Gammapatiler üzerine retrospektif bir çalışma

Serum immünglobulin düzeyleri, immünglobinlerin biyosentez ve/veya salıverilme hızlarının bozulmasına bağlı olarak değişiklik gösterir. Bazı hastalıklarda sadece bir immünglobulin sınıfında artış görülürken (monoklonal immünglobulin), kronik bakteriyel enfeksiyonlarda poliklonal immünglobulin bozuklukları görülebilir. Monoklonal gammapatiler, plazma hücrelerinin tek bir klonunun kontrolsuz bir şekilde çoğalması sonucu, söz konusu klonun ürettiği immünglobulinin serumdaki miktarının artmasıyla ortaya çıkmaktadır. Bu çalışmada; 3 yıl boyunca (1999 - 2002) çeşitli nedenlerle hastanemize başvuran ve kendilerinden protein+immünfıksasyon elektroforezi istenen toplam 730 vakanın elektroforez sonuçlarını değerlendirdik. Agaroz jel elektroforezi kullanılarak yapılan çalışmada; 730 olgunun 14'ünde (%1.9) gammapati görüldü. Bunların 12'si monoklonal (%85.7), 2'si ise biklonal (%14.3) gammapati idi. Toplam 14 olgudan 8'inde IgG'de (%57.1), 4'ünde IgM'de (%28.6) ve 2'sinde ise IgA'da (%14.3) gammapati gözlendi. Gammapatilerin Kappa (K) ve Lambda ($lambda$) hafif zincirlere göre dağılımı ise şöyle idi: IgG k 1(%7.1), IgG $lambda$ 5(35.7), IgG K+$lambda$ 2(%14.3), IgM K 3(%21.5), IgM $lamda$ 1(%7.1) ve IgA K 2(%14.3). Verilerimiz, monoklonal gammapati oranının %1.9, biklonal gammapati oranının ise %0.3 olduğunu göstermektedir. Literatürde monoklonal gammapatilerin toplumlardaki prevalansı %l-3, biklonal gammapatilerin prevalansı ise yaklaşık %1 olarak bildirilmektedir. Dolayısıyla bizim bulgularımız da bu oranları desteklemektedir.

A retrospective study on Gammopathies

The serum immunoglobulin levels change due to biosynthesis and/or release of immunoglobulins. While an increase in one class of immunoglobulins (monoclonal immunoglobulin) may be seen in some diseases, polyclonal immunoglobulins are observed in choronic bacterial infections. Monoclonal gammopathies are occurred by the abnormal proliferation of only one clone of plasma cells that the elevated level of serum immunoglobulin is produced by this clone. We evaluated the protein and immunofixation electrophoresis results of 730 patients applied to our hospital for various reasons during 3 years (1999 - 2002). Gammopathy was determined at 14 of 730 cases (1.9%) in the study using agarose gel electrophoresis. 12 of them (85.7%) were monoclonal gammopathy and 2(14.3%) were biclonal. At 8 of 14 cases (57.1%) IgG, at 4(28.6%) IgM and at 2(14.3%) IgA gammopathies were observed. The distribution gammopathies according to the light-chains of Kappa (k) and Lambda ($lambda$) were: IgG K 1(7.1%), IgG $lambda$ 5(35.7%), IgGK+$lambda$ 2(14.3%), IgM K 3(21.5%), IgM $lambda$ 1(7.1%) and IgA K 2(14.3%). Our data suggest that the ratio of monoclonal gammopathy is 1.9%, and the ratio of biclonal gammopathy is 0.3%. In literature, the prevalance of monoclonal and biclonal gammopathy of the populations were reported as 1-3% and 1%, respectively. As a result, our findings were support to this rations.

Kaynakça

1. Sivas A, Onat T, Emerk K, (Editörler), Amino asitler ve proteinler, Temel Biyokimya, 2. Baskı, Saray Medikal Yayıncılık, İzmir, s: 158-65, 1997

2. Lindsey BJ., Bishop ML, Duban-Engekirk JL, Fody EP, (Editors), lAmino acids and proteins,Clinical Chemistry, Principles, Procedures, Correlations, Third Edition, Lippincott-Raven Publishers, Philadelphia, pp. 183-4, 1996.

