PRACA ORYGINALNA / ORIGINAL ARTICLE

ZMIANY ZAWARTOŚCI NIEKTÓRYCH SKŁADNIKÓW MINERALNYCH U MŁODZIEŻY Z CHOROBAMI UKŁADU SERCOWO-NACZYNIOWEGO JAKO PODŁOŻE ROZWOJU PRZEWLEKŁEGO ZAPALENIA MIGDAŁKÓW PODNIEBIENNYCH

Olexander I. Smiyan, Andrii M. Loboda, Yuliia A. Manko, Tatiana P. Bynda, Sergiy V. Popov, Viktoriia O. Petrashenko, Petro I. Sichnenko, Oksana K. Romaniuk, Viktoriia A. Gorbas, Mykola P. Zagorodnii, Kateryna O. Smiian-Horbunova, Viktor V. Kosarchuk, Olena L. Ovsianko, Maria V. Kolesnikova

Sumy State University, Sumy, Ukraine

Abstract

Introduction: Chronic diseases of the upper respiratory tract in children and teenagers, such as chronic tonsillitis is quite common in pediatric populations, accompanied by changes in reactivity, causing a risk of complications. Due to the fact that the child’s body resistance to acute infectious diseases depends on the sufficiency of trace elements, then at present stage greatly increased interest in deeper study of exchange of macro- and microelements in the human body in normal and pathological conditions.

The aim: To study the dynamics of zinc, iron, potassium and magnesium in adolescents with disorders of the cardiovascular system with chronic tonsillitis.

Materials and methods: It was examined 63 patients with chronic tonsillitis, among them- 31 children suffer from chronic tonsillitis off-damage to the cardiovascular system (I group), 32 patients with disorders of the cardiovascular system against the background of chronic tonsillitis (II group). The content of trace elements zinc, iron, minerals potassium and magnesium was analyzed. The measurement and calculation were done according to AAS-SPECTR program. Analysis and statistics treatment was done on using application programs STATISTICA 7.0 and MS Excel XP.

Results: In result of investigation it was found a violation of trace element composition in the blood serum. Thus, in patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l. Similar changes were observed with the concentration of zinc in the blood serum. In patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l. Similar changes were observed with the concentration of zinc in the blood serum of patients of I groups during hospitalization (10,89 ± 0,57mmol/l) and was significantly lower compared with the data of healthy children (18,40 ± 0,71 mmol/l (p <0.05)).

Сonclusions: It should be noted that children with tonsillogene cardiac lesions during hospitalization have a significant decreasing in the level of magnesium compared with indicators of children without pathology of the cardiovascular system. After treatment, the normalization of trace elements iron, zinc, magnesium did not happen, moreover, significant changes were observed in patients with heart disease against the background of chronic tonsillitis.

 

Wiad Lek 2018, 71, 4, 861-864

 

INTRODUCTION

Chronic diseases of the upper respiratory tract in children and teenagers, such as chronic tonsillitis is quite common in pediatric populations, accompanied by changes in reactivity, causing a risk of local and general complications. Thus, the share in the structure of chronic tonsillitis ENT pathology is 25-35%, both in children and adults. This is caused by the high incidence of SARS, socio-economic reasons: deteriorating conditions and quality of life, migration, technological overload, living in ecologically unfavorable regions, breach adaptation to environmental pollution, untimely adequate treatment [1].

It should be noted that the existence of lymphogenous tonsils ties with distant organs at intercellular connections in the creation and regulation of the immune barrier explains the prevalence of toxic, metabolic, allergic and immunoreactive changes in children with chronic tonsillitis.

Due to the fact that the child’s body resistance to acute infectious diseases depends on the sufficiency of trace elements, then at present stage greatly increased interest in deeper study of exchange of macro- and microelements in the human body in normal and pathological conditions. Features of mineral metabolism are important to the functioning of all systems and organs of the child’s body. Particular attention should be paid to the impact of macro and micronutrients on the state of the immune and cardiovascular system in children with chronic tonsillitis [2,3].

