Sistemik skleroz tanılı akciğer tutulumu olan ve olmayan hastalarda akciğer fibrozisi ile DKK2 düzeyleri arasındaki ilişkinin araştırılması
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Tarih
2024
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Necmettin Erbakan Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Bu tez projemizde sistemik sklerozis (skleroderma) tanısı alıp akciğer tutulumu olan ve tutulum görülmeyen hastalarda Dickkopf protein 2 düzeyinin tutulum ile ilişkisini değerlendirmeyi hedefledik.
Yöntem: Necmettin Erbakan Üniversitesi (NEÜ) Tıp Fakültesi Hastanesi Dahiliye Anabilimdalı Romatoloji bilimdalı poliklinik ve servislerinde takipli 60 sistemik skleroz tanısı almış hasta kayıt altına alındı.Hastaların yaş, cinsiyet, hastalık süresi gibi demografik bilgileri alındıktan sonra anamnez, fizik muayene, kan tahlilleri ve görüntülemeleri ile hastalığın tutulum tipi belirlendi. Diffüz (sistemik) tutulumu olanlar çalışmaya dahil edildi. Hastane kayıtlarından yüksek çözünürlüklü bilgisayarlı tomografi ve toraks tomografisi raporlarına göre interstisyel akciğer hastalığı araştırılıp var veya yok şeklinde kayıt edildi. Hasta ve kontrol grubunun ependorf tüplerine konularak ayrılan serumları, serum DKK2 düzeyi analiz edilene kadar -80 derecede saklandı. HemhastahemdekontrolgrubundaserumDKK2 düzeyleri hemogram ve biyokimyasal parametreleri bakıldı. Hastalık ile ilişkisi değerlendirildi.
Bulgular:Çalışmamıza, 30’u akciğer tutulumu olan sistemik skleroz (SSc) hastası, 30’u akciğer tutulumu olmayan SSc hastası ve 30’u sağlıklı kontrol grubu olmak üzere toplam 90 katılımcı dahil edilmiştir. Tüm katılımcıların %81.1’i (n: 73) kadın olup, gruplar arasında cinsiyet dağılımları benzerdir (p: 0.446).
Tüm katılımcıların %81.1’i (73/90) kadın olup, gruplar arasında cinsiyet dağılımları benzerdir (p=0.446).
Hastaların yaşlarına bakıldığında, sağlıklı kontrol grubunun yaş ortalaması (37.23 ± 10.08), SSc hastalarının yaşlarına göre (55.57 ± 11.03) anlamlı olarak daha küçük bulunmuştur. Başka bir deyişle, SSc hastalarının yaşları anlamlı olarak daha yüksektir.
Çalışmadaki SSc hastalarında tanı yaşı ve hastalık süresi de ayrıca değerlendirilmiştir. Tanı yaşı SSc hastalarında ortalama 48.55 ± 10.69 yıl olup; akciğer tutulumu olanlarda tanı yaşı (52.37±11.50), akciğer tutulumu olmayanlara (44.73±8.38) kıyasla anlamlı olarak daha yüksektir (p=0.005).
Hastalık süresine bakıldığında ise; bu parametre normal dağılmadığından iki grup arası karşılaştırma Mann-Whitney U testi ile yapılmış ve değerler ortanca (25-75.persentil) cinsiden ifade edilmiştir. SSc hastalarında ortanca hastalık süresi 108 ay (25-75p=36-126 ay) olup; bu süre akciğer tutulumu olanlarda daha kısadır (ortanca 66 ay vs. 120 ay), ancak aradaki fark sınırdan anlamsız çıkmıştır (p=0.056).
Çalışmamızda sigara içme durumlarına bakıldığında, akciğer tutulumu olan SSc hastalarının sigara içicisi olmama oranı (%80) anlamlı olarak daha yüksek saptanmıştır (p=0.010).
SSc hastaları ile kontrol grubu katılımcılarının ANA pozitifliği durumlarına bakıldığında, sağlıklı kontrol grubunda pozitiflik oranı %20 iken, SSc hastalarında ANA pozitifliği oranı %90 olup anlamlı oranda daha yüksektir (p<0.001).
