Behçet hastalığında bazı lipid metabolizması parametreleri ve antikardiyolipin antikor düzeyleri

Abstract

ÖZET Etyopatogenezi tam olarak bilinmeyen Behçet hastalığı'nın temel patolojik bulgusu vaskülittir. Seyrinde görülen trombozların AKA'larla ilişkisi ve AKA'ların lipidlerle ilişkisi nedeniyle bu çalışma planlanmıştır. Bu çalışmanın amacı; tedavi almayan Behçetli hastalarda lipid metabolizması ile ilgili kolesterol, trigliserid, LDL, VLDL, HDL, apo-A, apo-B ve Lp(a) ile AKA düzeylerini ölçerek sonuçları kontrol grubu ile karşılaştırmak, bu parametrelerin klinik aktivite ile ilişkilerini araştırmaktır. Çalışma, GATA İç Hastalıkları kliniğinde takip edilen ve yaşları 21-52 arasında olan, 28'i erkek, 5'i kadın 33 olgu ile 17'si erkek, 3'ü kadın 20 sağlıklı gönüllüden oluşan kontrol grubunda yapılmıştır. Behçetli olgularda HDL düzeyleri kontrol grubuna göre anlamlı olarak düşük bulunmuştur(p<0.05). Aktif olgular ile kontrol grubu karşılaştırıldığında; aktif olgularda HDL ve apo-A düzeyleri kontrol grubuna göre anlamlı olarak düşük tespit edilmiştir (p<0.05). Lp(a) ise aktif olgularda kontrol grubuna göre anlamlı olarak yüksek saptanmıştır (p<0.05). Aktif ve inaktif olgular karşılaştırıldığında; aktif olgularda HDL ve apo-A düzeyleri inaktif gruba göre anlamlı olarak düşük tespit edilmiştir (p<0.05). Lp(a) ise aktif olgularda inaktif gruba göre anlamlı olarak yüksek tespit edilmiştir(p<0.05). Aktif olgularda Lp(a) ile CRP arasında pozitif korelasyon (p<0.05), AKA-lgM ile HDL ve apo-A arasında ise negatif korelasyon saptanmıştır (p<0.05). AKA düzeylerine gelince; Behçetli hastalarda AKA-lgG ve IgM düzeyleri kontrol grubuna göre anlamlı olarak yüksek saptanmıştır(p<0.05). Aktif olguların kontrol grubu ile karşılaştırmasında da AKA-lgG ve IgM düzeylerinin aktif olgularda anlamlı olarak yüksek olduğu tespit edilmiştir (p<0.05). Çalışmanın sonuçları şöylece özetlenebilir; 1) Behçetli hastalarda saptanan HDL düşüklüğünün, ateroskleroz için risk faktörü olduğu söylenebilir. 2) Lp(a)'nın aktif olgularda yüksek olarak tespit edilmesi, bu lipoproteinin aktif olgularda akut faz reaktanı olarak davrandığını desteklemektedir. 3) AKA'ların Behçetli olgulardaki yüksekliği, trombozların nedeni olabilir. Aktif olgularda AKA'lar ile HDL ve apo-A arasında tespit edilen negatif korelasyon, apo-A'nın AKA'ların antijeni olabileceği ihtimalini desteklemektedir. Bu yorumların değerlendirilmesi için; Behçetli hastalarda plazma lipid parametreleri periyodik olarak takip edilmeli ve epidemiyolojik çalışmalarla ateroskleroz sıklığı açıklığa kavuşturulmalıdır. Sonuç olarak, Behçet hastalığının klinik seyrinde görülebilen aterosklerotik ve trombotik sendromların gelişmesinde lipoproteinlerin ve AKA'ların rolünü ortaya çıkarmak için daha geniş prospektif çalışmalara ihtiyaç vardır. 42SUMMARY A Study on Some Parameters of Lipid Metabolism and Anticardiolipin Antibody Levels in Behcet's Disease Vasculitis is the basic pathological finding in Behcet's disease (BD) which is a multisystemic inflammatory disorder of unknown etiopathogenesis. This study was based on the suggested relationships among anticardiolipin antibodies (ACA) and lipids and development of thrombogenic complication in the course of BD. The purpose of this study was to measure the levels of cholesterol, triglyceride, LDL, VLDL, HDL, apo-A, apo-B, Lp(a), and ACA in sera of the patients with BD and to compare them with the controls and to investigate the relationships between these parameters and the clinical activity of BD in untreated patients. Thirty three patients with BD (28 male and 5 female) aged between 21-52 were followed in the Internal Medicine Department of GATA and twenty healthy blood donors (17 male and 3 female) served as control group. The patients with BD had significantly lower level of HDL than the controls (p<0.05). When the active cases were compared to control group; the active cases had significantly lower levels of HDL and apo-A than the controls (p<0.05). The level of Lp(a) in the active cases was significantly higher than that of control subjects (p<0.05). However, when the active cases were compared to the inactive cases; the active cases had significantly lower HDL and apo-A levels than the inactive cases (p<0.05). The level of Lp(a) in active cases was significantly higher than the inactive cases (p<0.05). A positive correlation between Lp(a) and CRP (p<0.05), and a negative correlation among HDL, apo-A and ACA-IgM (p<0.05) were only found in the active cases. As for the levels of ACA-IgG and IgM, the patients had significantly higher levels than control subjects (p<0.05). The levels of ACA-IgG and IgM in active cases were found significantly higher than those of control subjects (p<0.05). The result of this study could be summarized as follows. 1) Low serum HDL levels in the patients with BD may constitute a risk factor for atherosclerosis. 2) High Lp(a) levels may be considered that this lipoprotein may behave an acute phase reactant in the active cases. 3) ACA may harbor the development of thrombosis in patients with BD. The observed relationships among ACA and HDL and apo-A; support the idea that apo-A may play role of antigen. It may be considered that; the prevalence of atherosclerosis should be determined by epidemiological studies and serum lipid profile should be followed up periodically in the patients with BD. Finally, large prospective studies are needed to determine the possible role of lipoproteins and ACA in the atherosclerotic and thrombotic events in the course of BD. 43