THE AIM

The aim of this work was to study the dynamics of zinc, iron, potassium and magnesium in adolescents with disorders of the cardiovascular system with chronic tonsillitis.

MATERIALS AND METHODS

To study the characteristics of mineral metabolism in patients with chronic tonsillitis in the dynamics of the disease were examined 63 patients within 1-2 days of hospitalization and 25 children after standard therapy (within 12-14 days). The I group included 31 children suffering from chronic tonsillitis without cardiovascular system disease, the II group consisted of 32 patients with pathology of the cardiovascular system against the background of chronic tonsillitis. The number of control group was made up of 20 almost healthy children representative by age and gender.

Determination of concentration of trace elements of iron, zinc, magnesium microelements in blood serum was measured by atomic absorption spectrophotometry.

The measurement and calculation were done according to AAS-SPECTR program. Analysis and statistics treatment was done on the Personal Computer using application programs STATISTICA 7.0 and MS Excel XP. Parametric and nonparametric statistic methods were used in case of their acceptance by medico biological researchers.

Also, we have provided the requirements of the principles of bioethics and drafted a protocol in accordance with the basic principles of the Helsinki Declaration.

RESULTS AND DISCUSSION

In result of investigation it was found a violation of trace element composition in the blood serum of children with chronic tonsillitis in the form of lower concentrations of iron and zinc in I and II children groups and magnesium in patients of II group (Table I).

Thus, in patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l compared with the data of healthy children ((20,28 ± 1,37) mmol/l) (p <0.05), but its level was within the age rules. On the 12-14th days of standard therapy iron content in serum of patients did not change ((15,68 ± 1,23) mmol/l) (p> 0.05) and differed from the control group (p <0.05).

Similar changes were observed with the concentration of zinc in the blood serum in patient of I groups during hospitalization was (10,89 ± 0,57) mmol/l and was significantly lower compared with the data of healthy children (18,40 ± 0,71) mmol/l (p <0.05). After the standard treatment of zinc dynamics was not observed (p> 0.05). Reduction of microelements in the blood may indicate a compromised immune status, because zinc is the main bioelements involved in the functioning of the immune system.

Thus, in patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l compared with the data of healthy children ((20,28 ± 1,37) mmol/l) (p <0.05), but its level was within the age rules. After standard therapy iron content in the blood serum of patients did not change ((15,68 ± 1,23) mmol/l) (p> 0.05) and differed from the control group (p <0.05).

Similar changes were observed with the concentration of zinc in the blood serum of patients of I groups during hospitalization (10,89 ± 0,57mmol/l) and was significantly lower compared with the data of healthy children (18,40 ± 0,71 mmol/l (p <0.05)). After the standard treatment zinc dynamics was not observed (p> 0.05). Reduction of microelements in the blood may indicate a compromised immune status, because zinc is the main bioelements involved in the functioning of the immune system.

In II group patients before treatment iron levels was 15,01 ± 1,01 mmol/l (p <0.05), zinc – (9,57 ± 0,58) mmol/l (p <0.05) compared with indicators of the control group. After treatment, the concentration of these micronutrients remained low and values different from individuals without disease.

Iron deficiency of the respondents with chronic tonsillitis may be as a result of intestinal dysbiosis, where we determine reduction of absorption of microelements and transferrin, iron metabolism disorders due to pubertal hormonal imbalance and increased demand during its intensive growth of the child’s body. In addition, lower iron concentration in the blood serum may indirectly indicate a lack of cellular and humoral immunity of patients with chronic tonsillitis [4, 5]. Reduction of zinc, in turn, may contribute to compromised immune status, because zinc is a major bioelements involved in the functioning of the immune system [6, 7].

In analyzing the content of potassium and magnesium in the blood serum of patients of I group, was found that levels of referred above trace elements did not differ from these healthy children and did not change in the dynamics of treatment.

