4. DISCUSSION
Free radicals stemming mainly from post-traumatic processes leads to
damage in lipids, proteins in the cell membrane and DNA resulting in
infections, multiple organ failure, acute failure of respiratory, renal
and cerebral systems [30, 31]. Therefore, it is extremely important
to know the levels of thiol to reduce free oxygen radicals, prevent
harmful effects, and perform appropriate interventions to the patient
after trauma. Oxidative stress is an indication of tissue damage from
increased reactive oxygen species. Thiol inhibits cellular and tissue
damage by inhibiting the effects of reactive oxygen species by lipid
metabolism of the cell membrane.
It is known that oxidative stress increases after physical injuries in
trauma patients. Although many studies have shown that reactive oxygen
species in trauma increase and antioxidant levels to be decreased [30,
32, 33], there are two studies in the literature showing the
relationship between trauma and dynamic thiol-disulfide balance [34,
35]. With this study, the relationship between trauma and
thiol-disulfide and IMA levels in children was also shown.
In our study, total thiol, native thiol, disulfide/total thiol ratio
were found to be significantly decreased significantly, as consistent
with the literature and dynamic disulfide as increased in the trauma
group compared to the control. IMA and albumin levels were also
significantly decreased. In trauma group, however, there was not
significant difference between surgery and follow-up sub-groups, or
multiple and isolated trauma sub-groups, or type of trauma and systems
affected or organs. These laboratory findings indicate that trauma
results in a shift towards the oxidant side in favor of oxidative stress
in children. However, there was no difference in trauma type, or whether
there were surgery or not, multiple or isolated, systems or organs
effected, and thiol/disulfide balance and IMA levels.
These results point out that thiol/disulfide balance and IMA levels
cannot be used as an adjunctive marker in imaging and determining the
affected system and organ from trauma during the follow-up period and
deciding the surgical intervention. There was also not found statistical
difference in total thiol, native thiol, dynamic disulfide, dynamic
disulfide / total thiol rate, albümin or IMA levels between 2nd and 5th
days of hospitalization of children with trauma. The development of a
test that can help to determine the system and organ affected by the
trauma more quickly and easily and can help in the decision of surgical
intervention will help both early diagnosis and early surgical
intervention.