Epizodik ve kronik migren hastalarında serum adma düzeyi analizi, serum adma düzeyinin migrende kronikleşme ve kliniğe olan etkisinin araştırılması
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Date
2018
Authors
Sert Öksüz, Feride
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Publisher
Uludağ Üniversitesi
Abstract
Migren, disabilite oluşturan tekrarlayıcı baş ağrısı atakları ve otonom sinir sistemi bozukluğu ile karakterize yaygın, multifaktöryel nörovasküler bir sendromdur. Son yıllarda migrenle ilgili çalışmalarda altta yatan en muhtemel sebebin kortikal yayılan depresyon (CSD) olduğu ve CSD sırasında Nitrik oksit sentaz (NOS) aracılığıyla nitrik oksit (NO) salındığı gösterilmiştir; ADMA (Asimetrik dimetilarjinin) ise, NOS'un endojen inhibitörüdür. Bu çalışmada, serum ADMA düzeylerinin migren patofizyolojisindeki rolünü, migren tanısında ve migrenin kronikleşmesinde belirleyici bir gösterge olup olmayacağını araştırmayı planladık. Prospektif olarak planladığımız bu çalışmamızda IHS (Uluslararası başağrısı topluluğu) 2013 beta migren tanı kriterlerine göre 30'u sık epizodik migren (EM), 20'si kronik migren (KM) olmak üzere 50 migren hastası ile yaş ve cinsiyet özellikleri bakımından benzer 30 sağlıklı gönüllünün serum ADMA değerleri; migren hastaları ile kontrol grubu arasında ve migren altgrupları arasında karşılaştırıldı. Çalışmaya alınan 50 migren hastamızın 6 aylık takipleri sonucunda elde edilen ADMA değerleri ile 1.ay ADMA değerleri de karşılaştırıldı. Aynı zamanda ADMA değerleri ile yaş, cinsiyet, atak sıklığı, ağrı şiddeti, karakteri, lokalizasyonu ve bulantı-kusma, fotofobi-fonofobi, fiziksel aktivite ile artış, aura varlığı arasındaki ilişki araştırıldı. 10'u erkek 50 migren hastasının ADMA değerleri ortalaması 969.84 ng/dl iken, 6'sı erkek 30 kontrol grubunun ADMA değerleri ortalaması 583.87 ng/dl idive iki grup arasında anlamlı bir fark olduğu görüldü (p<0.001). ADMA değerleri ortalaması migren altgruplarında EM'li hastalarda 917.30 ng/dl iken, KM'li hastalarda 1048.65 ng/dl idi (p=0.279). Auralı ve aurasız migren grupları arasında ADMA değerleri açısından anlamlı fark saptanmadı. Migren klinik özellikleriyle ADMA değerlerini karşılaştırdığımız çalışmamızda; ADMA değerleri ile yaş, atak sıklığı, ağrı şiddeti, karakteri, lokalizasyonu, bulantı-kusma, fotofobi-fonofobi, fiziksel aktivite ile artış varlığı arasında anlamlı ilişki saptanmadı. Migren hastalarının 1. ay ve 6. ay serum ADMA konsantrasyonlarındaki değişim ile ağrılı gün sayısındaki değişim karşılaştırıldı. Ağrılı gün sayısı artan (n=25), azalan (n=13) ve değişmeyen (n=5) her 3 grubun da 6.ay ADMA değerlerinin 1.aya göre artmış olduğu görüldü. Ancak ağrılı gün sayısında artış olan 25 hastada ADMA değerlerindeki artışın belirgin olarak daha fazla olduğu tesbit edildi ve bu istatistiksel olarak anlamlı kabul edildi. 6 aylık izlem sonucunda EM'den KM'ye dönen 5 hastanın 1.ay ve 6.ay ADMA değerleri arasında istatistiksel olarak anlamlı fark saptanmadı. Sonuç olarak çalışmamızda migrenli grupta serum ADMA değerleri ortalaması, kontrol grubuna göre anlamlı derecede yüksek bulundu. Buna dayanarak serum ADMA değerinin migren tanısında destekleyici bir gösterge olabileceği düşünüldü. EM ve KM altgrupları arasında ADMA değerleri açısından istatistiksel olarak anlamlı bir fark saptanmadı. 6aylık takip sonucu ağrılı gün sayısı artan hastaların 6.aydaki serum ADMA değerlerinde, ağrılı gün sayısı azalan ve değişmeyen hastalara göre daha belirgin bir artış saptandı. Bu verilerin ışığında; daha fazla olgu ile yapılacak çalışmalarla ADMA'nın ağrılı gün sayısındaki artış ve dolayısıyla migrende kronikleşme ile ilişkisi desteklenebilir.
