Öz
Amaç: Türk sistemik skleroz (SSc) hastalarında metabolik sendrom (MetS) prevalansının saptanması amaçlamıştır.
Gereç ve Yöntem: Kesitsel ve tek merkezli çalışmaya, Temmuz-Eylül 2021 tarihleri arasında üçüncü basamak hastanemizin polikliniğinde başvuran 76 SSc olgusu alındı. MetS, National Cholesterol Education Program’s Adult Treatment Panel (NCEP-ATP III) kriterlerine göre tanımlandı. MetS’in SSc organ tutulumu ve hastalık özellikleri ile ilişkisi incelendi.
Bulgular: ATP III kriterlerine göre MetS, 37 olguda (%48.7) saptandı. MetS sıklığının ilerleyen yaşla birlikte arttığı (40-45 yaşta: %25, 46-60 yaşta: %48.4, >60 yaşta: %62.9) görüldü. Olgular MetS olup olmamasına göre 2 gruba ayrılarak karşılaştırıldı. MetS olan olguların yaşlarının daha yüksek (58.2±9.4’e karşı 51.6±13.5, p=0.015) ve modifiye Rodnan deri skorlarının daha düşük olduğu görüldü. (14’e karşı 22, p=0,019). Hastalık tipi, süresi, aktivitesi, tutulan organlar/sistemler ve hastalık ilişkili hasar bakımından da grupların benzer nitelikte oldukları görüldü.
Sonuç: Çalışmamızda SSc hastalarında saptanan Mets sıklığı ülkemiz genel popülasyonuna göre daha yüksek olsa da benzer yaş grubuna göre değerlendirildiğinde MetS sıklığının artmamış olduğu görülmektedir. MetS’in hastalığın kendisinden ziyade yaş ve cinsiyet baskınlığına bağlı olduğu düşünülmüştür. MetS'li hastalarda mRSS anlamlı olarak düşük saptanmasına rağmen, MetS'i öngörme duyarlılığı düşük bulunmuştur. Yine de verilerimiz SSc hastalarında MetS riskinin dikkate alınması gerektiğini ve daha geniş hasta gruplarında ileri çalışmalara ihtiyaç olduğunu ortaya koymaktadır.
Anahtar Kelimeler
sistemik skleroz metabolik sendrom prevalans insulin direnci
Kaynakça
- Denton CP, Khanna D. Systemic sclerosis. Lancet. 2017;390(10103):1685-1699.
- Elhai M, Meune C, Avouac J, Kahan A, Allanore Y. Trends in mortality in patients with systemic sclerosis over 40 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford). 2012 Jun; 51(6):1017-1026.
- Poudel DR. Jayakumar D, Danve A, Sehre ST, Derk CT. Determinants of mortality in systemic sclerosis: a focused review Rheumatol Int. 2018 Oct;38(10):1847-1858.
- Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005 Oct 25;112(17):2735-52.
- Medina G, Vera-Lastra O, Peralta-Amaro AL, et al. Metabolic syndrome, autoimmunity and rheumatic diseases. Pharmacol Res. 2018 Jul;133:277-288.
- Atzeni F, Marino F, Cirillo M, et al. Metabolic Syndrome in Systemic Sclerosis Patients: Data from Clinical Practice. Isr Med Assoc J. 2021 Apr;23(4):262-263.
- Gigante A, Iannazzo F, Navarini L, et al. Metabolic syndrome and adipokine levels in systemic lupus erythematosus and systemic sclerosis. Clin Rheumatol. 2021 Oct;40(10):4253-4258.
- Peralta-Amaro AL, Cruz-Domínguez Mdel P, Olvera-Acevedo A, Vera-Lastra OL. Prevalence of metabolic syndrome and insulin resistance in system sclerosis. Rev Med Inst Mex Seguro Soc. 2015 Jul-Aug;53(4):476-83.
- Frech TM, Revelo MP, Drakos SG, et al. Vascular leak is a central feature in the pathogenesis of systemic sclerosis. J Rheumatol. 2012 Jul;39(7):1385-91.
- Żółkiewicz J, Stochmal A, Rudnicka L. The role of adipokines in systemic sclerosis: a missing link? Arch Dermatol Res. 2019 May;311(4):251-263.
- Lee YH, Song GG. Meta-analysis of circulating adiponectin, leptin, and resistin levels in systemic sclerosis. Z Rheumatol. 2017 Nov;76(9):789-797.
