Oksidacioni stres i antioksidacioni status kod dece obolele od imunske trombocitopenične purpure
Medović, Raša, 1985-
Igrutinović, Zoran, 1964-
Đurđević, Predrag, 1951-
Kuzmanović, Miloš, 1966-
Srejović, Ivan, 1985-
UVOD: Idiopatska trombocitopenična purpura (ITP) je autoimunskatrombocitopenija nedovoljno jasne patofiziologije.Cilj rada je ispitivanje uticaja redoks ravnoteže na ITP kod dece.MATERIJAL I METODE: Sprovedena je prospektivna studija na 27 dece sanovootkrivenom ITP (ndITP), lečenih intravenskim imunoglobulinima (iv ig); 22sa perzistentnom ITP, lečenih kortikosteroidima; 29 sa hroničnom ITP (hITP),suplementirani askorbinskom kiselinom; 12 zdravih i 12 izlečenih od ITP(kontrolne grupe). Analizirani su osnovni anamnestički, laboratorijski i parametriredoks ravnoteže.REZULTATI: Parametri oksidacionog stresa, izuzev azot oksida (NO),prostaciklina (PgI2) i arginina (Arg) su viši kod obolelih nego u kontrolnoj grupi.Najviše vrednosti superoksid radikala (O2¯), indeksa lipidne peroksidacije(TBARS), tromboksana A2 (TxA2), asimetričnog dimetil arginina (ADMA) ioksidovanog LDL (oxLDL) zabeležene su kod ndITP i dece sa težom kliničkomslikom, nižim brojem trombocita i hiperprodukcijom megakariocita, a vrednostiNO, PgI2 i Arg su najniže u ovim grupama. Redukovani glutation (GSH) i katalaza(KAT) su viši u kontrolnoj grupi nego kod obolelih, a superoksid dizmutaza (SOD) jenajviša kod ndITP. Redoks ravnoteža se normalizuje kod izlečenih.Vrednosti O2¯, TBARS, H2O2, TxA2, ADMA i oxLDL značajno padaju, dokvrednosti NO, PgI2, Arg, i SOD, KAT i GSH rastu nakon terapije iv ig i u manjoj merinakon kortikosteroida. Recidiv bolesti dovodi do porasta O2¯, TBARS, oxLDL i SOD,uz smanjenje NO, Arg i KAT. Suplementacija askorbinskom kiselinom nema uticaja naredoks ravnotežu kod hITP.ZAKLjUČAK: Poremećaji redoks ravnoteže su definitivno uključeni upatogenezu svih oblika ITP, sa najizraženijim varijacijama kod ndITP i uegzacerbaciji bolesti, uz poboljšanje na standardnu terapiju.
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INTRODUCTION: Idiopathic thrombocytopenic purpura (ITP) is an autoimmunethrombocytopenia of insufficiently clear pathophysiology.The aim of the work is to examine the influence of redox balance on ITP in children.MATERIAL AND METHODS: A prospective study was conducted on 27 childrenwith newly diagnosed ITP (ndITP), treated with intravenous immunoglobulins (iv ig); 22 withpersistent ITP, treated with corticosteroids; 29 with chronic ITP (hITP), supplemented withascorbic acid; 12 healthy and 12 cured of ITP (control group). Basic anamnestic, laboratoryand redox balance parameters were analyzed.RESULTS: Oxidative stress parameters, with the exception of nitric oxide (NO),prostacyclin (PgI2) and arginine (Arg), are higher in patients than in the control group. Thehighest values of superoxide radical (O2¯), lipid peroxidation index (TBARS), thromboxaneA2 (TxA2), asymmetric dimethyl arginine (ADMA) and oxidized LDL (oxLDL) wererecorded in ndITP and children with a more severe clinical picture, lower platelet count andhyperproduction megakaryocytes, and the values of NO, PgI2 and Arg are the lowest in thesegroups. Reduced glutathione (GSH) and catalase (KAT) are higher in the control group thanin patients, and superoxide dismutase (SOD) is the highest in ndITP. The redox balance isnormalized in the cured children.The values of O2¯, TBARS, H2O2, TxA2, ADMA and oxLDL decrease significantly,while the values of NO, PgI2, Arg, and SOD, KAT and GSH increase after iv ig therapy andto a lesser extent after corticosteroids. The disease relapse leads to an increase in O2¯,TBARS, oxLDL and SOD, with a decrease in NO, Arg and KAT. The supplementation withascorbic acid has no effect on the redox balance in hITP.CONCLUSION: Disorders of redox balance are definitely involved in thepathogenesis of all forms of ITP, with the most pronounced variations in ndITP and in diseaseexacerbation, with improvement on standard therapy.
Serbian
2023
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