Astımlı Çocuklarda Tüberkülin Yanıtı Sağlıklı Çocuklardan Daha mı Düşük?

Yıl 2017, Cilt: 17 Sayı: 2, 72 - 76, 01.04.2017

Zeynep Tamay Deniz Özçeker Ahmet Akçay Gülbin Gökçay Ülker Öneş Nermin Güler

https://doi.org/10.5222/j.child.2017.072

Öz

Amaç: Alerjik hastalıkların prevelansı tüm dünyada artmaktadır. Astım ve alerjik hastalıklarda Th1/Th2 dengesinin Th2 yönünde değişim hipotezi öne sürülmektedir. Tüberkülin yanıtından da Th1 yanıtı sorumlu olup, alerjik çocuklarda sağlıklı çocuklardan farkı ile ilgili çelişkili veriler mevcuttur. Bu çalışmada, Türkiye’deki okul öncesi çocuklarda astım-atopi-tüberkülin ilişkisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Yaşları 2-5 yaş arasında olan doğumdan sonra ilk 2 ay içinde BCG aşısı yapılan 200 sağlıklı ve 200 astımlı çocuk çalışmaya alındı. Serum total Ig E, aeroalerjen duyarlılığı, hava yolu direnci, astım ağırlığı ve tüberkülin cilt testi kaydedildi.Bulgular: Astımlı çocuklarda anlamlı olarak sağlıklı çocuklara göre tüberkülin yanıtı daha düşük bulundu median=0 mm ve median= 7 mm p: 0,0001 . Tüberkülin yanıtı hava yolu direnci ve atopi belirteçleri ile ilişkili değildi. Mycobacterium tuberculozis enfeksiyonu astımlı çocuklarda %5 sağlıklı çocuklara %1 göre daha sık bulundu.Sonuç: Astımlı çocuklardaki düşük tüberkülin düzeyi ve Mycobacterium tuberculozis enfeksiyonuna artmış eğilim bu çocuklarda Th1 yanıtının daha az olması ile açıklanabilir. Tüberküloz prevelansının yüksek olduğu toplumlarda yaşayan astımlı çocuklarda, tüberküloz açısından klinik şüphe yüksek tutulmalıdır

Anahtar Kelimeler

Tüberkülin, atopi, astım, mycobacterium tuberkülozis enfeksiyonu

Is Tuberculin Response Lower in Asthmatics Relative to Healthy Children?

Öz

Objective: The prevalence of allergic diseases has been increasing all over the world. It has been hypothesized that asthma and allergic diseases are disorders showing an imbalance of Th1/Th2 with a predominant Th2 response. There are conflicting data whether tuberculin reaction, which elicits a T helper 1-type immune response, differs in children with allergic diseases and healthy children. This study was aimed to investigate the relationship between asthma, atopy and tuberculin response in Turkish preschool children. Material and Method: A total of 200 asthmatic children and 200 healthy controls, aged 2 to 5 years, vaccinated with BCG within the first two months of life were enrolled into the study. Serum IgE levels, sensitization to common aeroallergens, airway resistance, asthma severity and response to tuberculin 5TU skin test were retrospectively evaluated from the records.Results: Asthmatic children had significantly lower tuberculin response than healthy children median=0 mm vs median=7 mm p=0.001 . Tuberculin response was not associated with atopy markers and airway resistance. Mycobacterium tuberculosis infection was found to be more frequent among asthmatics 5% than the control group 1% .Conclusion: Lower tuberculin response of asthmatics and tendency to Mycobacterium tuberculosisinfection may be explained by the decreased capacity of asthmatics to produce Th1-type cytokines. High index of clinical suspicion for tuberculosis should be needed in asthmatic children living in communities where tuberculosis prevalence is high

Anahtar Kelimeler

Tuberculin, atopy, asthma, mycobacterium tuberculosis infection

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