Riketsli olguların retrospektif değerlendirilmesi
Loading...
Files
Date
2011-07-29
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Giriş: Rikets, büyüme plaklarında enkondral kalsifikasyonun bozulması sonucunda azalmış büyüme hızı ve iskelet deformiteleri ile seyreden bir grup hastalıktır. Ülkemizde D vitamini yetersizliği ve nutrisyonel riketsin bebek ve çocukları etkileyen önemli bir sorun olduğu bilinmektedir. Gereç ve Yöntem: Bu çalışmada rikets tanısı alan ve yaşları 0,5 ile 13 yıl arasında değişen, 2006-2010 yılları arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Endokrin Polikliniğinden takip edilen 20 hasta incelendi. Nütrisyonel rikets tanısı, hipokalsemi yanında riketse özgü radyolojik bulgular ve alkalen fosfataz (ALP) yüksekliği veya 25-OH vitamin D (25-OHD) düşüklüğünden birisinin olmasına ve tedaviye yanıtına göre tanımlandı. İstatistik karşılaştırmalarda p<0,05 değeri istatistiksel olarak anlamlı kabul edildi. Çalışmanın analizleri SPSS 16.0 programı kullanılarak yapıldı. Bulgular: Çalışmaya 14’ü erkek 6’sı kız olmak üzere 20 hasta dahil edildi. Olguların 10’u nutrisyonel rikets, 5’i hipofosfatemik rikets, 5’i de D vitamini bağımlı rikets tip 1 olarak değerlendirildi. Hastaların radyolojik değerlendirmesinde 11 hastada radius ve ulnanın distal metafizinde düzensizlik ve genişleme, 3 hastada alt ekstremitede "0 bacak" deformitesi saptandı. Hastaların 10’u ilçe, 5’i köy, 5’i il merkezinden gelmişti. Hastaların geliş nedenlerine bakıldığında; 5 hasta büyüme geriliği, 4 hasta yürümede bozukluk, 4 hasta tekrarlayan pnömoni, 4 hasta nöbet, 3 hasta kemik deformiteleri, 2 hasta tetani ve 1 hasta ballismus nedeniyle tarafımıza başvurmuştu. Sonuç: Rikets halen çocukluk çağında bir sorun olmaya devam etmektedir. Özellikle büyüme geriliği, yürüme bozukluğu nedeniyle başvuran olgularda rikets tanısı akla gelmelidir. D vitamini alımına rağmen rikets bulguları olan çocuklar aile hekimi veya çocuk sağlığı ve hastalıkları uzmanı tarafından değerlendirilip vitamin D bağımlı rikets ve hipofosfatemik rikets düşünülmeli, gerekli vakalar 3. basamak sağlık hizmetleri veren çocuk endokrinoloji uzmanına tetkik ve tedavisi amacıyla yönlendirilmelidir.
Introduction: Rickets is a group of diseases presenting with skeletal deformities and decreased growth rate due to diminished epiphyseal calcification. It has been previously reported that in our country, nutritional rickets with Vitamin D insufficiency is an important healthcare problem. Material and Method: In this study, we have evaluated 20 patients with rickets being followed up in pediatric endocrinology outpatient clinic of Uludag University between 2006 and 2010. The diagnosis of nutritional rickets was defined with positive response to treatment and hypocalcaemia accompanied by one of the followings; rickets specific radiological changes, high alkaline phosphates levels or low Vitamin D levels. p<0.05 is accepted as statistically significant. The statistical analysis was performed using SPSS 16.0. Results: A total of 14 boys and 6 girls were included in this study. Ten of the patients were considered as nutritional rickets, 5 were hypophosphatemic rickets and 5 were vitamin D dependent rickets type 1. On radiological evaluation, distal metaphyseal enlargement-irregularity of radius and ulna was found in 11 patients. O-bain deformity was seen in 3 patients. Ten of the patients were from small districts, 5 were from villages and the remainders were from city center. The main complaints were short stature in 5 patients, difficulty in walking in 4 patients, recurrent pneumonia in 4 patients, seizure in 4 patients, bone deformity in 3 patients, tetany in 2 patients, and ballismus in one patient. Discussion: Rickets is still a major health problem in childhood. It must be kept in mind in the patients who have short stature and difficulty in walking. Vitamin D dependent rickets or hypophosphatemic rickets must be considered in the patients who have signs and symptoms of rickets in spite of regular vitamin D supplementation. These patients should be referred to a pediatric endocrinologist.
Introduction: Rickets is a group of diseases presenting with skeletal deformities and decreased growth rate due to diminished epiphyseal calcification. It has been previously reported that in our country, nutritional rickets with Vitamin D insufficiency is an important healthcare problem. Material and Method: In this study, we have evaluated 20 patients with rickets being followed up in pediatric endocrinology outpatient clinic of Uludag University between 2006 and 2010. The diagnosis of nutritional rickets was defined with positive response to treatment and hypocalcaemia accompanied by one of the followings; rickets specific radiological changes, high alkaline phosphates levels or low Vitamin D levels. p<0.05 is accepted as statistically significant. The statistical analysis was performed using SPSS 16.0. Results: A total of 14 boys and 6 girls were included in this study. Ten of the patients were considered as nutritional rickets, 5 were hypophosphatemic rickets and 5 were vitamin D dependent rickets type 1. On radiological evaluation, distal metaphyseal enlargement-irregularity of radius and ulna was found in 11 patients. O-bain deformity was seen in 3 patients. Ten of the patients were from small districts, 5 were from villages and the remainders were from city center. The main complaints were short stature in 5 patients, difficulty in walking in 4 patients, recurrent pneumonia in 4 patients, seizure in 4 patients, bone deformity in 3 patients, tetany in 2 patients, and ballismus in one patient. Discussion: Rickets is still a major health problem in childhood. It must be kept in mind in the patients who have short stature and difficulty in walking. Vitamin D dependent rickets or hypophosphatemic rickets must be considered in the patients who have signs and symptoms of rickets in spite of regular vitamin D supplementation. These patients should be referred to a pediatric endocrinologist.
Description
Keywords
D vitamini eksikliği, Rikets, Hipokalsemi, Vitamin D deficiency, Rickets, Hypocalcemia
Citation
Ocak, M. vd. (2011). "Riketsli olguların retrospektif değerlendirilmesi". Güncel Pediatri, 9(2), 75-78.