Alt üriner sistem semptomları olan Multiple Skleroz hastalarında üriner sistem semptom skorlarının ve idrar-kan NGF düzeylerinin değerlendirilmesi
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Tarih
2021
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ VE AMAÇ: Multipl Skleroz (MS) enflamasyon, demiyelinizasyon ve akson hasarı
ile karakterize otoimmün bir santral sinir sistemi (SSS) hastalığıdır. Ataklarla veya
ilerleyici şekilde gidebilen kronik bir hastalıktır. Multipl Skleroz hastalarında alt üriner
sistem disfonksiyonu sık görülen bir bozukluktur. Tedavide birçok hedef olsa da ana amaç
nörojenik detrüsör aşırı aktivitesini (NDO) yönetmek, hastaların yaşam kalitesini arttırmak
ve üst üriner sistemi mesaneden kaynaklanan yüksek basınçtan korumaktır. Çalışmamızda;
ilerleyici bir seyir ve heterojen semptomlar gösteren Multipl Skleroz hastalarında Nerve
Growth Faktör (NGF) düzeylerini, güvenilirliği ve geçerliliği kanıtlanmış semptom
skorlamaları ve rasyonel bir ölçüm yöntemi olan ürodinami ile kıyaslamayı planlandık. Alt
üriner sistem semptomları eşlik eden MS hastalarında, MS süresi ve Genişletilmiş
Özürlülük Durum Ölçeği (EDSS) ile mesanenin etkilenme düzeylerini gözlemlemeyi
amaçladık.
GEREÇ VE YÖNTEM: Aralık 2019- Aralık 2020 tarihleri arasında hastanemiz Nöroloji
polikliniğe başvuran MS hastalarından alt üriner sistem semptomları (AÜSS) olan 33 hasta
ve AÜSS olmayan herhangi bir sebeple Üroloji polikliniğine başvuran 20 kontrol hastası
çalışmaya dahil edilmiştir. MS tanılı AÜSS olan hastalar incelenirken rutin kan ve idrar
tetkikleri yapılmıştır. AÜSS olan MS hastalarına kan ve idrar tetkiklerine ek olarak rutin
olarak mesane günlükleri, üroflovmetri, işeme sonrası rezidüel idrar miktarı ölçümü ve
ürodinamik çalışmalar üroloji kliniğinde yapılmıştır. Dahil edilen hastalardan geçerlilik ve
güvenirliği çalışmalarda gösterilmiş olan Mesane Durumunu Gösteren Hasta Algısı skoru,
Aşırı Aktif Mesane Değerlendirme Formu, Urgency Şiddetini Gösteren Hasta Algısı
Skoru, İnkontinans Yaşam Kalitesi Ölçeği Formu, Uluslararası İnkontinans Konsültasyon
Anketi ve King Sağlık Anketi (PPBC, OAB-V8, PPIUS, I-QOL, ICIQ-OAB ve KHQ)
doldurulmuştur. Hasta ve kontrol gruplarından, rutin tetkikler sırasında elde edilmiş kan ve
idrar tetkikleri kullanılarak NGF düzeyleri ELISA yöntemi kullanılarak çalışılmıştır. İdrar
NGF düzeyi spot idrar kreatinini kullanılarak normalize edilmiştir.
BULGULAR: Çalışmamıza AÜSS bulunan 33 MS hastası, kontrol grubuna ise 20 kişi
dahil edilmiştir. Hastaların yaş ortalaması 45 ± 8,1 yıl (25-60), MS süresi 8,9 ± 5,6 yıl (1-
20), ortalama EDSS düzeyi 3,15 ± 1,8 olarak ölçüldü. En sık Relapsing Remitting (RRMS)
alt tipinde hasta (n=22, % 66,7) bulunuyordu. Hastaların en sık semptomu % 91,9 oranıyla
urgency (ani idrara sıkışma) olarak tespit edildi. Ürodinamik çalışmada 22 (% 66,7)
x
hastada Detrüsör Aşırı Aktivitesi (DOA) tespit edildi. Hastaların 9’unda inkontinans
görülmedi. Kontrol grubu ile yaş, boy, kilo, BMI, cinsiyet ve idrar pH düzeyleri arasında
istatistiksel fark yok iken, MS ve kontrol grubunda serum NGF (serum NGF; MS= 115,9 ±
52,7 pg/ml, kontrol= 52,0 ± 35,8 pg/ml, p<0,001) ve idrar NGF/kre (idrar NGF/kre; MS=
174,1 ± 128,5 pg/ml kre, kontrol= 47,8 ± 25,7 pg/ml kre, p<0,001) oranlarında fark
istatistiksel olarak anlamlı bulundu. İnkontinans görülen MS hastalarında idrar NGF/kre
oranı 197,5 ± 138,4 pg/ml kre iken, inkontinans görülmeyen MS hasta grubunda bu oran
111,6 ± 70,4 pg/ml kre olarak bulundu (p=0,02).
