Astımlı çocuklarda CK-MB ve kardiak troponin-l seviyeleri

Journal Name: 
2005
Volume: 
21
Number: 
2
Sayfa Aralığı:: 
50-54
Publication Language: 
Turkish
Abstract (Original Language): 
Erişkinler ve çocuklarda serum myokardiai kreatinin kinaz (CK-MB) seviyesinde artış saptandığında öncelikli olarak kardıyak iskemi veya kardiyak hasar akla gelmektedir. Ancak bu durumda ileri tetkikler her zaman myokard iskemisini desteklememektedir. Çalışmamızda, astım atağı sırasında yükselen CK-MB'nin önem ve kaynağını araştırmak amacıyla. 30 astımlı çocuk ve 20 sağlıklı kontrolün CK-MB ve kardiak troponin-l (cTn-lj düzeylerini değerlendirdik. Astım atağı ile başvuru sırasında CK-MB seviyeleri, kontrol grubundan ve aynı hastaların ataktan sonraki seviyelerinden daha yüksek¬ti (p<0.05}. CK-MB seviyeleri ile solunum sayısı arasında pozitif korelasyon ve başvuruda ölçülen oksijen satürasyonu arasında negatif korelasyon bu/undu. CK-MB seviyelerinin yükselmesinde etkili faktörler olarak da solunum sayısının artışı ve oksijen satürasyonu düşüklüğü saptandı. Serum cTn-l CK-MB yüksek bulunan bütün hastalarda normal bulun¬du. Sonuç olarak astım atağı ile başvuran çocuklarda solunum kaslarının zorlanmasına bağlı olarak CK-MB yüksekliği saptanabilir.
Abstract (2. Language): 
The elevations of serum creatine kinase myocardiai bound (CK-MBj leveis can be observed in children and suggest a myocardial injury. We determined serum CK-MB and cardiac troponin-l (cTn-l) leveis in 30 asthmatic children to assess cardiac injury at admission for exacerbation and two vveeks later. Tvventy healthy age-matched children served as con-trois. The CK-MB leveis in admission for asthmatic exacerbation were higher than control group, and than the leveis of the same patients after exacerbation (p<0.05J. There was found to be a positive correlation betvveen the CK-MB leveis and respiratory rate, and a negative correlation betvveen the CK-MB leveis and oxygen saturation measured at admission. The effective factors on CK-MB leveis was found to be respiratory rate and oxygen saturation. However, serum cTn-I leveis were found to be normal in ali patients including those vvith CK-MB elevation. İn conclusion, CK-MB elevation may occur in children vvith acute astma attack related to the stress on respiratory muscles.
References: 

1. Becker JW, Evaluation of patients with chronic respirato¬ry symptoms. İmmunol Allergy Clin North Am 1999; 19: 1-18.
2. IMicolai T. Air pollution and respiratory diseases in chil¬dren: What is the clinicalıy relevant impact? Pediatr Pulmonol 1999; Suppl 18; 9-13.
3 Homey B, Zlotnik A. Chemokines in allergy. Current Opin İmmunol 1999; 1 I: 626-34.

4. Host A, Halken S The role of allergy in chıldhood asthma. Allergy 2000; 55: 600-8.
5 The International Study of Asthma and AJlergies İn Childhood

