Examination of the activities of serum malondialdehyde acid, superoxide dismutase, catalase, reduced glutation and glutation peroxidase in acute romatic fevered patients

Aims: This study includes investigating the role of oxidative stress (OS) in patients with acute rheumatic fever (ARF), the level of antioxidants, and its relationship to progression of the disease. Malondialdehyde activity, which is the oxidative stress parameter during the acute attack of patients newly diagnosed with acute rheumatic fever, and such antioxidant parameters superoxide dismutase, reduced glutathione and glutathione peroxidase levels were investigated. In our study, demographic characteristics, echocardiographic findings, and clinical & laboratory findings of pediatric patients diagnosed with acute rheumatic fever were investigated prospectively. Methods: This study is a prospective study. A total of 68 patients between the ages of 5-17, who were diagnosed with acute rheumatic fever after they had applied to the Pediatric Cardiology Outpatient Clinic and General Pediatric Outpatient Clinic of Yüzüncü Yıl University Faculty of Medicine between August 2016 and November 2019, were included in this study. Blood was collected from patients at the time of diagnosis; and malondialdehyde, catalase, superoxide dismutase, reduced glutathione and glutathione peroxidase activities were studied. As the control group, children of the same age and gender who applied to the Pediatric Cardiology Outpatient Clinic simultaneously and who did not have any disease were selected. Biochemical parameters were determined with serum samples. Results: While the mean age of the patients was 12.2 ± 3.2, the mean age was 11.8 ± 3.5 in the control group and no significant difference were observed between the groups (p> 0.05). Carditis was found in 48 (70.6%) of 68 patients. Of these 48 patients, 4 (5.9%) had isolated carditis without joint findings. Arthritis and carditis were present in 44 (64.7%) patients. Of the patients with carditis, 23 (47.9%) were mild carditis, 10 (33.3%) were middle carditis, and 9 (18.7%) were severe carditis. Mitral valve involvement was mostly observed among 48 patients with carditis. Mitral regurgitation was detected in 45 (93.8%) patients. Aortic valve involvement that is secondly frequent was observed in 25 (52.1%) patients. The association of mitral and aortic valve involvement was determined in 21 (43.8%) patients. When the oxidant and antioxidant values of the groups are examined; MDA was significantly higher in the control group (p = 0.001) than in the patient group. As for GSHPx, CAT, SOD ve GSH, they were found to be significantly less in patients than the control group. (p<0.05). There was no significant difference between the group with only arthritis and the group with carditis + arthritis in terms of MDA, GSHPx, CAT, SOD and GSH activity (p> 0.05). Looking at the correlation between parameters; significant colleration was detected moderately between CAT and GSHPx (r=0.359, p=0.003), positively and in a low level between MDA and GSH (r=+0.247, p=0.042), moderate between GSHPx and CK (r=-0.325, p=0.049), moderately negative between SOD and uric acid (r = -352, p = 0.022). No significant correlation was detected between MDA and CRP, ASO and ESR (p>0.05). In our study, according to the results of ROC curve analysis, in separating the patient and control groups,the area under the curve for MDA was found to be 1.000 0.001. The cut- off value for MDA was detected as 4.7105 (sensitivity 100%, specificity 100%). In our study, it was claimed that the discriminative power of MDA in differentiating patients and control groups was quite high and accordingly, it could be used as a supportive "diagnostic test" in separating patients from the control group. Conclusion: We determined that oxidative stress increases and antioxidants decrease in acute rheumatic fever. We found significantly higher levels of MDA, an oxidative stress biomarker, in patients with AFR. We found significantly lower levels of antioxidant GSHPx, SOD, CAT and GSH. We have stated that the increase of pro-oxidant enzymes of patients with AFR can be considered as a symptom in the explanation of the pathophysiology of AFR. In our study, we found that MDA can be used as a supportive "Diagnostic Test" in the assessment of AFR, along with other diagnostic tools available as a biomarker, to differentiate AFR patients from the control group. We have stated that antioxidants can reduce oxidative stress by being added to the treatment, which may be beneficial in patients with acute rheumatic fever. Considering the results, we have also reached that more randomized controlled clinical trials are needed to assess the true effect of antioxidant therapy in patients with ARA at different stages. More comprehensive and multicenter studies are needed on oxidative stress and antioxidants in the room with AFR. Keywords: Acute rheumatic fever, oxidative stress, antioxidant, malondialdehyde, catalase, superoxide dismutase, reduced glutathione, glutathione peroxidase, echocardiography.