International Journal of Scientific Pediatrics
DISMICROELEMENTOSIS IN CHILDREN WITH BRONCHIAL
ASTHMA AND THEIR DIAGNOSTIC SIGNIFICANCE
Karimova N.I.
, Shamsiev F.M.,
2
Abdullaev S.K.
3
1. Republican Specialized Scientific and Practical Medical Center of Pediatrics, PhD,
doctoral student of the department of pulmonology, Tashkent, Uzbekistan.
2. Republican Specialized Scientific and Practical Medical Center of Pediatrics, Doctor
of Medical Sciences, Professor, Head of the Department of Pulmonology, Tashkent,
Uzbekistan.
3. Tashkent Medical Academy, basic doctoral student of the Department of Children’s
Diseases №1, Tashkent, Uzbekistan.
Academic Editor:
Arzikulov A.
Professor, Andijan State Medical
Institute
Received:
10
September
2022
Accepted:
23
September
2022
Published:
30
September
2022
Publisher’s Note:
IJSP stays
neutral with regard to jurisdictional
claims in published maps and
institutional affiliations.
Copyright:
© 2022 by the
authors. Licensee IJSP, Andijan,
Uzbekistan. This article is an open
access article distributed under
the terms and conditions of the
Creative Commons Attribution
(CC BY-NC-ND) license (https://
creativecommons.org/licenses/by-
Annotation:
The aim of the study was to study the possible pathogenetic
mechanisms of the formation of bronchial hyperreactivity in bronchial asthma associated
with microelementoses. The study group consisted of 45 children with bronchial asthma.
The research methods were the method of neutron activation analysis of the content of
trace elements in hair and the method of atomic absorption spectrometry of blood serum.
The state of bronchial hyperreactivity was accompanied by a deficiency of essential
microelements (69.6%) in severe bronchial asthma, against the background of selenium
and zinc deficiency (plasma levels below 0.2 and 0.35 mg/l, respectively), and a decrease
in the speed parameters of the function of external respiration.
Introduction.
Airway reactivity is the most important characteristic
of the functional state of the bronchopulmonary apparatus. Bronchial
hyperreactivity syndrome (BRS) occurs not only in bronchial asthma (BA)
[1, 2], but also in other bronchopulmonary diseases: chronic and recurrent
obstructive pulmonary diseases, hay fever [1], allergic rhinitis, atopic
dermatitis [3]. Violation of metal-ligand homeostasis can indirectly affect
the reactivity of the bronchial tree. In the pathogenesis of the development
of bronchial asthma, the leading role belongs to calcium and magnesium
ions, which are directly involved in the contraction of the bronchi; such
microelements (MEs) as selenium, zinc, and copper affect the processes
of lipid peroxidation and the formation of an allergic inflammatory process
of the tracheobronchial tree, which is the morphological basis for the
development of hyperreactivity [4–9]. Under experimental and clinical
conditions, an important role of ME in the regulation of bronchial patency,
contractility of the respiratory muscles, sensitization processes, and the
intensity of the pathochemical and pathophysiological phases of allergic
reactions has been established [10–12].
Purpose of the study:
to study the possible pathogenetic mechanisms
of the formation of hyperreactivity of the bronchial tree in bronchial asthma
associated with microelement disorders in children.
Methods.
The study group included 45 children with BA with
persistent changes in bronchial tone. The average age of children was
9,1±0,6 years. The control group consisted of 30 children with no history
of atopic, chronic bronchopulmonary diseases and who had the last acute
respiratory disease for more than 1 month before the study.
When diagnosing BA, the classification adopted by the National
Program “Bronchial Asthma in Children. Treatment strategy and prevention”,
in Russia in 2006, which was supplemented in 2020 by the GINA program.
The basis for the diagnosis were: complaints, anamnesis data, results
of general clinical, immunological and functional research methods.
The trace element status of children was determined at the Institute of
Key words:
bronchial hyperreactivity, microelementoses, bronchial asthma.
Article
OPEN ACCESS
21
IJSP
published: 30 September 2022
doi.org/10.56121/2181-2926-2022-5-21-24
2022 / Issue 05 / Article 04
International Journal of Scientific Pediatrics
22
Nuclear Physics of the Academy of Sciences of the Republic of Uzbekistan
by studying the content of trace elements in hair by neutron activation
analysis and in blood serum by atomic absorption spectrometry. Mild BA
was registered in 15 (40,7%) cases, moderate BA - in 22 (48,2%) cases,
severe BA - in 8 (11,1%) cases. During the allergological examination, food
sensitization prevailed in 36 (82,6%) patients, household sensitization was
in second place in 25 (72,4%) patients, and pollen sensitization was in third
place in 28 (56,5%) patients. Determination of the ME content was carried
out by atomic absorption spectrometry (tested substrate - blood serum)
and by neutron activation analysis (tested substrate - hair). Mathematical
calculations were performed using the Microsoft Excel statistical analysis
package. When working with the database, the arithmetic mean values
and standard errors of the arithmetic means (M±m) were determined. The
significance of differences in the arithmetic means of ranked tests with
a normal distribution was assessed using Student’s t-tests. Results were
considered significant at a significance level of p<0,05.
