Stabil sarkoidoz hastalarında atopi ve alerjik hastalıkların sıklığının değerlendirilmesi
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Date
2009
Authors
Savaş, Nazan Nalcı
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Publisher
Uludağ Üniversitesi
Abstract
Solunum yolu ile alınan pek çok antijenik stimulus farklı immunolojik reaksiyonlara yol açmaktadır. Bunun sonucunda ise alerjik rinit, astım gibi alerjik hastalıklardan, sarkoidoz gibi granülomatöz hastalıklara kadar geniş spektrumda solunum hastalıkları oluşmaktadır. Sarkoidoz, T lenfosit, mononükleer fagosit infiltrasyonu ve etkilenen organlarda granülomlar ile karakterize, etyolojisi tam aydınlatılamamış, multiorgan disfonksiyonuna yol açan sistemik bir hastalıktır. Hastalık bilinmeyen sarkoid stimulus ile oluşmakta bunun sonucunda dormant T hücreler ve makrofajlardan çeşitli proinflamatuar sitokinler üretilmektedir. Sarkoidozda bronkoalveoler sıvısında T helper 1 sitokinler interferon-ɣ (IFN-ɣ) ve interlökin-2 (IL-2) görülmektedir. Atopi, tek ya da pek çok çevresel antijene Th2 tip immün cevap olarak oluşmaktadır. Atopi riskini etkileyen ana nedenler antijenik maruziyetin miktarı, süresi ve lokal mikroçevresel sitokin profilidir. Sarkoidoz hastalarında Th2 sitokin profilinin suprese ve aktif olmadığına inanılmaktadır Araştırmamızda amacımız stabil sarkoidoz hastalarında atopi ve alerjik hastalıkların sıklığının değerlendirilmesidir. Çalışmamıza stabil dönemde toplam 40 sarkoidoz hastası alındı. Bu hastaların tümüne deri prick testi ve alerjik yakınmaları sorgulamak amacı ile ECRHS II anketi uygulandı. İstatistiksel değerlendirme Uludağ Üniversitesi Tıp Fakültesi Biyoistatistik Anabilim Dalı’nda SPSS 13.0 paket programı kullanılarak yapıldı. Tüm hastaların %32.5’inde atopi pozitif olarak saptandı. Atopi olan grupta yaş ortalaması 50.3±2.4 iken atopi olmayan grupta 46.1±2.3 bulundu (p>0.05). Erkekler ve kadınlar arasında atopi sıklığı bakımından farklılık saptanmadı. Atopi olan ve olmayan olgular solunum fonksiyon parametrelerinden FEV1, FEV1%, FVC ve FVC% açısından değerlendirildiğinde, her 2 grup arasında istatistiksel anlamlı farklılık saptanmadı. (p>0.05). Hastaların sarkoidoz evresine bakılmaksızın solunum fonksiyon testinde FEV1 ve FVC %70 altı ve üstü olarak oluşturulmuş gruplar arasında atopi sıklığı açısından fark olmadığı görüldü. Atopik olan grup ile nonatopik grup karşılaştırıldığında egzema, atopik grupta istatistiksel olarak anlamlı şekilde daha sık saptandı (p=0.032). Hastalar sarkoidoz evrelemesine göre evre 1 ve 2 olarak değerlendirildi. Evre 1’de atopi %30, evre 2 ‘de %35 olarak saptandı. Tüm hastalara ECRHS II anketi uygulandı. Atopik olan ve olmayan hastalarda ECRHS II anketi solunum semptomları, dispne sıklığının değerlendirilmesi ve alerjik hastalıklar bakımından farklılık saptanmadı. Atopi durumu göz önüne alınmaksızın evre 1 ve 2 hastalarda ECRHS II anketi solunum semptomları, dispne sıklığının değerlendirilmesi ve alerjik hastalıklar bakımından farklılık saptanmadı. Bulgularımız stabil sarkoidoz hastalarında atopi oranını beklenenin üzerinde sonuçlanmıştır; ancak, olgu sayısı sınırlı olduğu için bu sonuç daha geniş serili çalışmalarla desteklenmelidir.
