Gonca AKYOL, Eyüp Sabri UÇAN, Sevgi ÖZALEVLİ

Ankilozan spondilitli hastaların solunum fonksiyonlarının egzersiz kapasitesi ve yaşam kalitesiyle ilişkisi

Giriş: Ankilozan spondilit, etyolojisi bilinmeyen, özellikle sakroiliyak eklemler, aksiyal iskelet ve büyük periferik eklemlerde tutulum gösteren, kronik otoimmün inflamatuvar bir hastalıktır. Hastalık, kostovertebral ve kostosternal eklemlerin ankilozu sonucunda göğüs kafesinin ekspansiyonunu kısıtlayarak restriktif tipte solunum bozukluğuna sebep olmaktadır. Çalışmamız; akciğer tutulum oranı yüksek olan ankilozan spondilitli hastaların solunum fonksiyonlarını değerlendirerek, sonuçları hastaların egzersiz kapasitesi ve yaşam kalitesi statüleriyle karşılaştırmak amacıyla planlandı.Materyal ve Metod: Modifiye New York kriterlerine göre ankilozan spondilit tanısı almış olan, Norveç'ten Türkiye'ye rutin fizyoterapi programına alınmak için gelen, yaş ortalaması 50.6 ± 6.6 yıl olan Norveçli 27 (18'i erkek, 9'u kadın) hasta değerlendirildi. Hastaların klinik öyküleri sorgulandı. Solunum fonksiyon testleri spirometre ile, solunum kas kuvvetleri ağız içi basınç ölçerle ölçüldü. Egzersiz kapasitesi altı dakika yürüme testiyle, sağlıkla ilgili yaşam kalitesi Short Form-36 yaşam kalitesi anketiyle değerlendirildi.Bulgular: Tanı süresi 18.85 ± 10.64 yıl olan hastaların, FEV1 değeri 3.75 ± 0.88 L/sn, FEV1/FVC oranı 80.44 ± 6.42, MİP değeri 62.96 ± 20.61, MEP değeri 80.22 ± 21.12 idi. Hastaların %40.7'sinde sigara öyküsü pozitifti ve %14.8'inde nefes darlığı, %11.1'inde öksürme-balgam semptomu mevcuttu. Hastaların %88.9'unun düzenli olarak egzersiz (jogging, bisiklet) yaptığı saptandı. Yürüme mesafeleri 595.50 ± 83.20 metre idi. Yaşam kalitesi kategori skorları minimum 42.82 ± 16.78, maksimum 83.58 ± 23.06 idi. Sigara içen ve içmeyen hastaların solunum fonksiyon testi değerleri ve solunum kas kuvvetlerinin benzer olduğu, ancak sigara içen hastaların yaşam kalitelerinin fiziksel fonksiyon ve sosyal fonksiyon skorlarında içmeyenlere göre daha fazla azalma olduğu saptandı.Sonuç: Solunumsal ve diğer kazanç parametrelerinin yüksek bulunması hastalarımızın egzersiz alışkanlıklarının olmasına ve Norveç'te yüksek standartlarda tedavi-izlem görmelerine bağlandı. Ankilozan spondilitli hastalarda uygun medikal tedavi ve yaşam tarzı haline getirilmiş olan egzersiz alışkanlığının hastalığın solunum sistemine olumsuz etkilerini en aza indirgeyebileceği düşünüldü.

The relationship between pulmonary function and exercise capacity and quality of life in patients with ankylosing spondylitis

Introduction: Ankylosing spondylitis causes restrictive respiratory disorder by limiting the expansion of the chest because of the costosternal and costovertebral joints. Our study is planned to evaluate the respiratory functions of the ankylosing spondylitis patients who have a high rate of pulmonary involvement, and to compare the results with the exercise capacity and life quality of these patients.Materials and Methods: There were 27 (18 male, 9 female) Norvegian patients who came to Turkey and had ankylosing spondylitis diagnose according to Modified New York criterias, to have a routine physical therapy and rehabilitation programme with an average age of 50.6 ± 6.6 years. The patients' clinical histories were taken. Pulmonary function tests were performed with spirometry and pulmonary muscle strength was measured with mouth pressure measure. 6 minute walk test was performed to determine exercise capacity and Short Form-36 Life Quality Questionairre was used to evaluate life quality of the patients.Results: The patients had 18.85 ± 10.64 average diagnose duration and the expected FEV1 value of the patients was 3.75 ± 0.88 L/sec, FEV1/FVC ratio was 80.44 ± 6.42, MIP was 62.96 ± 20.61 and MEP was 80.22 ± 21.12. 40.7% of the patients had positive smoking history while 14.8 % had dyspnea and 11.1% had symptoms of caughing-sputum. Walking distance was 595.50 ± 83.20 metre. Life quality category scores were 42.82 ± 16.78 minimally, 83.58 ± 23.06 maximally. Pulmonary function and pulmonary muscle strength values were similar in smoking and non-smoking patients. But in smoking patients, physical function and social function categories of quality of life survey scores were found lower than non-smoking patients.Conclusion: Respiratory and other parameters were high related to high standarts in treatment and following and exercise habit of the patients in Norway. Accordingly, it is thought that an appropriate medical treatment and exercise as a lifestyle habits of the patients reduce the negative effects of ankylosing spondylitis on respiratory system.

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