GEBELİKTE SERUM ÇİNKO DÜZEYİ VE İDRAR YOLU ENFEKSİYONU RİSKİ

Öz

AMAÇ: Gebelikte anatomik, fonksiyonel ve immun değişiklikler idrar yolu enfeksiyonu riskini artırmaktadır. Gebelik göreceli olarak immun yetersizlik durumu ortaya çıkarır. İmmun sistemin düzgün işlemesinde elzem olan çinko elementinin eksikliği beraberinde daha fazla genitoüriner enfeksiyon riskini de getirir. Bu araştırma gebelikte ilk trimester çinko değerleri ile idrar yolu enfeksiyonu arasındaki ilişkiyi değerlendirmek amacıyla yapılmıştır. GEREÇLER VE YÖNTEM: Ekim 2019 ve Ekim 2020 tarihleri arasında Özel Etlik Lokman Hekim hastanesine gebelik takibi amacıyla başvuran 184 hasta üzerinde retrospektif olarak yapılan bu çalışmada hastalardan gebeliğin ilk trimesterinde bakılan serum çinko seviyesi değerlendirildi. Çinko seviyesine göre hastalar düşük ve normal değere sahip olmak üzere iki gruba ayrıldı. İdrar yolu enfeksiyonu ile çinko seviyesi arasındaki ilişki incelendi. BULGULAR: Çalışmaya dahil gebe populasyonunda ilk trimesterde çinko eksiklik oranı %35,9 olarak bulunmuştur. İdrar yolu enfeksiyonu ile serum çinko seviyesi arasındaki ilişki istatistiksel olarak anlamlı değildir (p=0,562). Çinko içeren multivitamin kullanımı hastaların serum çinko seviyesinde istatistiksel olarak anlamlı değişiklikler oluşturmasına rağmen (p=0,039) multivitamin kullanımı ile idrar yolu enfeksiyonu arasındaki ilişki anlamlı değildir (p=0,073). Hasta yaşı artıkça idrar yolu enfeksiyonu riskinin azaldığı izlenmiştir (p=0,041). SONUÇ: Çalışma yaptığımız popülasyonda hastaların %35,9’unda ilk trimester çinko seviyesi normal değerin altındadır. Ancak çinko seviyesi ile idrar yolu enfeksiyonu arasında istatistiksel olarak anlamlı bir ilişki yoktur. Çinko içeren multivitamin kullanımı idrar yolu enfeksiyonu riskini azaltmamıştır. Ancak multivitamin kullanmayan hastalarda çinko seviyesi kullanan gruptan daha düşüktür.

Anahtar Kelimeler

• Çinko
• Enfeksiyöz gebelik komplikasyonlar
• İdrar yolu enfeksiyonu

SERUM ZINC LEVEL AND RISK OF URINARY TRACT INFECTION IN PREGNANCY

Öz

AIM: The risk of urinary tract infection increases in pregnancy due to anatomical, functional and immune changes. Pregnancy causes relatively immune deficiency. The deficiency of the zinc element, which is essential for the proper functioning of the immune system, brings with it more risk of genitourinary infections. This study was conducted to evaluate the relationship between the first trimester zinc values and urinary tract infection. . MATERIALS AND METHOD: In this retrospective study conducted on 184 patients who were admitted to the Private Etlik Lokman Hekim Hospital for pregnancy follow-up between October 2019 and October 2020, the serum zinc level of the patients in the first trimester of pregnancy was evaluated. The patients were divided into two groups according to the zinc level as low and normal values. The relationship between urinary tract infection and zinc level was analyzed. RESULTS: The first trimester zinc level is below the normal value in 35.9% of the patients in the population we studied. The relationship between urinary tract infection and serum zinc level is not statistically significant (p=0.562). Although the use of a zinc-containing multivitamin creates statistically significant changes in the serum zinc level of the patients (p=0.039), the relationship between multivitamin use and urinary tract infection is not significant (p=0.073). It was observed that the risk of urinary tract infection decreased as the age of the patient increased (p=0.041). CONCLUSION: In the population we studied, 35.9% of the patients had first trimester zinc levels below the normal value. There is no statistically significant relationship between zinc level and urinary tract infection. The use of a zinc-containing multivitamin did not reduce the risk of urinary tract infections. However, in patients who do not take a multivitamin, the zinc level is lower than the group taking it.

