Graves hastalarında pan immun inflamasyon değerleri
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Tarih
2024
Yazarlar
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Graves hastalığı (GH), diffüz guatr ve hipertiroidizm ile karakterize bir çok
sistemi etkileyebilen tiroidin otoimmün bir hastalığıdır. Çalışmamızda Graves
hastalığında başta Pan İmmune İnflamasyon Değeri (PIV) olmak üzere inflamasyon
belirteçlerinin önemini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmamız için Ocak 2010 - Ocak 2023 tarihleri arasında N.E.Ü.
Meram Tıp Fakültesi Hastanesi Endokrinoloji ve Metabolizma Hastalıkları
Kliniği’ne başvurmuş 1422 Graves hastasından kriterlere uygun 267 hasta birey ve
123 ötiroid sağlıklı kontrol grubu belirlendi. Hematolojik hastalık, malignite,
romatolojik ve otoimmün hastalıklar, aktif veya kronik enfeksiyon, kemik iliğini
baskılayan ilaç kullanımı ve nutrisyonel eksiklikler olan hastalar dışlandı. Veriler
hastanenin HBYS bilgi sistemi üzerinden toplandı. Her iki grup arasında inflamasyon
belirteçleri (NLO, TLO, LMO, SII, PIV) karşılaştırıldı. Daha sonra remisyona giren
grup (grup 1): en az 12 ay anti-tiroid tedavi (ATİ) sonrası 12 aydan uzun süre ilaçsız
izlemde kalabilen hastalar, remisyona girmemiş grup (grup 2): 12 aydan uzun süre
remisyona girmemiş veya tedavi sonrası nüks etmiş hastalar olarak belirlendi. Yine
her iki grup arasında inflamasyon belirteçleri, TSH, T3, T4, TRAB, TMAB, TGAB,
sedimantasyon, CRP, ultrason bulguları, oftalmopati ve sigara kullanımı
karşılaştırıldı. Son olarak tedavi grupları arası: anti-tiroid tedavi, RAİ ve cerrahi
tedavi gören hastalar arasında aynı parametreler karşılaştırıldı. Araştırma sonucu elde
edilen veriler bilgisayar ortamında SPSS (Statistical Package for Social Sciences)
18.0 paket programı ile analiz edildi. Tüm testler için istatistiksel anlamlılık düzeyi
p<0,05 olarak kabul edildi.
Bulgular: Çalışmamıza dahil edilen Graves hastaları ve kontrol grupların
demografik verileri karşılaştırıldığında yaş ve cinsiyet bakımından anlamlı farklılık
saptanmadı. Graves hasta grubunda LMO değerleri kontrol grubuna göre istatistiksel
olarak anlamlı düşük saptandı (p=0,015). Remisyon (grup 1) ve remisyona
giremeyen (grup 2) (antitiroid tedaviye devam eden, RAİ almış olan yada
tiroidektomiden yapılanlar) Graves hastalarının inflamasyon belirteçleri ve
laboratuvar değerleri karşılaştırıldı. Grup 1’in PLO düzeyleri grup 2’ ye göre
istatistiksel olarak anlamlı yüksek bulundu (p=0,044). Grup 1 ve grup 2 arasında
nodül, guatr, oftalmopati ve sigara kullanım durumlarının karşılaştırıldı. Grup 2’de
guatr varlığı ve oftalmopati varlığı grup 1’e göre istatistiksel olarak anlamlı yüksek
bulundu (p=0,037, p=0,020). Graves hastalarının tedavi şekline göre nodül, guatr,
oftalmopati ve sigara kullanım durumlarının karşılaştırıldı.Cerrahi yapılan hastaların
oftalmopati varlığı diğer tedavi şekilleri uygulanan hastalara göre istatistiksel olarak
anlamlı yüksek bulundu (p=0,032).Çalışmaya alınan Graves hastalarının nodül
varlığı, guatr varlığı, sigara kullanımı ve oftalmopati varlığına göre inflamasyon
belirteç düzeyleri benzer olarak saptandı (p>0,05).Çalışmaya dahil edilen Graves
tanılı hastaların inflamasyon belirteçlerinin yaş ve laboratuvar değerleriyle ilişkisi de
incelendi. PIV düzeyi ile TSH ve CRP arasında pozitif yönde istatistiksel olarak
anlamlı düşük önemsiz korelasyon saptandı (r=0,171, r=0,195, p=0,048, p=0,028).