Migraine is a general-characterized multifactorial and neurovascular syndrome, which makes disabilities, repeater headache attacks with autonomous neural system disorder. In recent years, studies, which are carried out as to migraine shows that the underlying cause is cortical-expansive depression (CSD) and They also show that nitric oxide is emitted via nitric oxide synthase (NOS). (ADMA) asymmetric dimethylarginine is endogenous inhibitor of NOS. In this research, we planned to search that whether serum is a determinant indicator as to role of ADMA levels in migraine pathophysiology, in diagnosis of migraine and as to acute stage of migraine. In this reseach as we planned perspectively, according to criteria (diagonsis of migraine IHS 2013) Serum ADMA levels of 50 migraine patients whose 30 percent is frequent episodic migraine (EM) whose 20 percent is cronic migraine (KM) and of 30 healthy volunteers similar to those migraine patients as to age and sex are compared between migraine patients, control group and migraine subgroups. ADMA levels of 50 migraine patients, who are examined within research acquired after six-months process are also compared with a-month ADMA levels of same patients. At the same time, the relationship between ADMA levels, age, sex, frequency of attacks, painlevel, paintype, painlocalisation, nausea, vomiting, photophobia, phonophobia, rising during physical activity, existing of aura has been searched. It is seen that, the average of ADMA levels of fifty migraine patients whose ten are men is 969.84 ng/dl while, the average of ADMA levels of thirty control group whose six are men is 583.87 ng/dl. As a result it can be said that there is a big difference between two groups (p<0.001). It is seen that the average of ADMA levels in migraine subgroups in patients who have HM 917.30 ng/dl, while it is 1048.65 ng/dl in patients who have KM (p=0.279). It is determined that there is no big difference between average of ADMA levels of migraine groups with aura and migraine groups without having aura. The study in which we compared migraine clinical characteristics and ADMA levels, it has seen that there is no big difference between ADMA levels, age, frequency of attacks, pain level, pain type, pain localisation, nausea-vomiting, photophobia, phonophobia, rising during physical activity, existing of aura. The change between first-month serum ADMA concentrations and sixth-month serum ADMA concentrations of migraine patients has been compared with the change of suffering days. It has been seen that six-month ADMA levels of all the three groups those whose pain is getting worse (n=25), those who are getting better (n=13) and those who remain unchanged (n=5) has rised compared to their first month ADMA levels. However it has also been seen thatADMA levels of those 25 patients whose pain rised, has certainly increased and it is accepted as statistically correct. After six-month observation it has been concluded that there is no significant change between first-month ADMA levels and six-month ADMA levels of those patients, who turned to KM from EM. In conclusion, in this research, the average of serum ADMA levels in patients with migraine has seen pretty high compared to control group. On this basis, use of serum ADMA levels in diagnosis of migrane can be an effective factor. It is seen that there is no big statistical difference between EM and KM subgroups as to ADMA levels. After six-month observation, it is seen that there is an undeniable increase of six-month ADMA levels of those patients who suffer a lot compared to six-month ADMA levels of those patients who suffer less or who suffer steadily.
Migraine is a general-characterized multifactorial and neurovascular syndrome, which makes disabilities, repeater headache attacks with autonomous neural system disorder. In recent years, studies, which are carried out as to migraine shows that the underlying cause is cortical-expansive depression (CSD) and They also show that nitric oxide is emitted via nitric oxide synthase (NOS). (ADMA) asymmetric dimethylarginine is endogenous inhibitor of NOS. In this research, we planned to search that whether serum is a determinant indicator as to role of ADMA levels in migraine pathophysiology, in diagnosis of migraine and as to acute stage of migraine. In this reseach as we planned perspectively, according to criteria (diagonsis of migraine IHS 2013) Serum ADMA levels of 50 migraine patients whose 30 percent is frequent episodic migraine (EM) whose 20 percent is cronic migraine (KM) and of 30 healthy volunteers similar to those migraine patients as to age and sex are compared between migraine patients, control group and migraine subgroups. ADMA levels of 50 migraine patients, who are examined within research acquired after six-months process are also compared with a-month ADMA levels of same patients. At the same time, the relationship between ADMA levels, age, sex, frequency of attacks, painlevel, paintype, painlocalisation, nausea, vomiting, photophobia, phonophobia, rising during physical activity, existing of aura has been searched. It is seen that, the average of ADMA levels of fifty migraine patients whose ten are men is 969.84 ng/dl while, the average of ADMA levels of thirty control group whose six are men is 583.87 ng/dl. As a result it can be said that there is a big difference between two groups (p<0.001). It is seen that the average of ADMA levels in migraine subgroups in patients who have HM 917.30 ng/dl, while it is 1048.65 ng/dl in patients who have KM (p=0.279). It is determined that there is no big difference between average of ADMA levels of migraine groups with aura and migraine groups without having aura. The study in which we compared migraine clinical characteristics and ADMA levels, it has seen that there is no big difference between ADMA levels, age, frequency of attacks, pain level, pain type, pain localisation, nausea-vomiting, photophobia, phonophobia, rising during physical activity, existing of aura. The change between first-month serum ADMA concentrations and sixth-month serum ADMA concentrations of migraine patients has been compared with the change of suffering days. It has been seen that six-month ADMA levels of all the three groups those whose pain is getting worse (n=25), those who are getting better (n=13) and those who remain unchanged (n=5) has rised compared to their first month ADMA levels. However it has also been seen thatADMA levels of those 25 patients whose pain rised, has certainly increased and it is accepted as statistically correct. After six-month observation it has been concluded that there is no significant change between first-month ADMA levels and six-month ADMA levels of those patients, who turned to KM from EM. In conclusion, in this research, the average of serum ADMA levels in patients with migraine has seen pretty high compared to control group. On this basis, use of serum ADMA levels in diagnosis of migrane can be an effective factor. It is seen that there is no big statistical difference between EM and KM subgroups as to ADMA levels. After six-month observation, it is seen that there is an undeniable increase of six-month ADMA levels of those patients who suffer a lot compared to six-month ADMA levels of those patients who suffer less or who suffer steadily.
Description
Keywords
ADMA, Epizodik migren, Kronik migren, Nitrik oksit, Episodic migraine, Chronic migraine, Nitric oxide
Citation
Öksüz, F. S. (2018). Epizodik ve kronik migren hastalarında serum adma düzeyi analizi, serum adma düzeyinin migrende kronikleşme ve kliniğe olan etkisinin araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.