Burçak KURUCU, Ali FETTAH, Şule YEŞİL, Esra FIRAT OĞUZ, Özcan EREL, Gürses ŞAHİN

Yeni Tanı Almış Demir Eksikliği Anemisi Olan Çocuklarda Dinamik Tiyol-Disülfid Homeostazisi

Amaç: Demir, antioksidan enzimlerin yapısında bulunan ve reaktif oksijen türlerinin inaktivasyonunda önemli rolü olan bir elementtir. Oksidan-antioksidan dengenin bozulması demir eksikliği anemisinin (DEA) patogenezinde rol oynuyor olabilir. Dinamik tiyol-disülfid homeostazisi (DTDH) ve serum iskemi modifiye albümin (IMA) seviyeleri prooksidan/antioksidan durumun önemli göstergeleridir. Bu çalışmada, demir tedavisi almayan, yeni tanı almış demir eksikliği anemisi olan çocuklarda DTDH parametreleri ve serum İMA düzeylerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Demir eksikliği tanısı almış 50 hasta ile yaş ve cinsiyet açısından uyumlu 33 sağlıklı kontrol çalışmaya dahil edildi. Hasta ve kontrol gruplarının DTDH parametreleri ve İMA düzeyleri ölçüldü. Aynı parametreler, Hb<7 g/dl (derin DEA) (n:14/50, %28) ve Hb≥7 g/dl (hafif-orta DEA) (n:36/50, %72) olan DEA grubundaki hastalarda da karşılaştırıldı. Bu gruplarda DTDH parametreleri arasındaki ilişki araştırıldı. Bulgular: Antioksidan kapasite göstergelerini oluşturan nativ tiyol, total tiyol, nativ tiyol/total tiyol seviyeleri DEA hastalarında anlamlı olarak daha düşük bulunurken; oksidan disülfid, disülfid/nativ tiyol, disülfid/total tiyol ve İMA seviyeleri kontrol grubundakilere göre istatistiksel olarak anlamlı daha yüksek bulundu (p<0.050). Dinamik tiyol-disülfid homeostazisi parametreleri ve IMA seviyeleri incelendiğinde; hemoglobin ve ferritin seviyeleri ile antioksidan parametreler arasında pozitif bir korelasyon ve oksidatif parametreler arasında negatif bir korelasyon vardı (p<0.050). Ayrıca derin DEA grubunda oksidatif parametreler, Hb>7 g/dl olan gruba göre çok daha yüksek bulundu (p<0.050). Sonuç: Bu çalışmada, DEA hastalarında tedavi öncesi kontrol grubuna göre serum nativ tiyol ve total tiyol düzeylerindeki düşüşle birlikte serum disülfid ve IMA düzeylerindeki artış oksidatif strese işaret etti. Çocuklarda bu göstergelerin değerlendirilmesi DEA’ya bağlı toksisiteyi öngermede önemlidir.

Anahtar Kelimeler:

Hemoglobin, Demir eksikliği anemisi, İskemi modifiye albümin, Oksidatif hasar, Tiyol-disülfid

Dynamic Thiol-Disulfide Homeostasis in Children with Newly Diagnosed Iron Deficiency Anemia

Objective: Iron is an element, which is found in the structure of antioxidant enzymes and has an important role in the inactivation of reactive oxygen species. Disruption of oxidant-antioxidant balance may be playing a role in the pathogenesis of iron deficiency anemia (IDA). Dynamic thiol-disulfide homeostasis (DTDH) and serum ischemia-modified albumin (IMA) levels are important indicators of pro-oxidant/antioxidant status. In this study, we aimed to evaluate DTDH parameters and serum IMA levels in children with newly diagnosed IDA, who did not receive iron therapy. Material and Methods: Fifty patients diagnosed with IDA and 33 healthy age- and sex-matched control patients were included in the study. DTDH parameters and IMA levels of the patients and control groups were measured. The same parameters were also compared in patients with Hb<7 g/dl (profound IDA) (n:14/50, 28%) and Hb≥7 g/dl (mild-moderate IDA) (n: 36/50, 72%) in the IDA group. The relationship between DTDH parameters in these groups were investigated. Results: Native thiol, total thiol, native thiol/total thiol levels, constituting antioxidant capacity indicators, were found to be significantly lower in IDA patients; while oxidant disulfide, disulfide/native thiol, disulfide/total thiol, and IMA levels were found to be statistically higher compared to those in the control group (p<0.050). When DTDH parameters and IMA levels were examined; there was a positive correlation between antioxidant parameters and a negative correlation between oxidative parameters with hemoglobin and ferritin levels (p<0.050). Also, oxidative parameters were found to be much higher in profound IDA group than in the group with Hb>7 g/dl (p<0.050). Conclusion: In this study, increase in serum disulfide and IMA levels with the decrease in serum native thiol and total thiol levels indicated oxidative stress in IDA patients before treatment, compared to the control group. Evaluation of these indicators in children is important in predicting the toxicity due to IDA.

Keywords:

Hemoglobin, Iron deficiency anemia, Ischemia modified albumin, Oxidative damage, Thiol-disulfide,

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