Akut herpes zoster geçiren diabetes mellitus'lu hastalarda immünolojik belirteç seviyelerinin postherpetik nevralji gelişimindeki etkisi
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Tarih
2023
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Nöropatik ağrı somatosensöriyel sistemin bir lezyonu veya hastalığından kaynaklanan bir ağrıdır ve
patogenezi halen net olarak ortaya konulamamıştır. Tüm dünyada yapılan son çalışmalar immünolojik
mekanizmaların etkin rol oynadığını düşündürmektedir. Bu çalışmada Akut Herpes Zoster (AHZ) geçirmekte olan
hastalarda, bir nöropatik ağrı sebebi olan Postherpetik Nevralji (PHN)’ ye ilerlemesinde immün mekanizmaların
rolü ve Diyabetes Mellitus’ un immün belirteçler üzerindeki etkisi araştırılmıştır.
Yöntem: Akut Herpes Zoster sonrası nöropatik ağrısı olan 20 hasta çalışmaya alındı. Diyabetes mellitusu olan 10
hasta grup I ve diyabetes mellitusu olmayan 10 hasta grup II olarak iki gruba ayrıldı. İlk başvuru anında hemogram,
C- Reaktif Protein (CRP), sedimentasyon (ESR), hemoglobin A1c, kan glukozu ölçümleri çalışıldı. Aynı kan
örneklerinden, immünolojik belirteç seviyeleri çalışıldı. Hastalar düzenli aralıklarla kontrollere çağırılarak 3.
aydaki kontrol muayenesinde alınan kan örneklerinde kontrol kan değerleri ve immünolojik belirteç seviyeleri
çalışıldı.Hastaların ağrı şiddetini ölçmek için nümerik derecelendirme skalası (NRS), ağrının uykuya etkisini
ölçmek için uyku interferans skorlaması (SIS) ve nöropatik ağrının değerlendirilmesinde DN4 ağrı skorlaması
kullanıldı. Çalışmamızda nöropatik ağrının oluşumunda ve kronikleşmesinde immünolojik mekanizmaların rolünü
değerlendirmek amacıyla literatüre uygun olarak, CD3+, CD4+, CD8+, T regülatuar (Foxp3), NK (defektif,
sitotoksik ve regulatuar subünitleri) NK CD56 (bright ve dim subünitleri) ve NK CD57 hücre düzeyleri çalışıldı.
Bulgular: Çalışmamıza alınan grup I ve II deki hastaların demografik özellikleri benzerdi. Rutin laboratuvar
tetkikleri arasında grup II’ deki hastaların tedaviyle crp ve sedimentasyon (ESR) değerleri anlamlı olarak azalırken;
diyabetik grupta anlamlı değişim olmadı. İmmünolojik belirteçlere bakıldığında ise grup I ve II’ deki hastaların
değerleri kıyaslandığında NK defektif subset başlangıç anında ve tedavi sonunda çalışılan değerler istatistiksel
olarak farklıydı. Grup içinde başlangıç ve 3.aydaki immün belirteç değişimlerine bakıldığında ise; diyabetik grupta
CD3+, CD4+, CD8+ değerleri tedaviyle anlamlı olarak azalırken, diyabetik olmayan grupta NK hücre alt grupları
olan defektif subset ve regülatuar subset değerleri anlamlı olarak azaldı. Bunun dışındaki grup I ve II deki diğer
immünolojik marker seviyelerin değişimi istatistiksel olarak anlamlı değildi.
Sonuç: Çalışmamızda diyabetes mellitus varlığının, zona ağrısının kronikleşerek postherpetik nevraljiye
dönüşmesinde ve sitokinler üzerinde etkisinin gösterilmesi hedeflenmiştir. Diyabetes mellitus varlığından
bağımsız olarak hastalığın erken döneminde uygun tedavi başlanan hastalarda ağrının kronikleşmesinin önüne
geçilebilir. Postherpetik Nevralji gelişen hastalarda diyabetes melltiusun immün belirteçler üzerindeki etkisinin
araştırılması için daha geniş çaplı randomize prospektif çalışmalara ihtiyaç vardır. Ayrıca AHZ’ ye bağlı nöropatik
ağrı semptomlarının kontrol altına alınmasında kullanılan gabapentinoid türü adjuvan ajanların sitokin düzeyleri
üzerine inhibisyon yapma olasılığı da göz önünde bulundurulmalı ve sağlıklı kontrol grubunu da içeren geniş çaplı
çalışmalara ihtiyaç vardır.