SSc hastaları ile kontrol grubu katılımcılarının Anti-Scl70 pozitifliği durumlarına bakıldığında, kontrol grubunda hiçbir hastada Anti-Scl70 pozitif gelmezken, SSc hastalarının %65’inde pozitif saptanmıştır. Akciğer tutulumu olmayan hastalarda Anti-Scl70 pozitiflik oranı %70 iken, olanlarda ise %60’dır ve SSc hastalarında akciğer tutulumu ile Anti-Scl 70 pozitifliği arasında bir ilişki bulunmamıştır (p=0.417).
Pulmoner arter basıncı (PAB), SSc hastaların hepsine bakılamamış olsa da, çalışmamızda takip edilen 60 SSc hastasının 51’inde PAB bakılmıştır. Bunların 22’si akciğer tutulumu olmayan, 29’u ise akciğer tutulumu olan SSc hastalarıdır. Kontrol grubunda hiçbir katılımcının PAB değeri ölçülmediği için bu analizde kontrol grubu analiz dışı bırakılmıştır.
SSc hastalarında akciğer tutulumu varlığına göre PAB karşılaştırıldığında; akciğer tutulumu olmayan 22 hastada PAB için ortanca değer 29 (25-75p=26-32) olarak belirlenmiştir, buna karşın akciğer tutulumu olan 29 hastada ise PAB ortanca değeri 32 (25-75p=28-42) olarak kaydedilmiştir. Akciğer tutulumu olan SSc hastalarının PAB değeri daha yüksek olsa da, gruplar arasındaki fark sınırdan anlamlı çıkmamıştır (p=0.063).
İlaç kullanım durumlarına bakıldığında, sağlıklı kontrol grubunda sadece 1 hastanın prednizon kullandığı belirlenirken, diğer kontrol grubu hastalarının hiçbirinde ilaç kullanım öyküsü olmadığı belirlenmiştir. SSc hastalarında ise ilaç kullanım oranı %93.3 olarak belirlenmiştir.
SSc hastalarında en sık kullanılan ilaçların Nifedipin, Prednizolon ve Hidroksiklorokin olduğu belirlenmiştir. İlaç kullanımları açısından akciğer tutulumu olan ve olmayan SSc hastaları karşılaştırıldığında, üç ilaç hariç tüm ilaçların kullanım oranları benzerdir. Sadece siklofosfamid (p=0.049), kolşisin (p=0.049) ve AZA (p=0.014), akciğer tutulumu olan SSc hastalarında anlamlı olarak daha yüksek oranda kullanılan ilaçlar olarak belirlenmiştir.
Çalışmamızda akciğer tutulumu olan SSc hastalarında DKK2 düzeyleri ortanca değeri 9.08 (7.45 – 12.21) iken, akciğer tutulumu olmayan SSc hastalarında bu değer 8.89 (7.78 – 10.11) olarak belirlenmiştir. Bu iki grup arasında anlamlı farklılık olmadığı belirlenmiştir (p=0.615).
Ancak, sağlıklı kontrol grubunda DKK2 düzeyleri, hem akciğer tutulumu olan hem de olmayan SSc hastalarından anlamlı olarak daha düşüktür (p=0.011).
Cinsiyet ile DKK2 düzeyleri arasında anlamlı bir ilişki saptanmamıştır (p=0.140). Çalışmamız verilerine göre kadınlarda ortanca DKK2 düzeyleri (8.81) erkeklere kıyasla (7.40) hafif yüksek olsa da, aradaki fark istatistiksel anlamlı düzeye erişememiştir.
Cinsiyetlere göre hastalık durumunun varlığı ve şiddeti ile DKK2 arasındaki ilişki incelendiğinde kontrol grubunda ve akciğer tutulumu olmayan SSc hastalarında kadınlarda DKK2 düzeyleri erkeklere kıyasla hafif yüksektir ancak aradaki fark anlamlı değildir (sırasıyla p=0.266 ve p=0.152). SSc tutulumu olan erkek hastalarda ise DKK2 düzeyleri kadınlardan hafif daha yüksektir, ancak aradaki fark yine anlamlı düzeyde değildir (p=0.978). DKK2 düzeyleri hiçbir grupta yaş, beyaz küre sayısı ve nötrofil sayısı ile ilişkili bulunmamıştır.
