Sarkoidoz Semptomlarında Cinsiyetler Arası Farklılıklar

Year 2018, , 16 - 20, 03.08.2018

Birsen Ocaklı , Sinem Güngör Eylem Tunçay , Emine Aksoy Sümeyye Alparslan Bekir , Fatma Tokgöz Akyıl , Pakize Sucu Dilek Yavuz Murat Yalçınsoy

https://doi.org/10.18678/dtfd.453605

Abstract

Amaç: Literatürde “büyük taklitçi” olarak anılan inflamatuar bir hastalık olan sarkoidoz olgularında semptomlar ve tutulan organlar açısından cinsiyete göre farklılıklar bildirilmiştir. Bu çalışmada sarkoidoz olgularındaki semptom ve bulguların cinsiyete ve hastalığın evrelerine göre farklılıkları araştırıldı.

Gereç ve Yöntemler: Bu retrospektif gözlemsel kohort çalışmamızda sarkoidoz tanılı olgular başvuru semptomlarına göre; asemptomatik, pulmoner semptomlar, ekstrapulmoner semptomlar, pulmoner ve ekstrapulmoner semptom birlikteliği olarak gruplandırıldı. Her iki cinsiyet bulguların sıklığı açısından karşılaştırıldı.

Bulgular: Çalışmaya alınan 338 hastanın %71’i kadın olup yaş ortalaması 42,5±11,6 idi. Olguların %86’sı başvuru anında semptomatik olup, semptomların %31’i yalnız pulmoner, %23’ü yalnız ekstrapulmoner, %32’sinde ise hem pulmoner hem de ekstrapulmoner semptomlar birlikte idi. Kadın ve erkeklerde öksürük (sırasıyla %45; %42; p=0,620), balgam çıkarma (sırasıyla %9; %11; p=0,535), hemoptizi (sırasıyla %2; %1; p=0,678), ateş (sırasıyla %4; %4; p=0,999) bulguları açısından cinsiyete göre anlamlı farklılık bulunamadı. Dispne kadınlarda erkek olgulara göre anlamlı olarak daha sık izlendi (sırasıyla %33; %22; p=0,048). Kadın hastalarda erkeklere kıyasla göğüs ağrısı anlamlı olarak daha az görüldü (sırasıyla %7; %20; p=0,001). Aşırı terleme erkeklerde kadınlara göre anlamlı olarak daha fazla görülürken (p=0,004), eritema nodosum kadınlarda erkeklere göre fazla bulundu (p=0,003). Terleme dışındaki konstitüsyonel yakınmalarda cinsiyet farkı izlenmedi.

Sonuç: Sarkoidozlu kadınlar daha yaşlıdır ve nefes darlığı ile eritema nodosum, kadınlarda erkeklere göre anlamlı oranda sık bulunmuştur. Erkeklerde ise terleme ve göğüs ağrısı belirgin yüksek tespit edilmiştir.

Keywords

Sarkoidoz, pulmoner semptomlar, ekstrapulmoner semptomlar, cinsiyet farkı

Gender Differences in Symptoms of Sarcoidosis

Abstract

Aim: Sarcoidosis is known as the ‘great imitator’ for its versatile manifestations which differ among genders. The objective of this study is to investigate the signs and symptoms and differences in respect to gender and phases of disease.

Material and Methods: This cohort study includes patients with sarcoidosis classified as asymptomatic, with pulmonary symptoms only, extrapulmonary symptoms only and those with both together. The frequency, prevalence, and severity of the signs and symptoms were compared between gender identities.

Results: This study enrolled 338 patients, of which 71% were female, and mean age was 42.5±11.6. Most patients (86%) were symptomatic on presentation, and pulmonary symptoms were noted in 31%, extrapulmonary symptoms in 23% and both in 32%. There were no significant differences between genders regarding cough (45% in women, 42% in men, p=0.620), sputum (9%, 11%, respectively, p=0.535), hemoptysis (2%, 1%, respectively, p=0.678), fever (4%, 4%, respectively, p=0.999). Dyspnea was reported significantly more common in women (33% and 22%, respectively, p=0.048) whilst chest pain was more common in men (7%, and %20 respectively, p=0.001). Excessive perspiration was significantly more common in men, and erythema nodosum in women (p=0.004 and p=0.003, respectively). Frequencies of constitutional symptoms other than perspiration did not differ between sexes.

Conclusion: Women with sarcoidosis were older than men and dyspnea and erythema nodosum were seen more commonly in women. Frequencies of other symptoms were similar between sexes.

