İmmun trombositopenide lenfosit kemoatraktan düzeylerinin değerlendirilmesi
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/embargoedAccess
Özet
İmmün trombositopeni (İTP) trombositlere karşı oluşan otoantikorların trombosit yıkımını arttırması, T hücre aracılı immün yıkım ve kemik iliğinde bozulmuş megakaryopoez sonucunda trombosit yaşam süresinde kısalma ve trombositopeni kliniği ile seyreden edinsel bir hastalıktır. T hücre aktivasyonu ve göçü karmaşık bir süreç olup bu süreçte bir dizi kemokin ve kemokin reseptörü görev alır. Kemokinler protein yapısında küçük kemotaktik sitokinler olup anjiyogenez, hematopoez, mast hücresi degranülasyonu, T hücre farklılaşması ve lökosit hareketliliği gibi birçok alanda rol alırlar. Çalışmamıza 85 İTP tanılı hasta ve yaş, cinsiyet, benzer bilinen bir kronik hastalığı olmayan ve ilaç kullanmayan 85 gönüllü dahil edildi. Sekonder İTP tanısı olması, kronik İTP tanısı olması, başvuru anında yüksek ESR ve CRP düzeylerinin olması dışlama kriterleri olarak kabul edildi. Hasta ve sağlıklı gönüllülerden alınan kan örneklerinden, ELISA yöntemi ile hedef moleküller olan CCL18, CCL20, CCL21 ve TRAF6 düzeyleri kitler içerisindeki çalışma prensiplerine göre ölçüldü. Hastaların yaş ortalaması 45,72 (22-87) yıl olup, erkek/ kadın oranı 0.30 (20/65) idi. 61 hastada majör veya minör kanama görüldü (%71,8). Hayatı tehdit edici kanama ise 5 hastada gözlendi (%5,9). Hasta grubunda ortalama TRAF6 düzeyi 2348 pg/mL, CCL18 düzeyi 132,97 ug/mL, CCL20 düzeyi 55,02 pg/mL, CCL21 düzeyi ise 3006,74 pg/mL, kontrol grubunda ise ortalama TRAF6 düzeyi 25,57 pg/mL, CCL18 düzeyi 116,53 ug/mL, CCL20 düzeyi 76,6 pg/mL ve CCL21 düzeyi ise 2476,26 pg/mL olarak ölçüldü. TRAF6 düzeyinde hasta ve kontrol grubunda istatistiksel anlamlı olarak farklılık saptandı (p=0,000). Hasta grubunda trombosit değerlerine göre 0-25.000/mm3, 26- 50.000/mm3, 51-75.000/mm3 ve 76-100.000/mm3 olarak yapılan dörtlü gruplama ile yapılan analizde trombosit sayısı düştükçe TRAF6 düzeyinde anlamlı bir yükseklik gözlendi. Bu yükseklik en şiddetli olarak trombosit sayısı tedavi ihtiyacı doğuran grup olan 0-25.000 arası olan grupta izlendi. Bu ilişkiye ilişkin korelasyon katsayısı oldukça yüksek bulundu (r2: -,665). İTP hastalarında tedavi ihtiyacı doğan grupta TRAF yüksekliğinin belirgin şekilde anlamlı bulunması İTP patogenezinde önemli yeri olabileceğini doğrulamakta ve tedavi ihtiaycını öngörebilecek bir parametre olarak karşımıza çıkmaktadır. Ancak İTP hastalarında TRAF6 düzeyinin trombosit sayısı ve hastalık seyrine etkisini gösteren daha geniş populasyonlu, çok merkezli, prospektif çalışmalara ihtiyaç vardır. İncelemeye alınan diğer değişkenler olarak yaş, geliş hemoglobin düzeyi, geliş lökosit düzeyi, splenomegali varlığı ele alındığında kemokin düzeylerinin bu değişkenlerden etkilenmediği gözlendi.
