Neziha YILMAZ, Reyhan ÖZTÜRK, Murat KORKMAZ, Çiğdem KADER, Mehmet BALCI, Hafize KIZILKAYA, Salih CESUR, Seda SABAH ÖZCAN

Sinovitli osteoartrit hastalarında herpes virüsler ve parvovirüs B19’a karşı oluşan antikor yanıtının serum ve sinoviyal sıvıda araştırılması

Amaç: Bu çalışmada diz ekleminde sinovit tanısı alan hastalarda, serum ve sinoviyal sıvıda sitomegalovirüs (CMV), Epstein-Barr virüsü (EBV), human herpes virüs-6 (HHV-6) ve parvovirüs B19’a karşı oluşan IgG yanıtlarının saptanması ve bu virüslere karşı oluşan spesifik lokal immun yanıtın, sinovit etiyolojisinin belirlenmesindeki rolünün araştırılması amaçlandı. Gereç ve Yöntem: Çalışmaya Bozok Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Polikliniği’ne müracaat eden Kellgren Lawrence sınıflamasına göre evre 3 ve 4 osteoartrit ve sinoviti mevcut olan yetişkinler, hasta grubu olarak alındı. Benzer yaş grubunda, diz ağrısı nedeniyle veya başka bir nedenle diz grafisi çekilen ancak Kellgren Lawrence sınıflamasına göre diz osteoartriti olmayan hastalar kontrol grubu olarak seçildi. Hasta grubuna 29 sinovitli olan hasta alındı ve kontrol grubu olarak da 31 hasta çalışmamıza dahil edildi. Sinovitli hastalardan sinoviyal sıvı ve serum örnekleri alınırken kontrol grubundan sadece serum örnekleri alındı. Tüm örneklerde anti-CMV, EBV, HHV-6 ve parvovirus B19 IgG antikorları mikro ELISA yöntemiyle araştırıldı. Sinoviyal ya da lokal antikor üretimini belirlemek için hasta grubuna ait tüm örneklerde albumin düzeyi spektrofotometrik yöntemle saptandı ve sinoviyal antikor indeksi (sABI) hesaplandı. Hasta ve kontrol grubuna ait tüm örneklerde anti- CMV, EBV, HHV-6 ve parvovirüs B19 IgG pozitiflik oranı araştırıldı. Hasta grubunda serum ve sinoviyadaki IgG düzeyi ve sinoviyal antikor indeksi (sABI) karşılaştırıldı. Bulgular: Tüm çalışma grubunda araştırılan virüsler için serumda IgG pozitifliği sırasıyla; CMV için %91, EBV için %85, parvovirus B19 için %36,6, HHV-6 içinse %43 olarak saptandı. Hasta serumlarında IgG poziflik oranı CMV ve EBV için en yüksekti ve sırasıyla; %100 ve 86 olarak saptandı. Kontrol grubunda EBV ve CMV IgG pozitiflik oranı %83 olarak saptandı. Hasta grubunda serumda parvovirus B19 ve HHV-6 IgG pozitiflik oranı ve absorbans değerleri kontrol grubuna göre daha yüksek saptandı. Hasta grubu serum ve sinoviyal antikor pozitifliği açısından karşılaştırıldığında; sinovitli olgularda lokal antikor üretiminin EBV IgG için %72,4 ile en fazla olduğu bunu %34,4 ile CMV IgG; % 27,5 ile parvovirus IgG ‘nin takip ettiği belirlendi. Sonuç: Sinovitli hastalarda serumda anti- EBV IgG, anti- CMV IgG ve anti-parvovirüs B19 IgG pozitiflik oranları kontrol grubuna göre daha yüksek idi. Sinovitli hastalarda sinoviyal kültür örneklerinde etkenin saptanmadığı durumlarda; CMV, EBV, HHV-6 ve parvovirüs-B19 gibi virüslerin etken olabileceğinin akılda tutulmasının ve hastalarda serum antikorlarına ilaveten sinoviyal sıvıda lokal antikor yanıtlarının araştırılması için antikor indeksinin belirlenmesinin de yararlı olacağı görüşündeyiz.

Anahtar Kelimeler:

Sinovit, CMV, EBV, HHV-6, Parvovirüs B19

Investigation of antibody response against herpes viruses and parvovirus B19 in serum and synovial fluid in osteoarthritis patients with synovitis

Aim: The aim of this study was to detect IgG responses against cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpes virus-6 (HHV-6) and parvovirus B19 in serum and synovial fluid in patients diagnosed with knee joint synovitis, and to investigate the role of specific local immune response against these viruses in detection of the etiology of synovitis. Material and Method: Adult patients with Grade 3 and 4 osteoarthritis and synovitis according to Kellgren-Lawrence classification who went into Bozok University Medical Faculty Hospital Orthopedics and Traumatology policlinic were included in the study as patient group. Patients in similar age group who had knee graphy because of knee pain or another reason but who didn’t have knee osteoarthritis according to Kellgren-Lawrence classification were chosen as control group. While 29 patients were included in patient group, 31 patients were included in control group. While synovial fluid and serum samples were taken from patients with synovitis, only serum samples were taken from control group. Anti-CMV,EBV, HHV-6 and parvovirus B19 IgG antibodies were analyzed with ELISA method in all serum samples. In order to determine synovial or local antibody production, albumin levels were detected in all samples belonging to patient group with spectrophotometric method as well as synovial antibody index (sABI) was calculated. Anti- CMV, EBV, HHV-6 and parvovirus B19 IgG positivity rate was investigated in samples of both patient and control groups. In patient group, IgG level in serum and synovial fluid and synovial antibody index (sABI) were compared. Results: For all viruses investigated in the study, IgG positivity rate in serum was detected as 91% for CMV, 85% for EBV, 36.6% for parvovirus B19 and 43% for HHV6. While the highest IgG positivity rates were found in CMV and EBV (100% and 86%, respectively) in patient group serums, IgG positivity rates for EBV and CMV were found 83% in control group serums. It was found that IgG positivity rates for parvovirus B19 and HHV-6 in serum and absorbance values were higher in patient group compared to control group. It was shown that in cases with synovitis, local antibody production was the highest for EBV IgG with 72.4%, and it was followed by CMV IgG (34.4%) and parvovirus IgG (27.5%). Conclusion: It was concluded that anti- EBV IgG, anti- CMV IgG, and anti-parvovirus B19 IgG positivity rates in serum were higher in patients with synovitis than control group. It should be kept in mind that viruses such as CMV, EBV, HHV-6 and parvovirüs-B19 can be considered as factors when the etiological agents cannot be detected in synovial culture samples in patients with synovitis, and it is believed that in addition to serum antibodies, determining the antibody index can be useful to investigate local antibody responses in synovial fluid in patients.

Keywords:

Synovitis, CMV, EBV, HHV-6, Parvovirus B19,

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