Type I Diabetes Mellitus (DM) is among the most common endocrinological diseases for adolescents. The purpose was to study the level of autoantibodies (AAT) to NMDA receptors and Type 2 dopamine receptors (DAR2) in children with varying severity of Type I Diabetes. We examined 38 children and adolescents aged 2 to 17 years. In order to determine the levels of AAT to NMDA receptors and dopamine receptors (DR2) in blood serum, we applied the enzyme-linked immunosorbent assay (ELISA). We found higher levels of AAT to NMDA receptors and dopamine receptors (DAR2) in children with chronic Type I Diabetes against the background of diabetic ketoacidosis (DKA), as compared to children with the diabetes onset or compensation of the disease. The increased levels of AAT to NMDA and dopamine receptors (DAR2) were found in children and adolescents against the background of a long history of the disease and frequent hospitalization to the intensive care unit.
Background. Type 1 diabetes mellitus (DM) is one of the most prevalent chronic diseases in children. Oxidative stress (OS) plays an important role in the development of diabetes and its complications. Aim of the study. To analyze markers of OS in children with newly diagnosed and chronic course of type 1 DM. Materials and methods. The study included 73 children aged 3 to 17 years. The study group consisted of 49 patients with type 1 DM, the control group included 24 children (apparently healthy children). The study group was split into 2 subgroups depending on the duration of the disease: 1 subgroup – children with newly diagnosed type 1 DM, 2 subgroup – children with a chronic course of DM. All children had their blood sampled to assess the following OS markers: 8-Oxo-2'-deoxyguanosine (8-OHdG; Pg/ml); 8-isoprostane (8 IS; Pg/ml); malondialdehyde (MDA; Ng/ml); advanced oxidation protein products (AOPPx10; Ng/ml). Statistical processing of data involved the use of the Mann–Whitney U test and the Kruskal–Wallis test. Results. Significant differences in the average values of OS markers between patients with type 1 DM and control group were revealed. The average levels of 8 IS – 89.53 [81.96-106.4] Pg/ml were significantly higher in the study group, compared with the control – 78.21500 [65.235-88.135] Pg/ml (p=0.0006), as were the average levels of 8-OHdG – 480.3 [413.8000-560.3000] Pg/ml in the study group; 417,9000 [361,7500-460.7] Pg/ml – in the control group (p=0.01). The maximum values were found in the levels of 8 IS and 8-OHdG, in the group of children with chronic type 1 diabetes: 510.1 [440.9-594.4] Pg/ml (p =0.0053) for 8-OHdG and 95.59 [86.32-197.5] Pg/ml (p=0.0001) for 8 IS. The average levels of MDA and AOPP did not show significant differences between the study and the control groups. Conclusion. Patients with type 1 DM have distinct manifestations of OS. These manifestations are most pronounced in the group of patients with chronic type 1 DM.
Diabetic ketoacidosis is a frequent complication of type 1 diabetes mellitus in children and adolescents. One of the leading causes of death in this pathology is cerebral edema. This complication is often asymptomatic, which makes it difficult to diagnose. The main risk factors for cerebral edema in children include the true factors (low partial pressure of carbon dioxide, high blood urea nitrogen, concomitant psychiatric pathology, etc.) and iatrogenic factors (large volume of infusion therapy, rapid decrease in blood glucose levels, administration of bicarbonate, etc.). The pathophysiology of this complication is not yet fully understood. The main pathophysiological elements of cerebral edema in children with DKA include the disruption of blood-brain barrier permeability, edema of brain cells, and dysfunction of cell membranes. Important roles are also played by hypercapnia and reduction of osmotic pressure. Based on the character of pathophysiologic changes, cerebral edema in children and adolescents with DKA is subdivided into vasogenic and cytotoxic. Gaining a better understanding of the pathophysiological mechanisms of this complication will increase the quality of care provided in pediatric practice.
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