42Natalia Kruszewska, Jan Styczynskiachieved when vaccination took place before cancerdiagnosis [5].Another important issue is the decreased rate ofHCV-infected patients. The use of serological methodsfor the diagnosis of HCV infection is not optimal,because of a risk of delayed seroconversion due toimmunosuppression. However, the same method wasused in both analyzed groups. Despite the lack of specificHCV prophylaxis, it was significantly reduced,comparably to the rate of HBV infections. This observationhighlights the importance of non-specific methodsin preventing HCV transmission. The non-specificprophylaxis can play an important role in reducingfrequency of HBV infections, in addition to vaccinations.In previous decade, HBV <strong>and</strong> HCV infectionsamong children with malignancy in Pol<strong>and</strong> were consideredto occur mainly during or following the treatmentof neoplastic disease [6]. Contrary to this observation,all HBV infections in the last analyzed periodwere present at the beginning of treatment among theexamined patients. No new HBV infections have beennoted during therapy over the last 4 years.World Health Organization (WHO) recommendsroutine vaccination of all infants against HBV infectionas an integral part of national immunization schedulesworldwide [7]. The main purpose of this strategy is toprotect the population from chronic HBV infections,which might be followed by liver cirrhosis <strong>and</strong> hepatocellularcancer. At the same time the m<strong>and</strong>atory vaccinationshelp to prevent hepatitis B in high risk groups,such as children with malignancy.CONCLUSIONS1. Introduction of routine vaccination against HBVhelped to control HBV infections among childrenwith malignancy.2. Coinciding reduction of HCV infections shows theimportance of non-specific prophylaxis.3. Currently, the risk of HBV <strong>and</strong> HCV infectionsduring anticancer treatment in children does not exceedgeneral population risk.REFERENCES1. Styczyński J., Wysocki M., Kołtan S. et al.: Epidemiologicaspects <strong>and</strong> preventive strategy of hepatitis B <strong>and</strong>C viral infections in children with cancer. Pediatr. Infect.Dis. J. 2001, 20, 1042-1049.2. Gorczyńska E., Bogusławska-Jaworska J.: Efficacy ofspecific passive immunization in limiting endemic wardhepatits B virus (HBV) infections. Post. Med. Klin.Dośw. 1992, 1, supl., 17-24.3. Madaliński K., Gregorek H., Zembrzuska-Sadkowska E.et al.: Immunogenicity of Engerix B vaccine in 786 childrenwith risk of hepatitis B infections. Hepatol. Pol.1998, 5, supl.1, 93-98.4. Woźniakowska-Gęsicka T.: Przewlekle WZW – aspektyepidemiologiczne i kliniczne. Fam. Med. Prim. Care Rev.2007, 4, 1021-1025.5. Baytan B., Gunes A.M., Gunay U.: Efficacy of primaryhepatitis B immunization in children with acute lymphoblasticleukemia. Ind. Pediatr. 2008, 45, 265-270.6. Januszkiewicz D., Wysocki J., Nowak J.: Hepatitis B <strong>and</strong>C virus infections in Polish children with malignancies.Eur. J. Pediatr. 1997, 156, 454-456.7. WHO: Weekly epidemiological record. 2004, 79, 253-264.Address for correspondence:Jan Styczyński, MD, PhD,Chair <strong>and</strong> Clinic of Pediatric Hematology<strong>and</strong> OncologyNicolaus Copernicus University<strong>Collegium</strong> <strong>Medicum</strong> in Bydgoszczul. Curie-Sklodowskiej 985-094 BydgoszczPol<strong>and</strong>e-mail: jstyczynski@cm.umk.pltel: +48 52 585 4860fax: +48 52 585 4867Received: 9.10.2008Accepted for publication: 20.12.2008
