Sistemik lupus eritematosus tanısı ile takipli hastalarda otoimmünitenin araştırılması
İnvestigation of polyautoimunity in patients with sistemic lupus erythematosus
Yazar: ARZU TAGHIYEVA
Danışman: PROF. DR. ŞAZİYE ŞULE APRAŞ BİLGEN ; DOÇ. DR. LEVENT KILIÇ
Hacettepe Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2022
Konu: Romatoloji = Rheumatology
Dizin: Hasta takibi = Follow up studies ; Lupus eritematozus-sistemik = Lupus erythematosus-systemic ; Otoimmün hastalıklar = Autoimmune diseases ; Otoimmünite = Autoimmunity ; Romatizmal hastalıklar = Rheumatic diseases

Özet:
Çalışmamızda Hacettepe Hastanesi Romatoloji bölümünde takipli SLE tanılı hastaların poliotoimmünite sıklığının, bu hastalarda klinik bulguları ve komorbiditelerinin, laboratuvar değerlerinin ve otoantikor profilinin, poliotoimmünitenin prognoza olan etkisinin, risk faktörlerinin değerlendirilmesi amaçlanmıştır. Aralık 2021 – Ağustos 2022 arasında polikliniğimize başvuran 310 (%88,1 kadın) hasta çalışmaya dahil edildi. Bunlardan 152'de (%49,0) poliotoimmünite mecvuttu. Hastaların ortalama yaşları 42,98 (14,3) yıldı. Ortalama SLE tanı yaşları 31,08 (14,0), ortalama hastalık süresi 148,4 (97,3) aydı. Poliotoimmünitesi olan hastalar olmayan kontrol grup hastalara göre daha ileri yaşta olduğu (45,21)±14,21) ve 40,84 (±14,26), p=0,007) ve daha ileri yaşta SLE tanısını aldığı (33,26 (±13,89) ve 28,98 (13,92), p=0,007) görüldü. En sık saptanan otoimmün hastalıklar ise sırasıyla AFAS 55 (%17,7), OİTH 36 (%17,7), SS 36 (%11,6) ve RA 15 (%4,8) idi. Kırk iki (%13,5) hastada 2 ve daha fazla ek otoimmün hastalık vardı. Overlap sendromu ise 56 (%18,1) hastada saptandı. Poliotoimmünite grubunda kontrol grubuna göre apL antikorlarının (71 (%46,7) ve 36 (%22,8), p=0,000), anti-Ro/SsA (50 (%33,1) ve 28 (%17,7), p=0,001), anti-La/SsB (16 (%10,5) ve 9 (%5,7), p=0,042) daha fazla, Anti-RNP antikorları (15 (%9,9) ve 27 (%17,1), p=0,011) ve kompleman düşüklüğü (95 (%62,5) ve 124 (%78,5), p=0,001) ise daha az görülmekteydi. Poliotoimmün grup hastalarda SLEDAİ-2K hastalık aktivitesi daha yüksek saptanmıştır. Çoklu değişkenli analize göre aile öyküsü olması poliotoimmünite riskini 2.5 kat arttırmaktadır (OR: 2.5 CI: 1,4-4,5, p=0,002). apL pozitifliği (OR: 3,8 CI: 2,0- 7,3, p=0,000) ve HT (OR: 2,0, CI: 1,0-3,9, p=0,049) da önemli risk faktörü olduğu görüldü. Hipokomplementemi olan hastalarda ise poliotoimmünitenin %50 daha az olduğu, renal tutulumu olan hastalarda poliotoimmünitenin %30 daha az olduğu görülmüştür.

Abstract:
İn our study, it was aimed to evaluate the frequency of polyautoimunity in patients with SLE diagnosed in Hacettepe Rheumatology Department, their clinical findings and comorbidities, laboratory values and autoantibody profile, it's effect on prognosis, and risk factors. Three hundred ten (88.1% female) patients who applied to our outpatient clinic between December 2021 and August 2022 were included in the study. Of these, 152 (49.0%) had polyautoimunity. The mean age of the patients was 42.98 (14,3) years. The mean age of the diagnosis of SLE was 31,08 (14,0) and the mean disease duration was 148,4 (97,3) month. Patients with polyautoimunity were older (45,21)±14,21) vs 40,84 (±14,26), p=0,007)) and were diagnosed with SLE at an older age (33,26 (±13,89) vs 28,98 (13,92), p=0,007) than the control group patients without polyautoimunity. The most common autoimmune diseaeses were AFAS 55 (17,7%), AİTH 36 (17,7%), SS 36 (11,6%) and RA 15 (4,8%), respectively. Forty-two (13,5%) patients had 2 or more additional autoimmune diseases. Overlap syndrome was detected in 56 (18,1%) patients. İn the polyautoimmunity group, compared to the normal group, aPL antibodies (71 (46,7%) vs 36 (22,8%), p=0,000), Ro/SsA (50 (33,1%) vs 28 (17,7%), p=0,001), anti- La/SsB (16 (10,5%) vs 9 (5,7%), p=0,042) were more common, while Anti-RNP antibodies (15 (9,9%) vs 27 (17,1%), p=0,011) and low complement (95 (62,5%) vs 124 (78,5%), p=0,001) were less common. SLEDAİ-2K disease activity was found to be higher in patients in the polyautoimmunity group. According to multivariate analyses, having the family history increases the risk of the polyautoimmunity 2.5 times (OR: 2.5 CI: 1,4-4,5, p=0,002). apL positivity (OR: 3,8 CI: 2,0-7,3, p=0,000) and hypertension (OR: 2,0, CI: 1,0-3,9, p=0,049) are also important risk factors. On the other hand, it was observed that polyautoimmunity was 50% less in patients with hypocomplementemia and 30% less in patients with renal involvement.