- Frommer KW, Neumann E, Müller-Ladner U. Role of adipokines in systemic sclerosis pathogenesis. Eur J Rheumatol. 2020 Oct;7(Suppl 3):S165-S172.
- Stein CM, Tanner SB, Awad JA, Roberts LJ 2nd, Morrow JD. Evidence of free radical-mediated injury (isoprostane overproduction) in scleroderma. Arthritis Rheum. 1996 Jul;39(7):1146-50.
- Doridot L, Jeljeli M, Chêne C, Batteux F. Implication of oxidative stress in the pathogenesis of systemic sclerosis via inflammation, autoimmunity and fibrosis. Redox Biol. 2019 Jul;25:101122.
- Abdulle AE, Diercks GFH, Feelisch M, Mulder DJ, van Goor H. The Role of Oxidative Stress in the Development of Systemic Sclerosis Related Vasculopathy. Front Physiol. 2018 Aug 24;9:1177.
- Gore-Hyer E, Pannu J, Smith EA, Grotendorst G, Trojanowska M. Selective stimulation of collagen synthesis in the presence of costimulatory insulin signaling by connective tissue growth factor in scleroderma fibroblasts. Arthritis Rheum. 2003 Mar;48(3):798-806. doi: 10.1002/art.10953.
- Barroso I, Gurnell M, Crowley VE, et al. Dominant negative mutations in human PPARgamma associated with severe insulin resistance, diabetes mellitus and hypertension. Nature. 1999 Dec 23-30;402(6764):880-3.
- Lakota K, Wei J, Carns M, et al. Levels of adiponectin, a marker for PPAR-gamma activity, correlate with skin fibrosis in systemic sclerosis: potential biomarker for siPAAR pilot clinical trial. Arthritis Res Ther. 2012;14(3)
- Wu M, Melichian DS, Chang E, et al. Rosiglitazone abrogates bleomycin-induced scleroderma and blocks profibrotic responses through peroxisome proliferator-activated receptor-gamma. Am J Pathol. 2009 Feb;174(2):519-33.
- Deboer MD. Ethnicity, obesity and the metabolic syndrome: implications on assessing risk and targeting intervention. Expert Rev Endocrinol Metab. 2011 Mar;6(2):279-289.
- van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Ann Rheum Dis. 2013 Nov;72(11):1747-55.
- Sobanski V, Giovannelli J, Allanore Y, et al. Phenotypes Determined by Cluster Analysis and Their Survival in the Prospective European Scleroderma Trials and Research Cohort of Patients With Systemic Sclerosis. Arthritis Rheumatol. 2019 Sep;71(9):1553-1570.
- Khanna D, Furst DE, Clements PJ, et al. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. J Scleroderma Relat Disord. 2017 Jan-Apr;2(1):11-18.
- Fasano S, Riccardi A, Messiniti V, et al. Revised European Scleroderma Trials and Research Group Activity Index is the best predictor of short-term severity accrual. Ann Rheum Dis. 2019 Dec;78(12):1681-1685.
- Ferdowsi N, Huq M, Stevens W, et al. Development and validation of the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI): a novel instrument to quantify organ damage in systemic sclerosis. Ann Rheum Dis. 2019 Jun;78(6):807-816.
- Abacı A, Kılıçkap M, Göksülük H, et al. Türkiye’de metabolik sendrom sıklığı verileri: Kardiyovasküler risk faktörlerine yönelik epidemiyolojik çalışmaların sistematik derleme, meta-analiz ve meta-regresyonu. Turk Kardiyol Dern Ars 2018;46(7):591-601.
- Kozan O, Oguz A, Abaci A, et al. Prevalence of the metabolic syndrome among Turkish adults. European Journal of Clinical Nutrition (2007) 61, 548-553.
- Onat A, Yüksel M, Köroğlu B, et al. TEKHARF 2012: Genel ve koroner mortalite ile metabolik sendrom prevalansı eğilimleri. Türk Kardiyol Dern Arş- Arch Turk Soc Cardiol 2013;41(5):373-378.
- Özmen M, Yersal Ö, Öztürk S, Soysal D, Köseeoğlu MH. Prevalence of the metabolic syndrome in rheumatoid arthritis. Eur J Rheumatol. 2014 Mar;1(1):1-4.
- Aygün Bilecik N, Tuna S, Samancı N, Balcı N, Akbaş H. Prevalence of metabolic syndrome in women with rheumatoid arthritis and effective factors. Int J Clin Exp Med. 2014 Aug 15;7(8):2258-65.
