Epilepsili çocuk olgularda anti-epileptik ilaç düzeyinin kemik metabolizması üzerindeki yan etkilerinin incelenmesi
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Epilepsili Çocuk Olgularda Anti-Epileptik İlaç Düzeyinin Kemik Metabolizması Üzerindeki Yan Etkilerinin İncelenmesi Amaç: Epilepsi çocukluk çağında başlayan ve uzun süreli tedavi gerektiren, kişiyi nörobiyolojik ve psikososyal olarak etkileyen kronik bir hastalıktır. Epilepsi tedavisinde kullanılan anti-epileptik ilaçlar uzun süreli kullanıldığı için vücutta metabolizma üzerinde çeşitli yan etkileri vardır. Biz çalışmamızda anti-epileptik ilaçların kemik metabolizması üzerindeki yan etkilerini inceledik. Gereç yöntem: Düzce Üniversitesi Çocuk Sağlığı ve Hastalıkları Polikliniğine epilepsi tanısıyla başvuran hastalardan; çalışma kriterlerine uyan, valproik asit alan 68 (% 61,2), karbamazepin alan 26 (% 23,4) ve fenobarbital alan 17 (% 15,3) toplam 111 olgu çalışmaya alındı. Çalışmaya dahil edilmiş olan hastaların poliklinikte rutin kontrol sırasında alınan kan ve idrar numuneleri Düzce Üniversitesi Merkez ve Farmakoloji laboratuarında çalışılarak biyokimya ve idrar verileri (kan Ca, P, ALP, PTH, 25(OH)D, idrar kalsiyum/kreatinin, ilaç düzeyi) ve kemik dansitometrisi çekilerek tüm vücut BMD ve z skorları elde edildi. Bulgular: Olgu grupları arasında cinsiyet dağılımı açısından fark saptanmadı. Olguların yaş ve tanı yaşları açısından gruplar arasında istatistiksel anlamlı fark saptandı (p <0,001). Olguların tedavi süreleri açısından anlamlı fark saptandı (p=0,022). Kalsiyum, fosfor, PTH, idrar kalsiyum/kreatinin ve z skorları açısından üç ilaç grubu arasında fark saptanmadı. ALP ortanca değerinin fenobarbital alan grupta daha yüksek olduğu, valproik asit alan grupta en düşük olduğu saptandı. Serum vitamin D ortanca değerlerinin tüm gruplarda düşük fakat karbamazepin alan grupta en düşük, fenobarbital alan grupta en yüksek olduğu saptandı. BMD değerleri arasında istatistiksel anlamlı fark saptanmakla birlikte en düşük BMD değerinin fenobarbital alan grupta olduğu saptandı (p=0,001). Sonuç: Epilepsi nedeniyle uzun süre anti-epileptik ilaç kullanan hastalara daha fazla kemik sağlığı bilinci, düzenli kemik dansitesi kontrolü, gerektiğinde kalsiyum ve D vitamini alımı sağlanmalıdır. Hastalara güneş ışığından daha fazla yararlanma ve fiziksel aktivite önerilmesi, hastaların metabolizması için uygun anti-epileptik ilaçların seçilmesi ve riskli hastaları belirleyip erken teşhis edilerek gerekli önlemlerin alınması epileptik hastaların genel yaşam standartlarını iyileştirici etki yaratabilir.
