CROHN hastalığı tanılı olgularda serum periostin düzeyinin değerlendirilmesi
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Dosyalar
Tarih
2021
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Crohn hastalığı (CH), gastrointestinal sistemin herhangi bir kısmını etkileyebilen, atak ve remisyonlarla seyreden, kronik inflamatuvar bir hastalıktır. Periostin multi-fonksiyonel bir ekstrasellüler matriks proteinidir. Kronik inflamasyon ve fibrozisle seyreden çeşitli hastalıklarda serum periostin düzeylerinin arttığı gösterilmiştir [1]. Çalışmamızın amacı kronik inflamasyon ve fibrozisle seyreden bir hastalık olan Crohn hastalığında serum periostin düzeylerinin araştırılması ve çeşitli klinik ve laboratuvar parametrelerle olan ilişkisinin değerlendirilmesidir. Materyal ve Metod: Çalışmaya, Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji-Hepatoloji polikliniklerine Mayıs 2020–Ocak 2021 tarihleri arasında başvuran klinik, endoskopik ve patolojik olarak tanısı konmuş 18-70 yaş arası remisyonda olan (CHAI 150'nin altında olan) 40 CH hastası dahil edildi. Kontrol grubu olarak, aynı polikliniklere başka nedenlerle başvuran bilinen kronik bir hastalığı olmayan, 18-70 yaş arası gönüllülerden oluşan 40 kişi dahil edildi. Hastaların tanı konulma anındaki yaş (yıl olarak kaydedildi), cinsiyet, hastalık süresi, hastalık lokalizasyonu, fistül ve/veya abse varlığı, anti TNF kullanımı, steroid bağımlılığı, steroid direnci, CH nedeniyle cerrahi uygulanıp uygulanmadığı, ankilozan spondilit varlığı kaydedildi. Hastanın toplam takip süresi kaydedildi. Toplam takip süresi, ilk tanı tarihi ile son başvuru tarihi arasındaki süre (gün) olarak kabul edildi. Hasta ve kontrol grubundaki bireylerin tam kan sayımı ve serum periostin düzeyleri çalışıldı. İstatiksel analizler, SPSS versiyon 25 ve MedCalc versiyon 15.8 yazılımları kullanılarak yapıldı. Çalışmada tüm testlerde istatiksel anlamlılık için Tip-1 hata düzeyi %5 olarak kullanıldı ve P-değerinin 0.05'in altında olduğu durumlar istatiksel olarak anlamlı sonuçlar şeklinde değerlendirildi. Çalışma için Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Etik Kurulunun, 22.05.2020 tarihinde 2020/2503 sayılı kararla onay alındı. Bulgular: Çalışmaya dahil edilen 40 CH hastasının 15'i (%37,5) kadın, 25'i (%62,5) erkekti. Kontrol grubunun ise 17'si (% 42,5) kadın, 23'ü (%57,5) erkekti. Crohn hastası grubunun yaş ortalaması 38.98, kontrol grubunun yaş ortalaması 33.70 idi. Crohn hastası grubu ile kontrol grupları arasında cinsiyet ve yaş açısından fark yoktu (sırasıyla p=0,116, p=0,653). Crohn hastaları, takip süresine göre < 4 yıl olan grupta 18 (%45), 4-8 yıl olan grupta 13 (%32.5), > 8 yıl olan grupta 9 (%22.5) hasta vardı. Crohn hastası grubunda periostin düzeyi 53.4, kontrol grubunda 23.13 olup CH grubunda, kontrol grubuna göre periostin düzeyi daha yüksek saptandı. Crohn hastası grubunda hemoglobin ve lenfosit düzeyleri kontrol grubundan daha düşük, nötrofil lenfosit oranı daha yüksekti (sırasıyla p= 0.017, p=<0.001, p<0.001). Korelasyon analizinde Crohn hastalığı varlığı ve serum periostin seviyesi arasında pozitif ve orta düzeyde bir korelasyon (p=<0.001), Crohn hastalığının süresi ve serum periostin seviyesi arasında ise negatif ve orta düzeyde bir korelasyon saptandı. (p=<0.001). ROC analizinde, Crohn hastalığının hastalık süresinden bağımsız tanısı için eşik periostin düzeyi 27.8 tespit edildi ve istatistiksel anlam saptandı (Şekil 2). Periostin 27.8 değeri için sensitivitesi %72.5 ve spesifitesi %77.5 saptanmıştır Sonuç: Crohn hastalığı ön tanısı ile değerlendirilen ve ayırıcı tanıda güçlük yaşanan olgularda, serum periostin düzeyi bakılması ve yüksek saptanması kesin tanıya ulaşmada yüksek sensitivite ve yüksek spesifiteye sahip bir yöntem olarak kullanılabilir. Çalışmamızda hastalık süresi uzadıkça serum periostin düzeyinin kontrol grubundan yüksek seyretmesine karşın hastalığın erken dönemlerine oranla azaldığını saptadık. Dolayısıyla yeni saptanan Crohn hastalarının serum periostin düzeylerinin çalışmamızda saptadığımız eşik periostin düzeyleri ile karşılaştırıldığında hastalığın sürecinin de öngörülmesine katkısı olacaktır.