Akciğer tutulumu olmayan SSc hastalarında DKK2 düzeyleri ile lenfosit düzeyleri arasında pozitif, orta düzeyde ve anlamlı bir korelasyon olduğu belirlenmiştir (p=0.015). Yani akciğer tutulumu olmayan SSc hastalarında DKK2 düzeyleri arttıkça lenfosit sayısı da anlamlı olarak artmaktadır.
DKK2 düzeyleri ile monosit sayısı, hemoglobin düzeyleri ve platelet sayısı ile de hiçbir grupta anlamlı ilişki saptanmamıştır.
DKK2 düzeyleri hiçbir grupta sedimantasyon ve CRP değerleri ile anlamlı korelasyon göstermemiştir.
DKK2 düzeyleri, pulmoner tutulumu olmayan grupta, üre düzeyleri ile negatif, orta düzeyde ve anlamlı bir korelasyon göstermiştir (p=0.016). Yani bu hasta grubunda üre düzeyleri artarken DKK2 düzeyleri azalmaktadır.
Yine aynı grupta, pulmoner tutulumu olmayan SSc hastalarında,DKK2 düzeyleri ile ürik asit düzeyleri arasında pozitif yönlü, çok kuvvetli ve anlamlı bir korelasyon saptanmıştır. Bu hastalarda DKK2 düzeyleri arttıkça ürik asit düzeyleri de artmaktadır (p<0.001).
DKK2 düzeyleri, pulmoner tutulumu olmayan grupta, trigliserid düzeyleri ile pozitif, orta düzeyde ve anlamlı bir korelasyon göstermiştir (p=0.004). Yani bu hasta grubunda trigliserid düzeyleri artarken DKK2 düzeyleri de artmaktadır.
DKK2 düzeyleri ile D vitamini, B12 vitamini, folik asit, ferritin, demir ve demir bağlama kapasiteleri arasında hiçbir grupta anlamlı bir korelasyon saptanmamıştır.
DKK2 düzeyleri ile TSH düzeyleri arasında, sadece sağlıklı kontrol grubunda, negatif, orta düzeyde ve anlamlı bir korelasyon saptanmıştır (p=0.023). Buna göre sağlıklı kontrollerde DKK2 düzeyleri arttıkça TSH düzeyleri azalmaktadır (tam tersi de geçerlidir).
SSc hastalarında DKK2 düzeyleri ile tiroid fonksiyon testleri arasında anlamlı bir korelasyon yoktur.
Sonuç:Çalışma konumuz olan Sklerodermalı 60 hastada DKK-2 düzeyleri ile akciğer tutulumu arasında SSc'li pulmoner tutulum olan hastalarda DKK-2 protein düzeyi yüksek bulunmuş fakat bu yükseklik bir anlam teşkil etmemiştir.
Hasta bireylerde cinsiyete göre DKK-2 protein düzeyi karşılaştırmasında kadın-erkek cinsiyet arasında istatistiksel açıdan anlamlı fark bulunmamıştır.
Sistemik sklerozlu hastalarda akciğer tutulumu ileri yaşlarda görülmüştür. Akciğer tutulumu olan grubun yaş ortalaması gruplar arasında en yüksektir.
Sistemik sklerozisli hastalarda DKK-2 düzeyi ile hemogram parametlerinden sadece lenfosit düzeyi ile pozitif korelasyon saptanmıştır.
Çalışmamızda dikkat çekici bir başka sonuç DKK-2 düzeyleri ile hiçbir grupta sedimantasyon ve crp arasında istatistiki yönden anlamlı ilişki olmayışıdır.
Hastalarımızın hiçbirinde skleroderma renal kriz ve kardiyal tutulum görülmemesi hem SSc tedavi alanında gösterilen ilerleme hem de sağlık hizmetlerine ulaşımın kolaylaşıp hastaların farkındalığının arttığı yönünde yorumlandı.
