Özlem Naciye ŞAHİN, Aysel ÖZPINAR, Muhittin SERDAR, Nuray KEÇECİOĞLU

ÇOCUKLARDA ÇİNKO DÜZEYLERİ İLE TEKRAR EDEN SOLUNUM YOLU ENFEKSİYONU ARASINDA İLİŞKİ VAR MIDIR?

Amaç: Eser elementlerin ve D vitaminin eksik alımı ve allerji çocuk solunum sistemi sağlığı üzerine etkileri bulunmaktadır. Kesitsel çalışmamızda tekrar eden solunum yolun yolu enfeksiyonu ile çinko düzeyleri ve neden olabilecek diğer faktörlerin ilişkisini araştırmak amaçlanmaktadır. Metod: 2015-2017 tekrar eden akut otitis media, farenjit, rinit gibi üst solunum yolu enfeksiyonu ve alt solunum yolu enfeksiyonu olan, Türkiye’de yaşayan 249 olgu ve 122 sağlıklı kontrol çalışmaya dahil edilmiştir. Çinko düzeyleri, adenoid hipertrofi varlığı allerji deri testi, yaş, cinsiyet, tekrar eden alt veya üst solunum yolu enfeksiyonu öyküsü değerlendirilmiştir. Sonuçlar: 180 kız, 191 erkek olmak üzere 371 olgu (ortalama ± SD, 47±31 ay), çalışmaya dahil edilmiştir. Tekrar eden üst ve alt solunum yolu enfeksiyonu ile çinko düzeyleri (ortalama ± SD, 0,88±0,28), (ortalama ± SD, 0,88±0,35), arasında anlamlı ilişki saptanmamıştır. Tekrar eden solunum yolu enfeksiyonu olan olgular ile sağlıklı grup arasında, IgE düzeyleri açısından anlamlı istatistiksel fark bulunmamıştır (p=0,4). D vitamini düzeyleri tekrar eden alt ve üst solunum yolu enfeksiyonu olan grupta anlamlı olarak düşük bulunmuştur(p=0,001). Sonuç: Sağlıklı kontroller ile tekrar eden solunum yolu enfeksiyonu olan olgular arasında çinko düzeyleri açısından anlamlı fark saptanmamıştır. Tekrar eden solunum yolu enfeksiyonunda çinko suplementasyonu ancak eksikliği saptanmış olgulara önerilebilir, ve bu olgular tekrar eden solunum yolu enfeksiyonunda bağımsız risk faktörü olan adenoid hipertrofi varlığı açısından değerlendirilmelidir.

IS THERE A RELATION BETWEEN ZINC LEVELS, AND RECURRENT RESPIRATORY SYSTEM INFECTIONS IN CHILDREN?

Objective: There are many consequences connected with aninadequate intake of trace elements and Vitamin D. Allergicdisorders and a susceptibility to respiratory infections maybe related to deficiencies of trace elements and/or vitaminD. This cross-sectional study aims to investigate associationsbetween recurrent respiratory system infections andZinc levels; as well as other dependent factors.Methods: Three hundred and seventy one children living inTurkey were enrolled in the study between 2015 and 2017.Two hundred and forty nine had a history of either recurrentupper respiratory infections such as, acute otitis media,pharyngitis, rhinitis, or lower respiratory tract infections.122 were considered as healthy controls. Age, gender,existence of adenoid hypertrophy, upper and lowerrespiratory tract infections, zinc levels, vitamin D levels, IgElevels, and a skin prick test were all evaluated.Results: A total of 371 children (mean age ± standard deviation= 47±31 months), 180 males and 191 females wereincluded. No significant difference between the zinc levelsof children with recurrent upper (mean ± standard deviation= 0,88±0,28) respiratory tract infections and lowerrespiratory tract (mean ±standard deviation= 0,88±0,35)infections was observed. Likewise, there was no significantdifference between IgE levels of children with recurrentrespiratory tract infections and healthy controls (p=0,4).Vitamin D levels, however, were found to be significantlylower in children with lower and upper respiratory tractinfections (p=0,001).Conclusion: There was no significant difference in zinc levelsbetween healthy controls and children with recurrentrespiratory tract infections. However, if there is a documentedlow zinc deficiency, children with recurrent respiratorytract infections may be recommended a zinc supplementationprotocol. Additionally, these children should alsobe monitored for adenoid hypertrophy; an independentrisk factor for recurrent respiratory tract infections.

