S. Oktay ARSLAN, O. Tayyar ÇELİK, S. A. BARAN, Dermiş S. GÜNGÖR, Esen AKKAYA

Sarkoidoz'da aktivite belirlemede serum belirteçlerinin önemi

Amaç: Sarkoidoz'da hastalığın aktivitesi, klinik takipte, tedavi kararını vermede, bu tedavinin şekli ve süresini belirlemede önemlidir. Çalışmamızda serum belirteçlerin sarkoidozda aktivite kriteri olarak yerini ve bu kriterlerin birbirleri ile olan ilişkilerini araştırmayı amaçladık. Gereç Yöntem: Birinci yıl için 77, ikinci yıl için 57 sarkoidoz tanılı olguları çalışmaya aldık. Hastaların klinik, radyolojik ve pulmoner fonksiyon olarak aktivite ve inaktivite tanımlanması yapıldı. Serumdan total ADA, ADA1, ADA 2, ACE ve IgE ölçümü yapıldı. Hastalar 1. yıl için aktif ve inaktif olanlar ve 2. yıl için aktif ve inaktif olanlar olmak üzere iki gruba ayrıldı. Bulgular: Aktif ve inaktif olan olguların yaş ortalamaları, cinsiyet dağılımları arasında istatistiksel olarak anlamlı bir farklılık bulunmadı. Son bir yıldır ve son 2 yıldır aktif veya inaktif olguların ACE, IgE, ADA 1, ADA 2 ve total ADA ortalamaları arasında istatistiksel olarak anlamlı bir farklılık bulunmadı. Son 1 yıldır aktif olan olguların serum belirteçleri dikkate alındığında IgE -ADA 1, IgE - total ADA arası, ADA 1-ADA 2, ADA 1-total ADA, inaktif olan olgular dikkate alındığında ADA 1-total ADA, ADA 2-total ADA değerleri arasında anlamlı korelasyon bulundu. Sonuç: Aktif ve inaktif sarkoidozlu hastaları karşılaştırdığımızda bu beş belirteç açısından anlamlı bir fark saptamadık. Fakat lenfosit kaynaklı belirteçler (Total ADA, ADA1, ADA2, IgE) arasında anlamlı korelasyon saptadık.

The importance of serum markers to detect the activity of Sarcoidosis

Aim: The aims of the present study were investigating the role of serum markers in estimating disease activity in sarcoidosis and determining the relationships between these markers. Material and Methods: The diagnosis of sarcoidosis was based on the clinical, radiological and hystopathological findings. The disease activity was determined according to the clinical and radiological findings and the results of pulmonary function tests. The levels of total ADA, ADA1, ADA2, ACE and IgE were determined in sera. The patients were divided into two groups according to the disease activity in year 1 and year 2. Results: There were no significant differences regarding mean serum levels of five markers between patients with active and inactive disease course. In patients with active disease course over last one year, there were significant correlations between serum levels of IgE-ADA1 and IgE-total ADA, ADA1-ADA2, and ADA1- total ADA. In patients with inactive disease course over last one year, there were significant correlations between serum levels of ADA1 - total ADA, ADA 2 - total ADA. Conclusion: Our findings suggest that there were no significant correlation between disease activity and serum levels of five markers in patients with sarcoidosis. However, our findings suggest that there are correlations between lymphocyte derived markers.