Bu çalışma ile ilk kez skleroderma ve dickkopf protein 2 arasındaki ilişki irdelenmiş ve literatüre katkı yapmak amaçlanmıştır. Daha geniş hasta popülasyonları ile daha çok sayıda çalışmaya ihtiyaç olduğu sonucuna varılmıştır.
Objective:In this research project, we aimed to evaluate the relationship between dipckof protein 2 level and involvement in patients diagnosed with systemic sclerosis with and without lung involvement. Materials and methods: 80 patients diagnosed with systemic sclerosis who were followed up in the outpatient clinics and services of Necmettin Erbakan University (NEU) Meram Faculty of Medicine Hospital, Department of Internal Medicine, Department of Rheumatology, were recorded. After obtaining the patients' demographic information such as age, gender, and disease duration, the type of disease involvement was determined by anamnesis, physical examination, blood tests and imaging. Those with diffuse (systemic) involvement were included. According to high-resolution computed tomography and thorax tomography reports from hospital records, interstitial lung disease was investigated and recorded as present or absent. The serums of the patient and control groups were placed in Eppendorf tubes and stored at -80 degrees until the serum DKK2 level was analyzed. Serum DKK2 levels, hemogram and biochemistry were measured in both patient and control groups. Its relationship with the disease was evaluated. Results:A total of 90 participants were included in our study, 30 of whom were systemic sclerosis (SS) patients with lung involvement, 30 of whom were SS patients without lung involvement, and 30 of whom were healthy control groups. 81.1% (n: 73) of all participants were women, and gender distributions were similar between groups (p: 0.446). 81.1% (73/90) of all participants were women, and gender distributions were similar between groups (p = 0.446). Considering the ages of the patients, the average age of the healthy control group (37.23 ± 10.08) was found to be significantly younger than the age of the SSc patients (55.57 ± 11.03). In other words, the ages of SSc patients are significantly higher. Age at diagnosis and disease duration were also evaluated in SSc patients. Mean and standard deviation values are given for the age at diagnosis, which complies with normal distribution, and t-test was applied in independent groups for comparison. The average age at diagnosis in SS patients is 48.55 ± 10.69 years; The age at diagnosis in patients with lung involvement (52.37±11.50) was significantly higher compared to those without lung involvement (44.73±8.38) (p=0.005). When looking at the duration of the disease; Since this parameter is not normally distributed, comparison between the two groups was made with the Mann-Whitney U test and the values are expressed as median (25-75th percentile). The median disease duration in SSc patients is 108 months (25-75p=36-126 months); This period is shorter in those with lung involvement (median 66 months vs. 120 months), but the difference was borderline insignificant (p=0.056).In our study, the median value of DKK2 levels in SSc patients with lung involvement was 9.08 (7.45 – 12.21), while this value was determined as 8.89 (7.78 – 10.11) in SSc patients without lung involvement. It was determined that there was no significant difference between these two groups (p=0.615). When we look at the smoking status in our study, the rate of non-smokers (80%) in SSc patients with lung involvement was found to be significantly higher (p = 0.010). Considering the ANA positivity status of SSc patients and control group participants, while the positivity rate is 20% in the healthy control group, the ANA positivity rate in SS patients is 90% and is significantly higher (p<0.001). When the Anti-Scl70 positivity status of SSc patients and control group participants was examined, while no patient in the control group was Anti-Scl70 positive, it was found positive in 65% of SSc patients. While the Anti-Scl70 positivity rate was 70% in patients without lung involvement, it was 60% in those with lung involvement, and there was no relationship between lung involvement and SCL70 positivity in SSc patients (p = 0.417). Although pulmonary artery pressure (PAP) could not be measured in all SSc patients, PAP was measured in 51 of the 60 SSc patients followed in our study. 