Sabri DEMİR, Yasemin DERE GÜNAL, Nermin DİNDAR BADEM, İsmail ÖZMEN, Özcan EREL, Salim NEŞELİOĞLU

Tiyol / Disülfit dengesinin değerlendirilmesi çocuklarda apandisitin ayırıcı tanısında yardımcı olabilir mi?

ÖzAmaç: Çalışmamızın amacı, tanı konulmasında zorlanılan çocuklarda, akut apandisitin ayırıcı tanısında, oksidatif stresin yeni bir belirteci olan tiyol/disülfit dengesinin, kullanılabilirliğini araştırmaktır.Gereç ve yöntemler: Çalışmaya, yaşları 0-18 yaşları aralığında bulunan kontrol grubunda 30, akut apandisit grubunda 30 olmak üzere toplam 60 gönüllü çocuk dahil edildi. Her iki grubun da nativ tiyol, total tiyol, dinamik disülfit, dinamik tiyol, iskemi modifiye albümin, albümin, lökosit, hemoglobin, hematokrit ve trombosit sayıları bakıldı. Her iki grubun sonuçları SPSS (Statistical Package for Social Sciences) versiyon 17 (Chicago, USA) programı kullanılarak karşılaştırıldı. Tüm değişkenler için p <0.05 anlamlı kabul edildi.Bulgular: Akut apandisit grubunda, kontrol grubu ile karşılaştırıldığında; total tiyol (p<0.001), nativ tiyol (p<0.001) ve albümin (p<0.001) düzeyleri anlamlı düzeyde düşük bulunmasına karşın, oksidatif tarafa kaymayı gösteren dinamik sülfit, dinamik tiyol (p=0.003) ve iskemi modifiye albümin (p<0.001) düzeyleri yüksek bulundu. Akut apandisit grubunda lökosit sayısı kontrol grubuna göre daha yüksek (p <0.001) bulunurken trombosit sayısı kontrol grubundan daha düşüktü (p = 0.03). Tartışma: Akut apandisitin ayırıcı tanısında, özellikle teşhis konmakta zorlanılan olgularda, fizik muayene, görüntüleme ve güncel laboratuvar testlerinin yanı sıra, tiyol / disülfid dengesinin değerlendirilmesi tanı koymada yardımcı olabilir. Ek olarak albümin ve iskemi modifiye albümin düzeylerinin değerlendirilmesi testin özgüllüğünü artırabilir. Bu test, yaşları küçük olan çocuklar ve mental retarde hastalar gibi tanının zor konabildiği hastaların ayırıcı tanısında daha yararlı olabilir.

Anahtar Kelimeler:

Çocuk, akut apandisit, oksidatif stres, tiyol/disülfit dengesi, apendektomi

Can thiol/disulphide homeostasis help in the differential diagnosis of appendicitis in children?

AbstractObjective: We aimed to investigate the potential of assessing thiol/disulfide homeostasis as novel oxidative stress markers to improve the challenging diagnosis of acute appendicitis in children.Materials and Methods: A total of 60 pediatric patients (0-18 years) were enrolled in the study, 30 of which were in the control group and 30 in the acute appendicitis group. Native thiol, total thiol, dynamic disulfide, dynamic thiol, ischemia modified albümin, albumin, White blood cell, hemoglobin, hematocrit, and platelet counts of both groups were measured. The results of both groups were compared using the SPSS (Statistical Package for Social Sciences) version 17 (Chicago, USA) program. For all variables, p <0.05 was considered significant.Results: Total thiol (p<0.001), native thiol (p<0.001), and albümin (p<0.001) levels were significantly decreased while dynamic disulfide, dynamic thiol (p=0.003), and ischemia modified albümin (p<0.001) levels those indicating oxidant sides were increased in the acute appendicitis group compared to control. White blood cell counts in acute appendicitis group were higher (p<0.001), and platelet counts were lower (p=0.03) than the control group. Conclusion: In the differential diagnosis of acute appendicitis, especially in cases that are difficult to diagnose, besides a physical examination, imaging, and current laboratory tests, quantification of thiol/disulfide homeostasis may be helpful in diagnosing. In addition, evaluating albumin and IMA levels may increase the specificity of the test. This test can be more helpful in case diagnosis is difficult such as children small in their ages and mental retardation.

Keywords:

Children, acute appendicitis, oxidative stress, thiol/disulphide homeostasis, appendectomy,

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