Multipl skleroz hastalarında atak ve remisyon dönemlerinde serum sitokin düzeylerinin karşılaştırılması, özürlülük ölçeği (EDSS) ile ilişkisi
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Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Multipl Skleroz, demiyelinizasyon, inflamasyon ve dejenerasyonla seyreden progresif seyirli, özürlülüğe yol açan bir hastalıktır. Etyopatogenezinde immun sistemin rol oynadığı bilinen MS'deki inflamasyonda sitokinler önemli görevlere sahiptir. Sitokinler hücresel ve humoral immun yanıtın düzenlenmesinde rol alarak MS'de relaps ve remisyonların oluşumuna katkıda bulunurlar. Amaç: MS'de sentezlenen sitokinlerin hastalığın gelişiminde nasıl bir rol oynadıkları belirsizliğini korumaktadır. Ayrıca MS'de hastalık aktivitesini gösteren objektif bir belirteç bulunmamaktadır. Çalışmamızda MS'de serum sitokin düzeylerinin atak ve remisyon dönemlerinde değişip değişmediği ve bunun Özürlülük Ölçeği ile ilişkisi araştrıldı. Gereç ve yöntemler: Çalışmamıza 29 MS olgusu (atak ve remisyon) ve 29 kontrol olmak üzere toplam 58 kişi alındı. Çalışmaya kabul edilen kişilerin atak ve remisyon dönemlerinde olmak üzere iki kez, antikoagulan içermeyen vakumlu tüplere venöz kan örnekleri alındı. Santrifüj edilip serumları ayrılarak serum sitokin düzeyi ölçümleri için -80° C deki derin dondurucuda saklandı. Çalışma günü tek seansta ve aynı ekip tarafından serumdan TNF-α, IFN-γ, IL-10, IL-6 ve Neopterin düzeyleri ölçüldü. Tüm katılımcıların aynı kişi tarafından genel fizik ve nörolojik muayeneleri yapıldı, "EDSS" puanları hesaplandı. İstatistiki değerlendirme için SPSS for Windows 18,0 programı kullanıldı. Sonuçlar ortalama ± standart sapma olarak belirlenip, gruplar karşılaştırıldı ve p<0,05 ise anlamlı kabul edildi. Yine serum sitokin düzeyleri, Özürlülük Ölçeği arasında korelasyon olup olmadığı araştırıldı. Bulgular: MS'lilerin yaş ortalaması 33,26 ± 11,50, kontrollerin 29,28 ± 7,90 olarak hesaplandı. Gruplar karşılaştırıldığında istatistiksel olarak yaş bakımından anlamlı bir fark saptanmadı (p> 0,05). MS'in başlangıç şekli en sık %38,5 ile Optik Nörit, ikinci sırada ise %23,1 ile duyusal semptomlar olarak belirlendi. Hastalığın atak profilinde ise en sık %38,5 ile duyusal semptomlar saptandı. IFN-γ ve IL-10 düzeyleri MS'lilerde anlamlı yüksek bulundu (p<0,05). Ancak Neopterin, IL-6 ve TNF-α düzeylerinde anlamlı fark bulunmadı (p>0,05). Serum sitokin düzeylerinden IFN-γ atak değeri ve serum IL-6 remisyon değeri ile EDSS değeri arasında anlamlı ilişki bulundu (p<0,05). Serum IFN-γ remisyon değeri ile atak dönemindeki EDSS değeri arasında pozitif (r=0,28), remisyon dönemindeki EDSS değeri arasında negatif (r=-0,24) bir korelasyon bulundu. MS olgularında immunmodülatör ilaç kullananlar ile kullanmayanlar arasında serum sitokin düzeyleri arasında anlamlı fark bulunmamıştır (p>0,05). Sonuç: MS olgularında Optik Nörit ve duyusal semptomların daha sık görüldüğü; MS'lilerde serum sitokin düzeylerinde anormallikler olabileceği; serum sitokinlerinden sadece IFN-γ ve IL-10'un atak ve remisyon dönemlerinde anlamlı yüksek olduğu ve sitokinlerden IFN-γ'nın EDSS değeri ile anlamlı korelasyon gösterdiği belirlenmiştir. Bunun yanında sitokinlerden IL-6 ve TNF-α ile otoimmün hastalıkların aktivite ve yaygınlığını gösteren bir belirteç olan Neopterin'in atak ve remisyon dönemleri karşılaştırıldığında anlamlı korelasyon bulunamamıştır. Bu nedenle IFN-γ ve IL-10 gibi sitokinler MS'de hastalık aktivitesini değerlendirmede spesifik biyomarker olarak kullanılabilir ve bu sitokinlere etkili medikasyonlar da MS'in medikal tedavisinde kullanılabilir
Multiple Sclerosis is a disease that causing demyelination, inflammation, progressive coursing beholding with degeneration and defectiveness. It is known that the cytokines in inflammation in MS in which etiopathogenesis immune system plays role, have important duties. Cytokines are taken roles in order to regulation of cellular and immune response and contribute formation of relapse and remissions in MS. Aim: The uncertainty is protected about that how cytokines synthesized in MS play a role in development of the disease. In addition, an objective determiner indicating disease activity in MS is not present. In our study, it is investigated that cytokines levels in the period of attack and remission are changed or not and its relation with defectiveness scale in MS. Material and Method: In our study, 29 MS case (attack and remission) and 29 control namely totally 58 person has been under debate. The venous blood samples of person who accepting the study, have been taken twice to the vacuum tube that not containing anticoagulant impending in the periods of attack and remission. Their serums have been separated by centrifuging and they are kept in deep freezer at -80º for measurements of serum cytokines level. The working day, TNF-α, IFN-γ, IL-10, IL-6 and Neopterin levels from serum were measured by same team at one session. Physical and neurological examination of all the participants were carried out, their "EDSS" scores were calculated. For statistical evaluation, programme SPSS for Windows 18.0 was used. The results were determined as mean ± standard deviation, the groups were compared and accepted as significant if p<0.05. Also, it was investigated that whether there is any correlation between serum cytokines levels and Defectiveness Scale. Evidences: The average of age was calculated as 33.26 ± 11.50 for MS's and 29.28 ± 7.90 for controls. When the groups were compared it was not found a significant difference statically (if p<0.05) from