Vitamin B12 eksikliği olan çocuklarda nörogelişimsel testlerin değerlendirilmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: B12 vitamini eksikliği, genelde diyetle alım eksikliğine veya otoimmün süreçlere bağlı olarak görülen ve sebep olabildiği sorunlar nedeniyle dikkatli takibi gereken bir durumdur. Vitamin B12 vücutta iki önemli tepkimede konezim olarak çalışır: homosisteinden metiyonin sentaz enzimi ile metiyonine dönüştürülmesi ve mitokondride metilmalonil KoA'nın metilmalonil KoA mutaz enzimi ile süksinil KoA elde edilmesidir. Bu tepkimelerde ortaya çıkan sorunlar hematopoetik hücrelerin çoğalmasını azaltarak hematolojik bulgulara yol açarken; DNA ve RNA sentezinin bozulmasına ve miyelinizasyonun yavaşlamasına sebep olduğu için de nörolojik bulguların görülmesine neden olur. Nörogelişimsel testler, çocukların yaşlarına uygun becerileri ne düzeyde gerçekleştirebildiğini izlemek üzere tasarlanmış araçlardır. Farklı yaş gruplar ve farklı beceriler için geliştirilmiş çok sayıda testler mevcuttur. Denver Gelişim Tarama Testi II; kısmen uygulamalı bölümleri olan, kısmen anket soruları içeren dünya çapında yaygın kullanılan bir gelişim tarama testidir. Sosyal İletişim Alan Tarama Testi ise Türkiye'de geliştirilmiş; 6 ay ile 24 ay arası çocukların sosyal becerileri, dil kullanımı ve farkındalığını aileye sorulan sorularla ölçen pratik ve kolay uygulanabilir bir testtir. Çalışmamızda aktif şikâyeti olmayan, kontrol taramalarında vitamin B12 eksikliği tespit edilmiş çocuklar ve benzer yaş grubundaki vitamin B12 düzeyi normal sağlıklı kontrol grubu iki ayrı nörogelişim testi ile (Denver Gelişim Tarama Testi II ve Sosyal İletişim Alan Tarama Testi) değerlendirilerek vitamin B12 eksikliğinin nörogelişime etkisinin araştırılması amaçlandı. Gereçler ve Yöntemler: Çalışmamızda polikliniklerimize rutin tarama veya kontrol amaçlı başvuran, şikâyeti olmayan 6 -24 ay arası 89 çocuk değerlendirmeye alındı. Çalışmaya katılan her olgu için Denver Gelişim Tarama Testi II ve Sosyal İletişim Alan Tarama Testi uygulandı. Çalışmaya katılanlar serum vitamin B12 düzeylerine göre çalışma grubu (serum vitamin B12 < 300 pg/ml) ve kontrol grubu (serum vitamin B12?300 pg/ml) olmak üzere iki grup halinde değerlendirildi. Folat eksikliği, büyüme gelişme geriliği, nörolojik bulgusu, prematüre doğum öykü vb. nörogelişimsel gecikme için vitamin B12 eksikliği dışında bilinen risk faktörü olanlar çalışmaya dahil edilmedi. Bulgular: Çalışmaya ortalama yaşı 14,48±5,10 ay olan toplam 89 olgu dahil edilmiştir. Serum B12 düzeyi 300 pg/ml altında izlenen 44 olgu çalışma grubunda, 300 pg/ml ve üstü olan 45 olgu kontrol grubunda değerlendirilmiştir. Çalışma grubunda vitamin B12 düzeyi ortalaması 206,11±9,1 pg/mL, kontrol grubunun vitamin B12 düzeyi ortalaması 540,65±24,1 pg/mL olarak izlenmiştir. Olguların yaş, cinsiyet, tartı persentil, boy persentil ve baş çevresi persentil değerleri açısından gruplar arası istatistiksel olarak anlamlı farklılık görülmemiştir (p>0,05). DGTT sonuçları karşılaştırıldığında kontrol grubundakiler normal sonuç alma oranının çalışma grubuna anlamlı düzeyde yüksek; şüpheli ve anormal sonuç alma oranlarının ise düşük olduğu saptanmıştır (p=0,001; p<0,01). Olguların SİATT sonuçlarının riskli olma oranı çalışma grubunda, kontrol grubundakilerden istatistiksel olarak anlamlı düzeyde daha yüksek izlenmiştir (p=0,003; p<0,01). DGTT sonucu şüpheli tespit edilen olguların vitamin B12 değerleri, normal olanlara göre istatistiksel olarak anlamlı düzeyde daha düşük görülmüştür. (p=0,001; p<0,01). Benzer şekilde, SİATT sonucu riskli olguların serum vitamin B12 değerleri, normal sonuç alan olgulara göre istatistiksel olarak anlamlı düzeyde düşük izlenmiştir (p=0,001; p<0,01). Sosyal İletişim Alan Tarama Testi'nin riskli persentil dilimlerle sonuçlanma ihtimalinin hangi vitamin B12 değerinden sonra arttığına yönelik yapılan ROC analizinde kesme değeri 205 pg/mL olarak saptanmıştır ve bu kesme değeri için; duyarlılık %82,35; özgüllük %81,94; pozitif öngörü değeri %51,85 ve negatif öngörü değeri %95,16 olmuştur. Denver Gelişim Tarama Testi II'nin şüpheli veya anormal sonuçlama olasılığının hangi vitamin B12 değerinden sonra yükseldiğine yönelik yapılan ROC analizinde, kesme değeri 286 pg/ml olarak tespit edilmiştir ve bu kesme değeri için; duyarlılık %78,13; özgüllük %78,95; pozitif öngörü değeri %67,57 ve negatif öngörü değeri %86,54'dır. Sonuçlar: Çalışmada elde edilen veriler göz önünde bulundurulduğunda; nörolojik ve hematolojik belirtiler ortaya çıkmadan veya çocukta şikâyetler olmadan da vitamin B12 eksikliği görülebilmekte ve sağlıklı çocuklara kıyasla eksiklik olan çocuklarda nörogelişimsel gecikmelere yol açabilmektedir. Bu nedenle sağlıklı çocuk takibinde nörogelişimin yakından izlenmesi ve bir gecikme gözlendiği takdirde vitamin B12 eksikliğinin ayırıcı tanıda düşünülmesi önemlidir.
