Orta hat kapanma defektlerinde fetuin-a, osteopontin, tas (total antioksidan status), tos (total oksidan status) araştırılması
A research of fetuin-a, osteopotin, tas (total antioxidant status), tos (total oxidant status) in midline closure defect of neural tube
Yazar: GULYARA ÇİĞDEM
Danışman: DOÇ. DR. HAMZA KARABAĞ
Harran Üniversitesi / Tıp Fakültesi / Beyin ve Sinir Cerrahisi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2018
Konu: Nöroşirürji = Neurosurgery
Dizin: Antioksidanlar = Antioxidants ; Fetuin A = Fetuin A ; Konjenital anomaliler = Congenital abnormalities ; Malformasyonlar = Abnormalities ; Oksidanlar = Oxidants ; Osteopontin = Osteopontin ; Spinal kord hastalıkları = Spinal cord diseases

Özet:
Giriş ve amaç: Orta Hat kapanma Defekti malformasyonu doğumsal spinal omurgaların
arka bölümlerinin birleşme kusurudur. OHD yüksek morbidite ve mortalite ile ilişkilidir. Bu
çalışmada OHD'li olan hastalarda total antioksidan ve total oksidan statuslerin, osteopontin ve
fetuin-A değerleri araştırıldı ve farklı hasta gruplarındaki dağılımı ortaya çıkarıldı. OHD
malformasyonlarının alınan tedbirler ile aile ve toplum içinde azaltılması hedeflendi.
Metot: Çalışma Kasım 2015-Nisan 2018 tarihleri arasında Harran Üniversitesi Araştırma
ve Uygulama Hastanesi Beyin ve Sinir Cerrahi polikliniğine ve kliniğine, Yenidoğan ve Çocuk
Hastalıkları kliniğine 0-5 yaş grubu arasında grup 1. Spina Bifida Occulta (n=22), grup 2. Spinal
Meningosele veya Miyelomeningosele (n=26), grup 3. Hidrosefali (n=31) toplam 80 vaka ile Orta
Hat Kapanma Defektleri olmayan 0-5 yaş kontrol grubu olarak 85 vaka, toplam 165 vaka çalışmaya
alındı. Muayene sonrası hemogram, kan biyokimya, koagulogram bakıldı. Sonra toplanan kan
serum örneklerinde OHD'yi etkileyen sitokinler fetuin-A, osteopontin, total antioksidant status
(TAS) ve total oksidan status (TOS) araştırıldı.
Bulgular: TAS değeri hariç hasta ve kontrol grupları arasında TOS, Osİ, fetuin-A,
osteopontin değerlerinde anlamlı farklılıklar tespit edildi (hepsi için, p<0.05).
Vaka grubunda TOS 12,31 ± 3,19. Osteopontin 4,69 ± 2,90. Fetuin A 1,03 ± 0,48. Osİ 1,06
± 0,34.
Kontrol grup TOS 10,13 ± 1,97. Osteopontin 6,74 ± 3,45. Fetuin A 2,40 ± 0,98. Osİ 0,82
± 0,19.
Hasta grupları arasında TAS değeri hariç TOS, fetuin-A, osteopontin değerlerinde anlamlı
fark tespit edildi (p<0.05).
1. grup: 22 hasta spina bifida occulta (%27,5), TOS 13,73±2,75. Osteopontin 6,92±3,70.
Fetuin-A 1,2±0,54. Osİ 1,25±0,38.
2. grup: 22 hasta meningomiyelosel ve meningosel ile birlikte alındı (%32,5). TOS
12,07±3,10. Osteopontin 3,22±1,68. Fetuin-A 1,04±0,61. Osİ 1,02±0,30.
3. grup: 32 hasta konjenital hidrosefali (%40). TOS 11,54±3,31. Osteopontin 4,36±2,12.
Fetuin A 0,87±0,21. Osİ 0,97±0,30.
Sonuç: OHD'li hastalarda oksidatif stresin miktarında artma tespit edildi. Oksidatif stres
değerleri ne kadar artarsa, doku ve organ hasarına bağlı OHD ile doğan bebeklerdeki malformasyon
şiddetinin de o kadar arttığı belirlendi. OHD'li hastalarda OPN değerleri düşüklüğü nedeni ile
osteoblast aktivitesinde azalma ve kemik matriksinde doku hasarının oluştuğu görüldü. Fetuin-A
değerleri ne kadar azalırsa o kadar sinir dokusundaki hasarın yüksek olduğu tespit edildi.

Abstract:
Background and aim: Midline closure defect malformation is a congenital fusional defect
of the posterior segments of spinal vertebrae. OHD is associated with high morbidity and mortality.
This study investigated total antioxidant and total oxidant status, osteopontin and fetuin-A values in
patients with OHD and found out their distribution in different patient groups. It aims to suggest
measures in order to reduce OHD malformations in the family and community.
Methods: The study was carried out between November 2015 and April 2018 at Harran
University Research and Practice Hospital Neurosurgical outpatient clinic and clinic, Neonatal and
Child Diseases clinic. The research included patients between 0-5 years old; group 1 with Spina
Bifida Occulta (n = 22), group 2 with Spinal Meningocele or Myelomeningocele (n = 26), group 3
with Hydrocephalus (n = 31), a total of 80 patients with middle line fold closure defects and 85
control group patients between 0-5 age without midline fold closure defects. After the examination,
hemogram, blood biochemistry, coagulogram were taken. Serum samples were collected and then
fetuin-A, osteopontin and total antioxidant status (TAS) and total oxidant status (TOS) of the
cytokines which affecting OHD were investigated in this serum samples.
Results: We did not find any significant differences in TAS value. But we found out
significant differences in TOS, OSI, fetuin-A, osteopontin values (p <0.05 for all) between patients
and control groups
TOS in the case group was 12.31 ± 3.19. Osteopontin was 4,69 ± 2,90. Fetuin-A was 1.03
± 0.48. OsI 1,06 ± 0,34
TOS in the control group was 10,13 ± 1,97. Osteopontin was 6.74 ± 3.45. Fetuin-A was
2.40 ± 0.98. OsI was 0,82 ± 0,19.
There were not significant differences in TAS value. But there were significant differences
in TOS, fetuin-A, and osteopontin values among the patient groups (p <0.05)
Group 1: 22 patients with spina bifida occulta (27,5%): TOS was 13,73 ± 2,75. Osteopontin
was 6.92 ± 3.70. Fetuin-A was 1.2 ± 0.54. OsI was 1.25 ± 0.38.
Group 2: 22 patients both with meningomyelocele and meningocele (32,5%): TOS was
12,07 ± 3,10. Osteopontin was 3,22 ± 1,68. Fetuin-A was 1,04 ± 0,61. OsI was 1,02 ± 0,30.
Group 3: 32 patients with congenital hydrocephaly (40%): TOS was 11,54 ± 3,31.
Osteopontin was 4,36 ± 2,12. Fetuin A was 0,87 ± 0,21. OsI was 0.97 ± 0.30.
Conclusion: It has been found out that the amount of oxidative stress increases in patients
with OHD. It has been underlined that the greater the oxidative stress values are, the greater the
tissue and the organ damages are in infants who were born with OHD. It has been seen that due to
the low OPN values, a reduction in osteoblast activity and tissue damage in the bone matrix occur
in patients with OHD. It has also been found out that the lower the fetuin-A values are, the higher
is the damages in the nerve tissues.