22 of these are SSc patients without lung involvement, and 29 are SSc patients with lung involvement. Since no participant's PAP value was measured in the control group, the control group was excluded from this analysis. When PAP was compared according to the presence of lung involvement in SSc patients; In 22 patients without lung involvement, the median value for PAP was determined as 29 (25-75p=26-32), whereas in 29 patients with lung involvement, the median PAP value was recorded as 32 (25-75p=28-42). Although SSc patients with lung involvement had higher PAP values, the difference between the groups was not borderline significant (p=0.063). When drug use status was examined, it was determined that only one patient in the healthy control group used prednisone, while none of the other control group patients had a history of drug use. The drug use rate in SS patients was determined as 93.3%. It has been determined that the most commonly used drugs in SS patients are Nifedipine, prednisolone and hydroxychloroquine. When SS patients with and without lung involvement are compared in terms of drug use, the use rates of all drugs except three drugs are similar. Only cyclophosphamide (p: 0.049), colchicine (p: 0.049) and AZA (p: 0.014) were determined as the drugs used at a significantly higher rate in SS patients with lung involvement. However, DKK2 levels in the healthy control group were significantly lower than in SSc patients both with and without lung involvement (p=0.011). No significant relationship was found between gender and DKK2 levels (p=0.140). According to our study data, although the median DKK2 levels in women (8.81) were slightly higher than in men (7.40), the difference did not reach statistical significance. When the relationship between the presence and severity of the disease condition and DKK2 is examined according to gender, DKK2 levels in women are slightly higher than in men in the control group and in SSc patients without lung involvement, but the difference is not significant (p=0.266 and p=0.152, respectively). In male patients with SSc involvement, DKK2 levels are slightly higher than in females, but the difference is still not significant (p=0.978). DKK2 levels were not associated with age, white blood cell count and neutrophil count in any group. It was determined that there was a positive, moderate and significant correlation between DKK2 levels and lymphocyte levels in SSc patients without lung involvement (p=0.015). In other words, as DKK2 levels increase in SSc patients without lung involvement, the number of lymphocytes also increases significantly. No significant relationship was found between DKK2 levels and monocyte count, hemoglobin levels and platelet count in any group. DKK2 levels did not show a significant correlation with sedimentation and CRP values in any group. DKK2 levels showed a negative, moderate and significant correlation with urea levels in the group without pulmonary involvement (p=0.016). In other words, while urea levels increase in this patient group, DKK2 levels decrease. Again, in the same group, a positive, very strong and significant correlation was detected between DKK2 levels and uric acid levels in SSc patients without pulmonary involvement. As DKK2 levels increase in these patients, uric acid levels also increase (p<0.001). DKK2 levels showed a positive, moderate and significant correlation with triglyceride levels in the group without pulmonary involvement (p=0.004). In other words, as triglyceride levels increase in this patient group, DKK2 levels also increase. No significant correlation was detected between DKK2 levels and vitamin D, vitamin B12, folic acid, ferritin, iron and iron binding capacities in any group. A negative, moderate and significant correlation was detected between DKK2 levels and TSH levels only in the healthy control group (p=0.023). Accordingly, as DKK2 levels increase in healthy controls, TSH levels decrease (and vice versa). There is no significant correlation between DKK2 levels and TSH in SSc patients. Conclusion:In our study subject, 60 patients with scleroderma, the difference between DKK-2 levels and lung involvement was found to be high in patients with SSc and pulmonary involvement, but this level was not significant. When comparing DKK-2 protein levels according to gender in patient individuals, no statistically significant difference was found between male and female gender. Lung involvement has been seen at older ages in patients with systemic sclerosis. The average age of the group with lung involvement is the highest among the groups. In patients with systemic sclerosis, a positive correlation was found between the DKK-2 level and the lymphocyte level among hemogram parameters. Another striking result in our study is that there is no statistically significant relationship between DKK-2 levels and sedimentation and CRP in any group. The fact that none of our patients had scleroderma renal crisis or cardiac involvement was interpreted as both the progress made in the field of SSc treatment and the ease of access to health services and increased awareness of patients. With this study, the relationship between scleroderma and Dickkopf protein 2 was examined for the first time and it was aimed to contribute to the literature. It was concluded that more studies with larger patient populations are needed.