point of view of age. The beginning style/form of MS were determined as sensorial symptoms, firstly the most frequently 38.5% with optic neuritis and secondly with 23.1%. In case of the attack profile of disease sensorial symptoms were determined most frequently with 38.5%. The levels of IFN-γ and IL-10 in MS's were found highly significant (p<0.05). But it could not be found significant difference the levels of Neopterin, IL-6 and TNF-α (p>0.05). It was found significant relation between IFN-γ attack value from levels of serum cytokines and serum IL-6 remission value with value of EDSS (p>0,05). A negative correlation (r=0.24) was found between EDSS values. Additionally, it was not found significant difference (p>0.05) between levels of serum cytokines in MS cases, between the patients who are taking immunmodulator medicine or not. Conclusion: It is determined that in MS cases, optic neuritis and sensorial symptoms are observed more frequent; in MS's it will be abnormalities in their serum cytokine levels, only IFN-γ ve IL-10 from serum cytokines are highly significant in the period of attack and remission and IFN-γ from cytokines have significant correlation with EDSS value. Furthermore, When the attack and remission periods of IL-6 and TNF-α from cytokines with Neopterin that is an indicator showing activity and prevalence of autoimmune diseases are compared it could not found significant correlation. Therefore, the cytokines as IFN-γ ve IL-10 can be used as specific biomarker in evaluation of disease activity in MS and the medications effective on cytokines can also be used medical treatment of MS.
Multiple Sclerosis is a disease that causing demyelination, inflammation, progressive coursing beholding with degeneration and defectiveness. It is known that the cytokines in inflammation in MS in which etiopathogenesis immune system plays role, have important duties. Cytokines are taken roles in order to regulation of cellular and immune response and contribute formation of relapse and remissions in MS. Aim: The uncertainty is protected about that how cytokines synthesized in MS play a role in development of the disease. In addition, an objective determiner indicating disease activity in MS is not present. In our study, it is investigated that cytokines levels in the period of attack and remission are changed or not and its relation with defectiveness scale in MS. Material and Method: In our study, 29 MS case (attack and remission) and 29 control namely totally 58 person has been under debate. The venous blood samples of person who accepting the study, have been taken twice to the vacuum tube that not containing anticoagulant impending in the periods of attack and remission. Their serums have been separated by centrifuging and they are kept in deep freezer at -80º for measurements of serum cytokines level. The working day, TNF-α, IFN-γ, IL-10, IL-6 and Neopterin levels from serum were measured by same team at one session. Physical and neurological examination of all the participants were carried out, their "EDSS" scores were calculated. For statistical evaluation, programme SPSS for Windows 18.0 was used. The results were determined as mean ± standard deviation, the groups were compared and accepted as significant if p<0.05. Also, it was investigated that whether there is any correlation between serum cytokines levels and Defectiveness Scale. Evidences: The average of age was calculated as 33.26 ± 11.50 for MS's and 29.28 ± 7.90 for controls. When the groups were compared it was not found a significant difference statically (if p<0.05) from point of view of age. The beginning style/form of MS were determined as sensorial symptoms, firstly the most frequently 38.5% with optic neuritis and secondly with 23.1%. In case of the attack profile of disease sensorial symptoms were determined most frequently with 38.5%. The levels of IFN-γ and IL-10 in MS's were found highly significant (p<0.05). But it could not be found significant difference the levels of Neopterin, IL-6 and TNF-α (p>0.05). It was found significant relation between IFN-γ attack value from levels of serum cytokines and serum IL-6 remission value with value of EDSS (p>0,05). A negative correlation (r=0.24) was found between EDSS values. Additionally, it was not found significant difference (p>0.05) between levels of serum cytokines in MS cases, between the patients who are taking immunmodulator medicine or not. Conclusion: It is determined that in MS cases, optic neuritis and sensorial symptoms are observed more frequent; in MS's it will be abnormalities in their serum cytokine levels, only IFN-γ ve IL-10 from serum cytokines are highly significant in the period of attack and remission and IFN-γ from cytokines have significant correlation with EDSS value. Furthermore, When the attack and remission periods of IL-6 and TNF-α from cytokines with Neopterin that is an indicator showing activity and prevalence of autoimmune diseases are compared it could not found significant correlation. Therefore, the cytokines as IFN-γ ve IL-10 can be used as specific biomarker in evaluation of disease activity in MS and the medications effective on cytokines can also be used medical treatment of MS.
Açıklama
Anahtar Kelimeler
Multiple sclerosis, Cytokines, Multipl skleroz, Sitokin
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Gezer, A. (2016). Multipl skleroz hastalarında atak ve remisyon dönemlerinde serum sitokin düzeylerinin karşılaştırılması, özürlülük ölçeği (EDSS) ile ilişkisi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
