Obsesif kompulsif bozuklukta plazma nötrofil jelatinaz ilişkili lipokalin ve hemogram düzeyleri ile hastalık şiddeti arasındaki ilişki
Amaç: Nötrofil jelatinaz ilişkili lipokalin (NGAL) immun regülasyonla ilişkili bir nöromediatördür. Obsesif kompulsif bozuklukta (OKB) hastalık-hemogram ilişkisiyle ilgili çalışma sayısı azdır. Çalışmamızda ilk kez tanı konan OKB hastalarında hastalık şiddeti ile kan NGAL düzeyi ve hemogram arasındaki ilişki araştırılmıştır. Yöntem: Ocak 2018-Ocak 2020 tarihleri arasında psikiyatri polikliniğine ayaktan başvuran 28050 hasta değerlendirildi. İlk atak OKB tanısı konulan ve çalışmaya katılmayı kabul eden 32 hastanın Yale Brown Obsesyon Kompulsiyon Skalası (Y-BOCS) ile hastalık şiddeti araştırıldı; periferik kan NGAL düzeyi, hemogram ölçüldü ve immun regülasyon ile ilişkili olarak toplam lökosit sayısı, % nötrofil granülosit (NEU%) değerlendirildi, C reaktif protein (CRP) bakıldı. Bulgular: İlk kez tanı konan OKB hastalarında NEU% ve CRP değerlerinde anlamlı farklılık saptanırken, kan NGAL düzeylerinde fark saptanmadı. Y-BOCS puanları arttıkça kan hemoglobin (Hb) ve hematokrit (Hct) değerlerinin azaldığı belirlendi. Sonuç: İlk kez tanı alan OKB hastalarında diğer inflamatuar mediatörlerde artış saptanırken, plazma NGAL düzeyi ile hastalık ve hastalık şiddeti arasında anlamlı bir artış yoktur, bu alan yazındaki ilk yayındır. OKB hastalarında hastalık şiddetinin artması Hb ve Hct düzeylerini etkilemektedir.
Plasma neutrophil gelatinase-associated lipocalin levels and the hemogram levels and their relationship to disease severity in OCD
Objective: The release of neutrophil gelatinase-associated lipocalin (NGAL), involved with immunity regulation, is a neuromediators. The number of studies related to disease-hemogram in Obsessive Compulsive Disorder (OCD) is low. The aim of our study was to measure the blood NGAL levels and hemogram results in first diagnosis of OCD and to evaluate the relationship between the findings and disease severity. Methods: A total of 28,050 patients, who were presented to psychiatry outpatient clinic between January 2018 and January 2020 were evaluated. Thirtytwo patients, for who were diagnosed first-episode OCD and agreed to participate the study were examined with using the Yale Brown Obsession Compulsion Scale (Y-BOCS), to measure the peripheral blood NGAL levels and hemogram results, and related to immune regulation the total leukocyte counts and neutrophil granulocyte percentage (NEU%); and the C reactive protein (CRP) levels were recorded. Results: In the comparison of the first-episode OCD patients, a significant difference was found between the NEU% and CRP values while was not found between the blood NGAL levels. Although there was no significant difference between the Y-BOCS scores and blood NGAL levels, the Y-BOCS scores increased as the blood hemoglobin and hematocrit values decreased. Conclusion: This is the first study on this topic in the literature, indicated that although there was an increase in some inflammatory mediators in first-episode OCD patients, there was no significant increase between plasma NGAL levels and OCD severity; and that increasing OCD severity did have an effect on blood hemoglobin and hematocrit levels.
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- 1. Demet MM, Deveci A, Deniz F, Taşkın EO, Şimşek E, Yurtsever F. Obsesif kompulsif bozuklukta sosyodemografik özellikler ve fenomenoloji. Anadolu Psikiyatri Derg 2005; 6:133-144.
- 2. Grabe HJ, Meyer C, Hapke U, Rumpf HJ, Freyberger HJ, H Dilling, et al. Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in Northern Germany. Eur Arch Psychiatry Clin Neurosci 2000; 250(5):262-268.
- 3. Bystritsky A, Liberman RP, Hwang S, Wallace CJ, Vapnik T, Saxena S. Social functioning and quality of life comparisons between obsessive-compulsive and schizophrenic disorders. Depress Anxiety 2001; 14(4):214-218.
- 4. Huppert JD, Simpson HB, Nissenson KJ, Liebowitz MR, Foa EB. Quality of life and functional impairment in obsessive-compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety 2009; 26(1):39-45.
- 5. Eisen JL, Mancebo MA, Pinto A, Coles ME, Pagano ME, Stout R, et al. Impact of obsessivecompulsive disorder on quality of life. Compr Psychiatry 2006; 47(4):270-275.
- 6. Storch EA, Wu MS, Small BJ, Crawford EA, Lewin AB, Horng B, et al. Mediators and moderators of functional impairment in adults with obsessivecompulsive disorder. Compr Psychiatry 2014; 55:489-496.
- 7. Turgut K, Ak M. Obsesif kompulsif bozukluk ve biyokimya. Turkiye Klinikleri J Psychiatry-Special Topics 2016; 9(2):15-22.
- 8. Amerikan Psikiyatri Birliği. Ruhsal Bozuklukların Tanısal ve Sayımsal El Kitabı, Beşinci Baskı (DSM-5), Tanı Ölçütleri Başvuru El Kitabı. E Köroğlu (Çev. Ed.), Ankara: Hekimler Yayın Birliği, 2013.
- 9. Zohar J, Sasson Y, Chopra M, Amiaz R, Nakash N. Obsessive compulsive disorder. DJ Nutt, JC Ballinger, (Eds.), Anxiety Disorders, Massachusetts: Blackwell, 2003, pp.83-93.
- 10. Morer A, Vinas O, Lazaro L, Calvo R, Andres S, Bosch J, et al. Subtyping obsessive-compulsive disorder: clinical and immunological findings in child and adult onset. J Psychiatr Res 2006; 40(3):207-213.
- 11. Monteleone P, Catapano F, Fabrazzo M, Tortoella A, Maj M. Decreased blood levels of tumor necrosis factor-alpha in patients with obsessivecompulsive disorder. Neuropsychobiology 1998; 37(4):182-185.
- 12. Attwells S, Setiawan E, Wilson AA, Rusjan PM, Mizrahi R, Miller L, et al. Inflammation in the neurocircuitry of obsessive-compulsive disorder. JAMA Psychiatry 2017; 74(8):833-840.
- 13. Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1998; 155(2):264-271.
- 14. Maina G, Albert U, Bogetto F, Borghese C,Berro AC, Mutani R, et al. Anti-brain antibodies in adult patients with obsessive-compulsive disorder. J Affect Disord 2009; 116(3):192-200.
- 15. Altekin E, Kenesarı Y. Potansiyel tanısal bir biyobelirteç olarak nötrofil jelatinaz ilişkili lipokalin. Türk Klinik Biyokimya Derg 2013; 11(1):37-41.
- 16. Lee S, Lee J, Kim S, Park JY, Lee WH, Mori K, et al. A dual role of lipocalin 2 in the apoptosis and deramification of activated microglia. J Immunol 2007; 179:3231-3241.
- 17. Kang SS, Ren Y, Liu C-C, Kurti A, Baker KE, Bu G, et al. Lipocalin-2 protects the brain during inflammatory conditions. Mol Psychiatry 2018; 23:344-350.
- 18. Dekens DW, Naud´e PJW, Engelborghs S, Vermeiren Y, Dam DV, Oude Voshaar RC, et al. Neutrophil gelatinase-associated lipocalin and its receptors in Alzheimer’s Disease (AD) brain regions: differential findings in AD with and without depression. J Alzheimers Dis 2017; 55(2):763- 776.