SONUÇ: MS hastalarında, kontrol grubuna göre NGF düzeyleri idrar ve serumda
artmaktadır. Hastalık süresi ve EDSS skorlarındaki artışla, hem serum hem de idrardaki
NGF düzeyleri arasında korelasyon gösterilememiştir. Buna karşılık hastaların alt üriner
sistemdeki semptomları arttıkça ve hastalarda inkontinansın görülmesiyle bu değer daha da
artmaktadır. Sonuç olarak AÜSS görülen MS hastaların değerlendirmesinde, NGF
seviyelerindeki yükselme alt üriner sistemdeki disfonksiyonun tanısında ve prognozunda
değerlendirilebilecek önemli bir gösterge olabilir.
INTRODUCTION: Multiple Sclerosis (MS) is an autoimmune and chronic central nervous system (CNS) disease characterized by inflammation, demyelination and axon damage. Exacerbations and progressions may occur during the course of the illness. Lower urinary tract dysfunction is a common disorder in Multiple Sclerosis patients. Although there are many targets in the treatment, the main goal is to manage neurogenic detrussor overactivity (NDO), to improve patients’ quality of life and to protect the upper urinary system from high pressure from the bladder. In our study; we planned to compare Nerve Growth Factor (NGF) levels, symptom scores and urodynamic results in Multiple Sclerosis patients with LUTS. We aimed to observe the efficacy levels of the bladder with MS duration and Expanded Disability Status Scale (EDSS) in MS patients with LUTS. METHODS: 33 Multiple Sclerosis patients with lower urinary system symptoms (LUTS) who applied to the Neurology clinic between December 2019 and December 2020, along with 20 control patients who applied to the Urology clinic for any reason without LUTS were included in this study. Blood and urine tests were routinely performed while examining patients with lower urinary tract symptoms diagnosed with Multiple Sclerosis. In addition to blood and urine tests, bladder diaries, uroflowmetry, post-void residual urine volume measurement and urodynamic studies were performed in the urology clinic in MS patients with LUTS. The Patient Perception of Bladder Condition, Patient Perception of Intensity of Urgency Scale, Overactive Bladder Validated 8, Incontinence Quality of Life, International Consultation on Incontinence Questionnaire Overactive Bladder Module and King’s Health Questionnaire (PPBC, OAB-V8, PPIUS, I-QOL, ICIQ-OAB and KHQ) have been recorded. NGF and spot urine creatinine levels were measured from blood and urine during routine examinations. Urine and blood NGF levels were studied by the ELISA method in NGF kits. Patient and control urine NGF values were normalized by proportioning to spot urine creatinine. RESULTS: In our study, 33 MS patients with LUTS and 20 people were included in the control group. The mean age of the patients was 45 ± 8,1 years (25-60), the duration of MS was 8,9 ± 5,6 years (1-20), and the mean EDSS level was 3,15 ± 1,8. Relapsing Remitting MS (RRMS) was the most common subtype (n = 22, 66,7%). The most common symptom of the patients was determined as urgency with a rate of 91,9%. Detrusor Overactivity (DOA) was detected in 22 (66,7%) patients in the urodynamic study. Incontinence was not xii observed in 9 of the patients. While there was no statistical difference between the control group and age, height, weight, BMI, gender and urine pH levels, serum NGF (serum NGF; MS= 115,9 ± 52,7 pg/ml, control= 52,0 ± 35,8 pg/ml, p <0.001) and urine NGF/cre (urine NGF/cre; MS= 174,1 ± 128,5 pg/ml cre, control= 47,8 ± 25,7 pg/ml cre, p <0.001) values were found to be statistically significant. Urinary NGF / cre ratio was 197,5 ± 138,4 pg/ml in MS patients with incontinence, while it was 111,6 ± 70,4 pg / ml in MS patients without incontinence (p = 0.02). CONCLUSION: NGF levels increase in urine and serum in MS patients compared to the control group. There was no correlation between the duration of illness and the increase in EDSS scores and NGF levels in both serum and urine. Furthermore, this value increases even more as the symptoms of the patients in the lower urinary tract increases and the patients experience incontinence. In conclusion, in the evaluation of MS patients with LUTS, the increase in NGF levels may be an important indicator that can be evaluated in the diagnosis and prognosis of dysfunction in the lower urinary system.