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Saglani S, Bush A. The early-life origins of asthma. Curr Opin Allergy Clin Immunol 2007; 7:83-90
Allen S, Britton JR, Leonardi-Bee JA. Association between antioxidant vitamins and asthma outcome measures:systematic review and meta-analysis. Thorax 2009; 64:610-619
Maret W. Zinc biochemistry:from a single zinc enzyme to a key element of life. Adv Nutr 2013; 1:82 -91
Dreosti IE. Recommended dietary intakes of iron, zinc and other inorganic nutrients and their chemical form and bioavailability. Nutrition 1993; 9 6:542-545
Prasad AS. Discovery of human Zinc deficiency: its impact on human health and disease. Adv Nutr 2013; 4:176-190
Yılmaz EA, Ozmen S, Bostanci I, Mısırlıoğlu ED, Ertan U. Erythrocyte zinc levels in children with bronchial asthma. Pediatr Pulmonol 2011; 46: 1189-1193
Urushidate S, Matzuka M, Ukobo N, et al. Association between concentration of trace elements in serum and bronchial asthma among Japaneese general population. J Trace Elem Med Biol 2010; 244:236- 242
Van Oeffellen AA, Bekkers MB, Smit HA, et al. Micronutrient concentrations and childhood asthma: the PIAMA birth cohort study. Pediatr Allergy Immunol 2011; 22:784-793
Allan K, Devereux G. Diet and asthma:nutrition implications from prevention to tretament. J Am Diet Assoc 2011; 111:258-268
Beck FW, Li Y, Bao B, et al. Evidence for reprogramming global gene expression during zinc deficiency in the HUT-78 cell line. Nutrition 2006; 22:1045-1056
Cousins RJ, Blanchard RK, Popp MP, et al. A global view of the selectivity of zinc deprivation and excess on genes expressed in human THP-1 mononuclear cells. Proc Natl Acad Sci USA 2003; 100:6952-6957
Haase H, Mazzatti DJ, White A, et al. Differential gene expression after zinc supplementation and deprivation in human leucocyte subsets. Mol Med 2007; 13:362-370
Girodon F, Galan P, Monget AL, et al. Impact of trace elements and vitamin supplementation on immunity and infections in institutionalized elderly patients: a randomized controlled trial. MIN. VIT. AOX. Geriatric network. Arch Intern Med 1999; 159:748-754
Darrow DH, Siemens C. Indications for tonsillectomy and adenoidectomy, Laryngoscope 112 (2002) 6-10, http://dx.doi.org/10.1002
Worley NK, Abdalkhani A, Hagmann MA, et al. Gold Laser versus curettage adenoidectomy: incidence of complications and otorhea after concurrent pressure -equalization tube placement. Laryngoscope 2007;117:2026-2029.
Anand V, Sarin B, Singh B. Changing trends in adenoidectomy. Indian J Otorhinolaryngol Head Neck Surg 2014; 66:375-380.
Bartley J. Vitamin D, innate immunity and upper respiratory tract infection. J laryngol Otol 2011; 124:1255-1260.
Reid D, Morton R, Salkeld L. Vitamin D and tonsil disease-preeliminary observations. Int J Ped Otorhinolaryngol 2011; 75:261-264.
20. Silva Rde C, Assis AM, Goncalves MS, et al.The prevalence of wheezing and its association with body mass index and abdominal obesity in children. J Asthma 2013;50:267-273.
21.Patel S, Murray CS, Woodcock A, et al. Dietary antioxidant intake, allergic sensitization and allergic diseases in young children. Allergy 2009;6:1766- 1772.
Liu J, Ai YX, Hanlon A, Shi Z, Dickerman B, Compher C. Micronutrients deficiency and associated sociodemographic factors in Chinese children. World J Pediatr 2011;7:217-223.
Asare GA, Nani A. Serum levels of Cu, Se, and Zn in adult rural/urban residents in Ghana:paradigm shift? Biol Trace Elem Res 2010; 137:139-149.
Razi CH Akelma AZ, Akin O, et al. Hair zinc and selenium levels in children with recurrent wheezing. Pediatr Pulmonol 2012;47:1185-1191.
Klanbabaee G, Omidian A, Imanzadeh F, et al. Serum level of zinc in asthatic patients: a case control study. Allergol Immunopathol 2013; 42:19-21.
Taussig, Landau, Le Souef, et al. Pediatric respiratory Medicine Chapter 2nd edition. Mosby ElsevierChapter 63, pp891
Huang L, Tepaamorndech S. The SLC30 family of zinc transporters- a review of current understanding of their biological and pathophysiological roles. Mol Aspects Med 2013;34:548.
Wang L, Song Y. Efficacy of zinc given as an adjunct to the treatment of severe pneumonia: a metaanalysis of randomized double-blind and placebocontrolled trials. Clin Respir J 2017 doı: 10.1111/ crj.12646