Behçet tanısı alan hastaların paterji pozitif ve negatif alanlarının histopatolojik olarak karşılaştırılması
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Dosyalar
Tarih
2020
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Behçet hastalığı, atak ve remisyonlarla kronik bir seyir izleyen, esas patolojisi hemen her organı ve sistemi tutabilen inflamatuar bir vaskülit tablosudur. Paterji reaksiyonu, hastalık için özgün bir klinik bulgu olup tanı kriterlerinin vazgeçilmez bir elemanıdır. Literatürde yeni tanı Behçet hastalarında negatif paterji testi ile pozitif paterji testinin histopatolojisini karşılaştıran bir çalışma bulunmamaktadır. Çalışmamızda, paterji pozitif ve paterji negatif olan yeni tanı konulan Behçet hastalarımızın, paterji pozitif ve paterji negatif reaksiyon bölgelerinden aldığımız cilt biyopsilerinin histopatolojik bulgularının karşılaştırılması amaçlandı. Behçet hastalığının önemli bir bulgusu olan vaskülitin paterji histopatolojisinde sıklığının araştırılması birincil hedefti. Gereç ve Yöntem Deri ve Zührevi Hastalıkları polikliniğine başvuran ve Uluslararası Çalışma Grubu kriterlerine göre Behçet hastalığı tanısı konulan 42 paterjisi pozitif, 46 paterjisi negatif olan toplam 88 hasta değerlendirmeye alındı. Çalışmada yer alan hastalarının demografik özellikleri, başvuru şikayeti, aile öyküsü, paterji testi pozitiflik oranı ve direkt immünfloresan işleminin sonuçları not edildi. Paterji testi pozitif ve paterji testi negatif olan hastaların histopatolojilerinde vaskülit mi, vaskülopati mi olduğu tespit edildi ve iltihabi reaksiyon histopatolojik şiddetine göre bir ile üç arasında skorlandı. Histopatolojide perivasküler alandaki nötrofil, lenfosit, eozinofil ve mast hücrelerinin sayımı yapılarak yüzde olarak kaydedildi. Bulgular Çalışmaya katılan 88 Behçet hastasının 45'i kadın, 43'ü erkek hastaydı. Olguların yaş ortalaması 30,17±8,65 idi. Paterji testi pozitif 42 hastanın 23'ünde histopatolojik olarak vaskülit saptanırken, paterji testi negatif 46 hastanın 18'inde histopatolojik olarak vaskülit saptandı. Paterji testi pozitif olanlarda histopatolojisinde vaskülit görülme oranı paterji testi negatif olanlara göre istatistiksel olarak anlamlı farklı değildi (p=0,14). Çalışmamızda özellikle erkek cinsiyet ile üveit arasında ilişki sınırda anlamlı ve paterji pozitifliği ile üveit arasında da ilişki anlamlı saptanmamış olmasına rağmen histopatolojide vaskülit görülmesi ile üveit arasında anlamlı ilişki saptandı (p=0,023). Sonuç Paterji fenomeninin Behçet hastalığının tanısını koymada sensitiviteyi artırdığı ve gerçek hastaları yakalamadaki başarısının oldukça yüksek olduğu bilinmektedir. Fakat değerlendirmenin sadece klinik olarak yapılması testin yanlış pozitif veya yanlış negatif yorumlanması riskini doğurmaktadır. Çalışmamızdan yola çıkan sonuçlarla histopatolojinin paterji testinin klinik olarak şüphe oluşturan ve özellikle negatif paterji testi olan olgularda klinik değerlendirmeye katkı sağlayacağını düşünmekteyiz. Belki de paterji testinin gerçek değeri bu yaklaşımla daha iyi anlaşılabilir.