INTRODUCTION: Multiple Sclerosis (MS) is an autoimmune and chronic central nervous system (CNS) disease characterized by inflammation, demyelination and axon damage. Exacerbations and progressions may occur during the course of the illness. Lower urinary tract dysfunction is a common disorder in Multiple Sclerosis patients. Although there are many targets in the treatment, the main goal is to manage neurogenic detrussor overactivity (NDO), to improve patients’ quality of life and to protect the upper urinary system from high pressure from the bladder. In our study; we planned to compare Nerve Growth Factor (NGF) levels, symptom scores and urodynamic results in Multiple Sclerosis patients with LUTS. We aimed to observe the efficacy levels of the bladder with MS duration and Expanded Disability Status Scale (EDSS) in MS patients with LUTS. METHODS: 33 Multiple Sclerosis patients with lower urinary system symptoms (LUTS) who applied to the Neurology clinic between December 2019 and December 2020, along with 20 control patients who applied to the Urology clinic for any reason without LUTS were included in this study. Blood and urine tests were routinely performed while examining patients with lower urinary tract symptoms diagnosed with Multiple Sclerosis. In addition to blood and urine tests, bladder diaries, uroflowmetry, post-void residual urine volume measurement and urodynamic studies were performed in the urology clinic in MS patients with LUTS. The Patient Perception of Bladder Condition, Patient Perception of Intensity of Urgency Scale, Overactive Bladder Validated 8, Incontinence Quality of Life, International Consultation on Incontinence Questionnaire Overactive Bladder Module and King’s Health Questionnaire (PPBC, OAB-V8, PPIUS, I-QOL, ICIQ-OAB and KHQ) have been recorded. NGF and spot urine creatinine levels were measured from blood and urine during routine examinations. Urine and blood NGF levels were studied by the ELISA method in NGF kits. Patient and control urine NGF values were normalized by proportioning to spot urine creatinine. RESULTS: In our study, 33 MS patients with LUTS and 20 people were included in the control group. The mean age of the patients was 45 ± 8,1 years (25-60), the duration of MS was 8,9 ± 5,6 years (1-20), and the mean EDSS level was 3,15 ± 1,8. Relapsing Remitting MS (RRMS) was the most common subtype (n = 22, 66,7%). The most common symptom of the patients was determined as urgency with a rate of 91,9%. Detrusor Overactivity (DOA) was detected in 22 (66,7%) patients in the urodynamic study. Incontinence was not xii observed in 9 of the patients. While there was no statistical difference between the control group and age, height, weight, BMI, gender and urine pH levels, serum NGF (serum NGF; MS= 115,9 ± 52,7 pg/ml, control= 52,0 ± 35,8 pg/ml, p <0.001) and urine NGF/cre (urine NGF/cre; MS= 174,1 ± 128,5 pg/ml cre, control= 47,8 ± 25,7 pg/ml cre, p <0.001) values were found to be statistically significant. Urinary NGF / cre ratio was 197,5 ± 138,4 pg/ml in MS patients with incontinence, while it was 111,6 ± 70,4 pg / ml in MS patients without incontinence (p = 0.02). CONCLUSION: NGF levels increase in urine and serum in MS patients compared to the control group. There was no correlation between the duration of illness and the increase in EDSS scores and NGF levels in both serum and urine. Furthermore, this value increases even more as the symptoms of the patients in the lower urinary tract increases and the patients experience incontinence. In conclusion, in the evaluation of MS patients with LUTS, the increase in NGF levels may be an important indicator that can be evaluated in the diagnosis and prognosis of dysfunction in the lower urinary system.
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Atıcı, A. (2021) Alt üriner sistem semptomları olan Multiple Skleroz hastalarında üriner sistem semptom skorlarının ve idrar-kan NGF düzeylerinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Üroloji Anabilim Dalı, Konya.