Objective:In this research project, we aimed to evaluate the relationship between dipckof protein 2 level and involvement in patients diagnosed with systemic sclerosis with and without lung involvement. Materials and methods: 80 patients diagnosed with systemic sclerosis who were followed up in the outpatient clinics and services of Necmettin Erbakan University (NEU) Meram Faculty of Medicine Hospital, Department of Internal Medicine, Department of Rheumatology, were recorded. After obtaining the patients' demographic information such as age, gender, and disease duration, the type of disease involvement was determined by anamnesis, physical examination, blood tests and imaging. Those with diffuse (systemic) involvement were included. According to high-resolution computed tomography and thorax tomography reports from hospital records, interstitial lung disease was investigated and recorded as present or absent. The serums of the patient and control groups were placed in Eppendorf tubes and stored at -80 degrees until the serum DKK2 level was analyzed. Serum DKK2 levels, hemogram and biochemistry were measured in both patient and control groups. Its relationship with the disease was evaluated. Results:A total of 90 participants were included in our study, 30 of whom were systemic sclerosis (SS) patients with lung involvement, 30 of whom were SS patients without lung involvement, and 30 of whom were healthy control groups. 81.1% (n: 73) of all participants were women, and gender distributions were similar between groups (p: 0.446). 81.1% (73/90) of all participants were women, and gender distributions were similar between groups (p = 0.446). Considering the ages of the patients, the average age of the healthy control group (37.23 ± 10.08) was found to be significantly younger than the age of the SSc patients (55.57 ± 11.03). In other words, the ages of SSc patients are significantly higher. Age at diagnosis and disease duration were also evaluated in SSc patients. Mean and standard deviation values are given for the age at diagnosis, which complies with normal distribution, and t-test was applied in independent groups for comparison. The average age at diagnosis in SS patients is 48.55 ± 10.69 years; The age at diagnosis in patients with lung involvement (52.37±11.50) was significantly higher compared to those without lung involvement (44.73±8.38) (p=0.005). When looking at the duration of the disease; Since this parameter is not normally distributed, comparison between the two groups was made with the Mann-Whitney U test and the values are expressed as median (25-75th percentile). The median disease duration in SSc patients is 108 months (25-75p=36-126 months); This period is shorter in those with lung involvement (median 66 months vs. 120 months), but the difference was borderline insignificant (p=0.056).In our study, the median value of DKK2 levels in SSc patients with lung involvement was 9.08 (7.45 – 12.21), while this value was determined as 8.89 (7.78 – 10.11) in SSc patients without lung involvement. It was determined that there was no significant difference between these two groups (p=0.615). When we look at the smoking status in our study, the rate of non-smokers (80%) in SSc patients with lung involvement was found to be significantly higher (p = 0.010). Considering the ANA positivity status of SSc patients and control group participants, while the positivity rate is 20% in the healthy control group, the ANA positivity rate in SS patients is 90% and is significantly higher (p<0.001). When the Anti-Scl70 positivity status of SSc patients and control group participants was examined, while no patient in the control group was Anti-Scl70 positive, it was found positive in 65% of SSc patients. While the Anti-Scl70 positivity rate was 70% in patients without lung involvement, it was 60% in those with lung involvement, and there was no relationship between lung involvement and SCL70 positivity in SSc patients (p = 0.417). Although pulmonary artery pressure (PAP) could not be measured in all SSc patients, PAP was measured in 51 of the 60 SSc patients followed in our study. 22 of these are SSc patients without lung involvement, and 29 are SSc patients with lung involvement. Since no participant's PAP value was measured in the control group, the control group was excluded from this analysis. When PAP was compared according to the presence of lung involvement in SSc patients; In 22 patients without lung involvement, the median value for PAP was determined as 29 (25-75p=26-32), whereas in 29 patients with lung involvement, the median PAP value was recorded as 32 (25-75p=28-42). Although SSc patients with lung involvement had higher PAP values, the difference between the groups was not borderline significant (p=0.063). When drug use status was examined, it was determined that only one patient in the healthy control group used prednisone, while none of the other control group patients had a history of drug use. The drug use rate in SS patients