Immune thrombocytopenia (ITP) is an acquired disease characterized by thrombocyte autoantibodies leading to increased platelet destruction, T-cell mediated immunodeficiency, and impaired megakaryopoiesis. T-cell activation and migration is a complex process in which a number of chemokines and chemokine receptors are involved. Chemokines are small chemotactic cytokines with a protein structure and play a role in many essential pathways such as angiogenesis, hematopoiesis, mast cell degranulation, T cell differentiation and leukocyte mobilization. The study included 85 patients with ITP diagnosis and 84 subjects with similar age and gender who did not use any kind of medication or have chronic diseases. Exclusion criteria were the presence of secondary of ITP, the presence of chronic ITP, and the presence of high levels of ESR and CRP at the time of admission. From the blood samples obtained from patients and healthy volunteers, the target molecules CCL18, CCL20, CCL21 and TRAF6 levels were measured by ELISA methods according to the working principles in the kit. The mean age of the patients was 47.31 (22-87) and the male/female ratio was 0.30 (20/65). 61 patients had major or minor hemorrhage and life-threatening severe bleeding was observed in only 5 patients. In the patient group, mean TRAF6 level was 2348 pg/mL, CCL18 level 132,97 ug/mL, CCL20 level 55,02 pg/mL and CCL21 level 3006,74 pg/mL, in the control group TRAF6 level was 25,57 pg/mL, CCL18 level 116,53 ug/mL, CCL20 level 76,6 pg/mL and CCL21 level 2476,26 pg/mL which are statistically significant. There was a statistically significant difference between patients and control group at TRAF6 levels (p = 0,000). Significant increased levels of TRAF6 were observed in the patient group when the platelet count was lowered by the quartile grouping of 0-25.000 / mm3, 26-50.000 / mm3, 51-75.000 / mm3 and 76-100.000 / mm3 according to thrombocyte counts. This elevation was most severely observed in the group with the number of platelets from 0 to 25,000 which required treatment. In the treatment group of patients with ITP, the significant increase in TRAF elevation in the treatment group confirms that there may be an important role in the pathogenesis of ITP and the antagonism emerges as a parameter that can predict treatment need. However, there is a need for multicenter, prospective studies with larger cohorts regarding TRAF6 in platelets with platelet count and disease progression. When the age, arrival hemoglobin level, incident leukocyte level, splenomegaly were considered as the other variables to be examined, it was observed that the chemokine levels were not affected by these variables.
Immune thrombocytopenia (ITP) is an acquired disease characterized by thrombocyte autoantibodies leading to increased platelet destruction, T-cell mediated immunodeficiency, and impaired megakaryopoiesis. T-cell activation and migration is a complex process in which a number of chemokines and chemokine receptors are involved. Chemokines are small chemotactic cytokines with a protein structure and play a role in many essential pathways such as angiogenesis, hematopoiesis, mast cell degranulation, T cell differentiation and leukocyte mobilization. The study included 85 patients with ITP diagnosis and 84 subjects with similar age and gender who did not use any kind of medication or have chronic diseases. Exclusion criteria were the presence of secondary of ITP, the presence of chronic ITP, and the presence of high levels of ESR and CRP at the time of admission. From the blood samples obtained from patients and healthy volunteers, the target molecules CCL18, CCL20, CCL21 and TRAF6 levels were measured by ELISA methods according to the working principles in the kit. The mean age of the patients was 47.31 (22-87) and the male/female ratio was 0.30 (20/65). 61 patients had major or minor hemorrhage and life-threatening severe bleeding was observed in only 5 patients. In the patient group, mean TRAF6 level was 2348 pg/mL, CCL18 level 132,97 ug/mL, CCL20 level 55,02 pg/mL and CCL21 level 3006,74 pg/mL, in the control group TRAF6 level was 25,57 pg/mL, CCL18 level 116,53 ug/mL, CCL20 level 76,6 pg/mL and CCL21 level 2476,26 pg/mL which are statistically significant. There was a statistically significant difference between patients and control group at TRAF6 levels (p = 0,000). Significant increased levels of TRAF6 were observed in the patient group when the platelet count was lowered by the quartile grouping of 0-25.000 / mm3, 26-50.000 / mm3, 51-75.000 / mm3 and 76-100.000 / mm3 according to thrombocyte counts. This elevation was most severely observed in the group with the number of platelets from 0 to 25,000 which required treatment. In the treatment group of patients with ITP, the significant increase in TRAF elevation in the treatment group confirms that there may be an important role in the pathogenesis of ITP and the antagonism emerges as a parameter that can predict treatment need. However, there is a need for multicenter, prospective studies with larger cohorts regarding TRAF6 in platelets with platelet count and disease progression. When the age, arrival hemoglobin level, incident leukocyte level, splenomegaly were considered as the other variables to be examined, it was observed that the chemokine levels were not affected by these variables.
Açıklama
Anahtar Kelimeler
İTP, Lenfosit Kemoatraktanları, TRAF6, Lymphocyte Chemoattractants
