Pediatrik Çölyak Hastalarında Homosistein, Vitamin B12 ve Folik Asit Düzeyleri

Yıl 2015, , 1 - 6, 01.06.2015

Dilek Beker Şanlı Yüksel Aliyazıcıoğlu Ayhan Gazi Kalaycı

https://doi.org/10.4274/jcp.92400

Öz

Giriş: Bu çalışmada amacımız çölyak hastalarında malabsorbsiyon nedeni ile gastrointestinal sistemden vitamin B12 ve folik asit emilimlerinin bozulmasının serum homosistein düzeyleri üzerine etkisini araştırmak.Gereç ve Yöntem: Yaşları 2-17 arasında değişmekte olan 32 tedavi öncesi çölyak hastası, 14 tedavi sonrası çölyak olgusu ve 30 sağlıklı kontrolde homosistein düzeyleri araştırıldı. Tedavi öncesi ve tedavi sonrası hasta grubunda ayrıca plazma vitamin B12 ve folik asit düzeyleri bakıldı.Bulgular: Homosistein için aritmetik ortalama±SD; tedavi öncesi hasta grubunda 22,87±1,69 µmol/L, tedavi sonrası hasta grubunda 17,31±1,94 µmol/L ve kontrol grubunda 15,21±1,69 µmol /L olarak belirlendi. Folik asit için ortalama±SD; tedavi öncesi hasta grubunda 7,04±0,74 ng/ml, tedavi sonrası hasta grubunda 12,95±1,9 ng/ml olarak bulundu. Folik asit ve homosistein için tedavi öncesi hasta grubu ile tedavi sonrası hasta grubu arasındaki fark istatistiksel olarak anlamlı bulundu p< 0,05 . Vitamin B12 için ortalama±SD; tedavi öncesi hasta grubunda 433,31±70,91 pg/ml, tedavi sonrası hasta grubunda 400,33±78,36 pg/ml olarak bulundu. İstatistiksel olarak iki grup arasında anlamlı bir fark saptanmadı p> 0,05 .Sonuç: Araştırmamızda tedavi öncesi çölyak hastalarında homosistein düzeyleri tedavi sonrası ve kontrol grubundan yüksek bulundu. Bu çalışmada gruplar arasında folik asit düzeyleri açısından anlamlı fark bulunması, folik asit düzeylerinin homosistein konsantrasyonlarındaki artışla daha fazla ilişkili olabileceğini göstermektedir

Anahtar Kelimeler

Çölyak hastalığı, homosistein, vitamin B12, folik asit

Homosistein, Vitamin B12 and Folic Acid Levels in Patients with Pediatric Celiac Disease

Öz

Introduction: Our aim in this study was to investigate effects of vitamin B12 and folic acid malabsorption to homocysteine levels in celiac patients.Materials and Methods: Between 2-17 years of ages 32 celiac patients before treatment, 14 celiac patient in remission and 30 healthy controls involved in this study. Homocystein levels were evaluated in all groups. In addition plasma levels of vitamin B12 and folic acid determined in celiac and remission groups.Results: Homocysteine levels as arithmetic mean±SD found 22.8±1.69 µmol/L in celiac group, 17.31±1.94 µmol/L in remission group and 15.21±1.69 µmol/L in control group. Folic acid levels as arithmetic mean±SD found 7.04±0.74 ng/ml in celiac patients and 12.95±1.9 ng/ml in remission group. There is statistically significant difference between folic acid and homocysteine levels of two groups p< 0.05 . Vitamin B12 levels as arithmetic mean±SD found 433.31±70.91 pg/ml in celiac patients and 400.33±78.36 pg/ml in remission group. Difference between two groups is not statistically significant p> 0.05 . Conclusions: In our study homocysteine levels were found to be higher in celiac group than remission group. In this study, difference in folic acid levels between two groups may show that changes in folic acid levels related to changes in homocysteine levels.