In patients with secondary cardiomyopathy potassium concentration was within the values of the control group both before and after treatment ((4,45 ± 0,10) mmol/l (4,47 ± 0,17) mmol/l, respectively) (p > 0.05). Along with the fact in the first days of therapy has been a significant decrease in magnesium up to (0,79 ± 0,05) mmol/l, in contrast to the values I and control groups ((1,11 ± 0,06) mmol/l ( 1,13 ± 0,08) mmol/l, respectively (p <0.05). After the standard treatment in patients with II group concentration of magnesium remained fairly low ((0,88 ± 0,05) mmol/l) (p> 0.05) and differed from the values of people without disease. The mentioned changes may affect the metabolic processes in the heart, because magnesium is an important element for the normal functioning of cells of the myocardium. In addition, lower magnesium in blood serum in children with secondary cardiomyopathy of tonsillogene origin may be associated with malabsorption in the intestines on the background of dysbiotic processes of the patients [8].

Thus, the analysis of microelement serum balance in children with chronic tonsillitis, showed a significant decrease in the concentration of iron and zinc in the first days of hospitalization in both groups of respondents, and there were no changes in the dynamics of treatment. Mentioned changes may indicate a reduction of micronutrient absorption in the intestine to dysbiotic background processes as well as the possibility of a specific breach of the immune system in children surveyed. In studying the concentration of macronutrients installed significant decrease in magnesium in patients of II group, compared to those of control group I and that may indicate a violation of metabolic processes in cells of the myocardium patients with secondary cardiomyopathy [7].

Studies by other authors also indicate a relationship between the decrease in blood serum of zinc and iron with the state of immunity in children. Thus, the study in children with chronic tonsillitis, was found iron and zinc deficiency can result from violations of the intestinal microflora, in which the reduced absorption of minerals and transferrin, and in relation to pubertal hormonal imbalances and increased need for iron the period of intensive growth of the child’s body. In addition, reducing the concentration of iron in the blood serum may indirectly indicate a insufficiency of cellular and humoral immunity of patients with chronic tonsillitis. Reduction of zinc may contribute to compromised immune status, because zinc is a basic bioelements involved in the functioning of the immune system [7, 8, 9, 10].

Along with those in patients with chronic tonsillitis and cardiac pathology at the hospitalization has been a reduction of Magnesium opposed to the values I and control groups was maintained and after standard treatment. According Marushko V. (2013), Zhernosek VF (2015) identified changes may affect the metabolism of the heart, because magnesium is an important element for the normal functioning of cells of the myocardium. In addition, decreased serum magnesium in children with secondary cardiomyopathy may be associated with malabsorption in the intestines on the background dysbiotic processes in patients [9, 10].

Thus, the results obtained in the study should be considered when choosing the appropriate treatment for the prevention of disorders of mineral metabolism, and in turn, improve the flow of chronic tonsillitis and secondary cardiac lesions in adolescents.

CONCLUSIONS

1. The analysis of the composition of micro and macro serum in children with chronic tonsillitis, during hospitalization showed a significant reduction in the concentration of iron and zinc in both groups of patients, and reduced magnesium levels in patients with lesions of the cardiovascular system on the background of chronic tonsillitis compared with indicators healthy children. The concentration of potassium in children with chronic tonsillitis in I and II groups did not change and stayed within the meaning of the control group both before and after treatment.

2. After the standard treatment, concentrations of iron and zinc in both groups, and magnesium in children the second group remained at a low level and different from the similar indicators of children without cardiac disease.

References

1. Todorović MM, Zvrko EZ. Immunoregulatory cytokines and chronic tonsillitis. Bosn J Basic Med Sci. 2013; 13:230–236.

2. Demirci, Ş.,Tüzüner, A.,Cengiz, C. et al. Are vitamins and trace elements important in children with chronic and recurrent tonsillitis. Turkiye Klinikleri Journal of Medical Sciences. 2016; 36(1): 36-39.

3. Reyan A. Mohamed, Abdelmula M. Abdalla. Assessment of serum zinc level in Sudanese patients with chronic tonsillitis infection in Khartoum state. JMSCR. 2017; 05(08): 26632-26636.

