Talasemi minörlü çocuklarda IGF-1 ve çinko düzeyleri
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Date
2013
Authors
Yüceer, M. Berfu
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Talasemi minörlü çocuklarda, büyümeyi etkileyen IGF-1 (insülin like growth factor-1) düzeyi ile ilgili az sayıda çalışma yapılmış ve bu olgularda IGF-1 düzeyinin, talasemi majorlu çocuklarda olduğu gibi düşük olduğu gösterilmiştir. Bu çocuklarda IGF-1 düzeyi ile çinko arasındaki ilişki ise henüz araştırılmamıştır. Çalışmamızın amacı; talasemi minörlü çocuklar ile sağlıklı çocukların IGF-1 ve IGF-BP3 (insülin like growth factor-binding protein 3) düzeylerinin karşılaştırılması ve talasemi minörlü çocuklarda IGF-1 düzeyi ile çinko arasındaki ilişkiyi araştırmaktır. Bu amaçla her olgu için özgeçmiş, beslenme öyküsü alınmış, fizik bakı yapılmıştır. Boy kısalığında, GH (growth hormone) ve IGF-1 düşüklüğü dışında pek çok etiyolojik faktörün rol oynaması nedeniyle çalışma ve kontrol grubuna, yalnızca boyu yaşına göre %3 persentilin üstünde olan çocuklar dahil edilmiştir. Tüm olgularda hemogram, serum IGF-1 ve IGF-BP3 düzeyi çalışılmış, ayrıca vücut çinko düzeyini değerlendirmek amacıyla serum, eritrosit içi ve saç çinko düzeyi ölçülmüştür. Çinkonun serum düzeyinin düşük bulunmasına neden olan hipoproteinemi ve demir eksikliği, her iki grupta da serum total protein, albümin, demir, demir bağlama kapasitesi ve ferritin düzeyi çalışılarak ve normal sınırlarda olduğu gösterilerek dışlanmıştır. Ayrıca olguların çinko bakımından yeterli beslenip beslenmediğini belirlemek amacıyla beslenme anketi doldurulmuş ve anket sonucuna göre günlük aldıkları çinko miktarı hesaplanmıştır. Talasemi minörlü çocuklar ile sağlıklı kontrol grubunda IGF-1, IGF-BP3 düzeyleri ve çinko ölçümleri birbirine benzer bulunmuştur. Ancak IGF-1 düşük olan hasta yüzdesi, talasemi minörlü grupta (%52) kontrol grubuna göre (%32) anlamlı olarak daha yüksek bulunmuştur (p=0,042). IGF-1 düzeyi düşük ve normal olan olgular karşılaştırıldığında; vücut çinko düzeyleri arasında anlamlı fark bulunmamıştır (p>0,05). Ancak hem çalışma, hem kontrol grubunda beslenmesi çinkodan fakir olan tüm olguların IGF-1 ve IGF-BP3 düzeyleri, çinkodan yeterli beslenenlerden anlamlı olarak düşük ii saptanmıştır (p<0,001, p<0,005). Ayrıca çinkodan yetersiz beslenen olgularda vücut çinko düzeyini gösteren parametrelerden birinin de anlamlı şekilde düşük olduğu görülmüştür (talasemi minörlülerde saç çinko p=0,002; sağlıklı kontrol grubunda eritrosit içi çinko p=0,005). Boy pikinin olduğu puberte evresinde talasemi minörlü hem kız hem erkek çocukların IGF-1, IGF-BP3 düzeyleri ve median boy değerleri, anlamlı olmasa da aynı puberte evresindeki kontrol grubundan daha düşük bulunmuştur. Sonuç olarak tüm bu bulgular göz önüne alındığında, çinko eksikliğinin yaygın olduğu ülkemizde, hem sağlıklı hem talasemi minörlü çocuklarda diyetin çinko içeriğinin önemli olduğu ve özellikle talasemi minörlü çocuklarda çinko desteği verilmesinin boy uzamasını olumlu yönde etkileyebileceği kanısına varılmıştır.