Anahtar Kelimeler

Celiac disease, homocysteine, vitamin B12, folic acid

Kaynakça

• 1. Schuppan D. Current concepts of celiac disease pathogenesis. Gastroenterology 2000;119:234-42.
• 2. Fine KD. The prevalence of occult gastrointestinal bleeding in celiac sprue. N Eng J Med 1996;334:1163-7.
• 3. Finkelstein JD. The metabolism of homocysteine: pathways and regulation. Eur J Pediatr 1998;157:40-4.
• 4. Lim PO, Tzemos N, Farguharson CAJ, Anderson JE, Deegan P, MacWalter RS, et al. Reversible hypertension folloving celiac disease treatment: the role of moderate hyperhomocysteinemia and vascular endothelial dysfunction. J Hum Hypertens 2002;16:411-5.
• 5. Nelson DA Jr. Gluten sensitive enteropathy (celiac disease): more common than you think. Am Fam Physician 2002;66:2259-66.
• 6. Rifai N, Warnick GR. Lipids, Lipoproteins, Apolipoproteins and Other Cardiovascular Risk Factors. In: Burtis CA, Ashwood ER, Bruns DE (eds). Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th edition. Philadelphia: Elsevier Saunders; 2006:968.
• 7. Selhub J, Jacques PF, Wilson PW, Rush D, Rosenberg IH. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993;270:2693-8.
• 8. Kannel WB, Castelli WP, Gordon T. Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the framingham study. Ann Intern Med 1979;90:85-91.
• 9. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837-47.
• 10. Rimm EB, Ascheiro A, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease in men. JAMA 1996;275:447-51.
• 11. Nexo E, Engbaek F, Ueland PM, Westby C, O’Gorman P, Johnston C, et al. Evaluation of Novel Assays in Clinical Chemistry: Quantification of plasma total homocysteine. Clin Chem 2000;46:1150-6.
• 12. El-Khairy L, Vollset SE, Refsum H, Ueland PM. Plasma total cysteine, mortality, and cardiovascular disease hospitalizations: The Hordaland Homocysteine Study. Clin Chem 2003;49:895- 900.
• 13. Papandreou D, Mavromichalis I, Makedou A, Rousso I, Arvanitidou M. Refference range of total serum homocysteine level and dietary indexes in healthy Greek school children aged 6-15 years. Br J Nutr 2006;96:719-24.
• 14. Ponziani FR, Cazzoto IA, Danese S, Faqiuoli S, Gionchetti P, Annicchiarico BE, et al. Folate in gastrointestinal health and disease. Eur Rev Med Pharmacol Sci 2012;16:376-85.
• 15. Verhoef P, Stampfer MJ, Buring JE, Gaziano JM, Allen RH, Stabler SP, et al. Homocysteine metabolism and risk of myocardial infarction: relation with vitamins B6, B12 and folate. Am J Epidemiol 1996;1;143:845-59.
• 16. Dahele A, Ghosh S. Vitamin B12 deficiency in untreated celiac disease. Am J Gastroenterol 2001;96:745-50.
• 17. Hadithi M, Mulder CJ, Stam F, Azizi J, Crusius JB, Pena AS, et al. Effect of B vitamin supplementation on plasma homocysteine levels in celiac disease. World J Gastroenterol 2009;15:955-60.
• 18. Hallert C, Grant C, Grehn S, Grannö C, Hultén S, Midhagen G, et al. Evidence of poor vitamin status in celiac patients on a gluten free diet for 10 years. Aliment Pharmacol Ther 2002;16(7):1333- 9.
• 19. Hozyasz K, Milanovski A. Hyperhomosisteinemia in celiac disease heterozygote for the two common mutations of MTHFR gene. Med Wieku Rozwoj 2002;6:57-61.
• 20. Ludvigsson JF, James S, Askling J, Stenestrand U, Ingelsson E. Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation 2011;123:483-90.