Psikolojik Stres ve İnflamasyonun Habituel Abortus ile İlişkisi: DASS-21 ve Proinflamatuar Belirteçler Üzerine Bulgular

Abstract

ÖZET Amaç: Habituel abortus (HA), 20. gebelik haftasından önce ve fetüs 500 grama ulaşmadan gerçekleşen iki veya daha fazla ardışık düşük olarak tanımlanır ve tüm gebeliklerin yaklaşık %1-2’sini etkiler. İnflamasyon, HA’nın patofizyolojisinde kritik bir faktördür ve Tümör Nekroz Faktörü-alfa (TNF-alfa) ve İnterlökin-8 (IL-8) gibi proinflamatuar sitokinler, fetoplasental fonksiyonları bozarak gebelik kaybına katkıda bulunabilir. Özellikle kronik stres gibi psikolojik sıkıntılar da inflamatuar yanıtları artırarak bu sürece katkıda bulunabilir. Bu çalışma, HA hastalarında inflamatuar belirteçler, hematolojik parametreler ve psikolojik stres (DASS-21 Depresyon Anksiyete Stres Ölçeği ile ölçülen) arasındaki ilişkiyi araştırmayı amaçlamaktadır. Yöntemler: Çalışmaya 34 HA hastası ve 32 sağlıklı kontrol olmak üzere toplam 66 katılımcı dahil edilmiştir. Kan örnekleri TNF-alfa, IL-8, Protein C ve Protein S düzeyleri ile hematolojik parametreleri analiz etmek için incelenmiştir. Psikolojik stres, DASS-21 ölçeği kullanılarak değerlendirilmiştir. Veriler bağımsız t-testi, Pearson korelasyonu ve lojistik regresyon analizi ile incelenmiştir. Bulgular: HA hastalarında TNF-alfa (p=0.023) ve IL-8 (p=0.034) seviyeleri anlamlı olarak daha yüksek, Protein C (p=0.009) ve Protein S (p=0.026) seviyeleri ise daha düşük bulunmuştur. DASS-21 skorları HA hastalarında anlamlı şekilde yüksek olup, TNF-alfa ve IL-8 ile pozitif korelasyon göstermiştir. DASS-21 toplam skorundaki bir birimlik artış HA riskini 3,8 kat artırırken (OR: 3.8, p=0.024), Protein C seviyesindeki bir birimlik artış HA riskini yaklaşık 0,8 kat azaltmıştır (OR: 0.8, p=0.028). Sonuç: Bulgular, inflamasyon ve psikolojik stresin HA’da önemli roller oynadığını göstermektedir. İnflamasyonun kontrol altına alınması ve stres yönetimi, HA hastalarında gebelik sonuçlarını iyileştirebilir.

Keywords

• habituel abortus
• inflamasyon
• stres

The Role of Inflammation and Psychological Distress in Habitual Abortion: Analysis of Cytokines, Coagulation Markers, and DASS-21 Scores

Abstract

Objective: Habitual abortion (HA) is defined as two or more consecutive miscarriages occurring before the 20th week of pregnancy and before the fetus reaches 500 grams, affecting approximately 1-2% of all pregnancies. Inflammation is a crucial factor in HA pathophysiology, with proinflammatory cytokines like Tumor Necrosis Factor-alpha (TNF-alpha) and Interleukin-8 (IL-8) potentially disrupting fetoplacental function. Psychological distress, particularly chronic stress, may also contribute by increasing inflammatory responses. This study investigates the relationship between inflammatory markers, hematological parameters, and psychological distress, as measured by the Depression Anxiety Stress Scales-21 (DASS-21), in HA patients. Methods: The study included 66 participants (34 HA patients, 32 healthy controls). Blood samples were analyzed for TNF-alpha, IL-8, Protein C, and Protein S levels, along with hematological parameters. Psychological distress was assessed using the DASS-21 scale. Data analysis involved independent t-tests, Pearson correlation, and logistic regression. Results: HA patients had significantly higher TNF-alpha (p=.023) and IL-8 (p=.034) levels and lower Protein C (p=.009) and Protein S (p=.026) levels than controls. DASS-21 scores were significantly higher in HA patients, positively correlating with TNF-alpha and IL-8. A one-unit increase in DASS-21 total score increased HA risk by 3.8 times (OR: 3.8, p=.024), while a one-unit increase in Protein C reduced HA risk by 0.8 times (OR: 0.8, p=.028). Conclusion: These findings suggest that inflammation and psychological distress play key roles in HA. Addressing inflammation and stress management may improve pregnancy outcomes in HA patients.

Keywords

• habitual abortion
• inflammation
• stress

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