Çocuk Yoğun Bakım Hastalarında Hiponatreminin Klinik Önemi

Yıl 2018, Cilt: 3 Sayı: 4, 206 - 214, 29.12.2018

Fatih Aygün , Seda Aras Fatih Varol Ahmet İrdem

https://doi.org/10.26453/otjhs.434105

Öz

Hiponatremi çocuk acil ve yoğun bakım
ünitelerinde sık görülen bir elektrolit bozukluğudur. Yetişkin hastalarda
hiponatreminin mortalite için bağımsız bir risk faktörü olduğu gösterilmesine
karşın özellikle çocuk yoğun bakım (ÇYB) hastalarında hiponatreminin klinik
önemi ve prognoza etkisi yeterince irdelenmemiştir. Bu çalışmada çocuk yoğun
bakım ünitesi’nde (ÇYBÜ) yatırılan hastalarda ilk gün hiponatremi sıklığı ve
erken dönem prognoz ile olan ilişkisinin araştırılması planlanmıştır. Ekim 2016
ile Mart 2018 tarihleri arasında yatırılan tüm hastaların verileri geriye dönük
olarak incelenmiştir. Çalışmaya alınan 435 hastanın 22’sinde orta ve ağır
düzeyde hiponatremi saptandı. Hastaların 12’si (%54,5) erkek, 10’u (%45,5)
kızdı. Yaş dağılımları 1,5 ay ile 17 yaş arasında olup ortalama hasta yaşı 3,67±2,00
yıldı. Hiponatremi saptanan hastaların ortalama yatış süresi 14,91±22,17 gündü.
Serum sodyum (Na) düzeyinin düşüklüğü (Na<130 mmol/L) ile mekanik
ventilatöre bağlanma, inotrop ilaç kullanımı, ÇYBÜ yatış süresi, çocuk
mortalite  (PRISM ) skoru, kan ürünü
kullanımı, ölüm, akut böbrek hasarı ve kalp yetmezliği arasında istatistiksel
anlamlı ilişki saptandı. Çocuk hastalarda ilk başvuru sırasında Na<130mml/L
olması mortalite ve morbidite ile ilişkili önemli bir prognostik belirteç
olarak değerlendirilmelidir.

Anahtar Kelimeler

Çocuk yoğun bakım, prognoz, hiponatremi, mortalite

The Clinical Importance of Hyponatremia in Pediatric Intensive Care Unit

Öz

Circulating tumor cells (CTCs) play a
crucial role in the metastatic spread of carcinoma. Therefore, CTC has been
interest of a subject in the past few decades in terms of prognosis and
response to the therapy in several cancer diseases. Recent improvements in
technical approaches maintain to identify CTCs from whole
blood have demonstrated the potential value of CTC detection as a liquid biopsy
especially in those tumors where tissue accessibility is often challenging as
in lung cancer. Lung cancer is the most common cause of death from cancer
worldwide in both men and women which is commonly metastasize before it is
diagnosed. The aim of this study is to enumerate of CTCs in peripheral blood
sample (7.5 mL) of lung cancer patients by flow cytometry.  Our modified method which consists of
enrichment and detection steps get involved in 9 patients with lung cancer and
9 healthy volunteers. We performed a density-based ficoll gradient
centrifugation and a immunomagnetic separation technique (CD45 negative selection)
for the enrichment step.  Next,
multi-parameter flow cytometry based on the expression of anti-epithelial cell
adhesion molecule and cytokeratins was used to detect circulating tumor cells
among enriched cells. According to our results, 
circulating tumor cells were not detected on healthy volunteers but
circulating tumor cells were found in all of patients with lung cancer
(Z=3.823; p<0.001). We demonstrate that circulating tumor cells were
detectable in peripheral blood sample of lung cancer patients by our modified
method.

