Yeni Tanı Almış Demir Eksikliği Anemisi Olan Çocuklarda Dinamik Tiyol-Disülfid Homeostazisi

Yıl 2023, Cilt: 17 Sayı: 1, 56 - 61, 30.01.2023

Burçak Kurucu Ali Fettah Şule Yeşil Esra Fırat Oğuz Özcan Erel Gürses Şahin

https://doi.org/10.12956/tchd.1196564

Öz

Amaç: Demir, antioksidan enzimlerin yapısında bulunan ve reaktif oksijen türlerinin inaktivasyonunda önemli rolü olan bir elementtir. Oksidan-antioksidan dengenin bozulması demir eksikliği anemisinin (DEA) patogenezinde rol oynuyor olabilir. Dinamik tiyol-disülfid homeostazisi (DTDH) ve serum iskemi modifiye albümin (IMA) seviyeleri prooksidan/antioksidan durumun önemli göstergeleridir. Bu çalışmada, demir tedavisi almayan, yeni tanı almış demir eksikliği anemisi olan çocuklarda DTDH parametreleri ve serum İMA düzeylerini değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Demir eksikliği tanısı almış 50 hasta ile yaş ve cinsiyet açısından uyumlu 33 sağlıklı kontrol çalışmaya dahil edildi. Hasta ve kontrol gruplarının DTDH parametreleri ve İMA düzeyleri ölçüldü. Aynı parametreler, Hb<7 g/dl (derin DEA) (n:14/50, %28) ve Hb≥7 g/dl (hafif-orta DEA) (n:36/50, %72) olan DEA grubundaki hastalarda da karşılaştırıldı. Bu gruplarda DTDH parametreleri arasındaki ilişki araştırıldı.

Bulgular: Antioksidan kapasite göstergelerini oluşturan nativ tiyol, total tiyol, nativ tiyol/total tiyol seviyeleri DEA hastalarında anlamlı olarak daha düşük bulunurken; oksidan disülfid, disülfid/nativ tiyol, disülfid/total tiyol ve İMA seviyeleri kontrol grubundakilere göre istatistiksel olarak anlamlı daha yüksek bulundu (p<0.050). Dinamik tiyol-disülfid homeostazisi parametreleri ve IMA seviyeleri incelendiğinde; hemoglobin ve ferritin seviyeleri ile antioksidan parametreler arasında pozitif bir korelasyon ve oksidatif parametreler arasında negatif bir korelasyon vardı (p<0.050). Ayrıca derin DEA grubunda oksidatif parametreler, Hb>7 g/dl olan gruba göre çok daha yüksek bulundu (p<0.050).

Sonuç: Bu çalışmada, DEA hastalarında tedavi öncesi kontrol grubuna göre serum nativ tiyol ve total tiyol düzeylerindeki düşüşle birlikte serum disülfid ve IMA düzeylerindeki artış oksidatif strese işaret etti. Çocuklarda bu göstergelerin değerlendirilmesi DEA’ya bağlı toksisiteyi öngermede önemlidir.

Anahtar Kelimeler

Hemoglobin, Demir eksikliği anemisi, İskemi modifiye albümin, Oksidatif hasar, Tiyol-disülfid

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Dynamic Thiol-Disulfide Homeostasis in Children with Newly Diagnosed Iron Deficiency Anemia

Öz

Objective: Iron is an element, which is found in the structure of antioxidant enzymes and has an important role in the inactivation of reactive oxygen species. Disruption of oxidant-antioxidant balance may be playing a role in the pathogenesis of iron deficiency anemia (IDA). Dynamic thiol-disulfide homeostasis (DTDH) and serum ischemia-modified albumin (IMA) levels are important indicators of pro-oxidant/antioxidant status. In this study, we aimed to evaluate DTDH parameters and serum IMA levels in children with newly diagnosed IDA, who did not receive iron therapy.

Material and Methods: Fifty patients diagnosed with IDA and 33 healthy age- and sex-matched control patients were included in the study. DTDH parameters and IMA levels of the patients and control groups were measured. The same parameters were also compared in patients with Hb<7 g/dl (profound IDA) (n:14/50, 28%) and Hb≥7 g/dl (mild-moderate IDA) (n: 36/50, 72%) in the IDA group. The relationship between DTDH parameters in these groups were investigated.

Results: Native thiol, total thiol, native thiol/total thiol levels, constituting antioxidant capacity indicators, were found to be significantly lower in IDA patients; while oxidant disulfide, disulfide/native thiol, disulfide/total thiol, and IMA levels were found to be statistically higher compared to those in the control group (p<0.050). When DTDH parameters and IMA levels were examined; there was a positive correlation between antioxidant parameters and a negative correlation between oxidative parameters with hemoglobin and ferritin levels (p<0.050). Also, oxidative parameters were found to be much higher in profound IDA group than in the group with Hb>7 g/dl (p<0.050).

Conclusion: In this study, increase in serum disulfide and IMA levels with the decrease in serum native thiol and total thiol levels indicated oxidative stress in IDA patients before treatment, compared to the control group. Evaluation of these indicators in children is important in predicting the toxicity due to IDA.

