Oxidative stress and antioxidant status in children suffering from immune thrombocytopenic purpura

[R. H. Medović]

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UVOD: Idiopatska trombocitopenična purpura (ITP) je autoimunska trombocitopenija nedovoljno jasne patofiziologije. Cilj rada je ispitivanje uticaja redoks ravnoteže na ITP kod dece. MATERIJAL I METODE: Sprovedena je prospektivna studija na 27 dece sa novootkrivenom ITP (ndITP), lečenih intravenskim imunoglobulinima (iv ig); 22 sa perzistentnom ITP, lečenih kortikosteroidima; 29 sa hroničnom ITP (hITP), suplementirani askorbinskom kiselinom; 12 zdravih i 12 izlečenih od ITP (kontrolne grupe). Analizirani su osnovni anamnestički, laboratorijski i parametri redoks ravnoteže. REZULTATI: Parametri oksidacionog stresa, izuzev azot oksida (NO), prostaciklina (PgI2) i arginina (Arg) su viši kod obolelih nego u kontrolnoj grupi. Najviše vrednosti superoksid radikala (O2¯), indeksa lipidne peroksidacije (TBARS), tromboksana A2 (TxA2), asimetričnog dimetil arginina (ADMA) i oksidovanog LDL (oxLDL) zabeležene su kod ndITP i dece sa težom kliničkom slikom, nižim brojem trombocita i hiperprodukcijom megakariocita, a vrednosti NO, PgI2 i Arg su najniže u ovim grupama. Redukovani glutation (GSH) i katalaza (KAT) su viši u kontrolnoj grupi nego kod obolelih, a superoksid dizmutaza (SOD) je najviša kod ndITP. Redoks ravnoteža se normalizuje kod izlečenih. Vrednosti O2¯, TBARS, H2O2, TxA2, ADMA i oxLDL značajno padaju, dok vrednosti NO, PgI2, Arg, i SOD, KAT i GSH rastu nakon terapije iv ig i u manjoj meri nakon kortikosteroida. Recidiv bolesti dovodi do porasta O2¯, TBARS, oxLDL i SOD, uz smanjenje NO, Arg i KAT. Suplementacija askorbinskom kiselinom nema uticaja na redoks ravnotežu kod hITP. ZAKLjUČAK: Poremećaji redoks ravnoteže su definitivno uključeni u patogenezu svih oblika ITP, sa najizraženijim varijacijama kod ndITP i u egzacerbaciji bolesti, uz poboljšanje na standardnu terapiju.

INTRODUCTION: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune thrombocytopenia of insufficiently clear pathophysiology. The aim of the work is to examine the influence of redox balance on ITP in children. MATERIAL AND METHODS: A prospective study was conducted on 27 children with newly diagnosed ITP (ndITP), treated with intravenous immunoglobulins (iv ig); 22 with persistent ITP, treated with corticosteroids; 29 with chronic ITP (hITP), supplemented with ascorbic acid; 12 healthy and 12 cured of ITP (control group). Basic anamnestic, laboratory and redox balance parameters were analyzed. RESULTS: Oxidative stress parameters, with the exception of nitric oxide (NO), prostacyclin (PgI2) and arginine (Arg), are higher in patients than in the control group. The highest values of superoxide radical (O2¯), lipid peroxidation index (TBARS), thromboxane A2 (TxA2), asymmetric dimethyl arginine (ADMA) and oxidized LDL (oxLDL) were recorded in ndITP and children with a more severe clinical picture, lower platelet count and hyperproduction megakaryocytes, and the values of NO, PgI2 and Arg are the lowest in these groups. Reduced glutathione (GSH) and catalase (KAT) are higher in the control group than in patients, and superoxide dismutase (SOD) is the highest in ndITP. The redox balance is normalized in the cured children. The values of O2¯, TBARS, H2O2, TxA2, ADMA and oxLDL decrease significantly, while the values of NO, PgI2, Arg, and SOD, KAT and GSH increase after iv ig therapy and to a lesser extent after corticosteroids. The disease relapse leads to an increase in O2¯, TBARS, oxLDL and SOD, with a decrease in NO, Arg and KAT. The supplementation with ascorbic acid has no effect on the redox balance in hITP. CONCLUSION: Disorders of redox balance are definitely involved in the pathogenesis of all forms of ITP, with the most pronounced variations in ndITP and in disease exacerbation, with improvement on standard therapy.

idiopatska trombocitopenična purpura, deca, oksidacioni stres, antioksidaciona zaštita

idiopathic thrombocytopenic purpura, children, oxidative stress, antioxidant protection

616-053.2

Pedijatrija - Hematologija

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