Bir üniversite hastanesinde eklem ağrısı şikayeti ile başvuran hastalarda otoimmün hastalık tanısına yönelik kullanılan immünolojik ve hematolojik parametrelerin irdelenmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çevresel ya da yapısal nedenlere bağlı olarak gelişen eklem ağrıları günümüzde toplumda sık görülen rahatsızlıklardan biridir. Sistemik Otoimmün Hastalıklar eklemlerin de yaygın tutulumuna bağlı olarak eklem ağrısı şikayeti ile hastalarca çok sık hastaneye başvuru nedeni olmaktadır. Bu hastalıkların tanısında ve tedavi izleminde otoantikor testleri büyük öneme sahiptir. Bu sebeple Anti nükleer antikor (ANA) testleri en sık istenen, altın standart tarama testleri olarak bilinmektedir. Ayrıca otoimmün hastalık tanı ve aktivitesinin değerlendirilmesinde Anti- CCP (Anti- Siklik sitrüllenmiş peptid) antikorları, RF (Romatoid Faktör) antikorları ve ESH (Eritrosit Sedimantasyon Hızı), CRP (C- reaktif protein) gibi belirteçler de yaygın olarak bakılmaktadır. Bu çalışmada üniversite hastanemize eklem ağrısı şikayeti ile başvuran hastalarda otoimmün hastalık tanısını desteklemeye yönelik hastanemizde kullanılagelen immünolojik ve hematolojik laboratuvar test sonuçlarının birbirleri arasında ilişki olup olmadığını incelemeyi amaçladık. Bunun için önce ANA IIF (İndirekt İmmünoflorasans) testi pozitifliğinin sıklığı, titresi ve patern dağılımını belirlemeyi, sonrasında ESH, CRP ve RF gibi diğer laboratuvar parametrelerinin ve cinsiyetin ANA ve Anti- CCP ile ilişkisini belirlemeyi hedefledik. Materyal ve Metot: Çalışmamız retrospektif tanımlayıcı tipte bir araştırma olup Ocak 2018 ile Eylül 2022 tarihleri arasında Namık Kemal Üniversitesi Tıp Fakültesi Hastanesi'ne eklem ağrısı şikayeti ile başvuran ve ANA IIF ile Anti-CCP testi çalışılan 848 hastaya ait sonuçlar değerlendirilmiştir. Çalışmamız iki aşamalı olacak şekilde planlandı. İlk aşamada çalışmaya dahil edilen hastaların ANA IIF ve Anti-CCP test sonuçları değerlendirilerek gruplandırıldı. ANA nükleer patern pozitif saptanan hastalar kendi içinde incelenerek ANA nükleer patern pozitif ve Anti-CCP pozitifliğine göre paternleri ve titreleri açısından değerlendirildi. İkinci aşamada ANA açısından ANA nükleer paterne göre pozitif, ANA sitoplazmik/mitotik paterne göre pozitif ve ANA negatif, Anti-CCP açısından Anti-CCP pozitif ve Anti-CCP negatif olarak hastalar toplamda 6 gruba ayrıldı. Bu gruplar kendi aralarına cinsiyet, ESH, RF ve CRP pozitifliği açısından karşılaştırıldı. Bulgular: 848 hastanın 585'inin (%69) ANA IIF testi pozitif, 268'inin (%31,6) Anti-CCP testi pozitif saptandı. ANA pozitif saptanan 585 hastanın ise 517'si (%88,4), Anti-CCP pozitif saptanan 268 hastanın 226'sı (%84,3) kadınlardan oluşmaktadır. ANA nükleer boyanma paterni olarak en fazla 181 (%31,5) ile ince benekli (AC-4) patern görülmüştür. ANA nükleer patern titresi olarak en çok 320 (%55,6) ile +1 titresi tespit edilmiştir. Kadın cinsiyette otoantikor pozitifliği daha sık görülmüş, özellikle ANA nükleer patern pozitif gruplarda anti- CCP pozitif gruplardan oran olarak daha yüksek olduğunu saptadık. RF pozitifliğinin ANA nükleer patern pozitifliğine göre anti-CCP pozitifliği ile anlamlı düzeyde ilişkili olduğunu tespit ettik (p<0,05). ESH ve CRP pozitifliğinin hem ANA nükleer patern pozitif hem anti-CCP pozitif olan grupta en yüksek tespit edilmelerinden dolayı her ikisinin de ESH ve CRP pozitifliğinde kümülatif etkisi olabileceğini fakat anti-CCP pozitif olan gruplarda daha yüksek olmalarından dolayı ANA nükleer patern pozitifliğine göre anti-CCP pozitifliği ile anlamlı düzeyde ilişkili olduklarını saptadık (p<0,05). Sonuçlar: Eklem ağrısı şikayetiyle başvuran hastalarda immünolojik ve hematolojik laboratuvar testleri tanı ve takipte önem taşımaktadır. Çalışmamızda buna yönelik ANA, Anti-CCP, RF, ESH ve CRP değerlendirilmiş, RF, ESH ve CRP pozitifliğinin Anti-CCP pozitifliği ile anlamlı ilişki gösterdiği saptanmıştır. Bu sonuçlar ve çalışmamızın sınırlılıkları da göz önüne alındığında prospektif ve kontrol grubu içeren daha fazla hasta sayısına sahip çalışmaların yapılması gerektiği kanaatindeyiz. Anahtar Kelimeler: Eklem ağrısı, Otoimmün hastalık, ANA, Anti- CCP