Introduction and Aim: Crohn's disease (CD) is a chronic inflammatory disease that can affect any part of the gastrointestinal system, with attacks and remissions. Periostin is a multi-functional extracellular matrix protein. It has been shown that serum periostin levels increase in various diseases with chronic inflammation and fibrosis [1]. The aim of our study is to investigate serum periostin levels in Crohn's disease, a disease with chronic inflammation and fibrosis, and to evaluate its relationship with various clinical and laboratory parameters. Material and Method: 40 patients with CD in remission (CHAI is below 150) between the ages of 18-70 who were diagnosed clinically, endoscopically and pathologically between May 2020 and January 2021, were included in the study. As the control group, 40 volunteers between the ages of 18-70 who did not have a known chronic disease and applied to the same polyclinics for other reasons were included. Patients' age at the time of diagnosis (recorded in years), gender, duration of disease, disease location, presence of fistula and / or abscess, anti TNF use, steroid addiction, steroid resistance; Whether surgery was performed due to Crohn's disease and the presence of ankylosing spondylitis were recorded. The total follow-up time of the patient was recorded. Total follow-up time was accepted as the period (days) between the first diagnosis date and the last application date. Complete blood count and serum periostin levels of individuals in the patient and control groups were studied. Statistical analyzes were performed using SPSS version 25 and MedCalc version 15.8 software. In the study, Type-1 error level was used as 5% for statistical significance in all tests, and cases where the P-value was below 0.05 were evaluated as statistically significant results. The approval of the Ethics Committee of Necmettin Erbakan University Meram Medical Faculty for the study was obtained on 22.05.2020 with the decision number 2020/2503. Results: Of the 40 CD patients included in the study, 15 (37.5%) were female and 25 (62.5%) were male. Of the control group, 17 (42.5%) were female and 23 (57.5%) were male. The mean age of the Crohn's disease group was 38.98, and the average age of the control group was 33.70. There was no difference between the Crohn's disease group and the control groups in terms of gender and age (p = 0.116, p = 0.653, respectively). Crohn patients were 18 (45%) in the group with <4 years of follow-up, 13 (32.5%) in the group with 4-8 years, and 9 (22.5%) patients in the group with> 8 years. The periostin level was 53.4 in the Crohn's disease group, 23.13 in the control group, and the periostin level was found to be higher in the CD group compared to the control group. Hemoglobin and lymphocyte levels were lower and neutrophil lymphocyte ratio was higher in the Crohn's disease group than in the control group (p = 0.017, p = <0.001, p <0.001, respectively). In correlation analysis, there was a positive and moderate correlation (p = <0.001) between the presence of Crohn's disease and serum periostin level, and a negative and moderate correlation between the duration of Crohn's disease and serum periostin level. (p = <0.001). In the ROC analysis, the threshold periostin level was determined as 27.8 for the diagnosis of Crohn's disease independent of the disease duration, and statistical significance was determined. Conclusion: In cases evaluated with a pre-diagnosis of Crohn's disease and having difficulties in differential diagnosis, checking serum periostin level and determining it to be high can be used as a method with high sensitivity and high specificity to reach a definitive diagnosis. In our study, we found that as the duration of the disease prolonged, the serum periostin level decreased compared to the early stages of the disease, although it was higher than the control group. Therefore, when the serum periostin levels of newly identified Crohn's patients are compared with the threshold periostin levels we found in our study, it will contribute to the prediction of the course of the disease.