PDF

___

1) Consensus conference: Activity of sarcoidosis. Third WASOG meeting, Los Angeles, USA, September 8-11, 1993. Eur Respir J 1994; 7:624-627
2) Çağatay T, Bilir S, Yanardağ H, Gulbaran Z, Papila C. Pulmoner sarkoidozlu olgularda immunglobulin ve kompleman düzeylerinin hastalığın aktivasyonuyla ilişkisi. Solunum Hastalıkları 1999; 10: 254–258.
3) Planck A, Eklund A, Grunewald J. Markers of activity in clinically recovered human leukocyte antigen-DR17-positive sarcoidosis patients. Eur Respir J 2003; 21: 52-57
4) Rothkrantz-Kos S, Dieijen-Vesser MP, Mulder PGH, Drent M. Potential usefulness of inflammatory markers to monitor respiratory functional impairment in sarcoidosis. Clinical Chemistry 2003; 49 : 1510-1517
5) ATS/ERS/WASOG Committee. Statement on Sarcoidosis. Am J Crit Care Med 1999; 160:73755
6) Costabel Ulrich, Hunninghake Gary. W. (on behalf of the sarcoidsis statment comitte).ATS/ERS/WASOG statment on sarcoidosis. Eur respir J 1999;14:735-737
7) Rust M, Bergman L, Kuhn T et al. Prognostic value of chest radiograph, serum ACE, T hepler cell count in blood and in bronchoalveolar lavage of patients with pulmonary sarcoidosis. Respiration 1985; 48 : 231-236.
8) Morell F, Levy G, Orriols R et al. Delayed cutaneous hypersensitivity tests and lymphopenia as activity markers in sarcoidosis. Chest 2002; 121; 1239-1244.
9) Lawrwnce EC, Brousseau KP, Berger MB et al. Elevated concentrations of soluble interleukin-2 receptors in serum samples and bronchoalveolar lavage fluids in active sarcoidosis. Am Rev Resp Dis 1988, 137; 759-764.
10) Ogushi F, Sone S, Singh SM et al. Elevated level of soluble interleukin-2 receptor in bronchoalveolar lavage fluid from sarcoidosis patients. Jpn J Med. 1991 Mar-Apr;30(2):113-117.
11) Eklund A, Blaschke E. Elevated serum neopterin levels in sarcoidosis. Lung 1986 ;164; 325-332
12) Papadopoulos KI, Melander O, Orho-Melander M, Groop LC et al. Angiotensin converting enzyme (ACE) gene polymorphism in sarcoidosis in relation to associated autoimmune diseases. J Intern Med. 2000 Jan; 247:71-77
13) Quernheim -Müller J. Sarcoidosis: Clinical manifestations, staging and therapy (part 2). RespirMed 1998; 92: 140-149.
14) Liebermann J, Schleissner LA, Nosal A. et al. Clinical correlation of serum ACE in sarcoidosis; A longitutinal study of serum ACE, Ga67 scan, chest roentgenograms and pulmonary function. Chest 1983; 84; 522-528.
15) Baughman RP, Fernandez M, Bosken CH, Mantil J, Hurtubise P. Comparison of galiium 67 scanning, bronchoalveolar lavage and serum ACE levels in pulmonary sarcoidosis. Am Rev Respir Dis 1984; 129; 676-668.
16) Lawrence EC, Brousseau KP, Berger MB et al. Elevated concentrations of soluble interleukin-2 receptors in serum samples and bronchoalveolar lavage fluids in active sarcoidosis. Am Rev Resp Dis 1988, 137: 759-764.
17) Hollinger WM, Staton GW Jr, Fajman WA et al. Prediction of therapeutic response in steroid-treated pulmonary sarcoidosis. Evaluation of clinical parameters, bronchoalveolar lavage, gallium-67 lung scanning, and serum angiotensin-converting enzyme levels. Am Rev Respir Dis 1985 Jul;132:65-69.
18) Klech H, Kohn H, Kummer F, Mostbeck A. Assesment of activity of sarcoidosis. Sensitivity and specificity of 67Gallium scintigraphy, serum ACE levels, chest roentgenography, and blood lymphocyte. subpopulations. Chest. 1982 Dec;82(6):732-738.
19) Alía P, Mañá J, Capdevila O, Alvarez A, Navarro MA. Association between ACE gene I/D polymorphism and clinical presentation and prognosis of sarcoidosis. Scand J Clin Lab Invest. 2005;65(8):691-697.
20) Martin Schürmann. Angiotensin-converting enzyme gene polymorphisms in patients with pulmonary sarcoidosis: impact on disease severity. Am J Pharmacogenomics. 2003;3:233-243.
21) Yagura T, Shimizu M, Yamamura Y, Tachibana T. Serum IgE levels and reaginic type skin reactions in sarcoidosis. Clin Exp Immunol 1975; 21: 289-297
22) Burnett D. Immunoglobulins in the lung. Thorax. 1986; 41: 337-344
23) Larsson PH, Eklund A, Johansson SG, Larsson K. Covalent binding of proteinsgrafted plastic surfaces suitable for immunoassays. II. Picograms of IgE detected in BAL fluid in sarcoidosis. J Immunol Methods 1997; 210: 41-49
24) Pforte A, Von Kress S, Beer B, Jutting U, Haussinger K, Ziegler-Heitbrook HW. Detection of the receptor CD23 in sarcoidosis. Pneumologie 1993; 47: 631-635.
25) Wetsel E, Muller-Quernheim J, Lorenz J. Serum adenozine deaminaz as a parameter for activity in sarcoidosis. Pneumologie 1999; 53; 323-327.
26) Kubota M, Katagiri M, Imasaki T, Yanase N, Soma K, Tomita T. [Adenosine deaminase activity in bronchoalveolar lavage fluid of sarcoidosis patients. Nihon Kokyuki Gakkai Zasshi 1999; 37; 374-379.
27) Albera C, Mabritto I, Ghio P, Solidoro P, Marchetti L, Pozzi E. Adenosine deaminase activity and fibronectin levels in bronchoalveolar lavage fluid in sarcoidosis and tuberculosis. Sarcoidosis 1993; 1081; 18-25.
28) Grutters JC, Fellrath JM, Mulder L, Janssen R, Bosch JMM, Velzen-Blad H. Serum soluble interleukin-2 receptor measurement in patients with sarcoidosis. Chest 2003; 124: 186-195.
29) Muller- Quernheim J, Pfeifer S, Strausz J, Ferlinz R. Correlation of clinical and immunologic parameters of the inflammatory activity of pulmonary sarcoidosis. Am Rev Respir Dis 1991; 144: 1322-1329
30) Keicho N, Kitamura K, Takaku F, Yotsumoto H. Serum concentration of solubleinterleukin-2 receptor as sensitive parameter of disease activity in sarcoidosis. Chest 1990; 98: 1125-1129.
31) Alper D, Kumbasar Ö Ö (Eds). Güncel Bilgiler Işığında Sarkoidoz. Türk Tüberküloz ve Toraks Derneği. Ankara, Bilimsel Tıp Yayınevi: 1999