Purpose: Neuropathic pain is pain arising from a lesion or disease of the somatosensory system and its pathogenesis has not been clearly revealed yet. Recent studies all over the world suggest that immunological mechanisms play an active role. In this study, the role of immune mechanisms in the progression to Postherpetic Neuralgia (PHN), which is a cause of neuropathic pain, and the effect of Diabetes Mellitus on immune markers were investigated in patients suffering from Acute Herpes Zoster (AHZ). Method: Twenty patients with neuropathic pain after acute Herpes Zoster were included in the study. Ten patients with diabetes mellitus were divided into group I and 10 patients without diabetes mellitus were divided into two groups as group II. At the first admission, hemogram, C-Reactive Protein (CRP), sedimentation (ESR), hemoglobin A1c, blood glucose measurements were studied. Immunological marker levels were studied from the same blood samples. Control blood values and immunological marker levels were studied in the blood samples taken at the control examination at the 3rd month by calling the patients at regular intervals. Numerical rating scale (NRS) was used to measure the pain severity of the patients, sleep interference scoring (SIS) to measure the effect of pain on sleep, and DN4 for the evaluation of neuropathic pain. pain scoring was used. In our study, in accordance with the literature, CD3+, CD4+, CD8+, T regulatory (Foxp3), NK (defective, cytotoxic and regulatory subunits), NK CD56 (bright and dim subunits) and NK CD57 cell levels were studied in order to evaluate the role of immunological mechanisms in the formation and chronicity of neuropathic pain. . Results: The demographic characteristics of the patients in groups I and II included in our study were similar. Among the routine laboratory tests, the CRP and sedimentation (ESR) values of the patients in group II decreased significantly with treatment; There was no significant change in the diabetic group. When the immunological markers were compared, when the values of the patients in groups I and II were compared, the values studied at the beginning of the NK defective subset and at the end of the treatment were statistically different. Considering the changes in immune markers in the group at the beginning and at the 3rd month; While CD3+, CD4+, CD8+ values decreased significantly with treatment in the diabetic group, defective subset and regulatory subset values, which are NK cell subsets, decreased significantly in the non-diabetic group. Apart from this, the change in other immunological marker levels in groups I and II was not statistically significant. Conclusion: In our study, it was aimed to show the effect of the presence of diabetes mellitus on the transformation of shingles pain into chronic postherpetic neuralgia and on cytokines. Regardless of the presence of diabetes mellitus, chronic pain can be prevented in patients who receive appropriate treatment in the early stages of the disease. Larger randomized prospective studies are needed to investigate the effect of diabetes melltius on immune markers in patients who develop postherpetic neuralgia. In addition, the possibility of inhibition on cytokine levels of gabapentinoid-type adjuvant agents used to control neuropathic pain symptoms related to AHZ should be considered, and large-scale studies including healthy control groups are needed.
Purpose: Neuropathic pain is pain arising from a lesion or disease of the somatosensory system and its pathogenesis has not been clearly revealed yet. Recent studies all over the world suggest that immunological mechanisms play an active role. In this study, the role of immune mechanisms in the progression to Postherpetic Neuralgia (PHN), which is a cause of neuropathic pain, and the effect of Diabetes Mellitus on immune markers were investigated in patients suffering from Acute Herpes Zoster (AHZ). Method: Twenty patients with neuropathic pain after acute Herpes Zoster were included in the study. Ten patients with diabetes mellitus were divided into group I and 10 patients without diabetes mellitus were divided into two groups as group II. At the first admission, hemogram, C-Reactive Protein (CRP), sedimentation (ESR), hemoglobin A1c, blood glucose measurements were studied. Immunological marker levels were studied from the same blood samples. Control blood values and immunological marker levels were studied in the blood samples taken at the control examination at the 3rd month by calling the patients at regular intervals. Numerical rating scale (NRS) was used to measure the pain severity of the patients, sleep interference scoring (SIS) to measure the effect of pain on sleep, and DN4 for the evaluation of neuropathic pain. pain scoring was used. In our study, in accordance with the literature, CD3+, CD4+, CD8+, T regulatory (Foxp3), NK (defective, cytotoxic and regulatory subunits), NK CD56 (bright and dim subunits) and NK CD57 cell levels were studied in order to evaluate the role of immunological mechanisms in the formation and chronicity of neuropathic pain. . Results: The demographic characteristics of the patients in groups I and II included in our study were similar. Among the routine laboratory tests, the CRP and sedimentation (ESR) values of the patients in group II decreased significantly with treatment; There was no significant change in the diabetic group. When the immunological markers were compared, when the values of the patients in groups I and II were compared, the values studied at the beginning of the NK defective subset and at the end of the treatment were statistically different. Considering the changes in immune markers in the group at the beginning and at the 3rd month; While CD3+, CD4+, CD8+ values decreased significantly with treatment in the diabetic group, defective subset and regulatory subset values, which are NK cell subsets, decreased significantly in the non-diabetic group. Apart from this, the change in other immunological marker levels in groups I and II was not statistically significant. Conclusion: In our study, it was aimed to show the effect of the presence of diabetes mellitus on the transformation of shingles pain into chronic postherpetic neuralgia and on cytokines. Regardless of the presence of diabetes mellitus, chronic pain can be prevented in patients who receive appropriate treatment in the early stages of the disease. Larger randomized prospective studies are needed to investigate the effect of diabetes melltius on immune markers in patients who develop postherpetic neuralgia. In addition, the possibility of inhibition on cytokine levels of gabapentinoid-type adjuvant agents used to control neuropathic pain symptoms related to AHZ should be considered, and large-scale studies including healthy control groups are needed.
Açıklama
Anahtar Kelimeler
Postherpetik Nevralji, Nöropatik ağrı, Sitokinler, Diyabetes mellitus, Postherpetic Neuralgia, Neuropathic pain, Cytokines, Diabetes mellitus
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Demiralp, N. (2023). Akut herpes zoster geçiren diabetes mellitus'lu hastalarda immünolojik belirteç seviyelerinin postherpetik nevralji gelişimindeki etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
