Şükran BERKMAN, Özlem SUVAK

Demir Eksikliği Olan Üreme dönemindeki Kadınlarda Demir Replasmanının Bilişsel İşlevlere Etkisi

Amaç: Demir normal beyin fonksiyonunda olduğu gibi, nörogenez, miyelinasyon, sinaptik gelişim, enerji ve nörotransmitter metabolizması dahil olmak üzere beyin gelişim süreçlerinde kilit rollere sahiptir. Bu araştırmanın amacı, demir eksikliği olan kadınlarda demir replasmanın zihinsel fonksiyonlar üzerine etkisini incelemektir. Gereç ve Yöntem: Demir düzeyi düşük (hemoglobin >12 g/dl, ferritin <15 ng/mL) veya demir eksikliği anemisi (hemoglobin <12 g/dl, ferritin <15 ng/mL) olan 15-49 yaş arası 165 kadında müdahale çalışması yapılmıştır. 165 katılımcıya ön bilişsel işlev durumlarını belirlemek amacıyla 1. Montreal Bilişsel Değerlendirme (MoCA) ölçeği uygulandı. Kadınlara, sekiz hafta süreyle sırasıyla 100 mg/gün (DE olanlara) ve 200 mg/gün (DEA olanlara) demir glisin sülfat verildi. Sekiz hafta sonra kontrole gelen ve demir tedavisini uygun şekilde kullanan 81 hastaya 2. MoCA skalası ile kontrol hemogram ve ferritin testleri uygulandı. Bağımlı iki grubun karşılaştırılmasında Wilcoxon İşaretli Sıralar Testi, bağımsız iki grubun karşılaştırılmasında Mann-Whitney U testi, üç ve daha fazla bağımsız grubun karşılaştırılmasında ise Kruskal Wallis testi tercih edildi. Yaş ve bilişsel fonksiyon puanları arasındaki ilişki Spearman korelasyon testi ile değerlendirildi. Bulgular: Çalışma başlangıcında DE veya DEA olan 165 kadının ilk MoCA skorları arasında anlamlı fark saptanmadı. 200 mg/gün demir replasmanı alan 81 hastanın hemogram ve ferritin düzeylerinde beklendiği gibi anlamlı artış oldu (p<0.001). Bekar, yüksek eğitim düzeyi ve düşük beden kitle indeksi olan kadınlarda bilişsel fonksiyonlar anlamlı düşük saptandı (p<0.001). Tedavi öncesi MoCA skor ortalaması 21(min:18-max:23) iken tedavi sonrası 26 (min:23-max:27) olarak saptandı (p<0,001) ve tüm fonksiyon alt grup skorlarında da tedavi sonrasında anlamlı yükselme görüldü. Bilişsel fonksiyonlardaki bu iyileşme demografik verilerden bağımsız olarak saptandı. Yaş ile toplam bilişselfonksiyon skoru arasında negatif yönde düşük düzeyde bir ilişki saptandı r:-0,335,p <0,001). Sonuç: Bu çalışmada demir eksikliği veya anemi tanısı alan kadınlarda replasman tedavisi sonrası bilişsel işlevlere karşılık gelen toplam ve alt grup puanlarında anlamlı artış olduğunu gözlemledik. Reproduktif dönemdeki kadınlarda demir replasman tedavisi bilişsel fonksiyonlara etkisi göz önünde bulundurularak, ihmal edilmemelidir.

Anahtar Kelimeler:

Demir eksikliği, demir replasmanı, bilişsel fonksiyon, kadın

The Effect of Iron Replacement on Cognitive Functions in Reproductive Women with Iron Deficiency

Objectives: Iron plays key roles in brain development including neurogenesis, myelination, synaptic development, energy and neurotransmitter metabolism as well as normal brain functioning. The aim of this study is to examine the effect of iron replacement on cognitive functions in women with iron deficiency. Methods: An intervention study was conducted in 165 women aged 15-49 years with low iron levels (ID;hemoglobin >12 gr/dl, ferritin <15 ng/mL) or iron deficiency anemia (IDA; hemoglobin <12 gr/dl, ferritin <15 ng/mL). 165 participants were subjected to 1st Montreal Cognitive Assessment (MoCA) scale in order to determine their preliminary cognitive function status. The women were given ferrous glycine sulfate at 100 mg/day (for those with ID) and 200 mg/day (for those with IDA), respectively, for eight weeks. Eight weeks later, the 2nd MoCA scale and control hemogram and ferritin tests were administered to 81 patients who came for follow-up and used iron treatment appropriately. Wilcoxon Signed Ranks Test was preferred when two dependent groups were compared, and Mann-Whitney U test was used when two independent groups were compared, and Kruskal Wallis test was used when three or more independent groups were compared. The analyze between age and cognitive function scores was evaluated with the Spearman correlation test. Results: There was not a significant difference between the 1st MoCA scores of patients with ID or IDA in 165 women at the onset of the study. There was a significant increase in hemogram and ferritin levels of 81 patients who received a 200 mg/day iron replacement as expected (p<0.001). Cognitive functions were found to be significantly lower in single women with a high education level and a low body mass index (p<0.001). Average pretreatment MoCA score was 21 (min: 18- max:21), whereas post treatment average score was 26 (min:23- max:27) (p<0.001). For all cognitive functions, subgroup scores significantly increased after treatment. This improvement in cognitive functions was determined independently of demographic data. A low negative correlation also was found between age and total cognitive function score (r:-0.335, p <0.001). Conclusion: In this study, we observed that after replacement therapy there was a significant increase in total and subgroup scores corresponding to cognitive functions of women diagnosed as iron deficiency or anemia. Considering the effect of iron replacement therapy on cognitive functions in women in the reproductive period, it should not be neglected.

Keywords:

iron deficiency, iron replacement, cognitive functions, female,

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez