Ahmet TİRYAKİ, Demet SAĞLAM AYKUT, Evrim ÖZKORUMAK, S. Caner KARAHAN

İki uçlu duygudurum bozukluğunda tedavi öncesi ve tedavi sonrası akut mani dönemlerinde kan nitrik oksit ve asimetrik dimetil arginin düzeylerinin karşılaştırılması

Amaç: Nitrik oksitin (NO) ve NO'nun sistem içi baskılayıcısı olan asimetrik dimetilargininin (ADMA) işlevi, duygudurum bozuklukları, şizofreni, otizm, obsesif kompulsif bozukluk ve Alzheimer hastalığında incelenmiş ve anlamlı sonuçlar bulunmuştur. Uzun yıllardır yapılan araştırmalara rağmen duygudurum düzenleyici ilaçların düzenekleri henüz açık değildir. Önceki çalışmalarda, iki uçlu duygudurum bozukluğunda (İDB) antimanik tedavi ile oksidatif stres parametrelerinin düştüğü gösterilmiştir. Çalışmalar lityumun antioksidan etkilerini açıkça göstermiştir. Lityumun çeşitli hedeflere olan düzenleyici etkileri ile oksidatif hasara karşı nöroprotektif etkiler ürettiği öne sürülebilir. Lityumun nitrik oksit sentaz enzimi üzerindeki etkileri laboratuvar çalışmalarında incelenmiştir. Bu çalışmada İDB tip I (İDB-I) hastalarının akut mani ve lityum ile tedavi sonrası ötimi dönemlerinde, plazma NO ve ADMA düzeylerinin karşılaştırılması amaçlanmıştır. Yöntem: Çalışmaya KTÜ Farabi Hastanesi'ne başvurmuş DSM-IV-TR'ye göre İDB-I mani nöbeti tanısı konulan ve lityumla izlenen 17 hasta alınmıştır. Hastalık dönemleri ve ötimi dönemlerinde hastalara SCID-I, HAM-D, YMRS, MADRS ölçekleri uygulanmıştır. Hastalardan mani ve ötimi dönemlerinde NO ve ADMA tayini için, iki tüp plazma örneği alınmıştır. Bulgular: Tedavi öncesi gruba göre tedavi sonrası grupta ADMA anlamlı olarak düşerken NO düzeyi anlamlı olarak yükselmiştir. Sonuç: Bu çalışmada, lityum tedavisi sonrasında İDB mani nöbeti hastalarının NO plazma düzeyinde artma ve ADMA plazma düzeyinde azalma görüldüğü, lityumun tedavi edici etkisine bu düzeneğin katkıda bulunabileceği gösterilmiştir.

Comparison of levels of serum nitric oxide and asymmetric dimethylarginine levels in manic episodes in bipolar disorder before and after the treatment

Objective: Function of nitric oxide (NO) and its intra-system competitive inhibitor of NO, asymmetric dimethylarginine (ADMA) has been investigated in mood disorders, schizophrenia, autism, obsessive compulsive disorder and Alzheirmer disorder and significant results were obtained. The mechanism of action in mood stabilizators is still unclear despite many years of studies. The parameters of oxidative stres were shown to decreased upon antimanic treatment in bipolar disorder (BD). The lithium may be suggested to produce neuroprotective effects against oxidative damage by regulatory effects towards various targets. The effects of lithium on nitric oxide synthase were researched in labarotory studies. In this study, two tubes of plasma were takenfrom the patients for determination of NO and ADMA during manic and eutdhymic phases. Methods: Seventeen patients who presented to the psychiatry or emergency departments of Farabi Hospital of Karadeniz Technical University and 30 İUD'de tedavi öncesi ve tedavi sonrası akut mani dönemlerinde kan nitrik oksit ve ... were diagnosed with BAD-I manic episode and followed with lithum were included into the study. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), Montgomery Asberg Depression Rating Scale (MADRS), were applied. For determination of NO and ADMA levels, two tubes of plasma were collected during the periods of mania and euthymia in the patient group. Results: The level of ADMA were significantly lower while the level of NO were higher in the posttreatment group than the pretreatment group. Conclusion: In this study, the level of NO were increased, the level of ADMA were dicreased in response to lithium treatment, the therapeutic effect of lityum may contribute this mechanism.

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