Anahtar Kelimeler

Hemoglobin, Iron deficiency anemia, Ischemia modified albumin, Oxidative damage, Thiol-disulfide

Proje Numarası

Yok

Kaynakça

• Referans1. Baker RD, Greer FR. Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age). Pediatrics. 2010;126(5):1040-1050.
• Referans2. Ani-Kibangou B, Bouhallab S, Molle D, et al. Improved absorption of caseinophosphopeptide-bound iron: role of alkaline phosphatase. J Nutr Biochem. 2005;16:398-401.
• Referans3. Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron deficiency anemia. N Engl J Med. 1993;329:1691-1695.
• Referans4. Sagone AL, Balcerzak SP. Activity of iron-containing enzymes in erythrocytes and granulocytes in thalassemia and iron deficiency. Am J Med Sci. 1970;259:350-357.
• Referans5. Kumerova A, Lece A, Skesters A, et al. Anemia and antioxidant defense of the red blood cells. Mater Med Pol. 1998;30:12–15.
• Referans6. Aslan M, Horoz M, Celik H. Evaluation of oxidative status in iron deficiency anemia through total antioxidant capacity measured using an automated method. Turk J Hematol. 2011;28:42-46. Referans7. Isler M, Delibas N, Guclu M, et al. Superoxide dismutase and glutathione peroxidase in erythrocytes of patients with iron deficiency anemia: effects of different treatment modalities. Croat Med J. 2002;43:16-19.
• Referans8. Tekin D, Yavuzer S, Tekin M, et al. Possible effects of antioxidant status on increased platelet aggregation in childhood iron-deficiency anemia. Pediatr Int. 2001;43:74-77.
• Referans9. Circu ML, Aw TY. Reactive oxygen species, cellular redox systems, and apoptosis. Free Radic Biol Med. 2010;48(6):749-762.
• Referans10. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem. 2014;47(18):326-332.
• Referans11. Sbarouni E, Georgiadou P, Voudris V. Ischemia modified albumin changes - review and clinical implications. Clin Chem Lab Med. 2011;49(2):177-184.
• Referans12. Bar-Or D, Lau E, Winkler JV. A Novel assay for cobaltalbumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med. 2000;19:311-315.
• Referans13. Pala E, Erguven M, Guven S et al. Psychomotor development in children with iron deficiency and iron deficiency anemia. Food Nutr Bull. 2010;31(5):431-435.
• Referans14. Glazer Y, Bilenko N. Effect of iron deficiency and iron deficiency anemia in the first two years of life on cognitive and mental development during childhood. Harefuah. 2010;149(4):309-314.
• Referans15. Pasricha S-R, Drakesmith H. Iron Deficiency Anemia. Hematol Oncol Clin North Am. 2016;30(2):309-325.
• Referans16. Kassebaum NJ. The Global Burden of Anemia. Hematol Oncol Clin North Am. 2016; 30(2):247–308.
• Referans17. Cheng ML, Ho HY, Chiu DTY, et al. Humic acidmediated oxidative damages to human erythrocytes: a possible mechanism leading to anemia in Blackfoot disease, Free. Radic. Biol. Med. 1999;27:470-477.
• Referans18. Kurtoglu E, Ugur A, Baltaci AK, et al. Effect of iron supplementation on oxidative stress and antioxidant status in iron-deficiency anemia. Biol Trace Elem Res. 2003;96:117-123.
• Referans19. Yoo JH, Maeng HY, Sun YK, et al. Oxidative status in iron deficiency anemia. J Clin Lab Anal. 2009;23:319–323.
• Referans20. Aycicek A, Koc A, Oymak Y, et al. Ferrous sulfate (Fe2+) had a faster effect than did ferric polymaltose (Fe3+) on increased oxidant status in children with iron-deficiency anemia. J Pediatr Hematol Oncol. 2014;36(1):57-61.
• Referans21. Akca H, Polat A, Koca C. Determination of total oxidative stress and total antioxidant capacity before and after the treatment of iron-deficiency anemia. J Clin Lab Anal. 2013; 27:227-230.
• Referans22. Akarsu S, Demir H, Selek S, et al. Iron deficiency anemia and levels of oxidative stress induced by treatment modality. Pediatr Int. 2013;55:289-295.
• Referans23. Topal I, Mertoglu C, Sürücü Kara I, et al. Thiol-Disulfide Homeostasis, Serum Ferroxidase Activity, and Serum Ischemia Modified Albumin Levels in Childhood Iron Deficiency Anemia. Fetal Pediatr Pathol. 2019;38(6):484-489.
• Referans24. Aran T, Unsal MA, Güven S, et al. Carbondioxide Pneumoperitoneum Induces Systemic Oxidative Stres: a clinical study. Eur J Obstet Gynecol Reprod Biol. 2012;161(1):80-83.
• Referans25. Bilgili S, Bozkaya G, Kırtay Tütüncüler F, et al. Investigation of ischemia modified al6umin levels in iron deficiency anemia. Turk J Biochem. 2017;42:259–264.
• Referans26. Dan K. Thrombocytosis in iron deficiency anemia. Intern Med. 2005;44:1025-1026.
• Referans27. Bilic E, Bilic E. Amino acid sequence homology of thrombopoietin and erythropoietin may explain thrombocytosis in children with iron deficiency anemia. J Pediatr Hematol Oncol. 2003; 25: 675–676.
• Referans28. Durmus A, Mentese A, Yılmaz M, et al. Increased oxidative stress in patients with essential thrombocythemia. Eur Rev Med Pharmacol Sci. 2013;17: 2860-2866.