- 19. Wei L, Du Y, Wu W, Fu X, Xia Q. Elevation of plasma neutrophil gelatinase-associated lipocalin (NGAL) levels in schizophrenia patients. J Affect Disord 2018; 226:307-312.
- 20. Naudé PJW, Eisel ULM, Comijs HC, Groenewold NA, DeDeyn PP, Bosker FJ, et al. Neutrophil gelatinase-associated lipocalin: A novel inflammatory marker associated with late-life depression. J Psychosom Res 2013; 75(5):444-450.
- 21. Korkmaz S, Yıldız S, Korucu T, Gundogan B, Sunbul ZE, Korkmaz H, et al. Frequency of anemia in chronic psychiatry patients. Neuropsychiatr Dis Treat 2015; 11:2737-2741.
- 22. Stewart R, Hirani V. Relationship between depressive symptoms, anemia, and iron status in older residents from a national survey population. Psychosom Med 2012; 74:208-213.
- 23. Becker M, Axelrod DJ, Oyesanmi O, Markov DD, Kunkel EJ. Hematologic problems in psychosomatic medicine. Psychiatr Clin North Am 2007; 30:739-759.
- 24. Aydemir Ö, Köroğlu E. Psikiyatride Kullanılan Klinik Ölçekler. Üçüncü baskı, Ankara: Hekimler Yayın Birliği, 2007.
- 25. Tezcan AE, Millet B, Kuloğlu M. Türkiye ve Fransa’da obsesif kompulsif bozukluk tanısı alan hastaların sosyodemografik, klinik ve görüngüsel özelliklerin karşılaştırılması. Klinik Psikiyatri Derg 1998; 1:35-41.
- 26. Gülseren L, Eğrilmez A, Gülseren Ş, Kültür S. Obsesif kompulsif bozukluk tanısı konmuş bir grup hastada kompulsiyonların biçim ve içerikleri: Kesitsel bir sınıflandırma çalışması. Turk Psikiyatri Derg 1995; 6:35-40.
- 27. Juang YY, Liu CY. Phenomenology of obsessivecompulsive disorder in Taiwan. Psychiatry Clin Neurosci 2001; 55:623-627.
- 28. Lensi P, Cassano GB, Correddu G, Ravagli S, Kunovac JL, Akiskal HS. Obsessive-compulsive disorder familial developmental history, symptomtology, comorbidity and course with special reference to gender-related differences. Br J Psychiatry 1996; 169:101-107.
- 29. Vahdat Shariatpanaahi M, Vahdat Shariatpanaahi Z, Moshtaaghi M, Shahbaazi SH, Abadi A. The relationship between depression and serum ferritin level. Eur J Clin Nutr 2007; 61:532-535.
- 30. Lever-van Milligen BA, Vogelzangs N, Smit JH, Penninx BW. Hemoglobin levels in persons with depressive and/or anxiety disorders. J Psychosom Res 2014; 76:317-321.
- 31. Onder G, Penninx BW, Cesari M, Bandinelli S, Lauretani F, Bartali B, et al. Anemia is associated with depression in older adults: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2005; 60:1168-1172.
- 32. Gouweleeuw L, Naudé PJW, Rots M, DeJongste MJL, Eisel ULM, Schoemaker RG. The role of neutrophil gelatinase associated lipocalin (NGAL) as biological constituent linking depression and cardiovascular disease. Brain Behav Immun 2015; 46:23-32.
- 33. Goetz DH, Holmes MA, Borregaard N, Bluhm ME, Raymond KN, Strong RK. The neutrophil lipocalin NGAL is a bacteriostatic agent that interferes with siderophore-mediated iron acquisition. Mol Cell 2002; 10:1033-1043.
- 34. Jha MK, Lee S, Park DH, Kook H, Park KG, Park KG. Diverse functional roles of lipocalin-2 in the central nervous system. Neurosci Biobehav Rev 2015; 49:135-156.