was determined as 93.3%. It has been determined that the most commonly used drugs in SS patients are Nifedipine, prednisolone and hydroxychloroquine. When SS patients with and without lung involvement are compared in terms of drug use, the use rates of all drugs except three drugs are similar. Only cyclophosphamide (p: 0.049), colchicine (p: 0.049) and AZA (p: 0.014) were determined as the drugs used at a significantly higher rate in SS patients with lung involvement. However, DKK2 levels in the healthy control group were significantly lower than in SSc patients both with and without lung involvement (p=0.011). No significant relationship was found between gender and DKK2 levels (p=0.140). According to our study data, although the median DKK2 levels in women (8.81) were slightly higher than in men (7.40), the difference did not reach statistical significance. When the relationship between the presence and severity of the disease condition and DKK2 is examined according to gender, DKK2 levels in women are slightly higher than in men in the control group and in SSc patients without lung involvement, but the difference is not significant (p=0.266 and p=0.152, respectively). In male patients with SSc involvement, DKK2 levels are slightly higher than in females, but the difference is still not significant (p=0.978). DKK2 levels were not associated with age, white blood cell count and neutrophil count in any group. It was determined that there was a positive, moderate and significant correlation between DKK2 levels and lymphocyte levels in SSc patients without lung involvement (p=0.015). In other words, as DKK2 levels increase in SSc patients without lung involvement, the number of lymphocytes also increases significantly. No significant relationship was found between DKK2 levels and monocyte count, hemoglobin levels and platelet count in any group. DKK2 levels did not show a significant correlation with sedimentation and CRP values in any group. DKK2 levels showed a negative, moderate and significant correlation with urea levels in the group without pulmonary involvement (p=0.016). In other words, while urea levels increase in this patient group, DKK2 levels decrease. Again, in the same group, a positive, very strong and significant correlation was detected between DKK2 levels and uric acid levels in SSc patients without pulmonary involvement. As DKK2 levels increase in these patients, uric acid levels also increase (p<0.001). DKK2 levels showed a positive, moderate and significant correlation with triglyceride levels in the group without pulmonary involvement (p=0.004). In other words, as triglyceride levels increase in this patient group, DKK2 levels also increase. No significant correlation was detected between DKK2 levels and vitamin D, vitamin B12, folic acid, ferritin, iron and iron binding capacities in any group. A negative, moderate and significant correlation was detected between DKK2 levels and TSH levels only in the healthy control group (p=0.023). Accordingly, as DKK2 levels increase in healthy controls, TSH levels decrease (and vice versa). There is no significant correlation between DKK2 levels and TSH in SSc patients. Conclusion:In our study subject, 60 patients with scleroderma, the difference between DKK-2 levels and lung involvement was found to be high in patients with SSc and pulmonary involvement, but this level was not significant. When comparing DKK-2 protein levels according to gender in patient individuals, no statistically significant difference was found between male and female gender. Lung involvement has been seen at older ages in patients with systemic sclerosis. The average age of the group with lung involvement is the highest among the groups. In patients with systemic sclerosis, a positive correlation was found between the DKK-2 level and the lymphocyte level among hemogram parameters. Another striking result in our study is that there is no statistically significant relationship between DKK-2 levels and sedimentation and CRP in any group. The fact that none of our patients had scleroderma renal crisis or cardiac involvement was interpreted as both the progress made in the field of SSc treatment and the ease of access to health services and increased awareness of patients. With this study, the relationship between scleroderma and Dickkopf protein 2 was examined for the first time and it was aimed to contribute to the literature. It was concluded that more studies with larger patient populations are needed.
Açıklama
Anahtar Kelimeler
Sistemik sklerozis, Systemic sclerozis, Pulmoner tutulum, Pulmonary involvement, İdiyopatik Pulmoner Fibroz, Idiopathic Pulmonary Fibrosis, Dickkopf protein 2 WNT Sinyal yolu İnhibitörü, Dickkopf protein 2 WNT Signaling pathway Inhibitor
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Ekici, N. (2024). Sistemik skleroz tanılı akciğer tutulumu olan ve olmayan hastalarda akciğer fibrozisi ile DKK2 düzeyleri arasındaki ilişkinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
