TY - JOUR T1 - Role of Ischemia and Oxidative Stress in Primary Dysmenorrhea Pathogenesis TT - Primer Dismenore Patogenezinde İskemi ve Oksidatif Stresin Rolü AU - Shundo, Harika AU - Karaca, İrem AU - Sevinç, Leyla AU - Serinkan Cinemre, Fatma Behice AU - Aydemir, Birsen AU - Akdemir, Nermin AU - Kaçal, Zübeyde AU - Cinemre, Hakan PY - 2018 DA - January DO - 10.31832/smj.363216 JF - Sakarya Medical Journal PB - Sakarya University WT - DergiPark SN - 2146-409X SP - 205 EP - 210 VL - 7 IS - 4 LA - en AB - Objective: Primarydysmenorrhea is pelvic pain without pathologic reasons during the menstrualperiod, induced by prostaglandin synthesis. Last studies have shown the relationof primary dysmenorrhea with ischemia/hypoxia. Ischemia-ModifiedAlbumin (IMA) is a marker used for detecting the early period of ischemia. Inthis study we planned to investigate role of ischemia and oxidative stress in etiopathogenesis ofprimary dysmenorrhea according to the severity of its symptomatology.Materialsand Methods: 47 female university students withprimary dysmenorrhea were included in this study. Each student passed throughthe full physical and gynecological examination. Visual Analog scale (VAS) was used to measure pain intensity (nopain-score of 0;worst imaginable pain-score of 10). VAS grading from 1-4 was accepted as mild; 5-7 asmoderate; and 8-10 as severe pain. Bloodsamples were collected from all participants on the third day of mens period.After separation of serum, they were kept at -80°C until analyzed. Serum IMAlevels were measured by albumincobalt binding (CAB) test. The results were corrected by using serum albumin values-expressedas corrected IMA(C-IMA). Malondialdehyde (MDA) levels were measuredby using thiobarbituric acid reactive substance (TBARS) and the results wereexpressed as µmol/L.Results:C-IMA values were: 0.867±0.23 in mild; 1.279±0.31 in moderate and 1.222±0.20 insevere pain group. There were significant difference between the averages ofgroups with Oneway ANOVA (p<0.024). By using Tukey test the C-IMA values ingroup with mild pain found significantly lower than the C-IMA values of the groupwith moderate pain(p = 0,021). MDA results were: 9.01±0.64 in the mild; 11.78±1.97in the moderate and 15.20± 6.86 severe pain group. The difference betweengroups with Oneway-ANOVA was statistically significant (p<0.016). Groupcomparisons with Tukey test showed significant difference between the groupwith mild dysmenorrhea and the group with severe pain (p<0.016).Conclusions:C-IMA and MDA levels increased in patients with primary dysmenorrhea. Theirlevels were related with the severity of the pain, suggesting roles of ischemiaand oxidative stress in primary dysmenorrhea. Probably pain-generatingmechanisms also produce oxidative stress and ischemia. Molecular mechanismswhich induce oxidative stress together with ischemia and pain should beinvestigated in further studies. KW - Primary dysmenorrhea KW - ischemia-modified albumin KW - malondialdehyde N2 - Amaç: Primer dismenore, menstrual dönemdepatolojik nedenlere bağlı olmayan ve prostaglandin sentezi tarafındanuyarılabilen pelvik ağrıdır. Sonçalışmalarda, primer dismenore ile iskemi/hipoksi arasındaki ilişkigöstermiştir. İskemi ModifiyeAlbumin (IMA) iskeminin erken döneminin saptanmasında kullanılan yeni bir belirteçtir. Bu çalışmada iskemi ve oksidatif, stresin primerdismenore etiyopatogenezindeki rolünü ve semptomatolojisinin şiddeti ile ilişkisini araştırmayıplanladık.Gereçve Yöntem: Buçalışmaya primer dismenoreli 47 üniversite öğrencisi dahil edildi. Her öğrencinin tam bir fizik vejinekolojik muayenesi yapıldı. Ağrı şiddetini ölçmek için Görsel Analog Skala(VAS) kullanıldı (ağrı yok- 0, hayal edilebilen en şiddetli ağrı-10). Görsel Analog Skala ile, 1-4 arası skorlarhafif; 5-7 arası orta; ve 8-10 arası şiddetli ağrı olarak kabul edildi. Kan örnekleri, menstrüel döneminin üçüncügünü toplandı. Serumayrıldıktan sonra analiz edilinceye kadar -80 °C'de saklandı. Serum IMAdüzeyleri albumin kobalt bağlama (CAB) testi ile ölçüldü. Sonuçlar, serumalbümin değerleri kullanılarak düzeltilmiş IMA (C-IMA) olarak ifade edildi.Malondialdehit (MDA) düzeyleri tiyobarbitürik asit reaktif madde (TBARS)kullanılarak ölçüldü ve sonuçlar μmol/L olarak verildi.Bulgular: C-IMA değerleri: hafif ağrılı grupta 0.867± 0.23; orta ağrılı grupta 1.279 ± 0.31 ve şiddetli ağrılu grupta 1.222 ± 0.20bulundu. Oneway ANOVA ilekarşılaştırıldığında, grupların ortalamaları arasında anlamlı fark vardı (p<0.024). Tukey testikullanılarak hafif ağrılı gruptaki C-IMA değerlerinin orta ağrılı olan grubunC-IMA değerlerinden anlamlı derecede düşük olduğu görüldü (p = 0,021). MDA sonuçları: hafif ağrılı grupta 9.01 ±0.64; orta ağrılı grupta15.20 ± 6.86 ve şiddetli ağrılı grupta 11.78 ± 1.97bulundu. Oneway-ANOVA ile gruplararasında istatistiksel anlamlı fark vardı (p <0.016). Tukey testi ile grup karşılaştırmaları,hafif dismenoreli grup ile şiddetli ağrılı grup arasında anlamlı fark olduğunugösterdi (p <0.016).Sonuçlar: Primer dismenore hastalarında C-IMA ve MDAdüzeyleri artmaktadır. Ayrıca, bunların seviyeleri, ağrının şiddeti ile deilişkiliydi. Bu bulgular, primer dismenorede iskemi ve oksidatif stresin roloynadığını düşündürmektedir. Muhtemelenağrı oluşturan mekanizmalar, aynı zamanda oksidatif stres ve iskemiye de nedenolmaktadır. İskemi ve ağrı ile birlikte oksidatif stres oluşturan bu mekanizmalardaha ileri araştırmalar ile aydınlatılmalıdır. CR - Referans1. Oladosu FA, Tu FF, Hellman KM. 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