SII indeksi ile T3 arasında negatif yönde istatistiksel olarak anlamlı düşük-önemsiz
korelasyon bulundu (r=-0,178, p=0,004). NLO ile TSH arasında pozitif yönde; T3 ve
T4 arasında negatif yönde istatistiksel olarak anlamlı düşük-önemsiz korelasyon
saptandı (r=0,201, r=-0,242, r=-0,129, p=0,019, p<0,001, p=0,038).
Sonuç: LMO değeri Graves hastaları grubunda sağlıklı kontrol grubundan anlamlı
derece düşük bulunmuştur. Remisyona giren hastalarda PLO düzeyleri remisyona
giremeyenlere göre istatistiksel olarak anlamlı yüksek bulunmuştur. Ancak
çalışmanın esas hedefi olan PIV değeri açısından Graves hastaları ve sağlıklı kontrol
grubu arasında da remisyona giren ve remisyona girmemiş Graves hastalarında da
anlamlı bir farklılık bulunmamıştır. PIV değeri Graves hastalarında tanı anında
prognozu ön görmede kullanımı ile ilgili daha kapsamlı çalışmaya ihtiyaç olduğu
görülmüşür.
Objective: Graves' disease (GD) is an autoimmune disease of the thyroid characterized by diffuse goiter and hyperthyroidism that can affect multiple systems. In our study, we aimed to investigate the importance of inflammation markers, especially Pan immune Inflammation Value (PIV) in Graves' disease Materials and Methods:For our study, 267 patients and 123 euthyroid healthy controls were selected from 1422 Graves' disease patients who were admitted to the Endocrinology and Metabolic Diseases Clinic of N.E.U. Meram Medical Faculty Hospital between January 2010 and January 2023. Patients with hematologic disease, malignancy, rheumatologic and autoimmune diseases, active or chronic infection, bone marrow suppressing drug use and nutritional deficiencies were excluded. Data were collected through the hospital's HIS information system. Markers of inflammation (NLO, TLO, LMO, SII, PIV) were compared between both groups. The group that subsequently entered remission (group 1): patients who were able to remain in drug-free follow-up for more than 12 months after at least 12 months of anti-thyroid therapy (ATI), and the group that did not enter remission (group 2): Patients who were not in remission for more than 12 months or relapsed after treatment. Inflammation markers, TSH, T3, T4, TRAB, TMAB, TGAB, sedimentation, CRP, ultrasound findings, ophthalmopathy and smoking were compared between both groups. Finally, the same parameters were compared between treatment groups: anti-thyroid therapy, RAI and surgical treatment. The data obtained from the study were analyzed using SPSS (Statistical Package for Social Sciences) 18.0 package program. Statistical significance level was accepted as p<0.05 for all tests. Results: When the demographic data of the Graves' patients and control groups included in our study were compared, no significant difference was found in terms of age and gender. LMO values were statistically significantly lower in the Graves' patient group compared to the control group (p=0.015). Inflammation markers and laboratory values of Graves' patients in remission (group 1) and in remission (group 2) (those who continued antithyroid therapy, received RAI or underwent thyroidectomy) were compared. PLO levels of group 1 were statistically significantly higher than group 2 (p=0.044). Nodules, goiter, ophthalmopathy and smoking status were compared between group 1 and group 2. The presence of goiter and ophthalmopathy were statistically significantly higher in group 2 compared to group 1 (p=0.037, p=0.020). Nodules, goiter, ophthalmopathy and smoking status of Graves' disease patients were compared according to the type of treatment. The presence of ophthalmopathy in patients who underwent surgery was found to be statistically significantly higher than in patients who underwent other forms of treatment (p=0.032). Inflammation marker levels were similar in Graves' disease patients according to the presence of nodules, goiter, smoking and ophthalmopathy (p>0.05). The relationship between inflammation markers and age and laboratory values of the patients with Graves' disease included in the study was also analyzed. A statistically significant low insignificant correlation was found between PIV level and TSH and CRP (r=0.171, r=0.195, p=0.048, p=0.028). There was a statistically significant low-significant negative correlation between SII index and T3 (r=-0.178, p=0.004). There was a statistically significant low-significant correlation between NLO and TSH in a positive direction and between T3 and T4 in a negative direction (r=0.201, r=-0.242, r=-0.129, p=0.019, p<0.001, p=0.038). Conclusion: The LMO value was significantly lower in the Graves' disease group than in the healthy control group. PLO levels were statistically significantly higher in patients who went into remission compared to those who did not go into remission. However, in terms of PIV value, which is the main objective of the study, no significant difference was found between Graves' patients and healthy control group, nor between remission and non-remission Graves' patients. It has been observed that more comprehensive studies on the use of PIV value in predicting prognosis at the time of diagnosis in Graves' disease patients are needed.
