age and sex-matched 59 healthy children without any psychiatric and/or medical disorder were included as a control group. The children who had an intellectual disability and/or autism spectrum disorder, acute, chronic or inflammatory diseases were excluded from the study. Smoking, obesity and using psychotropic medications and lack of data in records were other exclusion criteria. ADHD and control groups were compared in terms of sociodemographic characteristics, inflammatory markers and hematological parameters.

Results: Mean platelet volume (MPV) and Basophil (BASO) levels were significantly higher in the ADHD group compared to the control group and this statistical difference was only observed for boys. In hyperactivity subtype, red cell distribution width (RDW), lymphocyte (LYMPH) and monocytes (MONO) were higher; in attention deficit subtype mean platelet volume-to-lymphocyte ratio (MPVLR) was higher than all other subtypes and control group. MPV was similar in three subtypes, and were higher in all of them than the control group.

Conclusion: This study revealed that MPV and BASO tend to be higher in the ADHD group especially in boys. Hematological biomarkers may be useful for diagnosis of ADHD and determination of ADHD subtypes but data on this subject are insufficient and more comprehensive studies are needed.

Keywords

ADHD, biomarkers, child, inflammation, sex

References

• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
• Sharp SI, McQuillin A, Gurling HMD. Genetics of attention-deficit hyperactivity disorder (ADHD). Neuropharmacology. 2009;57(7-8):590-600.
• Ercan ES, Polanczyk G, Akyol Ardıc U, Yuce D, Karacetin G, Tufan AE, et al. The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatry. 2019;73(2):132-40.
• Paloyelis Y, Rijsdijk F, Wood AC, Asherson P, Kuntsi J. The genetic association between ADHD symptoms and reading difficulties: the role of inattentiveness and IQ. J Abnorm Child Psychol. 2010;38(8):1083-95.
• Thapar A, Cooper M, Jefferies R, Stergiakouli E. What causes attention deficit hyperactivity disorder? Arch Dis Child. 2012;97(3):260-5.
• van den Berg SM, Willemsen G, de Geus EJC, Boomsma DI. Genetic etiology of stability of attention problems in young adulthood. Am J Med Genet Part B Neuropsychiatr Genet. 2006;141B(1):55-60.
• Dunn GA, Nigg JT, Sullivan EL. Neuroinflammation as a risk factor for attention deficit hyperactivity disorder. Pharmacol Biochem Behav. 2019;182:22-34.
• Yirmiya R, Goshen I. Immune modulation of learning, memory, neural plasticity and neurogenesis. Brain Behav Immun. 2011;25(2):181-213.
• Leffa DT, Torres ILS, Rohde LA. A Review on the role of inflammation in attention-deficit/hyperactivity disorder. Neuroimmunomodulation. 2018;25(5-6):328-33.
• Donfrancesco R, Nativio P, Di Benedetto A, Villa MP, Andriola E, Melegari MG, et al. Anti-yo antibodies in children with ADHD: First results about serum cytokines. J Atten Disord. 2016;108705471664338.
• Giana G, Romano E, Porfirio MC, D’Ambrosio R, Giovinazzo S, Troianiello M, et al. Detection of auto-antibodies to DAT in the serum: Interactions with DAT genotype and psycho-stimulant therapy for ADHD. J Neuroimmunol. 2015;278:212-22.
• Verlaet AAJ, Noriega DB, Hermans N, Savelkoul HFJ. Nutrition, immunological mechanisms and dietary immunomodulation in ADHD. Eur Child Adolesc Psychiatry. 2014;23(7):519-29.
• Instanes JT, Halmøy A, Engeland A, Haavik J, Furu K, Klungsøyr K. Attention-deficit/hyperactivity disorder in offspring of mothers with inflammatory and immune system diseases. Biol Psychiatry. 2017;81(5):452-9.
• Buske-Kirschbaum A, Schmitt J, Plessow F, Romanos M, Weidinger S, Roessner V. Psychoendocrine and psychoneuroimmunological mechanisms in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder. Psychoneuroendocrinology. 2013;38(1):12-23.
• Riazi K, Galic MA, Kuzmiski JB, Ho W, Sharkey KA, Pittman QJ. Microglial activation and TNFα production mediate altered CNS excitability following peripheral inflammation. Proc Natl Acad Sci USA. 2008;105(44):17151-6.
• Darwish AH, Elgohary TM, Nosair NA. Serum interleukin-6 level in children with attention-deficit hyperactivity disorder (ADHD). J Child Neurol. 2019;34(2):61-7.
• Vogel SWN, Bijlenga D, Verduijn J, Bron TI, Beekman ATF, Kooij JJS, et al. Attention-deficit/hyperactivity disorder symptoms and stress-related biomarkers. Psychoneuroendocrinology. 2017;79:31-9.
• Hao X, Li D, Wu D, Zhang N. The relationship between hematological indices and autoimmune rheumatic diseases (ARDs), a meta-analysis. Sci Rep. 2017;7(1):10833.
