Hicabi Sezgin, Birol Gulman, Alper Cirakli, Abdulkerim Bedir, Dilek Usta, Sina Coskun, Alisan Yildiran

Dolaşımdaki endotelial progenitör hücreler, serum vasküler endotelial büyüme faktörü ve hipogamaglobulineminin Perthes hastalığına etkileri

Amaç: Bu çalışmada Legg-Calvé-Perthes hastalığının (PH) etiyopatogenezinin aydınlatılması amaçlanmıştır. Bu amaca yönelik olarak Perthes hastaları ile kontrol grubu olgularında dolaşımdaki endotelial progenitör hücre (EPH) sayısı, serum vasküler endotelial büyüme faktörü-A (VEBF-A) ve immünoglobulin düzeyleri karşılaştırıldı.Çalışma planı: Çalışmaya 28 PH olgusu (ortalama yaş: 8±3.8) ve yaşları eşleşen 25 sağlıklı kontrol olgusu dahil edildi. Periferik venöz kan örneklerinde EPH, serum VEBF-A ve immünoglobulin düzeyleri ölçüldü. Karşılaştırma ve korelasyon analizleri uygulandı.Bulgular: PH grubundaki olguların 17’si fragmantasyon, 11’i ise iyileşme döneminde idi. Hastalık 4 olguda bilateral iken, 14 hastada hipogamaglobulinemi mevcuttu. PH grubundaki medyan EPH sayısı 80 olup kontrol grubuna göre anlamlı derecede yüksekti (p=0.011). Serum VEBF-A düzeylerinde anlamlı farklılık saptanmadı (p=0.354). PH grubunda EPH sayısı serum IgG düzeyi ile tersine korele idi (r=-0.403, p=0.03). Mutlak EPH sayısı fragmantasyon dönemindeki hastalarda, iyileşme dönemindekilerden; bilateral hastalığı olanlarda ise unilateral olanlardan anlamlı olarak yüksekti. Dolaşımdaki EPH sayısı Perthes hastalığının fragmantasyon safhasında (r=0.605, p=0.01) ve hipogamaglobulinemi varlığında (r=0.599, p=0.001) serum VEBF-A düzeyi ile korelasyon göstermekteydi.Çıkarımlar: Fragmantasyon evresindeki hastalarda görülen yüksek EPH sayısı ve bilateral tutulumu olan hastalarda nispeten daha yüksek bulunan EPH sayısı, PH’nin takibinde değerli bir gösterge olabilir. Hastalığın fragmantasyon evresinde ve hipogamaglobulinemi varlığında EPH sayısı ve serum VEBF-A düzeyi arasındaki güçlü korelasyonu açıklamak için daha fazla çalışma yapılmasına ihtiyaç vardır..

Anahtar Kelimeler:

Dolaşımdaki endotelial progenitör hücre; hipogamaglobulinemi; Perthes hastalığı; serum vasküler endotelial büyüme faktörü.

Effects of circulating endothelial progenitor cells, serum vascular endothelial growth factor and hypogammaglobulinemia in Perthes disease

Objective: The aim of this study was to investigate Legg-Calvé-Perthes disease (PD) pathogenesis by comparing absolute circulating endothelial progenitor cell (EPC) counts, serum levels of vascular endothelial growth factor-A (VEGF-A) and immunoglobulins between PD patients and controls.Methods: The study included 28 PD cases (mean age: 8±3.8) and 25 healthy age-matched control subjects. EPC, serum VEGF-A and immunoglobulin levels were measured in peripheral blood samples. Comparisons and correlation analysis were performed.Results: In the PD group, 17 subjects were in the fragmentation stage and 11 in the healing stage. Four patients had bilateral disease and 14 had hypogammaglobulinemia. Median EPC count of the PD group was 80 and was significantly higher than those of the control group (p=0.011). No significant difference was determined in serum VEGF-A levels (p=0.354). EPC count were inversely correlated with serum IgG levels of the PD group (r=0.403, p=0.03). Absolute EPC count was also significantly higher in the fragmentation stage than in the healing stage and were also greater in bilaterally affected than in unilaterally affected patients. Circulating EPC count was correlated to the serum VEGF-A levels in patients with fragmentation stage of PD (r=0.605, p=0.01) and in those with hypogammaglobulinemia (r=0.599, p=0.001).Conclusion: High EPC count at the fragmentation stage of PD and relatively higher counts in bilateral disease suggest that EPC may be a valuable marker in the diagnosis and follow-up of PD. Additional studies are needed to explain the strong correlation between EPC and serum VEGF-A level in the fragmentation stage and in the presence of hypogammaglobulinemia.

Keywords:

Circulating endothelial progenitor cells, hypogammaglobulinemia, Perthes disease serum vascular endothelial growth factor,

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