Emel TORUN, Türkay SARITAŞ, Feyza KAHRAMAN USTABAŞ, Nurcan OSMANOĞLU KESKİN, Faruk ÖKTEM

The relationship between idiopathic chest pain, Vitamin D deficiency and insufficiency in school children and adolescents

Amaç: Okul çocuğu ve ergenlerde, nedeni bilinmeyen göğüs ağrısı ile vitamin D düzeyinin ilişkisini belirlemek amaçlanmıştır. Yöntemler: Çalışmamıza, nedeni bilinmeyen göğüs ağ- rısı şikayeti ile pediatrik kardiyoloji birimimize başvuran 120 okul çocuğu ve ergen ile genel polikliniğimize baş- vuran 60 sağlıklı kontrol hastası alındı. Öykü alınması ve fizik muayenenin ardından, biyokimyasal testler (tam kan sayımı, kan biyokimyası, troponin I ve vitamin D düzeyi) akciğer grafisi, elektrokardiyogram, ekokardiyogram tüm hastalarda değerlendirildi. Bulgular: Çalışma grubu ile kontrol grubu arasında yaş, cinsiyet dağılımı ve vücut kitle indeksi açısından anlamlı fark saptanmadı (sırasıyla, p=0,7, 0,2 ve 0,3). Çalışma grubunda %22 hastanın aile öyküsünde kalp hastalığı, %6 sında ani ölüm olduğu saptandı. Çalışma grubunda, göğüs ağrısının %19,2 hastada 1 aydır, %79,2 hastada 1 aydan uzun sürdüğü; %64ünde sol prekordiyumda, %32sinde sağ prekordiyumda, %18inde midsternal alanda olduğu öğrenildi. Göğüs ağrısı sıklığı ve süresi değiş- kendi. Serum vitamin D düzeyi çalışma grubunda kontrol hastalarına göre anlamlı derecede düşüktü (p< 0,0001). Alkalen fosfataz dışında biyokimyasal parametrelerde iki grup arasında fark saptanmadı. Göğüs ağrısı süresi ve ağrı sıklığı serum vitamin D düzeyi düşüklüğü ile ilşikili bulundu (r= 0,621, p=0,002 ve r=0,213, p=0,02). Sonuç: Çocukluk çağında sebebi bilinmeyen göğüs ağrı- sının süresi ve sıklığı ile serum vitamin D eksiliği ve yetersizliği arasında ilişki saptanmıştır.

Okul çocuğu ve ergenlerde nedeni belli olmayan göğüs ağrısının vitamin D eksikliği ve yetersizliği ile olan ilişkisi

Objective: The aim of this study is to determine an association between vitamin D status and idiopathic chest pain in school children and adolescents. Methods: Included in the study were a control group of 60 healthy children for comparison with 120 school children and adolescents referred to our pediatric cardiology department, after being diagnosed with idiopathic chest pain. A patients examination included taking a history and doing a physical examination, chest radiograph, electrocardiogram, echocardiogram complete blood count, and 25-hydroxyvitamin D and troponin I levels. Results: Age, gender distribution, and body mass index were not statistically different between the control and study groups (p=0.7, p=0.2 and p=0.3, respectively). Histories of the patients with idiopathic chest pain revealed 22% with heart disease and 6% with recent death in the family. Chest pain was present for 1 month in 19.2%, and for <1 month in 79.2% of the patients. Location of the patients chest pain was in the left precordium (64%), right precordium (32%) and midsternal area (18%). Frequency and duration of the pain were variable. Serum vitamin D levels were significantly lower in the study group than in the controls (p<0.0001), but except for alkaline phosphatase, other biochemical parameters did not differ to a statistically significantly degree. The duration of symptoms and episodes increased as vitamin D levels decreased (r= 0.621, p=0.002 and r=0.213, p=0.02, respectively). Conclusion: In pediatric patients, there is a significant association between vitamin D deficiency/ insufficiency and the duration and frequency of idiopathic chest pain in pediatric patients.