İnvestigation of the anti-epileptic drug adverse effects on the bone metabolism in epileptic children Objective: Epilepsy is a chronic disease that starts in childhood and requires long-term treatment and affects the person neurobiologically and psychosocially. There are adverse effects on metabolism in the body, because of anti-epileptic drugs used in the treatment of epilepsy for a long time. In our study, we examined the adverse effects on bone metabolism in epileptic children. Method: Patients who were admitted to Düzce University Pediatrics Clinic with the diagnosis of epilepsy; A total of 111 patients who compliance in the criteria, 68 (% 61,2) with valproic acid untake, 26 (% 23,4) with carbamazepine and 17 (% 15,3) with phenobarbital were included in the study. Blood and urine samples which taken during routine control in the outpatient clinic of the pediatrics were investigated pharmacology laboratory and biochemistry in Düzce University Medical Center. Blood and urine analyses (Ca, P, ALP, PTH, 25 (OH) D, urine calcium / creatinine, drug level) were done. Bone densitometry of children were performed to obtain whole body BMD and z scores. Results: There was no difference in gender distribution between case groups. We found a statistically significant difference between the groups in terms of age and age of diagnosis (p <0,001). There was a significant difference in terms of treatment duration of the patients (p=0,022). Serum calcium, phosphorus, PTH, urine calcium / creatinine and z scores were not different between the three drug groups. The median value of ALP was higher in the phenobarbital group and the lowest in valproic acid group. We found that the median serum vitamin D level was the lowest in all groups but the lowest in the group receiving carbamazepine and the highest in the group with phenobarbital. We found that there was a statistically significant difference between BMD values and the lowest in the phenobarbital group (p=0,001). Conclusions: Patients who used anti-epileptic drugs for a long time due to epilepsy should be provided by more bone health awareness, regular bone dansity checks, intake of calcium and vitamin D. If patients provide more benefit from sunlight and physical activity and select appropriate anti-epileptic drugs for patients metabolism and taking necessary measures, we can identify risky patients early and improve general living standards of epileptic patients.
İnvestigation of the anti-epileptic drug adverse effects on the bone metabolism in epileptic children Objective: Epilepsy is a chronic disease that starts in childhood and requires long-term treatment and affects the person neurobiologically and psychosocially. There are adverse effects on metabolism in the body, because of anti-epileptic drugs used in the treatment of epilepsy for a long time. In our study, we examined the adverse effects on bone metabolism in epileptic children. Method: Patients who were admitted to Düzce University Pediatrics Clinic with the diagnosis of epilepsy; A total of 111 patients who compliance in the criteria, 68 (% 61,2) with valproic acid untake, 26 (% 23,4) with carbamazepine and 17 (% 15,3) with phenobarbital were included in the study. Blood and urine samples which taken during routine control in the outpatient clinic of the pediatrics were investigated pharmacology laboratory and biochemistry in Düzce University Medical Center. Blood and urine analyses (Ca, P, ALP, PTH, 25 (OH) D, urine calcium / creatinine, drug level) were done. Bone densitometry of children were performed to obtain whole body BMD and z scores. Results: There was no difference in gender distribution between case groups. We found a statistically significant difference between the groups in terms of age and age of diagnosis (p <0,001). There was a significant difference in terms of treatment duration of the patients (p=0,022). Serum calcium, phosphorus, PTH, urine calcium / creatinine and z scores were not different between the three drug groups. The median value of ALP was higher in the phenobarbital group and the lowest in valproic acid group. We found that the median serum vitamin D level was the lowest in all groups but the lowest in the group receiving carbamazepine and the highest in the group with phenobarbital. We found that there was a statistically significant difference between BMD values and the lowest in the phenobarbital group (p=0,001). Conclusions: Patients who used anti-epileptic drugs for a long time due to epilepsy should be provided by more bone health awareness, regular bone dansity checks, intake of calcium and vitamin D. If patients provide more benefit from sunlight and physical activity and select appropriate anti-epileptic drugs for patients metabolism and taking necessary measures, we can identify risky patients early and improve general living standards of epileptic patients.
Açıklama
YÖK Tez No: 550838
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, Antikonvülsanlar, Anticonvulsants, Epilepsi, Epilepsy, Kemik dansitesi, Bone density, Kemik ve kemikler, Bone and bones, Çocuklar, Children, İlaç yan etkileri ve istenmeyen reaksiyonlar, Drug-related side effects and adverse reactions, Anti-Epileptik İlaç, Çocuk, Epilepsi, Kemik Metabolizması, Kemik Mineral Dansitesi, Anti-epileptic drugs, Bone metabolism, Bone mineral density, Children, Epilepsy