Anahtar Kelimeler

pediatric intensive care unit, prognosis, hyponatremia, mortality

Kaynakça

• The Globocan Project. Cancer Fact Sheets: Population Fact Sheets. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. Accesed June 06, 2016.
• Turkey Cancer Statistics. http://kanser.gov.tr/Dosya/ca_istatistik/ANA_rapor_2013v01_2.pdf. Accesed June 06, 2016. Truini A, Alama A, Dal Bello MG, et al. Clinical applications of circulating tumor cells in lung cancer patients by cellsearch system. Front Oncol. 2014; 4: 242.
• The Globocan Project. Lung Cancer Estimated Incidence, Mortality and Prevalence Worldwide. http://globocan.iarc.fr/old/FactSheets/cancers/lung-new.asp. Accesed June 24, 2016.
• Spiro SG, Porter JC. Lung cancer-where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med. 2002; 166(9): 1166-1196.
• Wong BS, Hsiao YC, Lin TW, et al. The in vitro and in vivo apoptotic effects of Mahonia oiwakensis on human lung cancer cells. Chem Biol Interact. 2009; 180(2): 165-174.
• Beckles MA, Spiro SG, Colice GL, et al. Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes. Chest. 2003; 123: 97-104.
• Chambers AF. The metastatic process: basic research and clinical implications. Oncol Res. 1999; 11(4): 161-168.
• Gao W, Yuan H, Jing F, et al. Analysis of circulating tumor cells from lung cancer patients with multiple biomarkers using high-performance size-based microfluidic chip. Oncotarget. 2017; 8(8): 12917-12928.
• Rolfo C, Castiglia M, Hong D, et al. Liquid biopsies in lung cancer: the new ambrosia of researchers. Biochim Biophys Acta. 2014; 1846(2): 539-546.
• Zhang Z, Ramnath N, Nagrath S. Current status of CTCs as liquid biopsy in lung cancer and future directions. Front Oncol. 2015; 5: 209.
• Hong B, Zu Y. Detecting circulating tumor cells: current challenges and new trends. Theranostics. 2013; 3(6): 377-394.
• Lowes LE, Allan AL. Recent advances in the molecular characterization of circulating tumor cells. Cancers (Basel). 2014; 6(1): 595-624.
• Simsek E, Guler OO, Carhan A, et al. The determination of circulating tumor cells in peripheral blood by flow cytometry. Niche. 2014; 3. doi: 10.5152/niche.2015.246.
• Wang L, Wu C, Qiao L, et al. Clinical Significance of Folate Receptor-positive Circulating Tumor Cells Detected by Ligand-targeted Polymerase Chain Reaction in Lung Cancer. J Cancer. 2017; 8(1): 104-110.
• Joosse SA, Gorges TM, Pantel K. Biology, detection, and clinical implications of circulating tumor cells. EMBO Mol Med. 2015; 7(1): 1-11.
• Welinder C, Jansson B, Lindell G, et al. Cytokeratin 20 improves the detection of circulating tumor cells in patients with colorectal cancer. Cancer Lett. 2015; 358(1): 43-46.
• Bevilacqua S, Gallo M, Franco R, et al. A “live” biopsy in a small-cell lung cancer patient by detection of circulating tumor cells. Lung Cancer. 2009; 65(1): 123-125.
• Tanaka F, Yoneda K, Kondo N, et al. Circulating tumor cell as a diagnostic marker in primary lung cancer. Clin Cancer Res. 2009; 15(22): 6980-6986.
• Krebs MG, Sloane R, Priest L, et al. Evaluation and prognostic significance of circulating tumor cells in patients with non–small-cell lung cancer. J Clin Oncol. 2011; 29(12): 1556-1563.
• Krebs MG, Hou JM, Sloane R, et al. Analysis of circulating tumor cells in patients with non-small cell lung cancer using epithelial marker-dependent and-independent approaches. J Thorac Oncol. 2012; 7(2): 306-315.
• Alunni-Fabbroni M, Sandri MT. Circulating tumour cells in clinical practice: Methods of detection and possible characterization. Methods. 2010; 50(4): 289-297.
• Allard WJ, Matera J, Miller MC, et al. Tumor cells circulate in the peripheral blood of all major carcinomas but not in healthy subjects or patients with nonmalignant diseases. Clin Cancer Res. 2004; 10(20): 6897-6904.
• Bøyum A, Løvhaug D, Tresland L, et al. Separation of leucocytes: improved cell purity by fine adjustments of gradient medium density and osmolality. Scand J Immunol. 1991; 34(6): 697-712.
• Liu Z, Fusi A, Klopocki E, et al. Negative enrichment by immunomagnetic nanobeads for unbiased characterization of circulating tumor cells from peripheral blood of cancer patients. J Transl Med. 2011; 9: 70.
• Went P, Vasei M, Bubendorf L, et al. Frequent high-level expression of the immunotherapeutic target Ep-CAM in colon, stomach, prostate and lung cancers. Br J Cancer. 2006; 94(1): 128-135.
• Domanski D, Perzanowska A, Kistowski M, et al. A multiplexed cytokeratin analysis using targeted mass spectrometry reveals specific profiles in cancer-related pleural effusions. Neoplasia. 2016; 18(7): 399-412.
• Huang HB, Ge MJ. The effects of different surgical approaches on the perioperative level of circulating tumor cells in patients with non-small cell lung cancer. Thorac Cardiovasc Surg. 2016; 64(6): 515-519.
• Ren C, Han C, Wang D, et al. Detection of circulating tumor cells: Clinical relevance of a novel metastatic tumor marker. Exp Ther Med. 2011; 2(3): 385-391.