- Lee SG, Kim JM, Lee SH, et al. Frequency of Metabolic Syndrome in Female Patients with Systemic Sclerosis: A Preliminary Report J Rheum Dis 2012; 19(5): 262-269.
- Wu W, Jordan S, Graf N, et al. Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort. Ann Rheum Dis. 2019 May;78(5):648-656.
Öz
Objective: To determine the prevalence of metabolic syndrome (MetS) in Turkish systemic sclerosis (SSc) patients.
Materials and Methods: In this cross-sectional, single-centre study, 76 SSc patients admitted to the outpatient clinic of our tertiary care hospital between July and September 2021 were included. The National Cholesterol Education Programme's Adult Treatment Panel (NCEP-ATP III) criteria were used to define metabolic syndrome (MetS). The relationship between MetS and SSc organ involvement and disease characteristics was investigated.
Results: According to the ATP III criteria, 37 cases (48.7%) were identified as having MetS. The prevalance of MetS increased with advancing age (40-45 years: 25%, 46-60 years: 48.4%, >60 years: 62.9%). The cases were divided into two groups according to the presence or absence of MetS. Patients with MetS had higher mean age (58.2±9.4 vs. 51.6±13.5, p=0.015) and lower modified Rodnan skin scores (14 vs. 22, p=0.019). The groups were comparable regarding disease subtype, duration and activity, organs/systems involved and disease-related damage.
Conclusion: Although the prevalence of MetS in SSc patients in our study was higher than that observed in the general population of our country, the prevalence of MetS did not increase when compared to the similar age group. MetS was thought to be related to age and gender predominance rather than the disease itself. Although mRSS was found to be significantly lower in patients with MetS, its sensitivity to predict MetS was found to be low. Nevertheless, our data suggest that the risk of MetS should be considered in SSc patients.
Anahtar Kelimeler
systemic sclerosis metabolic syndrome prevalence insulin resistance
Kaynakça
- Denton CP, Khanna D. Systemic sclerosis. Lancet. 2017;390(10103):1685-1699.
- Elhai M, Meune C, Avouac J, Kahan A, Allanore Y. Trends in mortality in patients with systemic sclerosis over 40 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford). 2012 Jun; 51(6):1017-1026.
- Poudel DR. Jayakumar D, Danve A, Sehre ST, Derk CT. Determinants of mortality in systemic sclerosis: a focused review Rheumatol Int. 2018 Oct;38(10):1847-1858.
- Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005 Oct 25;112(17):2735-52.
- Medina G, Vera-Lastra O, Peralta-Amaro AL, et al. Metabolic syndrome, autoimmunity and rheumatic diseases. Pharmacol Res. 2018 Jul;133:277-288.
- Atzeni F, Marino F, Cirillo M, et al. Metabolic Syndrome in Systemic Sclerosis Patients: Data from Clinical Practice. Isr Med Assoc J. 2021 Apr;23(4):262-263.
- Gigante A, Iannazzo F, Navarini L, et al. Metabolic syndrome and adipokine levels in systemic lupus erythematosus and systemic sclerosis. Clin Rheumatol. 2021 Oct;40(10):4253-4258.
- Peralta-Amaro AL, Cruz-Domínguez Mdel P, Olvera-Acevedo A, Vera-Lastra OL. Prevalence of metabolic syndrome and insulin resistance in system sclerosis. Rev Med Inst Mex Seguro Soc. 2015 Jul-Aug;53(4):476-83.
- Frech TM, Revelo MP, Drakos SG, et al. Vascular leak is a central feature in the pathogenesis of systemic sclerosis. J Rheumatol. 2012 Jul;39(7):1385-91.
- Żółkiewicz J, Stochmal A, Rudnicka L. The role of adipokines in systemic sclerosis: a missing link? Arch Dermatol Res. 2019 May;311(4):251-263.
- Lee YH, Song GG. Meta-analysis of circulating adiponectin, leptin, and resistin levels in systemic sclerosis. Z Rheumatol. 2017 Nov;76(9):789-797.
- Frommer KW, Neumann E, Müller-Ladner U. Role of adipokines in systemic sclerosis pathogenesis. Eur J Rheumatol. 2020 Oct;7(Suppl 3):S165-S172.
- Stein CM, Tanner SB, Awad JA, Roberts LJ 2nd, Morrow JD. Evidence of free radical-mediated injury (isoprostane overproduction) in scleroderma. Arthritis Rheum. 1996 Jul;39(7):1146-50.
- Doridot L, Jeljeli M, Chêne C, Batteux F. Implication of oxidative stress in the pathogenesis of systemic sclerosis via inflammation, autoimmunity and fibrosis. Redox Biol. 2019 Jul;25:101122.