Objective: Graves' disease (GD) is an autoimmune disease of the thyroid characterized by diffuse goiter and hyperthyroidism that can affect multiple systems. In our study, we aimed to investigate the importance of inflammation markers, especially Pan immune Inflammation Value (PIV) in Graves' disease Materials and Methods:For our study, 267 patients and 123 euthyroid healthy controls were selected from 1422 Graves' disease patients who were admitted to the Endocrinology and Metabolic Diseases Clinic of N.E.U. Meram Medical Faculty Hospital between January 2010 and January 2023. Patients with hematologic disease, malignancy, rheumatologic and autoimmune diseases, active or chronic infection, bone marrow suppressing drug use and nutritional deficiencies were excluded. Data were collected through the hospital's HIS information system. Markers of inflammation (NLO, TLO, LMO, SII, PIV) were compared between both groups. The group that subsequently entered remission (group 1): patients who were able to remain in drug-free follow-up for more than 12 months after at least 12 months of anti-thyroid therapy (ATI), and the group that did not enter remission (group 2): Patients who were not in remission for more than 12 months or relapsed after treatment. Inflammation markers, TSH, T3, T4, TRAB, TMAB, TGAB, sedimentation, CRP, ultrasound findings, ophthalmopathy and smoking were compared between both groups. Finally, the same parameters were compared between treatment groups: anti-thyroid therapy, RAI and surgical treatment. The data obtained from the study were analyzed using SPSS (Statistical Package for Social Sciences) 18.0 package program. Statistical significance level was accepted as p<0.05 for all tests. Results: When the demographic data of the Graves' patients and control groups included in our study were compared, no significant difference was found in terms of age and gender. LMO values were statistically significantly lower in the Graves' patient group compared to the control group (p=0.015). Inflammation markers and laboratory values of Graves' patients in remission (group 1) and in remission (group 2) (those who continued antithyroid therapy, received RAI or underwent thyroidectomy) were compared. PLO levels of group 1 were statistically significantly higher than group 2 (p=0.044). Nodules, goiter, ophthalmopathy and smoking status were compared between group 1 and group 2. The presence of goiter and ophthalmopathy were statistically significantly higher in group 2 compared to group 1 (p=0.037, p=0.020). Nodules, goiter, ophthalmopathy and smoking status of Graves' disease patients were compared according to the type of treatment. The presence of ophthalmopathy in patients who underwent surgery was found to be statistically significantly higher than in patients who underwent other forms of treatment (p=0.032). Inflammation marker levels were similar in Graves' disease patients according to the presence of nodules, goiter, smoking and ophthalmopathy (p>0.05). The relationship between inflammation markers and age and laboratory values of the patients with Graves' disease included in the study was also analyzed. A statistically significant low insignificant correlation was found between PIV level and TSH and CRP (r=0.171, r=0.195, p=0.048, p=0.028). There was a statistically significant low-significant negative correlation between SII index and T3 (r=-0.178, p=0.004). There was a statistically significant low-significant correlation between NLO and TSH in a positive direction and between T3 and T4 in a negative direction (r=0.201, r=-0.242, r=-0.129, p=0.019, p<0.001, p=0.038). Conclusion: The LMO value was significantly lower in the Graves' disease group than in the healthy control group. PLO levels were statistically significantly higher in patients who went into remission compared to those who did not go into remission. However, in terms of PIV value, which is the main objective of the study, no significant difference was found between Graves' patients and healthy control group, nor between remission and non-remission Graves' patients. It has been observed that more comprehensive studies on the use of PIV value in predicting prognosis at the time of diagnosis in Graves' disease patients are needed.
Açıklama
Anahtar Kelimeler
Graves hastalığı, Graves disease, Pan İmmun İnflamatuvar Değeri, Pan-Immune Inflammatory Value, Platelet Lenfosit Oranı, Platelet-Lymphocyte Ratio, Lenfosit Monosit Oranı., Lymphocyte-Monocyte Ratio.
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Polat, G. Ç. (2024). Graves hastalarında pan immun inflamasyon değerleri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