Medical <strong>and</strong> Biological Sciences, 2008, 22/4, 43-47ORIGINAL ARTICLE / PRACA ORYGINALNAHanna Styczyńska 1 , Grażyna Odrowąż-Sypniewska 2 , Kinga Lis 2 , Izabela Sobańska 2 , Agnieszka Pater 2 , JoannaPollak 2 , Aneta Mańkowska 2BONE TURNOVER DURING PREGNANCYWSKAŹNIKI PRZEBUDOWY KOŚCI PODCZAS CIĄŻY1 Outpatient Rehabilitation Department, Biziel Hospital, Bydgoszcz2 Department of Laboratory Medicine, Nicolaus Copernicus University, <strong>Collegium</strong> <strong>Medicum</strong> in BydgoszczHead: Grażyna Odrowąż-Sypniewska PhD, MD, professor of clinical chemistrySummaryThe mechanisms involved in bone turnover during pregnancyremain partly unknown. Increase of osteoprotegerinwith elevated bone turnover is supposed to be a homeostaticmechanism limiting bone loss. The aim of the study was toassess if OPG may be involved in the regulation of boneturnover during pregnancy. Osteocalcin (OC), beta-crosslaps(CTx), osteoprotegerin (OPG), vitamin 25 OH D 3 , parathormone(PTH), <strong>and</strong> calcium (Ca) were determined in 30healthy women at 1 st <strong>and</strong> at 3 rd trimester of pregnancy <strong>and</strong>27 healthy age-matched non pregnant women.During pregnancy a significant increase in serum OPG<strong>and</strong> CTx concentrations with concomitant decrease of calciumlevel was observed. OPG correlated positively with OC<strong>and</strong> Ca only at 1 st trimester. Serum OPG <strong>and</strong> to a lesser extentCTx already during 1 st trimester seemed to indicateelevated bone turnover whereas osteocalcin level remainedwithin the reference range during pregnancy.In pregnancy bone turnover increases mainly due to enhancedbone resorption. The determination of osteocalcin atthe beginning of pregnancy seems to be of limited clinicaluse. Instead, measuring CTx <strong>and</strong>/or osteoprotegerin mayhave a good predictive value for later pregnancy-associatedbone loss.StreszczenieMechanizmy zaangażowane w proces przebudowy kościu kobiet w ciąży nie są dokładnie poznane. Wzrost stężeniaosteoprotegeryny towarzyszący nasileniu przebudowy tkankikostnej jest prawdopodobnie elementem mechanizmu homeostazyograniczającym utratę masy kostnej. Celem pracy byłaocena związku między osteoprotegeryną a procesem przebudowytkanki kostnej w przebiegu prawidłowej ciąży. Oznaczonostężenie osteokalcyny (OC), beta-crosslaps (CTx),osteoprotegeryny (OPG), witaminy 25 OH D 3 , parathormonu(PTH) i wapnia (Ca) u 30 zdrowych kobiet w pierwszymi trzecim trymestrze ciąży oraz u 27 zdrowych kobiet niebędącychaktualnie w ciąży, dobranych pod względem wieku.W przebiegu ciąży zaobserwowano istotny wzrost stężeniaw surowicy OPG i CTx oraz obniżenie stężenia wapnia.OPG korelowała dodatnio z OC i Ca tylko w pierwszymtrymestrze ciąży. Stężenie OPG i w mniejszym stopniu CTxjuż w trakcie pierwszego trymestru mogło wskazywać nanasilenie przebudowy kości, podczas gdy stężenie osteokalcynypozostawało w zakresie wartości referencyjnych przezcały czas trwania ciąży.W ciąży obserwuje się nasilenie procesu przebudowy kości,przede wszystkim jednak zwiększenie resorpcji. Wydajesię, że oznaczanie na początku ciąży stężenia osteokalcynywskaźnikatworzenia kości ma ograniczone zastosowanie,natomiast wczesne oznaczanie CTx i/lub osteoprotegeryny,odzwierciedlających resorpcję, może mieć znaczną wartośćpredykcyjną dla oceny utraty masy kostnej w późniejszymokresie ciąży.Key words: osteoprotegerin, bone turnover, pregnancySłowa kluczowe: osteoprotegeryna, wskaźniki przebudowy kości, ciąża
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