• Avcil S. Evaluation of the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume as inflammatory markers in children with attention-deficit hyperactivity disorder. Psychiatry Clin Neurosci. 2018;72(7):522-30.
• Özer S, Yılmaz R, Sönmezgöz E, Karaaslan E, Taşkın S, Bütün İ, et al. Simple markers for subclinical inflammation in patients with familial mediterranean fever. Med Sci Monit. 2015;21:298-303.
• Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58.
• Yorbik O, Mutlu C, Tanju IA, Celik D, Ozcan O. Mean platelet volume in children with attention deficit hyperactivity disorder. Med Hypotheses. 2014;82(3):341-5.
• Binici NC, Kutlu A. Is ADHD an inflammation-related disorder? Anadolu Psikiyatri Derg. 2019;20(3):313-20.
• Uçar HN, Eray Ş, Murat D. Simple peripheral markers for inflammation in adolescents with major depressive disorder. Psychiat Clin Psych. 2018;28(3):254-60.
• Semiz M, Yildirim O, Canan F, Demir S, Hasbek E, Tuman TC, et al. Elevated neutrophil/lymphocyte ratio in patients with schizophrenia. Psychiatr Danub. 2014;26(3):220-5.
• Giynas Ayhan M, Cicek IE, Inanli I, Caliskan AM, Kirci Ercan S, Eren I. Neutrophil/lymphocyte and platelet/lymphocyte ratios in all mood states of bipolar disorder. Psychiat Clin Psych. 2017;27(3):278-82.
• Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer. 2011;47(17):2633-41.
• Demircan F, Gözel N, Kılınç F, Ulu R, Atmaca M. The impact of red blood cell distribution width and neutrophil/lymphocyte ratio on the diagnosis of major depressive disorder. Neurol Ther. 2016;5(1):27-33.
• Yüksel O, Helvaci K, Başar O, Köklü S, Caner S, Helvaci N, et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets. 2009;20(4):277-81.
• Safak S, Uslu AU, Serdal K, Turker T, Sonar S, Lutfi A. Association between mean platelet volume levels and inflammation in SLE patients presented with arthritis. Afr Health Sci. 2015;14(4):919-24.
• Tanju C, Ekrem G, Berksoy Emel A, Nur A. Mean platelet volume as a negative marker of inflammation in children with rotavirus gastroenteritis. Iran J Pediatr. 2014;24(5):617-22.
• İleri M, Kanat S, Orhan G, Türker Bayır P, Gürsoy HT, Şahin D, et al. Increased mean platelet volume in patients with infective endocarditis and embolic events. Cardiol J. 2015;22(1):37-43.
• Mert DG, Terzi H. Mean platelet volume in bipolar disorder: The search for an ideal biomarker. Neuropsychiatr Dis Treat. 2016;12:2057-62.
• Bondade S, Supriya, Seema HS, Shivakumar BK. Mean platelet volume in depression and anxiety disorder- a hospital based case-control study. Int Neuropsychiatr Dis J. 2018;11(4):1-8.
• Orum MH, Kara MZ, Egilmez OB. Mean platelet volume and neutrophil to lymphocyte ratio as parameters to indicate the severity of suicide attempt. J Immunoass Immunochem. 2018;39(6):647-59.
• Asoglu M, Aslan M, Imre O, Kivrak Y, Akil O, Savik E, et al. Mean platelet volume and red cell distribution width levels in initial evaluation of panic disorder. Neuropsychiatr Dis Treat. 2016;12:2435-8.
• Yang CF, Yang CC, Wang IJ. Association between allergic diseases, allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale, population-based study. J Chinese Med Assoc. 2018;81(3):277-83.
• Chang HY, Seo JH, Kim HY, Kwon JW, Kim BJ, Kim HB, et al. Allergic diseases in preschoolers are associated with psychological and behavioural problems. Allergy Asthma Immunol Res. 2013;5(5):315-21.
• Wang LJ, Yu YH, Fu ML, Yeh WT, Hsu JL, Yang YH, et al. Attention deficit-hyperactivity disorder is associated with allergic symptoms and low levels of hemoglobin and serotonin. Sci Rep. 2018;8(1):10229.
• Siracusa MC, Kim BS, Spergel JM, Artis D. Basophils and allergic inflammation. J Allergy Clin Immunol. 2013;132(4):789-801.
• Menegassi M, de Mello ED, Guimarães LR, Matte BC, Driemeier F, Pedroso GL, et al. Food intake and serum levels of iron in children and adolescents with attention-deficit/hyperactivity disorder. Braz J Psychiatry. 2010;32(2):132-8.
• Kocak MZ, Aktas G, Erkus E, Duman TT, Atak BM, Savli H. Mean platelet volume to lymphocyte ratio as a novel marker for diabetic nephropathy. J Coll Physicians Surg Pak. 2018;28(11):844-7.
• Bozlu G, Akar A, Durak F, Kuyucu N. Role of mean platelet volume-to-lymphocyte ratio in the diagnosis of childhood appendicitis. Arch Argent Pediatr. 2019;117(6):375-80.
• Hudzik B, Szkodziński J, Lekston A, Gierlotka M, Poloński L, Gąsior M. Mean platelet volume-to-lymphocyte ratio: a novel marker of poor short- and long-term prognosis in patients with diabetes mellitus and acute myocardial infarction. J Diabetes Complications. 2016;30(6):1097-102.