Results and discussion.
Hypomicroelementoses were found in all
children. In general, there was a deficiency of calcium, selenium, iodine,
manganese, zinc (65 (94,2%), 57 (82,6%), 55 (79,7%), 52 (75,3%), 42
(60,9%) respectively). Deficiencies of molybdenum (24 (34,8%)), chromium
(21 (30,4%)), copper (18 (26,1%)), nickel (17 (24,6%)), iron (15 (21,7%)).
Deficiency of more than four MEs was noted in 33 (47,8%) cases, four
- in 21 (30,4%), three - in 15 (21,7%) cases, none of the children was
diagnosed deficiency of one or two MEs. Hypermicroelementoses were
observed in the majority of patients with HRD (n=66; 95,7%), more often
an increased content of several MEs was recorded: five to seven (n =
27; 40,9%), four (n=15; 21,7%), three (n=13; 18,2%), two (n=13; 18,2%).
The predominant variants were intoxication with bromine (n=48; 69,6%)
and lead (n=36; 52,2%), rubidium hypermicroelementosis (n=22; 31,9%),
zirconium (n=19; 27,5%), arsenic (n=15; 21,7%), nickel (n=14; 20,3%).
Taking into account the high frequency of microelement disorders in HRD,
we analyzed the sensitivity parameters of the bronchial tree depending on
the concentration of essential and toxic MEs. The severity of microelement
disorders differed among «hyper-reactor» children with high sensitivity
of the bronchi to histamine and methacholine and various gradations of
sensitivity (Table 1.).
When studying the correlation interactions of essential and toxic ME
contained in the hair tissue, it was found that in the control group, where the
indicators of both essential and toxic ME did not differ from the values of
the «external standard», a moderate negative correlation dependence was
determined between zinc and selenium (r =-0,41), indicating the strength
of compensatory reactions. A moderate inverse correlation was observed
between zinc and lead (r=-0,51), confirming the competing relationship
between these MEs, and a direct In the group of patients with bronchial
tree hyperreactivity syndrome, a direct correlation between selenium and
zinc (r=0,34) remained, indicating a violation of compensatory reactions;
between zinc and lead, a negative correlation relationship remained (r =
-0,57), and between selenium and lead, the relationship acquired a direct
direction (r = 0,42). Such relationships may reflect a weakening of the
controlling role of selenium in protection against toxic MEs.
published: 30 September 2022
2022 / Issue 05 / Article 04
International Journal of Scientific Pediatrics
23
Table-1.
Concentrations of macro- and microelements in the hair tissue of the examined children
(µg/g)
published: 30 September 2022
2022 / Issue 05 / Article 04
Element
Control group,
n = 85
High
sensitivity of
the bronchi,
n = 42
Various
gradations of
the degree of
sensitivity of
the bronchi, n
= 27
Average group
values,
n = 69
«External
standard»
National
Institute for
Environmental
Studies, Japan,
1996
Ca
651,33 ± 277,8
380,94 ± 140,9 460,81 ± 160,4 457,32 ± 138,48
280–900
Fe
164,53 ± 48,51
160,22 ± 68,1 168,36 ± 50,27 165,12 ± 58,20
24–54
Zn
188,67 ± 26,48
96,82 ± 25,81* 180,94 ± 41,32 163,33 ± 40,28
110–170
Cr
1,2 ± 0,15
2,42 ± 0,18
2,58 ± 0,25
2,45 ± 0,16
0,7–1,9
Cu
13,33 ± 4,20
10,0 ± 2,41*
13,8 ± 3,42
13,52 ± 1,95
6,1–12,2
Mn
3,82 ± 0,46
2,65 ± 0,38
2,802 ± 0,66
2,82 ± 0,89
0,6–2,4
Pb
3,56 ± 1,19
4,2 ± 0,84*
1,89 ± 0,89
2,59 ± 1,01
0–2,1
Se
0,68 ± 0,12
0,26 ± 0,12*
0,48 ± 0,14
0,42 ± 0,14#
0,4–1,2
Sr
1,96 ± 0,27
1,50 ± 0,68
1,44 ± 0,55
1,48 ± 0,72
0,7–1,9
Br
34,83 ± 18,63
50,14 ± 21,20
56,28 ± 18,91
52,78 ± 20,61
2–6,4
Rb
0,21 ± 0,04
0,57 ± 0,21
0,59 ± 0,18
0,58 ± 0,17
0,03–0,1
Note: * — at p < 0.05 (significance of differences in ME concentrations
among patients with high bronchial sensitivity and different gradations of
sensitivity); ## — at p < 0.05 (significance of differences in ME concentrations
among patients with high bronchial sensitivity and the control group)
Thus, a close relationship was found between the studied MEs,
the features of which manifest themselves depending on the ratio of
essential and toxic MEs. In parallel, the content of zinc and selenium
in the blood serum was determined. The choice of these MEs was
due, firstly, to the high frequency of their deficiency in the hair tissue of
children with HRD, and secondly, to their participation in the processes
of lipid peroxidation and the maintenance of a chronic inflammatory
process and, as a result, hyperreactivity of the respiratory tract. Among
the «hyper-reactor» children, the average content of selenium in the
blood serum was 0,228±0,024 mg/l, zinc – 0,561±0,049 mg/l, in the
control group – 0,889±0,11 and 0,888±0,13 mg/l, respectively, p<0,05.
