Ailesel Akdeniz Ateşli çocuklarda subklinik inflamasyonun değerlendirilmesinde serum pentraxin-3 düzeylerinin rolü

Abstract

Amaç: Bazı Ailesel Akdeniz Ateşi hastalarında subklinik inflamasyon, kolşisin tedavisine rağmen devam edebilmektedir. Pentraxin-3 (PTX-3), çeşitli inflamatuvar hastalıklarda inflamatuvar aktivitenin potansiyel bir biyobelirteci olarak kullanılmaktadır. Bu çalışmada, Ailesel Akdeniz Ateşli çocuklarda atak ve ataksız dönemlerde serum PTX-3 düzeylerinin değerlendirilmesi ve PTX-3 ile subklinik inflamasyon arasındaki olası ilişkinin araştırılması amaçlandı.
Gereç ve yöntem: Çalışmaya kolşisin tedavisi alan 45 Ailesel Akdeniz Ateşi hastası ile 40 sağlıklı çocuk dahil edildi. Serum pentraxin-3 düzeyleri ve klasik akut faz reaktanları atak ve ataksız dönemlerde ölçüldü. Ataksız dönemde en az bir akut faz reaktanı yüksek bulunan hastalar subklinik inflamasyon varlığı olarak kabul edildi.
Bulgular: Pentraksin-3 düzeyleri ve konvansiyonel akut faz reaktanları, atak dönemlerinde ataksız dönemlere ve sağlıklı kontrollere kıyasla anlamlı derecede yüksek bulunmuştur (sırasıyla 3,21±0,67 vs 1,90±0,15 vs 0,88±0,39 ng/mL; p<0,001). Serum pentraksin-3 düzeyleri, subklinik inflamasyonu olan ve olmayan hastalar arasında benzer bulunmuştur (1,9±0,05 vs 1,8±0,03 ng/mL; p=0,29); ancak her iki alt grup da sağlıklı kontrollere göre anlamlı derecede yüksek pentraksin-3 düzeylerine sahiptir (p=0,001). ROC analizi, PTX-3'ün AAA hastalarını sağlıklı kontrollerden ayırt etmede mükemmel tanısal performans gösterdiğini ortaya koymuştur; atak döneminde AUC=1,000 (kesim değeri ≥1,80 ng/mL, duyarlılık %100, özgüllük %100), ataksız dönemde ise AUC=0,997 (kesim değeri ≥1,64 ng/mL, duyarlılık %97,8, özgüllük %100) olarak bulunmuştur.
Sonuç: Pentraksin-3 düzeyleri, AAA'lı çocuklarda hem atak hem de ataksız dönemlerde sağlıklı kontrollere kıyasla yüksek seyretmiş olup, PTX-3 hem atak döneminde (AUC=1,000) hem de ataksız dönemde (AUC=0,997) AAA hastalarını sağlıklı kontrollerden mükemmel tanısal doğrulukla ayırt etmiştir. Bu bulgular, PTX-3'ün pediatrik AAA hastalarında kalıcı inflamatuar aktiviteyi yansıtabileceğini ve aşikâr klinik ataklar dışında da hastalık aktivitesinin faydalı bir belirteci olarak hizmet edebileceğini düşündürmektedir. Bu bulguları doğrulamak için daha büyük prospektif çalışmalara ihtiyaç vardır.

Keywords

• Ailesel Akdeniz Ateşi
• pentraxin-3
• subklinik inflamasyon
• akut faz reaktanları

Supporting Institution

Bu çalışma Pamukkale Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi tarafından desteklenmiştir (Proje No: 2013TPF025).

Project Number

2013TPF025

Ethical Statement

Çalışma, Pamukkale Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Toplantı No: 12, Tarih: 26 Ağustos 2014). Tüm katılımcıların ebeveynlerinden yazılı bilgilendirilmiş onam alınmıştır.

Role of serum pentraxin-3 levels in the evaluation of subclinical inflammation in children with Familial Mediterranean Fever

Abstract

Purpose: Subclinical inflammation may persist in some patients with Familial Mediterranean Fever despite colchicine treatment. Pentraxin-3 is used as a potential biomarker of inflammatory activity in various inflammatory diseases. This study aimed to evaluate serum PTX-3 levels during attack and attack-free periods in children with Familial Mediterranean Fever and to investigate the possible association between serum PTX-3 levels and subclinical inflammation.
Materials and methods: Forty-five children diagnosed with Familial Mediterranean Fever and receiving colchicine treatment and 40 healthy controls were included. Serum pentraxin-3 levels and conventional acute-phase reactants were measured during attack and attack-free periods. Patients with at least one elevated acute-phase reactant during the attack-free period were considered to have subclinical inflammation.
Results: Pentraxin-3 levels and conventional acute-phase reactants were significantly higher during attack periods compared with attack-free periods and healthy controls (3.21±0.67 vs 1.90±0.15 vs 0.88±0.39 ng/mL, respectively; p<0.001). Serum pentraxin-3 levels were similar between patients with and without subclinical inflammation (1.9±0.05 vs 1.8±0.03 ng/mL; p=0.29); however, both subgroups had significantly higher pentraxin-3 levels than healthy controls (p=0.001). ROC analysis showed excellent diagnostic performance of PTX-3 for differentiating FMF patients from healthy controls, with an AUC of 1.000 (cut-off ≥1.80 ng/mL, sensitivity 100%, specificity 100%) during the attack period and 0.997 (cut-off ≥1.64 ng/mL, sensitivity 97.8%, specificity 100%) during the attack-free period.
Conclusion: Pentraxin-3 levels remained elevated in children with Familial Mediterranean Fever during both attack and attack-free periods compared with healthy controls, and PTX-3 discriminated FMF patients from healthy controls with excellent diagnostic accuracy during both the attack period (AUC=1.000) and the attack-free period (AUC=0.997). These findings suggest that PTX-3 may reflect persistent inflammatory activity in pediatric FMF patients and could serve as a useful marker of disease activity beyond overt clinical episodes. Larger prospective studies are needed to confirm these findings.
 

Keywords

• Familial Mediterranean Fever
• pentraxin-3
• subclinical inflammation
• acute-phase reactants

Supporting Institution

This study was supported by the Scientific Research Projects Coordination Unit of Pamukkale University (Project No: 2013TPF025).

Project Number

2013TPF025

Ethical Statement

The study was approved by the Pamukkale University Non-Interventional Clinical Research Ethics Committee (Meeting No: 12, Date: August 26, 2014). Written informed consent was obtained from the parents of all participants.

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