Şule Nur ACAR DUYAN, Banu BOZKURT, Ali UNLU, Sema YİLMAZ, Yalçın KARAKÜÇÜK

Sjögren Sendromlu ve Diabetik Hastalarda Serum Büyüme Faktörleri ve İnflamatuar Sitokin Düzeyleri

ÖZ Amaç: Sjögren sendromu (SS) ve diabetes mellitus (DM) kuru göz hastalığının yaygın nedenleridir ve yapay gözyaşı preperatları yeterli olmadığında otolog serum kullanılmaktadır. Amacımız SS ve DM hastalarının serum büyüme faktörü ve inflamatuar sitokin düzeylerini sağlıklı bireylerle karşılaştırmaktı. Gereç ve Yöntem: Çalışmaya 23 SS hastası (ortalama yaş 52,70±7,55), 25 DM hastası (ortalama yaş 56,68±6,53) ve 23 sağlıklı birey (ortalama yaş 51,70±9,14) alındı. Ayrıntılı oftalmolojik muayene sonrasında Schirmer testi, gözyaşı kırılma zamanı (GKZ) ve Ocular Surface Disease Index (OSDI) skorları ölçüldü. Altı farklı proinflamatuar interlökin (IL), beş büyüme faktörü, matriks metaloproteinaz-9 ve fibronektinin serum seviyeleri, immünoassay ile ölçüldü. Karşılaştırma için tek yönlü ANOVA veya Kruskal-Wallis testleri ve Dunn-Bonferroni post hoc analizi kullanıldı ve p<0,05 anlamlı kabul edildi. Bulgular: Schirmer testi ve GKZ, SS grubunda (2,08±1,72 mm/5 dk ve 3,08±2,08 sn), DR (10,24±4,63 mm/5 dk ve 4,20±3,09 sn) ve kontrol grubuna (13.30±5.95 mm/5 dk ve 9.00±1.75 sn) göre anlamlı olarak düşüktü (p<0,001). İncelenen parametrelerden ortalama serum IL-23 düzeyi SS grubunda (156,66±207,94 pg/mL), DM ve kontrol gruplarına göre (sırasıyla 73,48±95,91 ve 69,59±105,39 pg/mL) anlamlı olarak yüksekti (p< 0.05). Serum insülin benzeri büyüme faktörü 1 (IGF-1) düzeyi DM'li hastalarda en düşüktü (DM: 12,89±21,09, SS: 30,77±19,85 ve kontrol: 27,08±21,93 ng/mL) (p<0,05). Sjögren sendromu hastalık aktivite indeksi (ESSDAI) GKZ ile negatif, IL-1, IL-2 ve fibronektin ile pozitif korelasyon gösterdi (p<0.005). Sonuç: IL-23 ve IGF-1 dışında SS ve DM'li hastalardan elde edilen serum içerikleri sağlıklı bireylerle benzerdir. Bu nedenle, otolog serum, bu kişilerde eksik olan gözyaşını yerine koymak için iyi bir seçenek gibi görünmektedir.

Anahtar Kelimeler:

İnflamatuar sitokinler, Büyüme Faktörleri, Sjögren sendromu, Diabetes mellitus, Otolog serum

Serum Inflammatory Cytokines and Growth Factors in Patients with Sjögren’s Syndrome and Diabetes Mellitus

Abstract Background/ Aims: Sjögren’s syndrome (SS) and diabetes mellitus (DM) are common causes of dry eye disease (DED) and autologous serum is used when artificial tears are not sufficient. Our aim was to compare serum growth factor and inflammatory cytokine levels of SS and DM patients with the healthy individuals. Methods: Twenty-three SS patients (mean age 52.70±7.55 years), 25 DM patients (mean age 56.68±6.53 years), and 23 healthy subjects (mean age 51.70±9.14 years) were included in the study. After detailed ophthalmological examination, Schirmer test, tear break-up time (TBUT) and Ocular Surface Disease Index (OSDI) scores were measured. Serum levels of six different proinflammatory interleukins (IL), five growth factors, matrix metalloproteinase-9, and fibronectin were measured by immunoassay. One-way ANOVA or Kruskal-Wallis tests and Dunn-Bonferroni post hoc analysis were used for comparison and p<0.05 was considered significant. Results: Schirmer test and TBUT were significantly lower in the SS group (2.08±1.72 mm/5 min and 3.08±2.08 s) than in the DR (10.24±4.63 mm/5 min and 4.20±3.09 s) and control groups (13.30±5.95 mm/5 min and 9.00±1.75 s) (p<0.001). Among the parameters studied, mean serum IL-23 level was significantly higher in the SS group (156.66±207.94 pg/mL) than in the DM and control groups (73.48±95.91 and 69.59±105.39 pg/mL, respectively) (p<0.05). Serum insulin-like growth factor 1 (IGF-1) level was lowest in DM patients (DM: 12.89±21.09, SS: 30.77±19.85, and control: 27.08±21.93 ng/mL) (p<0.05). Sjögren’s syndrome disease activity index (ESSDAI) showed a negative correlation with TBUT and a positive correlation with IL-1, IL-2 and fibronectin (p<0.005). Conclusions: Except IL-23 and IGF-1, the contents of serum obtained from patients with SS and DM are similar with the healthy individuals. Therefore, autologous serum seems to be a good option to replace deficient tear fluid in these subjects.

Keywords:

Inflammatory cytokines, Growth factors, Sjögren’s syndrome, Diabetic mellitus, Autologous serum,

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