Introduction and Aim: Crohn's disease (CD) is a chronic inflammatory disease that can affect any part of the gastrointestinal system, with attacks and remissions. Periostin is a multi-functional extracellular matrix protein. It has been shown that serum periostin levels increase in various diseases with chronic inflammation and fibrosis [1]. The aim of our study is to investigate serum periostin levels in Crohn's disease, a disease with chronic inflammation and fibrosis, and to evaluate its relationship with various clinical and laboratory parameters. Material and Method: 40 patients with CD in remission (CHAI is below 150) between the ages of 18-70 who were diagnosed clinically, endoscopically and pathologically between May 2020 and January 2021, were included in the study. As the control group, 40 volunteers between the ages of 18-70 who did not have a known chronic disease and applied to the same polyclinics for other reasons were included. Patients' age at the time of diagnosis (recorded in years), gender, duration of disease, disease location, presence of fistula and / or abscess, anti TNF use, steroid addiction, steroid resistance; Whether surgery was performed due to Crohn's disease and the presence of ankylosing spondylitis were recorded. The total follow-up time of the patient was recorded. Total follow-up time was accepted as the period (days) between the first diagnosis date and the last application date. Complete blood count and serum periostin levels of individuals in the patient and control groups were studied. Statistical analyzes were performed using SPSS version 25 and MedCalc version 15.8 software. In the study, Type-1 error level was used as 5% for statistical significance in all tests, and cases where the P-value was below 0.05 were evaluated as statistically significant results. The approval of the Ethics Committee of Necmettin Erbakan University Meram Medical Faculty for the study was obtained on 22.05.2020 with the decision number 2020/2503. Results: Of the 40 CD patients included in the study, 15 (37.5%) were female and 25 (62.5%) were male. Of the control group, 17 (42.5%) were female and 23 (57.5%) were male. The mean age of the Crohn's disease group was 38.98, and the average age of the control group was 33.70. There was no difference between the Crohn's disease group and the control groups in terms of gender and age (p = 0.116, p = 0.653, respectively). Crohn patients were 18 (45%) in the group with <4 years of follow-up, 13 (32.5%) in the group with 4-8 years, and 9 (22.5%) patients in the group with> 8 years. The periostin level was 53.4 in the Crohn's disease group, 23.13 in the control group, and the periostin level was found to be higher in the CD group compared to the control group. Hemoglobin and lymphocyte levels were lower and neutrophil lymphocyte ratio was higher in the Crohn's disease group than in the control group (p = 0.017, p = <0.001, p <0.001, respectively). In correlation analysis, there was a positive and moderate correlation (p = <0.001) between the presence of Crohn's disease and serum periostin level, and a negative and moderate correlation between the duration of Crohn's disease and serum periostin level. (p = <0.001). In the ROC analysis, the threshold periostin level was determined as 27.8 for the diagnosis of Crohn's disease independent of the disease duration, and statistical significance was determined. Conclusion: In cases evaluated with a pre-diagnosis of Crohn's disease and having difficulties in differential diagnosis, checking serum periostin level and determining it to be high can be used as a method with high sensitivity and high specificity to reach a definitive diagnosis. In our study, we found that as the duration of the disease prolonged, the serum periostin level decreased compared to the early stages of the disease, although it was higher than the control group. Therefore, when the serum periostin levels of newly identified Crohn's patients are compared with the threshold periostin levels we found in our study, it will contribute to the prediction of the course of the disease.
Açıklama
Anahtar Kelimeler
Gastroenteroloji, Gastroenterology, Crohn hastalığı, Crohn's disease
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Topkaç, A. (2021). CROHN hastalığı tanılı olgularda serum periostin düzeyinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri İç Hastalıklar Anabilim Dalı, Konya.