Keywords

Sarcoidosis, pulmonary symptoms, extrapulmonary symptoms, gender difference

References

• 1. Casimir, GJ, Lefèvre N, Corazza F, Duchateau J. (2013). Sex and inflammation in respiratory diseases: a clinical viewpoint. Biology of sex differences, 4(1), 16.).
• 2. Semenzato, G. (2005). ACCESS: A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, vasculitis, and diffuse lung diseases: Official journal of WASOG, 22(2), 83-86. 3. Hunninghake GW, Costabel U, Ando M, Baughman R, Cordier JF, du Bois R, et al: ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis 1999; 16: 149–1733
• 4. Liang, N. C., Truong, K. T., & Afshar, K. (2016). Key management considerations in sarcoidosis from the American Thoracic Society 2016 Conference. J Thorac Dis, 8(Suppl 7), S569.
• 5. Lill, H., Kliiman, K., Altraja, A. (2016). Factors signifying gender differences in clinical presentation of sarcoidosis among Estonian population. Clin Resp J, 10(3), 282-90.
• 6. Siltzbach, L. E., James, D. G., Neville, E., Turiaf, J., Battesti, J. P., Sharma, O. P., et al. (1974). Course and prognosis of sarcoidosis around the world. Am J Med, 57(6), 847-52.
• 7. Baggio, G., Corsini, A., Floreani, A., Giannini, S., & Zagonel, V. (2013). Gender medicine: a task for the third millennium. Clin Chem Lab Med, 51(4), 713-727.
• 8. Regitz‐Zagrosek, Vera. "Sex and gender differences in health: Science & Society Series on Sex and Science." EMBO reports13.7 (2012): 596-603.
• 9. Pinkerton, K. E., Harbaugh, M., Han, M. K., Jourdan Le Saux, C., Van Winkle, L. S., Martin, W. J., et al. (2015). Women and lung disease. Sex differences and global health disparities. Am J Resp Crit Care Med, 192(1), 11-16.).
• 10. Musellim B, Kumbasar OO, Ongen G, et al. Epidemiological features of Turkish patients with sarcoidosis. Respir Med 2009;103:907-12.
• 11. Brito-Zeron, P., Sellares, J., Bosch, X., Hernández, F., Kostov, B., Sisó-Almirall, A., et al. (2016). Epidemiologic patterns of disease expression in sarcoidosis: age, gender and ethnicity-related differences. Clin Exp Rheumatol, 34(3), 380-388.
• 12. Baughman, R. P., Teirstein, A. S., Judson, M. A., Rossman, M. D., Yeager Jr, H., Bresnitz, E. A., et al. (2001). Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 164(10), 1885-89.
• 13. Newman LS, Rose CS, Bresnitz EA, et al. A case control etiologic study of sarcoidosis: environmental and occupational risk factors. Am J Respir Crit Care Med 2004; 170: 1324-30.
• 14. Spagnolo P, Rossi G, Trisolini R, Sverzellati N, Baughman RP, Wells AU. Pulmonary sarcoidosis. Lancet Respir Med. 2018;6(5):389-402.
• 15. D.G. James. Clinical picture of sarcoidosis M.I. Schwarz, T.E. King Jr. (Eds.), Interstitial lung disease, 2nd ed, Mosby—Year Book, St. Louis (1993), pp. 159-178.
• 16. European Respiratory Society. Becklake, M. R. (2003). Gender differences in airway behaviour (physiology) over the human lifespan. European Respiratory Monograph, 8, 8-25.).
• 17. Terčelj, M., Salobir, B., Harlander, M., Rylander, R. (2011). Fungal exposure in homes of patients with sarcoidosis-an environmental exposure study. Environ Health, 10(1), 8.
• 18. Gunbatar, H., Sertogullarindan, B., Ozbay, B., Avcu, S., Bulut, G., Kosem, M. (2012). Chronic effects of environmental biomass smoke on lung histopathology in Turkish non-smoking women: a case series. Arch Industr Hygiene Toxicol, 63(3), 357-365
• 19. Pietinalho, A., Tukiainen, P., Haahtela, T., Persson, T., Selroos, O. (2002). Early treatment of stage II sarcoidosis improves 5-year pulmonary function. Chest, 121(1), 24-31.
• 20. Bargagli E, Prasse A. Sarcoidosis: a review for the internist. Intern Emerg Med. 2018;13(3):325-331.
• 21. Brand PL, Rijcken B, Schouten JP, Koëter GH, Weiss ST, Postma DS. Perception of airway obstruction in a random population sample: Relationship to airway hyperresponsiveness in the absence of respiratory symptoms. Am Rev Respir Dis. 1992;146(2):396–401.
• 22. Kauffmann F, Becklake M. Maladies obstructives pulmonaires: un paradigme de la complexité des différences de sante entre hommes et femmes. Med Sci (Paris) 1996; 12(2):209–233. (French).
• 23. Dicpinigaitis PV, Rauf K. The influence of gender on cough reflex sensitivity. Chest. 1998;113(5):1319–1321.
• 24. Ungprasert, P., Carmona, E. M., Utz, J. P., Ryu, J. H., Crowson, C. S., Matteson, E. L. (2016). Epidemiology of sarcoidosis 1946-2013: a population-based study. In Mayo Clinic Proceedings 91(2), 183-188.
• 25. Stavem, K., Sandvik, L., & Erikssen, J. (2006). Breathlessness, phlegm and mortality: 26 years of follow‐up in healthy middle‐aged Norwegian men. J Intern Med, 260(4), 332-342.
• 26. Demirkok, S. S., Basaranoglu, M., Akinci, E. D., Karayel, T. (2007). Analysis of 275 patients with sarcoidosis over a 38 year period; a single-institution experience. Respir Med, 101(6), 1147-1154.
• 27. Yanardağ, H., Pamuk, Ö. N., & Karayel, T. (2003). Cutaneous involvement in sarcoidosis: analysis of the features in 170 patients. Respir Med, 97(8), 978-982.
• 28. Y. C. Cozier, J. S. Berman, J. R. Palmer, D. A. Boggs, L. A. Wise, L. Rosenberg, “Reproductive and hormonal factors in relation to incidence of sarcoidosis in US black women,” Am J Epidemiol, 176(7). 635–641, 2012.
• 29. Marcellis, R. G., Lenssen, A. F., Elfferich, M. D. P., De Vries, J., Kassim, S., Foerster, K., et al. (2011). Exercise capacity, muscle strength and fatigue in sarcoidosis. Eur Respir J, erj01177-2010.
• 30. da Costa, C. H., Silva, V. L., Fabricio-Silva, G. M., Usnayo, M., Rufino, R., Porto, L. C. (2013). HLA in a cohort of Brazilian patients with sarcoidosis. Human immunology, 74(10), 1326-1332.