SUMMARY A Study on Some Parameters of Lipid Metabolism and Anticardiolipin Antibody Levels in Behcet's Disease Vasculitis is the basic pathological finding in Behcet's disease (BD) which is a multisystemic inflammatory disorder of unknown etiopathogenesis. This study was based on the suggested relationships among anticardiolipin antibodies (ACA) and lipids and development of thrombogenic complication in the course of BD. The purpose of this study was to measure the levels of cholesterol, triglyceride, LDL, VLDL, HDL, apo-A, apo-B, Lp(a), and ACA in sera of the patients with BD and to compare them with the controls and to investigate the relationships between these parameters and the clinical activity of BD in untreated patients. Thirty three patients with BD (28 male and 5 female) aged between 21-52 were followed in the Internal Medicine Department of GATA and twenty healthy blood donors (17 male and 3 female) served as control group. The patients with BD had significantly lower level of HDL than the controls (p<0.05). When the active cases were compared to control group; the active cases had significantly lower levels of HDL and apo-A than the controls (p<0.05). The level of Lp(a) in the active cases was significantly higher than that of control subjects (p<0.05). However, when the active cases were compared to the inactive cases; the active cases had significantly lower HDL and apo-A levels than the inactive cases (p<0.05). The level of Lp(a) in active cases was significantly higher than the inactive cases (p<0.05). A positive correlation between Lp(a) and CRP (p<0.05), and a negative correlation among HDL, apo-A and ACA-IgM (p<0.05) were only found in the active cases. As for the levels of ACA-IgG and IgM, the patients had significantly higher levels than control subjects (p<0.05). The levels of ACA-IgG and IgM in active cases were found significantly higher than those of control subjects (p<0.05). The result of this study could be summarized as follows. 1) Low serum HDL levels in the patients with BD may constitute a risk factor for atherosclerosis. 2) High Lp(a) levels may be considered that this lipoprotein may behave an acute phase reactant in the active cases. 3) ACA may harbor the development of thrombosis in patients with BD. The observed relationships among ACA and HDL and apo-A; support the idea that apo-A may play role of antigen. It may be considered that; the prevalence of atherosclerosis should be determined by epidemiological studies and serum lipid profile should be followed up periodically in the patients with BD. Finally, large prospective studies are needed to determine the possible role of lipoproteins and ACA in the atherosclerotic and thrombotic events in the course of BD. 43