3. George ED, Sadovsky R, Multiple Myeloma: Recognition and managament, Am Fam Physician, 59(7); 1885-94, 1999.

4. Beyan C, Kaptan K, Çetin T, Waldenstrom Makroglobunemisi, Türkiye Klinikleri Tıp Bilimleri Dergisi, 22(1); 87-93, 2002.

5. Silverman LM, Christensen RH, Burtis CA, Ashwood ER (Editors), Amino acids and proteins, Tiez Textbook of Clinicel Chemistry, Second Edition, W.B: Saunders Company, Philedelphia, pp.678-88, 1994.

6. Cohen Y, Ben-Bassat I, Bioclinical gammopathies: clinical and theoretical aspects, Harefuah, 124 (7); 393-5, 1993.

7. Andreone P, Zignego AL, Cursaro C, Gramnezi A, Gherlizoni F, Fiorino S, Giannini C, Boni P, Sabattini E, Pileri S, Tura S, Bernardi M, Prevalance of monoclonal gammopathies in patients with hepatitis C virus ingection, Ann Intern Med, 129(4); 294-8, 1998.

8. Heer M, Joller-Jemelka H, Fontana A, Seefeld U, Schmid M, Amman R, Monoclonal gammopathy in chronic active hepatitis, Liver, 4(4); 255-63, 1984.

9. Kuchler B, KellerH, Spangler GA, Incidence of accidentally discovered paraproteinemias among the patients of a hospital for internal diseases, SchweizMed Wochenschr, 112(48); 1723-9, 1982.

10. Colls BM, monoclonal gammopathy of undetermined significance (MGUS)-31 year follow up of a community study, Aust N ZJ Med, 29(4); 500-4, 1999.

11. Lemonie A, Pham P, Azoulay D, Saliba F, Emile JF, Saffroy R, Broet P, Bismuth H, Samuel D, Debuire B, Detection of gammopathy by serum protein electrophoresis for predicting and managing therapy of lymphoproliferative disonder in 911 recipients of liver transplants, Blood, 98(5); 1332-8, 2001.

12. Passweg J, Thiel G, Bock HA, Monoclonal gammopathy after intense induction immunosuppression in renal transplant patients, Nephrol Dial Transplant, 11(12); 2461-5, 1996.

13. Badley AD, Portela DF, Patel R, Kyle RA, Habermann TM, Strickler JG, Ilstrup DM, Wiesner RH, de Groen P, Walker RC, Paya CV, Development of monoclonal gammopathy precedes the development of Epstein-Barr virus-induced posttransplant lymophoproliferative disorder, Liver Transpl Surg, 2(5); 375-82, 1996.

14.Arnulf B, Bengoufa D, sarfati E, Toubert ME, Meignin V, Brouet JC, Femand JP, Prevalance of monoclonal gammopathy in patients with primary hyperparathyroidism: a prospective study, Arch Intern Med, 162(4); 464-7, 2002.

15. Singh J, Dudley AW Jr, Kulig K4, Increased incidence of monoclonal gmmopathy of undetermined signigicance in blacks and its age-related differences with whites on the basis of a study of 397 men and one women in a hospital setting, J Lab Clin Med, 116(6); 785-9, 1990.

16. Cohen HJ, Crawford J, Rao MK, Pieper CF, Currie MS, Racial differences in the prevalance of monoclonal gammopathy in a community-based sample of the elderly, Am JMed, 104(5); 439-44, 1998.

17. Crawford J, EyeMK, Cohen HJ, Evaluation of monoclonal gammopathy in the "well" elderly, Am JMed, 82(1); 39-45, 1987.

18. Moller-Petersen J, Schmid EB, Leegaard OF, Detection rate and clinical significance of monoclonal gammopathy in different age groups in the population of Northern Jutland, Denmark, Dan Med Bull, 32(3); 179-81, 1985.

19. Giraldo P, Rubio-Feliks D, Delgado P, Giralt M, Transient monoclonal gammopathies, Study of 34 cases, Sangre (Bare), 39(5); 351-5, 1994.

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