Çocuklarda akut astım atağının özellikleri ve iskemi modifiye albumin düzeyleri
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Dosyalar
Tarih
2009
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çocukluk çağı kronik hastalıklarının en sık görüleni olan astım morbiditesi, mortalitesi ve prevelansı artan bir hastalık haline gelmiştir. Yeterli tedavi almayan veya herhangi bir tetikleyici etkene maruz kalan hastada, öksürük, nefes darlığı, göğüste sıkışma hissi, hışıltı gibi semptomların ortaya çıkmasına akut astım atağı denilmektedir. Akut astım atakları, astımın mortalite ve morbiditesini belirleyen en önemli faktördür. İskemi durumunda ortaya çıkan hipoksi, asidoz, serbest radikal hasarı gibi nedenler albumin yapısında değişikliğe yol açar değişikliğe uğramış bu albumine ?iskemi modifiye albumin? (IMA) denilmektedir. Bu çalışmanın amacı, akut astım atağı ile başvuran çocukların özelliklerinin belirlenmesi ve astım atağı sırasında IMA düzeylerinin değerlendirilmesidir. Hastalar ve Yöntem: Ocak 2008 - Ocak 2009 tarihleri arasında kliniğimizde astım tanısıyla takipli ve astım atağı nedeniyle başvurmuş 40 çocuk hastanın atak özellikleri belirlendi. Bu hastalardan 30'unda atak esnasında ilk başvuruda ve ataktan 14 gün sonra semptomsuz dönemde IMA düzeyleri belirlenerek istatistiksel olarak değerlendirildi. Sonuçlar: Çalışma gurubunu oluşturan 40 çocuk hastanın 23'ü erkek, 17'si kız idi ve yaş ortalaması 7.8±1.9 yıl olarak bulundu. Atağa neden olan en önemli risk faktörleri enfeksiyon ve sigara dumanı maruziyeti olarak bulunurken, en sık atak semptomu ise öksürük olarak saptandı. Atak şiddetleri değerlendirildiğinde hafif atak 20 hastada, orta atak 18 hastada ve ağır atak 2 hastada mevcuttu. Atak şiddeti ve başlangıç tedavisine cevabına göre, 24 hasta sadece O2 ve kısa etkili bronkodilatatör ile düzelirken, 16 hastanın tedavisinde parenteral steroid ihtiyacı oldu. Acil serviste uygulanan tedavi sonrası, 34 hasta taburcu edilirken, 4 hasta tedavi için yataklı çocuk servisine, 2 hasta yoğun bakım ünitesine yatırıldı. Astım atağında IMA düzeyleri değerlendirildiğinde ise atakta bakılan IMA değerleri (ortalama 0.51±0.16 ABSU) hem kontrol gurubundan (ortalama 0.39±0.12 ABSU ) hemde aynı hastaların tedavi sonrası semptomsuz döneminden (ortalama 0.33±0.08 ABSU) istatistikî olarak anlamlı düzeyde yüksek bulundu. Hastaların IMA düzeylerinin yaş, cinsiyet, astım şiddeti, atak semptomları, atopi varlığı, atak nedeni, düzenli steroid tedavisi ve atak öncesi tedavi alma durumu ile değerlendirildiğinde istatistikî olarak anlamlı bir ilişki saptanmadı. Bu çalışma akut astım atağı sırasında IMA düzeylerinin belirgin olarak arttığını göstermiştir. Ancak IMA, astım atağında yükselmesine rağmen atak şiddetinin değerlendirilmesi için uygun bir belirteç değildir.
