Çocukluk Çağı Toplum Kökenli Pnömonilerinde Toll-Like Reseptör 2 Ve Toll-Like Reseptör 4’ün Bir Biyobelirteç Olarak Tanıda Ve Prognozdaki Yerinin Belirlenmesi

Abstract

Necipoglu, O. The role of toll-like receptor 2 and toll-like receptor 4 in childhood community-acquired pneumonia. Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics, Ankara, 2022. Pneumonia is one of the most important causes of death in children and the inadequacy of tests that can provide rapid and accurate results that can still be used in diagnosis and determination of severity is one of the most important problems in the follow-up of pneumonia patients. Classical biomarkers such as serum procalcitonin and C-reactive protein have been used frequently in the differentiation of mild and severe pneumonia, and another of the evaluated markers is toll-like receptors (TLR). The investigation of the place of TLR-2 and TLR-4 in pneumonia has been limited with animal and adult human studies until now; therefore, the aim of this study is to determine the role of TLR-2, TLR-4, interleukin (IL)-1β, IL-4, IL-6, IL-10, interferon (IFN)-α, and tumor necrosis factor (TNF)-α as biomarkers in the diagnosis as well as prognosis in pediatric patients with community-acquired pneumonia (CAP). In this study, TLR-2, TLR-4, IL-1β, IL-4, IL-6, IL-10, IFN-α and TNF-α levels were evaluated in serum and saliva samples of 67 pediatric patients with CAP (43 inpatients and 24 outpatients) and 22 healthy pediatric control. In saliva samples taken at the time of diagnosis, threshold level of TLR-2 was 1.16 2^-(∆∆Ct) and of TLR-4 was 1.28 2^-(∆∆Ct) to differentiate patients with and without pneumonia. The sensitivity of salivary TLR-2 and TLR-4 tests were found to be 0.80 and 0.86, respectively. In serum samples, TLR-2, TLR-4, IL-1β, IL-4, IL-6, Il-10, IFN-α and TNF-α levels were significantly decreased in patients with Novel Coronavirus Disease (COVID-19) as compared with other viruses (p<0.05 in each). In the serum samples of patients with pneumonia due to COVID-19, IL-6 and IFN-α values were found to be significantly lower than the control group (p<0.05 in each). Salivary analyses of TLR-2 and TLR-4 seem beneficial in the diagnosis of pneumonia, particularly in childhood. Considering the difficulty of obtaining serum samples from pediatric patients requiring hospitalization, the importance of using a material such as saliva that can be recovered easily and painlessly has been once demonstrated in the present study.