Introduction and Objectives: Vitamin B12 deficiency is a condition, which is generally seen due to a lack of dietary intake or autoimmune processes, that should be followed carefully; because of the problems it can cause. Vitamin B12 functions as a coenzyme in two important reactions in the body: conversion of homocysteine to methionine by the enzyme methionine synthase and obtaining succinyl CoA from methylmalonyl CoA in mitochondria by the methylmalonyl CoA mutase enzyme. The problems in these reactions cause hematological findings by reducing the proliferation of hematopoietic cells. Also, neurological symptoms and neurodevelopmental delay can be seen; as vitamin B12 deficiency causes disrupted DNA-RNA synthesis and decreases myelin sheath. Neurodevelopmental tests are inventories and questionnaires which are designed to detect whether children perform some skills normally compared to their peers. There are many tests developed for different age groups and different skills. Denver Developmental Screening Test II is a widely used developmental screening test worldwide that questions the family or caregiver about a child's behaviors and also tests the child some skills practically. Social Communication Area Screening Test was developed in Turkey; It is a practical and easily applicable test that measures the social skills, language use, and awareness of children aged 6 months to 24 months with 43 questions answered by family. Investigating the effect of vitamin B12 deficiency on the neurodevelopment of children without neurological symptoms or complaints, by evaluating two different neurodevelopmental tests in the study and healthy control groups of similar ages, was the main goal of our study. Materials and Methods: Our study included 89 children aged 6 months to 24 months without any complaints, who applied to our clinics for routine screening or control examination. Both Denver Developmental Screening Test II and Social Communication Area Screening Test were performed for each case in the study. The participants in the study were evaluated according to their serum vitamin B12 levels in two groups: the study group (serum vitamin B12< 300 pg/ml) and the healthy control group (serum vitamin B12?300 pg/ml). The patients with folate deficiency, physical developmental delay, neurological findings or disorders, history of premature birth, etc. those with known risk factors other than vitamin B12 deficiency for neurodevelopmental delay were not included in the study. Results: Eighty-nine cases with a mean age of 14.48±5.10 months were included in the study. Forty-four cases with serum B12 levels below 300 pg/ml were evaluated in the study group, and forty-five cases with a serum B12 level of 300 pg/ml and above were evaluated in the control group. The mean plasma vitamin B12 level in the study group was 206,11±9,1 pg/mL, and in the healthy control group was 540,65±24,1 pg/mL. There was no statistically significant difference between the groups in terms of age, gender, weight percentile, height percentile and head circumference percentile values (p>0.05). When Denver Developmental Screening Test II results were analyzed, the rate of getting normal results in the control group was significantly higher compared to the study group; and also the rates of getting suspicious and abnormal results were found to be statistically low (p=0.001; p<0.01). The ratio of the "risky" Social Communication Area Screening Test results of the cases was found to be statistically significantly higher in the study group than in the control group (p=0.003; p<0.01). Vitamin B12 values of cases with suspicious Denver Developmental Screening Test II results were found to be statistically significantly lower than those with normal results (p=0.001; p<0.01). Similarly, serum vitamin B12 values of patients with risky Social Communication Area Screening Test results were statistically significantly lower than those with normal results (p=0.001; p<0.01). For the cut-off value of Social Communication Area Screening Test for plasma vitamin B12 level of 205 pg/mL; sensitivity 82.35%; specificity 81.94%; positive predictive value was 51.85% and negative predictive value was 95.16%; For plasma vitamin B12 286 pg/mL cut-off value of Denver Developmental Screening Test; sensitivity 78.13%; specificity 78.95%; positive predictive value is 67.57% and negative predictive value is 86.54%. Conclusions: Considering the data obtained in this study; vitamin B12 deficiency can be presented even without neurological and hematological symptoms or complaints, and it can cause neurodevelopmental delays in children with deficiency compared to healthy children. Therefore, it is very important to monitor neurodevelopment closely in the follow-up of healthy children and vitamin B12 deficiency should be considered in the differential diagnosis when a neurodevelopmental delay is observed.