- Abdulle AE, Diercks GFH, Feelisch M, Mulder DJ, van Goor H. The Role of Oxidative Stress in the Development of Systemic Sclerosis Related Vasculopathy. Front Physiol. 2018 Aug 24;9:1177.
- Gore-Hyer E, Pannu J, Smith EA, Grotendorst G, Trojanowska M. Selective stimulation of collagen synthesis in the presence of costimulatory insulin signaling by connective tissue growth factor in scleroderma fibroblasts. Arthritis Rheum. 2003 Mar;48(3):798-806. doi: 10.1002/art.10953.
- Barroso I, Gurnell M, Crowley VE, et al. Dominant negative mutations in human PPARgamma associated with severe insulin resistance, diabetes mellitus and hypertension. Nature. 1999 Dec 23-30;402(6764):880-3.
- Lakota K, Wei J, Carns M, et al. Levels of adiponectin, a marker for PPAR-gamma activity, correlate with skin fibrosis in systemic sclerosis: potential biomarker for siPAAR pilot clinical trial. Arthritis Res Ther. 2012;14(3)
- Wu M, Melichian DS, Chang E, et al. Rosiglitazone abrogates bleomycin-induced scleroderma and blocks profibrotic responses through peroxisome proliferator-activated receptor-gamma. Am J Pathol. 2009 Feb;174(2):519-33.
- Deboer MD. Ethnicity, obesity and the metabolic syndrome: implications on assessing risk and targeting intervention. Expert Rev Endocrinol Metab. 2011 Mar;6(2):279-289.
- van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Ann Rheum Dis. 2013 Nov;72(11):1747-55.
- Sobanski V, Giovannelli J, Allanore Y, et al. Phenotypes Determined by Cluster Analysis and Their Survival in the Prospective European Scleroderma Trials and Research Cohort of Patients With Systemic Sclerosis. Arthritis Rheumatol. 2019 Sep;71(9):1553-1570.
- Khanna D, Furst DE, Clements PJ, et al. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. J Scleroderma Relat Disord. 2017 Jan-Apr;2(1):11-18.
- Fasano S, Riccardi A, Messiniti V, et al. Revised European Scleroderma Trials and Research Group Activity Index is the best predictor of short-term severity accrual. Ann Rheum Dis. 2019 Dec;78(12):1681-1685.
- Ferdowsi N, Huq M, Stevens W, et al. Development and validation of the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI): a novel instrument to quantify organ damage in systemic sclerosis. Ann Rheum Dis. 2019 Jun;78(6):807-816.
- Abacı A, Kılıçkap M, Göksülük H, et al. Türkiye’de metabolik sendrom sıklığı verileri: Kardiyovasküler risk faktörlerine yönelik epidemiyolojik çalışmaların sistematik derleme, meta-analiz ve meta-regresyonu. Turk Kardiyol Dern Ars 2018;46(7):591-601.
- Kozan O, Oguz A, Abaci A, et al. Prevalence of the metabolic syndrome among Turkish adults. European Journal of Clinical Nutrition (2007) 61, 548-553.
- Onat A, Yüksel M, Köroğlu B, et al. TEKHARF 2012: Genel ve koroner mortalite ile metabolik sendrom prevalansı eğilimleri. Türk Kardiyol Dern Arş- Arch Turk Soc Cardiol 2013;41(5):373-378.
- Özmen M, Yersal Ö, Öztürk S, Soysal D, Köseeoğlu MH. Prevalence of the metabolic syndrome in rheumatoid arthritis. Eur J Rheumatol. 2014 Mar;1(1):1-4.
- Aygün Bilecik N, Tuna S, Samancı N, Balcı N, Akbaş H. Prevalence of metabolic syndrome in women with rheumatoid arthritis and effective factors. Int J Clin Exp Med. 2014 Aug 15;7(8):2258-65.
- Lee SG, Kim JM, Lee SH, et al. Frequency of Metabolic Syndrome in Female Patients with Systemic Sclerosis: A Preliminary Report J Rheum Dis 2012; 19(5): 262-269.
- Wu W, Jordan S, Graf N, et al. Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort. Ann Rheum Dis. 2019 May;78(5):648-656.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları, Romatoloji ve Artrit |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Eylül 2024 |
| Gönderilme Tarihi | 14 Ağustos 2024 |
| Kabul Tarihi | 16 Ağustos 2024 |
| Yayımlandığı Sayı | Yıl 2024 |