6. Lovis C, Manın F, Unger PF, Bouillie M. Chevrolet JC. Elevation of creatine kinase in acute severe asthma is not of cardiac origın. Intensive Care Med 2001; 27: 528-33.
7. Alberts W, U/illiams J. Eansdell J. Clinical implıcatıon of serum creatine kinase leveis in acute asthma. West J Med 1986; 144: 321-3.
8. Burkı N. Serum creatine kinase activity in asthma. Am Rev RespırDıs 1977; 1 16: 327-31.
9. Hirsch R. Landt Y. Porter S, Canter CE, Jaffe AS, Ladenson JH, Grant JW, Landt M. Cardiac troponin I in pediatrics: normal values and potential use ın the assessmenr of car¬diac injury. J Pediatr 1997; 130. 853-5.
10. Gerhardt W, Katus H. RavkildeJ, Hamm C, Jorgensen P, Peheim E, Ljungdahl J, Lofdahl P S-troponin T in sus-pected ischemic myocardial injury compared with mass and catalytic concentration of s-creatine kinase ısoen-zyme MB. Clin Chem 1991; 37:1405-11
1 I. Chiang VW, Burns JP, Rifai N, Upsbuto SE, Adams MJ, Weiner DL Cardiac toxıcıty of intravenous terbutaline for the treatment of severe asthma in children: A prospectıve assessment. J Pediatr 2000; 137: 73-7
12. International Paediatnc Asthma Consensus Group. Asthma: a follovv up statement. Arch Dis Child 1992. 67: 240-8
13 National Asthma Education Program Expert Repon, Guidelines for the Dıagnosis and Management of Asthma, Publication No. 91-3042, Department of Health and Human Services, Public Health Service, National Institutes of Health, August 1991
14. National Institutes of Health, National Heart, Lung and Blood Institute. Highlights of the Experî Panel Report; Guidelines for diagnosis and Management of Asthma. Prepared for the 1997 /vleeting of the American Academy of Asthma, Allergy, and Immunology. U. S. Department for Health and Human Services. NIH, NHL6I. February 1997.
15 Soldin SJ. Murthy NJ, Agarvvalla PK, Ojeifo O, Chea J. Pediatric reference ranges for creatine kinase, CKMB. tro¬ponin I, iron, and cortizol. Clin Biochem 1999; 32: 77-80
1 6. Galvani M, Ottani F, Ferrini D, Ladenson JH. Destro A, Baccos D Prognosric influence of elevated values of car¬diac troponin I in patients with unstable angına. Circulatıon 1997; 95: 2053-9
17. Smith SC, Ladenson JH, Mason JW, Jaffe AS. Elevations of cardiac troponin I associated vvith myocardıtıs: expen-menta! and clinical correlates. Orculaüon 1997; 95: 163-8
18. Adams JE, Davılla-Roman VG. Bessey P, Blake DP, Ladenson JH, Jaffe AS. Improved detection of cardiac contusion with cardiac troponin I. Am Heart J 1996; 131. 308-12
1 9. La V/u AH, Apple FS, Gibler WB. National Academy of
Clinical Biochemıstry standards of laboratory practice: re-commendations for the use of cardiac markers in coro-nary artery diseases. Clin Chem. 1999, 45: 1104-21 20. Missov E, Calzolari C, Pau B Circulating cardiac troponin I in severe congestıve heart failure. Circulatıon 1997; 96: 2953-8
2 I. La Vecchıa L, Mezzena G. Ometto R. Frnocchr G, Bedogni
F, Soffıati G, Vincenzi M. Detectable serum troponin I in patients with heart failure of non-myocardial ischemic ori-gin. Am J Cardiol 1997; 80: 88-90
22. Adams JE, Bodor GS. Davilla-Roman VG, Delmez JA Apple FS, Ladenson JH, Jaffe AS. Cardiac troponin I: a marker vvith high specificity for cardiac injury. Circulatıon 1993; 88: 101-6
23. Van Marie W, Woods K. Acute hydrocortisone myopathy. BMJ 1980; 281; 271-2
24. Griffin D, Fairman N, Coursin D, Ravvsthorne, Grossmann F. Acute myopathy during treatments of status asthmatı-cus vvith corticosteroıds and steroidal muscle re!axants. Chest 1992; 102: 510-4
25. Giostra E, Chevrolet JC. Magistris M. Pizzolato GP. Cox J. Acute neuromyopathy in critically ili patients treated vvith pancuronıum bromıde. Chest 1994; 109; 345-54

Thank you for copying data from http://www.arastirmax.com