4. Kumar, V., Choudhry, V.P. Iron deficiency and infection. Indian Journal of Pediatrics. 2010; 77(7): 789-793.

5. Somuk, B.T.,Sapmaz, E.,Soyaliç, H. et al. Evaluation of iron and zinc levels in recurrent tonsillitis and tonsillar hypertrophy. American Journal of Otolaryngology – Head and Neck Medicine and Surgery. 2016; 37(2): 116-119.

6. Chasapis, C.T., Spiliopoulou, C.A., Loutsidou et al. Zinc and human health An update. Archives of Toxicology. 2012; 86(4): 521-534.

7. Bonaventura P, Benedetti G, Albarède F, Miossec P. Zinc and its role in immunity and inflammation. Autoimmun Rev. 2015; 14:277: 285-289.

8. Smiyan O.I., Mozghova U. A., Popov S.V. et al Dynamika vmistu deiakykh mineraliv u pidlitkiv iz patolohiieiu sertsevo-sudynnoi systemy na tli khronichnoho tonzylitu. Zaporizkyi medychnyi zhurnal. – 2017; 4(103): 404-408.

9. Bynda T.P., Romaniuk O.K., Sichnenko P.I. et al. Stan imunnoi systemy u ditei z tonzylohennymy urazhenniamy sertsevo-sudynnoi systemy. Likarska sprava. 2013; 2 : 89-93.

10. Mozghova U. A., Bynda T.P., Romaniuk O.K. et al. Znachennia ultrazvukovovoho doslidzhennia v diahnostytsi tonzylohennykh urazhen sertsevuo-sudynnoi systemy u ditei. Pediatriia, akusherstvo, hinekolohiia. 2012; 4(452): 19-23.

 

The initiative research work «Regional features of the state of health and levels of morbidity among children» (0117U004937), the term of implementation till 2020, the head professor Olexander Smiyan, is carried out at Sumy State University.

Conflict of interest:

The Authors declare no conflict of interest

ADDRESS FOR CORRESPONDENCE

Olexander Smiyan

Department of Pediatrics, Medical Institute

Sumy State University

Zalyvnaia street 7/48, Sumy, Ukraine

tel: +380506316005

e-mail: smiyana@ukr.net

Received: 26.02.2018

Accepted: 29.05.2018

Table I. The dynamics of trace element composition in children with chronic tonsillitis of I and II studied groups, M ± m

МЕ

І Group

ІІ Group

Almost healthy children (n=20)

before treatment (n=31)

after treatment (n=15)

before treatment (n=32)

after treatment (n=10)

1

2

3

4

5

Iron, mmol/l

15,47±1,12

р 1–2 >0,05

р 1–3>0,05

р 1–5<0,05

15,68±1,23

р 2–4>0,05

р 2–5<0,05

15,01±1,01

р 3–4>0,05

р 3–5<0,05

15,48±1,58

р 4–5<0,05

20,28±1,37

Zinc, mmol/l

10,89±0,57

р 1–2 >0,05

р 1–3>0,05

р 1–5<0,05

11,12±0,83

р 2–4>0,05

р 2–5<0,05

9,57±0,58

р 3–4>0,05

р 3–5<0,05

10,03±1,06

р 4–5<0,05

18,40±0,71

Magnesium,

mmol/l

1,11±0,06

р 1–2 >0,05

р 1–3<0,05

р 1–5>0,05

1,12±0,07

р 2–4>0,05

р 2–5<0,05

0,79±0,05

р 3–4>0,05

р 3–5<0,05

0,88±0,05

р 4–5<0,05

1,13±0,08

Potassium,

mmol/l

4,53±0,10

р 1–2 >0,05

р 1–3>0,05

р 1–5>0,05

4,48±0,12

р 2–4>0,05

р 2–5>0,05

4,45±0,10

р 3–4>0,05

р 3–5>0,05

4,47±0,17

р 4–5>0,05

4,49±0,13

Notes: р– reliability differences;

р1–2, р3–4 – between indicators in the same group before and after treatment;

р1–3, р2–4– between indicators in the I and II groups before and after treatment;

р1–5, р2–5, р3–5, р4–5 – between indicators of sick children before and after treatment and control group data.