Purpose: Joint pains that are observed by environmental or structural reasons, are one of the most prevalent diseases in the society. In Systemic Autoimmune Diseases, it is very common for patients to complain of joint pain due to widespread involvement of the joints and this complaint is the reason for admission to the hospital. In the diagnosis and treatment of these diseases autoantibody tests have great importance. For this reason, Antinuclear antibody (ANA) tests are frequently used and they are known as gold standard diagnosis tests. Also for diagnosing autoimmune diseases Anti-CCP (Anti-Cyclic citrullated peptide) antibodies, RF (Rheumatoid Factor) antibodies and ESH (Erythrocyte Sedimentation Rate), CRP (C- reactive protein) can be commonly examined. In this study, we aimed to investigate the relationship between immunological and hematological laboratory test results for supporting the diagnosis of autoimmune diseases in our university hospital. Therefore, first we aimed to determine the frequency, titer and pattern distribution of first ANA IIF (Indirect Immunofluorescence) test positivity and then aimed to investigate the relationships between gender, other laboratory parameters such as ESH, CRP, RF and ANA, anti-CCP. Material and Method: Our study is a retrospective descriptive type research. The data in our study belongs to 848 patients with ANA IIF and Anti-CCP tests who applied with the complaint of joint pain to the Namık Kemal University Faculty of Medicine Hospital between January 2018 and September 2022. The study has been conducted with two stages. In the first stage, the patients have been grouped by evaluating the ANA IIF and Anti-CCP test results of them. Patients with positive ANA nuclear pattern have been examined in terms of their patterns and titers according to nuclear pattern positive and Anti-CCP positivity. In the second stage, patients have been divided into 6 groups according to the ANA and Anti-CCP: positive in terms of ANA nuclear pattern, ANA positive for cytoplasmic/mitotic pattern and negative for ANA, Anti-CCP positive and Anti-CCP negative. The data has been compared in terms of gender, ESH, RF and CRP positivity between these groups. Results: We found 585 (69%) patients with positive ANA IIF and 268 (31.6%) patients with positive Anti-CCP test. The 517 patients (88.4%) in the ANA positive group and the 226 patients (84.3%) in the anti-CCP positive group were women. It was found that the 181 fine speckled pattern (31.5%) was the main nuclear staining pattern (AC-4). ANA nuclear pattern titer is +1 with a maximum of 320 (55.6%) titer determined. The autoantibody positivity was observed more frequently in female groups especially in ANA nuclear pattern positive groups than the values in anti-CCP positive groups. We found that there was a significant relationship between RF positivity and anti-CCP positivity (p<0,05). Since the positivity of ESH and positivity of CRP was maximally observed in the group with positivity of ANA nuclear pattern and anti-CCP, a cumulative effect was found. Moreover, we reported a significant correlation between positivity of anti-CCP and positivity of ESH, CRP (p<0,05). Conclusion: The patients with joint pain complaints, the laboratory tests (immunological and hematological) are important for diagnosis and treatment. In our study, the ANA, Anti-CCP, RF, ESR and CRP data were evaluated. It was found that there was a significant correlation between RF, ESH, CRP positivity and Anti-CCP positivity. For future studies, prospective studies with a larger number of patients and a control group recommended. Keywords: Joint pain, Autoimmune disease, ANA, Anti-CCP