Anahtar Kelimeler

• Zinc
• Infectious pregnancy complications
• Urinary tract infections

Kaynakça

1. Referans1. Dwyer PL, O'Reilly M. Recurrent urinary tract infection in the female. Curr Opin Obstet Gynecol. 2002; 14:537-543.
2. Referans2. Habak PJ, Griggs, Jr RP. Urinary Tract Infection In Pregnancy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 21, 2020.
3. Referans3. Lee AC, Mullany LC, Koffi AK, et al. Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance. BMC Pregnancy Childbirth. 2019; 20:1
4. Referans4. Shaw AC, Joshi S, Greenwood H, Panda A, Lord JM. Aging of the innate immune system. Curr Opin Immunol. 2010; 22:507-513.
5. Referans5. Nowicki B. Urinary Tract Infection in Pregnant Women: Old Dogmas and Current Concepts Regarding Pathogenesis. Curr Infect Dis Rep. 2002; 4:529-535.
6. Referans6. Borysiewicz L. Prevention is better than cure. Clin Med (Lond). 2009; 9:572-583.
7. Referans7. Christensen B. Which antibiotics are appropriate for treating bacteriuria in pregnancy? J Antimicrob Chemother. 2000; 46:29-65.
8. Referans8. Hughes S, Kelly P. Interactions of malnutrition and immune impairment, with specific reference to immunity against parasites. Parasite Immunol. 2006; 28:577-588.

9. Referans9. Prasad AS. Effects of zinc deficiency on Th1 and Th2 cytokine shifts. J Infect Dis. 2000; 182:62-68.
10. Referans10. King JC, Shames DM, Woodhouse LR. Zinc homeostasis in humans. J Nutr. 2000; 130:1360-1366.
11. Referans11. Akdeniz V, Kınık Ö, Yerlikaya O, Akan E. İnsan sağlığı ve beslenme fizyolojisi açısından çinkonun önemi. Akademik Gıda, 2016; 14:307-314.
12. Referans12. Maares M, Haase H. Zinc and immunity: An essential interrelation. Arch Biochem Biophys. 2016; 611:58-65.
13. Referans13. Taneli, B. Anadolu toplumunda çinko. Ege Tıp Dergisi. 2005; 44: 1-10
14. Referans14. de Seymour JV, Beck KL, Conlon CA. Nutrition in pregnancy. Obstet Gynaecol Reprod Med. 2019; 29:219-24.
15. Referans15. Golden MH. Specific deficiencies versus growth failure: type I and type II nutrients. SCN News. 1995; 12:10-14.
16. Referans16. Özgan Çelikel Ö, Doğan Ö, Aksoy N. A multilateral investigation of the effects of zinc level on pregnancy. J Clin Lab Anal. 2018; 32:e22398.
17. Referans17. Bookallil M, Chalmers E, Andrew B. Challenges in preventing pyelonephritis in pregnant women in Indigenous communities. Rural Remote Health. 2005; 5:395.
18. Referans18. Tadesse A, Negash M, Ketema LS. Asymtomatic bacteriuria in pregnancy: assesment of prevlence, microbial agents and ther antimicrobial sensitivty pattern in Gondar Teaching Hospital, north west Ethiopia. Ethiop Med J. 2007; 45:143-149.
19. Referans19. El-Kashif, M. M. L. Urinary Tract Infection among Pregnant Women and its Associated Risk Factors: A Cross-Sectional Study. BPJ. 2019; 12:2003-2010.
20. Referans20. Haider G, Zehra N, Munir AA, Haider A. Risk factors of urinary tract infection in pregnancy. J Pak Med Assoc. 2010; 60:213-216.
21. Referans21. Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014; 210:219. e1-6.
22. Referans22. Bahadi A, El Kabbaj D, Elfazazi H, et al. Urinary tract infection in pregnancy. Saudi J Kidney Dis Transpl. 2010; 21:342-344.
23. Referans23. Wang H, Hu YF, Hao JH, et al. Maternal zinc deficiency during pregnancy elevates the risks of fetal growth restriction: a population-based birth cohort study. Sci Rep. 2015; 5:11262.
24. Referans24. Berhe K, Gebrearegay F, Gebremariam H. Prevalence and associated factors of zinc deficiency among pregnant women and children in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 2019; 19:1663.
25. Referans25. https://www.who.int/elena/bbc/zinc_pregnancy/en/ Zinc supplementation during pregnancy Biological, behavioural and contextual rationale, Ian Darnton-Hill Adjunct Professor, Tufts University, USA and University of Sydney, Australia July 2013