It has been established that the course of BA is the more
unfavorable, the lower the concentration of selenium and zinc in
the blood serum. Thus, in patients with a selenium concentration
of 0,04-0,2 mg/l and zinc – 0,08-0,35 mg/l, the severity of objective
and subjective disorders had significantly significant differences from
similar indicators in children with a selenium concentration of 0,21
–0,75 mg/l and zinc 0,36–0,62 mg/l, р<0,01.
The frequency of BA exacerbations per year and severe forms
of the disease were significantly more common in patients with low
levels of selenium, p<0.01. Correlation analysis of the SCORAD index
with the content of selenium and zinc revealed an average negative
correlation of indicators (r=-0,48 and r=-0,42, respectively, p<0,05),
the most severe course, with complications, was noted in the group
of children with low zinc values (r=0,54). In addition to the correlation
International Journal of Scientific Pediatrics
24
published: 30 September 2022
2022 / Issue 05 / Article 04
ratios of indicators characterizing the severity of dermatitis and
selenium content in the blood, a moderate negative dependence of
the frequency of exacerbation of BA and the content of selenium in
serum (r = -0,50) was established.
Conclusion. The state of hyperreactivity of the bronchial
tree in children with combined forms of allergy is accompanied
by polymicroelement disorders (deficiency of essential MEs was
detected in 69,6%), which are especially pronounced with high
sensitivity of the bronchi, against the background of selenium and zinc
deficiency (plasma levels below 0,2 and 0,35 mg/l, respectively) and is
characterized by a decrease in the speed parameters of the function
of external respiration.
REFERENCES
1. Chernyak B.A., Vorzheva I.I., Sukmanskaya E.O. Asthma. -
2020. - Vol. 1 (31). — pp. 69–77.
2. Koh Y. Y. Bronchial hyperresponsiveness in adolescents
with long-term asthma remission: importance of a Family history of
bronchial hyperresponsiveness / Y. Y. Koh, E. K. Kang, H. Kang //
Chest. - 2015. - Vol. 124, No. 3. - P. 819-825.
3. Molokova A. V. Clinical and pathogenetic aspects of
hyperreactivity of the bronchial tree in children with atopic dermatitis in
combination with bronchial asthma: author. dis. ... Dr. med. Sciences /
A. V. Molokova. - Novosibirsk, 2014. - 36 p.
5. Pavlenko N. S. Clinical, immunological and metabolic features
of atopic dermatitis in children with selenium and zinc deficiency:
author. dis. ... cand. honey. Sciences / N. S. Pavlenko. - Novosibirsk,
2021. - 21 p.
6. Mineral homeostasis and respiratory disorders in children with
bronchial asthma / T. G. Reshetova [et al.] // Pulmonology of childhood:
problems and solutions, no. 2. - Moscow-Ivanovo, 2020. - P. 140–142.
7. Barbarino F. Zinc and T-lymphocyte subsets in patients with
pulmonary diseases / F. Barbarino, E. Toganel, A. Cocarla // Trace
Elements in Man and Animals - TEMA - 8 / Eds. M. Anke, D. Meissner,
C. F. Mils. - Dresden, 1993. - P. 890-891.
8. Beasley R. Selenium, glutathione peroxidase and asthma / R.
Beasley // Clin. Exp. Allergy. - 1991. - P. 157-159
9. Richter M. Zinc status modulates bronchopulmonary eosinophil
infiltration in a murine model of allergic inflammation / M. Richter, R.
Bonneau, M. A. Girard // Chest. - 2018. - Vol. 123 (3 Suppl). — P. 446.
10. Vural H. Concentrations of copper, zinc and various elements
in serum of patients with bronchial asthma / H. Vural, K. Uzun, E. Uz //
J. Trace Elem. Med. Biol. - 2020. - Vol. 14(2). — P. 88–91.
11. Immunopharmacology of trace elements / A. V. Kudrin [et al.].
- M. : KMK Publishing House, 2020. - 537 p.
12. Rustembekova S. A. Microelementoses and environmental
risk factors / S. A. Rustembekova, T. A. Baraboshkina. — M.: Logos,
2016. — 196 p.
13. Boulet L. P. Physiopathology of airway hyperresponsiveness
/ L. P. Boulet // Curr. Allergy Asthma Rep. - 2013. - Vol. 3, No. 2. — P.
166–171.
14. Standardization of tests for the study of pulmonary function /
A. G. Chuchalin [et al.]. — M.: Pulmonology, 1993. — S. 60–86.