Asthma is the most commonly chronical diseases in childhood and has a high prevalence, morbidity and mortality. In a patient taking unsatisfactory treatment and exposed to any triggering effect, such symptoms as coughing, shortness of breath, chest squeezing and wheezing are called acute asthma attack. Acute asthma attacks are the most significant factor in the determination of the mortality and morbidity of asthma. Effects, such as hypoxia, acidosis and free radical injury witnessed in the case of ischemia, lead to changes in the nature of albumin. The altered albumin is called ?ischemia modified albumin? (IMA). The objective of this study is to determine the features of acute asthma attacks in children and evaluate IMA levels upon attacks. Patients and Method: Between January 2008 and January 2009, 40 children who were diagnosed and followed-up with the complaint of asthma, were evaluated in terms of the features of their attacks. In 30 of the patients, IMA levels were determined and evaluated during the attacks on admission and symptom-free period 14 days after the attacks. Results: Of 40 children consisting of the study group, 23 were boys, and 17 were girls. Mean age level was found to be 7.8±1.9 years. While the most significant risk factors causing attacks were determined as infections and exposure to cigarette smoking, coughing was found as the most frequent symptom during attacks. When we assessed the severity of the attacks, mild attacks existed in 20 patients, moderate attacks existed in 18, and severe ones existed in 2 patient. According to the severity of the attacks and response to the initial treatment, while 24 patients improved only with O2 and short-acting bronchodilator, parenteral steroid was required in the treatment of 16 patients. After the treatment given in the emergency unit, while 34 patients were discharged, 4 were hospitalized in the department of pediatrics and 2 into the intensive care unit. Upon the assessment of IMA levels during astma attacks, however, IMA values during attacks ( average 0.51±0.16 ABSU ) were found to be higher (p<0.05) than both those of controls ( average 0.39±0.12 ABSU ) and those of the patients ( average 0.33±0.08 ABSU ) during symptom-free period after the teratment. When we compared IMA levels of the patients with age, sex, severity of asthma, symptoms of the attacks, presence of atopy, cause of the attacks, regular steroid treatment, and the treatment administered prior to attacks, no statistically significant association could be determined. Consequently, although IMA is definitely an increasing marker in asthma attacks it is inapproprate for the evaluation of the severity of the attacks.
Asthma is the most commonly chronical diseases in childhood and has a high prevalence, morbidity and mortality. In a patient taking unsatisfactory treatment and exposed to any triggering effect, such symptoms as coughing, shortness of breath, chest squeezing and wheezing are called acute asthma attack. Acute asthma attacks are the most significant factor in the determination of the mortality and morbidity of asthma. Effects, such as hypoxia, acidosis and free radical injury witnessed in the case of ischemia, lead to changes in the nature of albumin. The altered albumin is called ?ischemia modified albumin? (IMA). The objective of this study is to determine the features of acute asthma attacks in children and evaluate IMA levels upon attacks. Patients and Method: Between January 2008 and January 2009, 40 children who were diagnosed and followed-up with the complaint of asthma, were evaluated in terms of the features of their attacks. In 30 of the patients, IMA levels were determined and evaluated during the attacks on admission and symptom-free period 14 days after the attacks. Results: Of 40 children consisting of the study group, 23 were boys, and 17 were girls. Mean age level was found to be 7.8±1.9 years. While the most significant risk factors causing attacks were determined as infections and exposure to cigarette smoking, coughing was found as the most frequent symptom during attacks. When we assessed the severity of the attacks, mild attacks existed in 20 patients, moderate attacks existed in 18, and severe ones existed in 2 patient. According to the severity of the attacks and response to the initial treatment, while 24 patients improved only with O2 and short-acting bronchodilator, parenteral steroid was required in the treatment of 16 patients. After the treatment given in the emergency unit, while 34 patients were discharged, 4 were hospitalized in the department of pediatrics and 2 into the intensive care unit. Upon the assessment of IMA levels during astma attacks, however, IMA values during attacks ( average 0.51±0.16 ABSU ) were found to be higher (p<0.05) than both those of controls ( average 0.39±0.12 ABSU ) and those of the patients ( average 0.33±0.08 ABSU ) during symptom-free period after the teratment. When we compared IMA levels of the patients with age, sex, severity of asthma, symptoms of the attacks, presence of atopy, cause of the attacks, regular steroid treatment, and the treatment administered prior to attacks, no statistically significant association could be determined. Consequently, although IMA is definitely an increasing marker in asthma attacks it is inapproprate for the evaluation of the severity of the attacks.
Açıklama
Anahtar Kelimeler
Çocuk, Astım atağı, İskemi modifiye albumin, Children, Asthma attacks, Ischemia modified albumin
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Karagöl, İ. (2009). Çocuklarda akut astım atağının özellikleri ve iskemi modifiye albumin düzeyleri. Selçuk Üniversitesi, Yayımlanmış tıpta uzmanlık tezi, Konya.