Several airborne antigenic stimuli may cause different immunologic reactions that may result in a broad spectrum of respiratory disorders from asthma and allergic rhinitis to granulomatous disorders such as sarcoidosis. Sarcoidosis is a multiorgan disorder of unknown etiology characterized by T lymphocyte and mononuclear phagocyte infiltration and granuloma formation in affected sites. The disease is believed to be triggered by an unknown sarcoid stimulus that activates dormant T cells and macrophages to produce various proinflammatory cytokines. In sarcoidosis, the bronchoalveolar fluid T cells have been shown to release T helper 1 (Th1) cytokines, such as interferon-ɣ (IFN-ɣ) and interleukin-2 (IL-2) spontaneously. Atopy is developed as a result of Th2 type immune response to single or multiple environmental antigens. The intensity and duration of antigenic exposure and the local microenvironmental cytokine profile are the main contributors that affect the risk of atopy. In patients with sarcoidosis, Th2 cytokine profile are believed to be supressed and nonactive. In this study we aimed to investigate atopy and allergic diseases frequency in stabil sarcoidosis patients. 40 sarcoidosis patients were enrolled in our study. Skin prick tests (SPT) and European Community Respiratory Health Survey (ECRHS) questionnaire were applied to all cases. Statistical analyses were performed at Uludag University Biostatistics Department using SPSS version 13.0 programme. The ratio of atopy in sarcoidosis was 32.5%. Mean age in atopic patient is 50.3±2.4 years, in nonatopic patient is 46.1±2.3 years (p>0.05). No difference were observed between men and women concerning atopy frequecy. When atopy pozitive and negative cases are compared according to pulmonary function parameters FEV1, FEV1%, FVC ve FVC%, there is no statistical significant difference detected between 2 groups (p>0.05) Without concerning stage of the sarcoidosis patients, between the groups formed according to pulmonary function test (as over and under FEV1 ve FVC 70%) there was no difference observed concerning atopy frequency. When compared atopic and nonatopic groups, eczema were confronted significantly more frequently in atopic group. (p=0.032) Patients were evaluated as stage 1 and Stage 2 according to sarcoidosis staging system. Atopy were observed 30% in stage 1 and 35% in stage 2. All patients were questioned for ECRHS II. No difference were observed for atopic and nonatopic patients concerning ECRHS II questionere pulmonary symptoms, evaluation and dyspne frequency and allergic diseases. Without taking atopy situation into consideration, no difference were observed stage 1 and 2 sarcoidosis patients concerning ECRHS II questionnaire pulmonary symptoms, evaluation and dyspne frequency and alergic diseases. Results are demonstrated that atopy frequency is higher than the expected for stable sarcoidosis patients, however, this result should be supported by wide range study, since the number of cases with in this study in rather small.
Several airborne antigenic stimuli may cause different immunologic reactions that may result in a broad spectrum of respiratory disorders from asthma and allergic rhinitis to granulomatous disorders such as sarcoidosis. Sarcoidosis is a multiorgan disorder of unknown etiology characterized by T lymphocyte and mononuclear phagocyte infiltration and granuloma formation in affected sites. The disease is believed to be triggered by an unknown sarcoid stimulus that activates dormant T cells and macrophages to produce various proinflammatory cytokines. In sarcoidosis, the bronchoalveolar fluid T cells have been shown to release T helper 1 (Th1) cytokines, such as interferon-ɣ (IFN-ɣ) and interleukin-2 (IL-2) spontaneously. Atopy is developed as a result of Th2 type immune response to single or multiple environmental antigens. The intensity and duration of antigenic exposure and the local microenvironmental cytokine profile are the main contributors that affect the risk of atopy. In patients with sarcoidosis, Th2 cytokine profile are believed to be supressed and nonactive. In this study we aimed to investigate atopy and allergic diseases frequency in stabil sarcoidosis patients. 40 sarcoidosis patients were enrolled in our study. Skin prick tests (SPT) and European Community Respiratory Health Survey (ECRHS) questionnaire were applied to all cases. Statistical analyses were performed at Uludag University Biostatistics Department using SPSS version 13.0 programme. The ratio of atopy in sarcoidosis was 32.5%. Mean age in atopic patient is 50.3±2.4 years, in nonatopic patient is 46.1±2.3 years (p>0.05). No difference were observed between men and women concerning atopy frequecy. When atopy pozitive and negative cases are compared according to pulmonary function parameters FEV1, FEV1%, FVC ve FVC%, there is no statistical significant difference detected between 2 groups (p>0.05) Without concerning stage of the sarcoidosis patients, between the groups formed according to pulmonary function test (as over and under FEV1 ve FVC 70%) there was no difference observed concerning atopy frequency. When compared atopic and nonatopic groups, eczema were confronted significantly more frequently in atopic group. (p=0.032) Patients were evaluated as stage 1 and Stage 2 according to sarcoidosis staging system. Atopy were observed 30% in stage 1 and 35% in stage 2. All patients were questioned for ECRHS II. No difference were observed for atopic and nonatopic patients concerning ECRHS II questionere pulmonary symptoms, evaluation and dyspne frequency and allergic diseases. Without taking atopy situation into consideration, no difference were observed stage 1 and 2 sarcoidosis patients concerning ECRHS II questionnaire pulmonary symptoms, evaluation and dyspne frequency and alergic diseases. Results are demonstrated that atopy frequency is higher than the expected for stable sarcoidosis patients, however, this result should be supported by wide range study, since the number of cases with in this study in rather small.
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Keywords
Sarkoidoz, Atopi, Alerjik hastalıklar, ECRHS II anketi, Sarcoidosis, Allergic diseases, ECRHS II questionnaire, Atopy
Citation
Savaş, N. N. (2009). Stabil sarkoidoz hastalarında atopi ve alerjik hastalıkların sıklığının değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.