Behçet's disease is an inflammatory vasculitis which has a chronic course with attacks and remissions and its main pathology can involve almost every organ and system. Pathergy reaction is a unique clinical finding for the disease and is an indispensable element of the diagnostic criteria. In the literature, there is no study comparing the histopathology of negative pathergy test and positive pathergy test in newly diagnosed Behçet's patients. In our study, we aimed to compare the histopathological findings of skin biopsies obtained from pathergy positive and pathergy negative reaction sites of newly diagnosed Behçet's patients who are patergy positive and patergy negative. The primary goal was to investigate the frequency of vasculitis, which is an important finding of Behçet's disease, in the pathergy histopathology. Materials and Methods A total of 88 patients, 42 of whom were pathergy positive and 46 whom were pathergy negative who were admitted to the outpatient clinic of Skin and Venereal Diseases and diagnosed as Behçet's disease according to the International Study Group criteria were included in the study. Demographic characteristics, presenting complaints, family history, pathergy test positivity rate and results of direct immunofluorescence procedure of the patients included in the study were noted. The histopathology of patients with positive and negative pathergy tests revealed vasculitis or vasculopathy and the inflammatory reaction was scored between one and three according to the histopathological severity. In the histopathology, neutrophils, lymphocytes, eosinophils and mast cells in the perivascular area were counted and recorded as a percentage. Results Of the 88 Behçet patients who participated in the study, 45 were female and 43 were male. The mean age of the cases was 30.17±8.65 years. Vasculitis was detected histopathologically in 23 of 42 patients who were positive for pathergy test and vasculitis was detected histopathologically in 18 of 46 patients who were negative for pathergy test. The rate of vasculitis in histopathology of those who were positive for pathergy test was not statistically different than those of those with negative pathergy test (p=0,14). In our study, although the relationship between male gender and uveitis was significant at the border and the relationship between pathergy positivity and uveitis was not found to be significant, a significant relationship was found between vasculitis and uveitis in histopathology (p=0,023). Conclusion It is known that pathergy phenomenon increases the sensitivity in the diagnosis of Behçet's disease and its success in catching real patients is quite high. However, only clinical evaluation of the test poses the risk of false positive or false negative interpretation of the test. Based on the results of our study, we think that pathergy test of histopathology will contribute to the clinical evaluation in cases with suspicious clinical pathergy test and especially in cases with negative pathergy test. Perhaps the true value of the pathergy test can be better understood with this approach.
Behçet's disease is an inflammatory vasculitis which has a chronic course with attacks and remissions and its main pathology can involve almost every organ and system. Pathergy reaction is a unique clinical finding for the disease and is an indispensable element of the diagnostic criteria. In the literature, there is no study comparing the histopathology of negative pathergy test and positive pathergy test in newly diagnosed Behçet's patients. In our study, we aimed to compare the histopathological findings of skin biopsies obtained from pathergy positive and pathergy negative reaction sites of newly diagnosed Behçet's patients who are patergy positive and patergy negative. The primary goal was to investigate the frequency of vasculitis, which is an important finding of Behçet's disease, in the pathergy histopathology. Materials and Methods A total of 88 patients, 42 of whom were pathergy positive and 46 whom were pathergy negative who were admitted to the outpatient clinic of Skin and Venereal Diseases and diagnosed as Behçet's disease according to the International Study Group criteria were included in the study. Demographic characteristics, presenting complaints, family history, pathergy test positivity rate and results of direct immunofluorescence procedure of the patients included in the study were noted. The histopathology of patients with positive and negative pathergy tests revealed vasculitis or vasculopathy and the inflammatory reaction was scored between one and three according to the histopathological severity. In the histopathology, neutrophils, lymphocytes, eosinophils and mast cells in the perivascular area were counted and recorded as a percentage. Results Of the 88 Behçet patients who participated in the study, 45 were female and 43 were male. The mean age of the cases was 30.17±8.65 years. Vasculitis was detected histopathologically in 23 of 42 patients who were positive for pathergy test and vasculitis was detected histopathologically in 18 of 46 patients who were negative for pathergy test. The rate of vasculitis in histopathology of those who were positive for pathergy test was not statistically different than those of those with negative pathergy test (p=0,14). In our study, although the relationship between male gender and uveitis was significant at the border and the relationship between pathergy positivity and uveitis was not found to be significant, a significant relationship was found between vasculitis and uveitis in histopathology (p=0,023). Conclusion It is known that pathergy phenomenon increases the sensitivity in the diagnosis of Behçet's disease and its success in catching real patients is quite high. However, only clinical evaluation of the test poses the risk of false positive or false negative interpretation of the test. Based on the results of our study, we think that pathergy test of histopathology will contribute to the clinical evaluation in cases with suspicious clinical pathergy test and especially in cases with negative pathergy test. Perhaps the true value of the pathergy test can be better understood with this approach.
Açıklama
Anahtar Kelimeler
Behçet hastalığı, Behcet's disease, Paterji fenomeni, Pathergy phenomenon, Histopatoloji, Histopathology, Direkt immünfloresan, Direct immunofluorescence
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Temiz, S. A. (2020).Behçet tanısı alan hastaların paterji pozitif ve negatif alanlarının histopatolojik olarak karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Deri ve Zührevi Hastalıklar Anabilim Dalı, Konya.