PDF

___

1. Geggel RL. Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics 2004;114:409-417.
2. Fyfe DA, Moodie DS. Chest pain in pediatric patients presenting to a cardiac clinic. Clin Pediatr 1984;23:321-324. 3. Selbst SM. Chest pain in children. Pediatrics 1985;75:1068- 1070.
4. Zavaras-Angelidou KA, Weinhouse E, Nelson DB. Review of 180 episodes of chest pain in 134 children. Pediatr Emerg Care 1992;8:189-193.
5. Driscoll DJ, Glicklich LB, Gallen WJ. Chest pain in children: a prospective study. Pediatrics 1976;57:648-651.
6. Pantell RH, Goodman BW. Adolescent chest pain: a prospective study. Pediatrics 1983;71:881-887.
7. Selbst SM, Ruddy RM, Clark BJ, et al. Pediatric chest pain: a prospective study. Pediatrics 1988;82:319-323.
8. Rowe BH, Dulberg CS, Peterson RG, et al. Characteristics of children presenting with chest pain to a pediatric emergency department. Can Med Assoc J 1990;143:388-394.
9. Tunaoglu FS, Olguntürk R, Akcaby S, et al. Chest pain in children referred to a cardiology clinic. Pediatr Cardiol 1995;16:69-72.
10. Evangelista JK, Parsons M, Renneburg AK. Chest pain in children: diagnosis through history and physical examination. J Pediatr Health Care 2000;14:3-8.
11. Massin MM, Bourguignont A, Coremans C, et al. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr 2004;43:231-238.
12. Asnes RS, Santulli R, Bemporad JR. Pshchogenic chest pain in children. Clin Pediatr 1981;20:788.
13. Kashani JH, Lababidi Z, Jones RS. Depression in children and adolescents with cardiovasculer symptomatology: the significance of chest pain. J Am Acad Child Psychiatry 1982;21:187-189.
14. Greenbaum LA. Rickets and hypervitaminosis D. In: Behrman RE, Kliegman RM, Jensen HB, Stanton BF, editors. Nelson textbook of pediatrics, 18th ed. Saunders, 2007:253258.
15. Heidari B, Shirvani JS, Firouzjahi A, et al. Association between nonspecifi c skeletal pain and vitamin D deficiency. Int J Rheum Dis 2010;13:340346.
16. Tezer H, Sıklar Z, Dallar Y, Dogankoç S. Early and severe presentation of vitamin D deficiency and nutritional rickets among hospitalized infants and the effective factors. Turk J Pediatr 2009;51:110115.
17. Ahmed SF, Franey C, McDewitt H, et al. Recent trends and clinical features of childhood vitamin D deficiency presenting to a children s hospital in Glasgow. Arch Dis Child 2011;96:694-625.
18. Hussain MZ, Ishrat S, Salehuddin M, et al. Chest pain in children: an update. Mymensingh Med J 2011;20:165-170.
19. Need AG, OLoughlin PD, Morris HA, et al. Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J Bone Miner Res 2008;23:1859-1863.
20. Sanli C, Akalin N, Kocak U, et al. Could lower bone turnover be a cause of chest pain during childhood? Pediatr Cardiol 2010;31:991996.
21. Roberto AM, Terreri MT, Szejnfeld V, et al. Bone mineral density in children: association with musculoskeletal pain and/or joint hypermobility. J Pediatr 2002;78:523528.
22. Cesur Y, Doğan M, Ariyuca S, et al. Evaluation of children with nutritional rickets. J Pediatr Endoc Met 2011,24:35- 43.
23. Plotniof GA, Quingly JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003;78:1463-1470.
24. de Torrente de la Jara G, Pecaud A, Favrat B. Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D. BMC Fam Prac 2006;7:4-11.
25. Hick GE, Shardell M, Miller RR, et al. Associations between vitamin D status and pain in older adults: the invecchiare in Chianti study. J am Geriatr Soc 2008;56:785-791.
26. Gloth FM 3rd, Lidsay JM, Zelesnick LB, et al. Can vitamin D deficiency produce an unusual pain syndrome? Arch Intern Med 1991;15:1662-1664.
27. Arvold DS, Odeon MJ, Donfeld MP, et.al. Correlation of symptoms with vitamin D deficiency and symptoms response to cholecalciferol treatment: a randomized controlled trial. Endocr Pract 2009;15:203-212.
28. Warner AE, Arnspiger SA. Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. J Clin Rheumatol 2008;14:12-6.
29. Wagner CL, Greer FR, for the American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D defi ciency in infants, children and adolescents. Pediatrics 2009;123:197.