Gülseren EVİRGEN ŞAHİN, Erhun KASIRGA, Semin AYHAN

ÇOCUKLARDA HELİKOBAKTER PYLORİ ENFEKSİYONU İLE PLAZMA 25 HİDROKSİ VİTAMİN D3 DÜZEYİ ARASINDAKİ İLİŞKİ

AMAÇ: Helicobacter pylori (H.pylori) enfeksiyonunun şiddeti ve ilişkili hastalıkların varlığı konakçı, bakteriyel ve çevresel faktörlerden etkilenir. Bu çalışmada, H.pylori enfeksiyonu saptanan çocuklarda inflamatuar yanıtın düzenlenmesinde önemli rolü olan plazma 25 hidroksi vitamin D3 (vitD3) ile H.pylori enfeksiyonu arasındaki ilişkinin gösterilmesi amaçlanmıştır. GEREÇ VE YÖNTEM: Mart 2010 - Mart 2011 tarihleri arasında Celal Bayar Üniversitesi Tıp Fakültesi gastroentroloji bölümünde dispeptik yakımalar ve medikal tedaviye dirençli demir eksikliği anemisi nedeni ile üst gastrointestinal endoskopi yapılan 3-18 yaş arası 201 hasta bu çalışmaya alındı. Biyopsi örneklerinin histopatolojik tanıları değerlendirildiğinde, H.pylori pozitif grupta 98, H.pylori negatif grupta 103 hasta vardı. Vitamin D3 düzeyi, H.pylori pozitif ve H.pylori negatif gruplarda karşılaştırıldı. Helicobacter pylori pozitif grupta ise gastrik mukozal aktivite ve inflamasyon şiddetinin derecesi ile vitD3 düzeyleri karşılaştırıldı. BULGULAR: Helicobacter pylori pozitif hastaların 80'inde (81.6%), H.pylori negatif hastalarn 76'sında (73%) vitD3 düzeyleri düşüktü. Bu fark istatistiksel olarak anlamlı değildi (p>0.05). Helicobacter pylori pozitif ve negatif grupların plazma vitD3 düzeylerinin ortalama değeri sırasıyla 15.64±8.9 ng/mL ve 16.36±1.35 ng/mL idi. Gruplar arasındaki fark istatistiksel olarak anlamlı değildi (p>0.05). Helicobacter pylori pozitif ve negatif gruptaki hastalar, plazma vitD3 düzeyine göre eksiklik, şiddetli eksiklik, yetersizlik ve yetmezlik olarak dört farklı grupta sınıflandırıldığında ise H.pylori pozitif grupta vitD3 eksikliği H.pylori negatif gruba göre daha sıktı. Bu sonuç istatistiksel olarak anlamlıydı (p<0.05). Her iki grupta kronik inflamasyonun şiddeti ve doku H.pylori aktivitesi ortalama vitD3 düzeyi ile ters orantılı olarak arttığı görüldü (p<0.05). SONUÇ: Çalışmamızın sonuçları bölgemizde çocuklarda vitD3 düşüklüğünün yaygın olduğunu göstermektedir. Vitamin D3 eksikliği H.pylori enfeksiyonu için risk faktörüdür. Bu çalışma H.pylori enfeksiyonunda vitD3'ün antibakteriyel etkiyi artırdığını ve inflamasyonun şiddetini azalttığını göstermektedir.

Anahtar Kelimeler:

Çocukluk Çağı, Helicobakter pylori, Vitamin D3, Risk Faktörleri, Komplikasyonlar

ÇOCUKLARDA HELİKOBAKTER PYLORİ ENFEKSİYONU İLE PLAZMA 25 HİDROKSİ VİTAMİN D3 DÜZEYİ ARASINDAKİ İLİŞKİ

OBJECTIVE: The severity of the Helicobacter pylori (H.pylori) infection and the presence H.pylori related diseases are affected by host, bacterial and environmental factors. In this study it is aimed to show relationship between H.pylori infection and plasma Vitamin D3 (vitD3) has significant role in regulation inflamatory response in children with H.pylori infection. MATERIAL AND METHODS: Two hundred one patients aged between 3-18 years, referred to pediatric gastroentrology department of Celal Bayar University Medical Faculty between March 2010 to March 2011 and performed upper gastrointestinal endoscopy because of gastrointestinal symptoms and iron deficiency anemia refractory to medical therapy were enrolled in this study. Histopathologic diagnosis of biopsy speciments of the patients were evaluated. There were 98 patients in H.pylori positive group and 103 patients in H.pylori negative group. Plasma level of vitD3 of H.pylori positive and H.pylori negative cases were compared. Relationship between gastric mucosal activity the degree of inflammation severity and vitD3 level were evaluated in the H.pylori positive group. RESULTS: Vitamin D3 levels were low in 80 (81.6%) H.pylori positive patients and in 76 (73%) H.pylori negative patients. This difference was not statistically significant (p>0.05). The mean value of plasma level of vitD3 H.pylori positive and negative groups were 15.64±8.9 ng/mL and 16.36±11.35 ng/mL respectively. The difference between the groups was not statistically significant (p>0.05). When patients in H.pylori positive and negative groups were classified according to plasma vitD3 level in four different groups as severe deficiency, deficiency, insuficiency and sufficiency. Vitamin D3 severe deficiency in H.pylori positive group was statistically more frequent than H.pylori negative group (p<0.05). Severity of chronic inflamation and tissue H.pylori activity increased inversely with the mean vitD3 level in both groups (p<0.05). CONCLUSIONS: Results of this study suggests that vitD3 deficiency is common in children in our region. Vitamin D3 deficiency is risk factor for H.pylori infection. The findings of this study shows vitD3 increasing antibacterial effect and reducing the severity of inflammation in H.pylori infection.

Keywords:

Childhood, Helicobacter pylori, Vitamin D3, Risk Factors, Complications,

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