Department of pediatric neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Department of pediatria, Karadeniz Technical University, Trabzon, Turkey.
Klin Padiatr. 2021 Jul;233(4):173-180. doi: 10.1055/a-1369-9426. Epub 2021 Mar 10.
Breath-holding spells (BHS) are common non-paroxysmal events with unknown pathophysiology. BHS have been associated not only with iron deficiency anemia (IDA) but also with oxidant/antioxidant imbalance and erythrocyte injury induced by hypoxia. The present study was designed to investigate the contribution of IDA in BHS and the oxidant/antioxidant balance in children with or without IDA in BHS and compare them with healthy controls.Additionally, the study also aimed to examine the effect of the frequency of BHS attacks (mild or severe) on the oxidant/antioxidant balance and to determine the best predictive oxidant and antioxidant markers.
The study included 66 children with BHS aged 6-48 months who had been followed up for a minimum period of one year between 2014 and 2018. A control group of 30 age- and gender-matched healthy children was included in the study. The patient group was divided into 2 groups (IDA and non-IDA) and these groups were compared between each other and also with the control group. The IDA group was divided into subgroups based on the frequency of BHS attacks. Blood samples were obtained within a maximum period of 24 h following the spell. Levels of protein carbonyl, nitrite, nitrate, TOS, TAS, OSI, MDA, enzyme activities of GPx, CAT,enzyme activities of erythrocyte SOD, CAT, and GPx, and the level of MDA were measured.
In patients with IDA, the oxidant levels increased while the antioxidant enzyme activities decreased. In all patients, the levels of MDA, carbonyl, TOS, OSI increased and the levels of TAS, activities SOD, and CAT decreased, whereas the enzyme activities of erythrocyte SOD, CAT, GPx decreased significantly compared to those of control group. Increased of erythrocyte MDA levels had 10.32, decreased enzyme activities of erythrocyte SOD levels had a 10.25, and decreased enzyme activities of erythrocyte CAT had a 5.33 times greater risk for spell.
The results indicated that the oxidant/antioxidant balance in children with BHS was impaired in favor of oxidants at both levels, regardless of the presence of IDA and the increased frequency of BHS attacks per day. Moreover, the presence of IDA was found to be associated with increased oxidative stress in children with BHS, particularly at the erythrocyte level. Erythrocyte level; among the erythrocyte MDA oxidant parameters, erythrocyte SOD and antioxidant parameters, they are the biomarkers that show the best probability of having a BHS attack and an increase in the frequency of apnea attacks.
屏气发作（BHS）是一种常见的非阵发性事件，其病理生理学尚不清楚。BHS 不仅与缺铁性贫血（IDA）有关，而且与缺氧诱导的氧化/抗氧化失衡和红细胞损伤有关。本研究旨在探讨 IDA 在 BHS 中的作用以及 BHS 患儿和无 BHS 患儿的氧化/抗氧化平衡，并将其与健康对照组进行比较。此外，本研究还旨在研究 BHS 发作频率（轻度或重度）对氧化/抗氧化平衡的影响，并确定最佳预测氧化和抗氧化标志物。
本研究纳入了 2014 年至 2018 年期间接受至少一年随访的 66 名 6-48 个月龄的 BHS 患儿。纳入了 30 名年龄和性别匹配的健康儿童作为对照组。将患儿分为 2 组（IDA 和非 IDA），并对每组进行比较，同时与对照组进行比较。根据 BHS 发作频率将 IDA 组分为亚组。在发作后 24 小时内采集血样。测定蛋白羰基、亚硝酸盐、硝酸盐、TOS、TAS、OSI、MDA、GPx、CAT 酶活性、红细胞 SOD、CAT、GPx 酶活性和 MDA 水平。
IDA 患儿的氧化水平升高，抗氧化酶活性降低。所有患者的 MDA、羰基、TOS、OSI 水平升高，TAS、SOD、CAT 活性降低，而红细胞 SOD、CAT、GPx 酶活性与对照组相比显著降低。红细胞 MDA 水平升高的风险增加了 10.32 倍，红细胞 SOD 酶活性降低的风险增加了 10.25 倍，红细胞 CAT 酶活性降低的风险增加了 5.33 倍。
研究结果表明，无论是否存在 IDA 以及 BHS 发作频率的增加，BHS 患儿的氧化/抗氧化平衡均受到损害，有利于氧化剂。此外，还发现 IDA 与 BHS 患儿的氧化应激增加有关，特别是在红细胞水平。在红细胞 MDA 氧化参数、红细胞 SOD 和抗氧化参数中，它们是最有可能发生 BHS 发作和呼吸暂停发作频率增加的生物标志物。