Purpose: Joint pains that are observed by environmental or structural reasons, are one of the most prevalent diseases in the society. In Systemic Autoimmune Diseases, it is very common for patients to complain of joint pain due to widespread involvement of the joints and this complaint is the reason for admission to the hospital. In the diagnosis and treatment of these diseases autoantibody tests have great importance. For this reason, Antinuclear antibody (ANA) tests are frequently used and they are known as gold standard diagnosis tests. Also for diagnosing autoimmune diseases Anti-CCP (Anti-Cyclic citrullated peptide) antibodies, RF (Rheumatoid Factor) antibodies and ESH (Erythrocyte Sedimentation Rate), CRP (C- reactive protein) can be commonly examined. In this study, we aimed to investigate the relationship between immunological and hematological laboratory test results for supporting the diagnosis of autoimmune diseases in our university hospital. Therefore, first we aimed to determine the frequency, titer and pattern distribution of first ANA IIF (Indirect Immunofluorescence) test positivity and then aimed to investigate the relationships between gender, other laboratory parameters such as ESH, CRP, RF and ANA, anti-CCP. Material and Method: Our study is a retrospective descriptive type research. The data in our study belongs to 848 patients with ANA IIF and Anti-CCP tests who applied with the complaint of joint pain to the Namık Kemal University Faculty of Medicine Hospital between January 2018 and September 2022. The study has been conducted with two stages. In the first stage, the patients have been grouped by evaluating the ANA IIF and Anti-CCP test results of them. Patients with positive ANA nuclear pattern have been examined in terms of their patterns and titers according to nuclear pattern positive and Anti-CCP positivity. In the second stage, patients have been divided into 6 groups according to the ANA and Anti-CCP: positive in terms of ANA nuclear pattern, ANA positive for cytoplasmic/mitotic pattern and negative for ANA, Anti-CCP positive and Anti-CCP negative. The data has been compared in terms of gender, ESH, RF and CRP positivity between these groups. Results: We found 585 (69%) patients with positive ANA IIF and 268 (31.6%) patients with positive Anti-CCP test. The 517 patients (88.4%) in the ANA positive group and the 226 patients (84.3%) in the anti-CCP positive group were women. It was found that the 181 fine speckled pattern (31.5%) was the main nuclear staining pattern (AC-4). ANA nuclear pattern titer is +1 with a maximum of 320 (55.6%) titer determined. The autoantibody positivity was observed more frequently in female groups especially in ANA nuclear pattern positive groups than the values in anti-CCP positive groups. We found that there was a significant relationship between RF positivity and anti-CCP positivity (p<0,05). Since the positivity of ESH and positivity of CRP was maximally observed in the group with positivity of ANA nuclear pattern and anti-CCP, a cumulative effect was found. Moreover, we reported a significant correlation between positivity of anti-CCP and positivity of ESH, CRP (p<0,05). Conclusion: The patients with joint pain complaints, the laboratory tests (immunological and hematological) are important for diagnosis and treatment. In our study, the ANA, Anti-CCP, RF, ESR and CRP data were evaluated. It was found that there was a significant correlation between RF, ESH, CRP positivity and Anti-CCP positivity. For future studies, prospective studies with a larger number of patients and a control group recommended. Keywords: Joint pain, Autoimmune disease, ANA, Anti-CCP
Açıklama
Tıp Fakültesi, Tıbbi Mikrobiyoloji Ana Bilim Dalı
Anahtar Kelimeler
Mikrobiyoloji, Microbiology