Introduction and Objectives: Vitamin B12 deficiency is a condition, which is generally seen due to a lack of dietary intake or autoimmune processes, that should be followed carefully; because of the problems it can cause. Vitamin B12 functions as a coenzyme in two important reactions in the body: conversion of homocysteine to methionine by the enzyme methionine synthase and obtaining succinyl CoA from methylmalonyl CoA in mitochondria by the methylmalonyl CoA mutase enzyme. The problems in these reactions cause hematological findings by reducing the proliferation of hematopoietic cells. Also, neurological symptoms and neurodevelopmental delay can be seen; as vitamin B12 deficiency causes disrupted DNA-RNA synthesis and decreases myelin sheath. Neurodevelopmental tests are inventories and questionnaires which are designed to detect whether children perform some skills normally compared to their peers. There are many tests developed for different age groups and different skills. Denver Developmental Screening Test II is a widely used developmental screening test worldwide that questions the family or caregiver about a child's behaviors and also tests the child some skills practically. Social Communication Area Screening Test was developed in Turkey; It is a practical and easily applicable test that measures the social skills, language use, and awareness of children aged 6 months to 24 months with 43 questions answered by family. Investigating the effect of vitamin B12 deficiency on the neurodevelopment of children without neurological symptoms or complaints, by evaluating two different neurodevelopmental tests in the study and healthy control groups of similar ages, was the main goal of our study. Materials and Methods: Our study included 89 children aged 6 months to 24 months without any complaints, who applied to our clinics for routine screening or control examination. Both Denver Developmental Screening Test II and Social Communication Area Screening Test were performed for each case in the study. The participants in the study were evaluated according to their serum vitamin B12 levels in two groups: the study group (serum vitamin B12< 300 pg/ml) and the healthy control group (serum vitamin B12?300 pg/ml). The patients with folate deficiency, physical developmental delay, neurological findings or disorders, history of premature birth, etc. those with known risk factors other than vitamin B12 deficiency for neurodevelopmental delay were not included in the study. Results: Eighty-nine cases with a mean age of 14.48±5.10 months were included in the study. Forty-four cases with serum B12 levels below 300 pg/ml were evaluated in the study group, and forty-five cases with a serum B12 level of 300 pg/ml and above were evaluated in the control group. The mean plasma vitamin B12 level in the study group was 206,11±9,1 pg/mL, and in the healthy control group was 540,65±24,1 pg/mL. There was no statistically significant difference between the groups in terms of age, gender, weight percentile, height percentile and head circumference percentile values (p>0.05). When Denver Developmental Screening Test II results were analyzed, the rate of getting normal results in the control group was significantly higher compared to the study group; and also the rates of getting suspicious and abnormal results were found to be statistically low (p=0.001; p<0.01). The ratio of the "risky" Social Communication Area Screening Test results of the cases was found to be statistically significantly higher in the study group than in the control group (p=0.003; p<0.01). Vitamin B12 values of cases with suspicious Denver Developmental Screening Test II results were found to be statistically significantly lower than those with normal results (p=0.001; p<0.01). Similarly, serum vitamin B12 values of patients with risky Social Communication Area Screening Test results were statistically significantly lower than those with normal results (p=0.001; p<0.01). For the cut-off value of Social Communication Area Screening Test for plasma vitamin B12 level of 205 pg/mL; sensitivity 82.35%; specificity 81.94%; positive predictive value was 51.85% and negative predictive value was 95.16%; For plasma vitamin B12 286 pg/mL cut-off value of Denver Developmental Screening Test; sensitivity 78.13%; specificity 78.95%; positive predictive value is 67.57% and negative predictive value is 86.54%. Conclusions: Considering the data obtained in this study; vitamin B12 deficiency can be presented even without neurological and hematological symptoms or complaints, and it can cause neurodevelopmental delays in children with deficiency compared to healthy children. Therefore, it is very important to monitor neurodevelopment closely in the follow-up of healthy children and vitamin B12 deficiency should be considered in the differential diagnosis when a neurodevelopmental delay is observed.
Açıklama
Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