IGF-1 plays an important role in growth and there are only a few studies about IGF-1 levels in thalassemia minor children. In these studies, it has been shown that serum IGF-1 levels are decreased in thalassemia minor children like thalassemia major. In children with thalassemia minor, the relationship between IGF-1 levels and zinc has not been investigated. Our aim is to evaluate the level of IGF-1 and IGF-BP3 in ß-thalassemia minor children and compare it with healthy children; also investigate if there is a relationship between IGF-1 levels and zinc. For his aim; medical and dietary history were taken and physical examination was done for each case. Because of there are so many etiological factors for shorth stracture, only the children whose length over third persentil were included the study. In all cases, complete blood count, serum IGF-1 and IGF-BP3 levels were measured and in order to asses the levels of body zinc; serum, erythrocyte and hair zinc levels measured too. Serum iron, iron binding capacity, ferritin, total protein, and albumin levels had been shown in normal range in study groups. Thus, hypoproteinemia and iron deficiency, that causing the loss in the level of serum zinc, were excluded. Also in order to determine whether daily intake of zinc is adequate or not, nutrition survey was administered. According to the survey results, the amount of daily zinc intake was calculated in all cases. Serum IGF-1, IGF-BP3 levels and zinc measurements were similar in both thalassemia minor and healty control group. However, the percentage of cases with low levels of IGF-1 was significantly higher (52%) in thalassemia minor group than healty group (32%) . When the cases compared as IGF-1 low and normal groups, there was no significant difference between body zinc levels in thalassemia minör and control group (p>0,05). However, the levels of IGF-1 and IGF-BP3 were iv significantly lower in all cases whose fed with zinc deficient diet in thalassemia minor and control group then the patients those fed with zinc adequate diet. Also in both groups, in zinc deficient cases, one of the parametres indicating the levels of zinc were found significantly lower than zinc adequate cases (in thalasemmia minor- hair zinc: p=0,002; healty control- erythrocyte zinc: p=0,005). At phase of peak height shown in puberty, serum IGF-1, IGF-BP3 and median height value were lower in thalasemmia minör girls and boys than the controls. As a result of this study; it was concluded that, zinc content of diet is important for both thalasemmia minor and healty children and especially in thalasemmia minor, zinc supplementation can positively affect the height growth.
IGF-1 plays an important role in growth and there are only a few studies about IGF-1 levels in thalassemia minor children. In these studies, it has been shown that serum IGF-1 levels are decreased in thalassemia minor children like thalassemia major. In children with thalassemia minor, the relationship between IGF-1 levels and zinc has not been investigated. Our aim is to evaluate the level of IGF-1 and IGF-BP3 in ß-thalassemia minor children and compare it with healthy children; also investigate if there is a relationship between IGF-1 levels and zinc. For his aim; medical and dietary history were taken and physical examination was done for each case. Because of there are so many etiological factors for shorth stracture, only the children whose length over third persentil were included the study. In all cases, complete blood count, serum IGF-1 and IGF-BP3 levels were measured and in order to asses the levels of body zinc; serum, erythrocyte and hair zinc levels measured too. Serum iron, iron binding capacity, ferritin, total protein, and albumin levels had been shown in normal range in study groups. Thus, hypoproteinemia and iron deficiency, that causing the loss in the level of serum zinc, were excluded. Also in order to determine whether daily intake of zinc is adequate or not, nutrition survey was administered. According to the survey results, the amount of daily zinc intake was calculated in all cases. Serum IGF-1, IGF-BP3 levels and zinc measurements were similar in both thalassemia minor and healty control group. However, the percentage of cases with low levels of IGF-1 was significantly higher (52%) in thalassemia minor group than healty group (32%) . When the cases compared as IGF-1 low and normal groups, there was no significant difference between body zinc levels in thalassemia minör and control group (p>0,05). However, the levels of IGF-1 and IGF-BP3 were iv significantly lower in all cases whose fed with zinc deficient diet in thalassemia minor and control group then the patients those fed with zinc adequate diet. Also in both groups, in zinc deficient cases, one of the parametres indicating the levels of zinc were found significantly lower than zinc adequate cases (in thalasemmia minor- hair zinc: p=0,002; healty control- erythrocyte zinc: p=0,005). At phase of peak height shown in puberty, serum IGF-1, IGF-BP3 and median height value were lower in thalasemmia minör girls and boys than the controls. As a result of this study; it was concluded that, zinc content of diet is important for both thalasemmia minor and healty children and especially in thalasemmia minor, zinc supplementation can positively affect the height growth.
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Keywords
Talasemi minör, IGF-1, IGF-BP3, Çinko, Thalassemia minor, Zinc
Citation
Yüceer, M. B. (2013). Talasemi minörlü çocuklarda IGF-1 ve çinko düzeyleri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.