Bronşiolitis obliteranslı çocuklarda serum total oksidan ve antioksidan durumun değerlendirilmesi / Evaluation of serum total oxidants and antioxidant stability in children with bronchiolithis obliterans

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Introduction Bronchiolitis obliterans (BO) is a rare chronic lung disease characterized by obstruction of the distal airways and an intense inflammatory reaction, usually following acute lower respiratory tract injury in children [1-3]. BO is divided into three categories; Post-infectious BO (PIBO), BO after hematopoietic stem cell transplantation (BMT) and BO after lung transplantation (LT). In the studies conducted, chronic inflammation and fibrosis were found to be common pathologic findings in variable degrees in the pathogenesis of PIBO. At the same time, recent publications have shown that children with PIPO have a significant increase in neutrophil count and interleukin-8 in bronchoalveolar lavage (BAL) [1]. The cytoplasm of the neutrophil cell contains granules containing various enzymes. These structures are classified as azurophilic and specific granules. The enzymes found in azurophilic granules are grouped into acid hydrolase, lysozyme and myeloperoxidase (MPO) bactericidal enzymes. Paraoxonase 1 (PON1) and arylesterase (ARES) are enzymes that act as antioxidants. Serum or plasma levels of many oxidant and antioxidant molecules can be measured separately by various analytical methods. However, in recent years more practical methods have been developed that totally measure oxidants and antioxidants in serum or plasma. These measurements, expressed as "Total oxidative state (TOS)" and "Total antioxidant state (TAS)", are easier and cheaper than the measurement of oxidants and antioxidants separately [2, 3]. Thiol is an organic compound containing a sulfhydryl group that plays a critical role in preventing the formation of any oxidative stress state in cells. Cysteine, one of the defensive protein mechanisms of the body, plays an important role in the prevention of oxidative damage by the functional thiol group it contains [4]. Goal In children with BO, the infection caused by pulmonary damage is shown in the etiology, but the mechanisms causing the disease are not fully explained. In our study, it was aimed to investigate whether oxidative stress and antioxidant status play a role in disease etiology. Materials and Methods This multicenter, cross-sectional study includes 63 post-infectious BO children diagnosed in Bezmialem Foundation University, Marmara University and Kocaeli University Children's Chest Diseases Departments. Sick children with PIBO; A standardized data extraction form was used to obtain demographic characteristics such as date of birth, sex, age of diagnosis, weight and length Z scores, parental smoking, breast milk intake, and respiratory symptoms in medical records. In all patients, complete blood count, total eosinophil count, serum total IgE, total protein, transferrin, prealbumin, vitamin D levels, sweat test, chest X-ray, microbiological examinations in sputum, immunologic examinations and bronchoscopy, lung biopsy and gastroesophageal reflux done. For the control group, a total of 57 patients were applied, whose ages 1 to 16 without malnutrition, no chronic disease, no anemia such as anemia, no immunocompromised, and no drug use history to cause immunosuppression, similar to the age and sex ratios enrolled to the Bezmialem Foundation University Child Health and Disease Policlinic. Results The study was carried out in Bezmialem Foundation University, Marmara University and Kocaeli University Hospital between September 2012 and December 2013 with a total of 120 cases in 38.3% (n = 46) girls and 61.7% (n = 74) boys. The ages of the subjects participating in the study ranged from 8 months to 16 years, with an average of 6.68 ± 3.87 years. The TAS measurement value of the patients in the patient group was found to be statistically significantly higher than those in the control group (p = 0,005, p <0,01). The TOS measurement value of the patients in the patient group was not statistically significant compared to the cases in the control group (p = 0,073, p> 0,05). There was no statistically significant difference between the measurements of Thiol according to the groups (p> 0,05). The ARES measurement value of the patients in the patient group was found to be significantly higher than the control group (p = 0,001, p <0,01). The MPO measurement value of the patients in the patient group was statistically significantly lower than the control group (p = 0,001, p <0,01). The PON measurement value of the patients in the patient group was found to be significantly higher than the control group (p = 0,001, p <0,01). Discussion and Conclusion In our study, serum PON1 and ARES enzyme levels were significantly higher in patients with postinfectious BO than in the control group. Normally, it can be thought that this enzyme should be produced by the liver at high rates to remove the effect of harmful oxidants in chronic inflammation, then to be released into the blood to be used at tissue level or systemically to break free radicals. Another parameter that we evaluate in this study is the MPO enzyme which plays an important role in the defense system of the body. In our study, we found that the MPO level was significantly lower in the PIBO-diagnosed group of patients than in the control group. Studies in the literature suggest that high levels of serum MPO may be used as a marker of inflammation and in evaluating the degree of inflammation in these patients. TOS levels in our study were not different between the two groups. Normally, high levels of oxidative stress can be explained as tissue destruction effects during acute periods of disease, while in later stages these levels may be normalized by antioxidant system. Our study is the first study in the literature regarding the status of oxidative stress and antioxidant system in post infectious BO and is a work that can inspire the future studies.
Thesis (Medical)--Bezmialem Vakıf University, Faculty of Medicine, Department of Child Health and Diseases, Istanbul, 2017
Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases
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