Association of human leucocyte antigens with valvar involvement and rheumatic valvar disease development in children with acute rheumatic fever

Abstract

Objective: The relation between HLA antigens and valvar involvement at fist atack in patiens with acute rheumatic fever (ARF) was investigated in our study. We also purposed to study the same relation in patients who developed rheumatic valvar disease during follow up period. Material and method: Tissue typing of 80 patiens was performed by Polimerise Chain Reaction (PCR).The control group consisted of 63 healthy persons. The patients were subgrouped accoring to the manifestations at first attack.Results: HLA DQ8 in cases of isolated carditis with aortic (AI) and mitral insufficiency (MI) at first attack, and HLA DR7, DR8 and DQ8 in the same group with remaining aortic+mitral insufficency after the first year, were more frequent than controls. By the first year HLA B27 was more frequent than controls in patients with remaining isolated mitral insufficiency in this subgroup.HLA B57 and HLA B61 were found more frequent in poliartritis+carditis patients with mitral+aortic insufficiency at first attack. After follow up period more than one year, HLA-Cw3 in patients with remaining isolated MI, HLA-DRB1*04 and DQB!*08 in patients with remaining isolated AI and HLA-DRB!*07 in patients with remaining MI+AI were found more ferquent than controls.In chorea+carditis subgroup at first attack, HLA B13 was more frequent in patients with isolated MI, and HLA-A1 and B49 in patients with MI+AI. In this subgroup HLA-B27 was found more ferquent in patients with remaining isolated MI after follow up period more than one year.Conclusion: The results of our study pointed out that HLA Class II antigens may be more determinig on the development of rheumatic valvar disease. But it is concluded that the results of our study should be supported by wider studies including more number of patients in each subgroups.

Keywords

• HLA antigens, valvar involvement, rheumatic heart disease

Akut Romatizmal Ateşli Çocuklarda İnsan Lokosit Antijenleri İle Kapak Tutulumunun ve Romatizmal Kapak Hastalığı Gelişiminin İlişkisi

Abstract

Giriş: Çalışmamızda akut romatizmal ateş (ARA) tanılı hastalarda ilk atakta kapak tutumu ile HLA antijenleri arasındaki ilişki araştırıldı. Ayrıca aynı ilişkinin izlemde romatizmal kapak hastalığı gelişen hastalarda değerlendirilmesi amaçlandı Materyal ve Metod: 80 hastanın antijen tiplendirmesi Polimerise Chain Reaction (PCR) metoduyla yapıldı. Kontrol grubu tamamen sağlıklı 63 bireyden oluştu. Hastalar ilk ataktaki bulgularına göre alt gruplara ayrıldı.Bulgular: Kontrollerle kıyaslandığında alt gruplardan izole karditli vakalarda ilk atakta mitral yetmezliği (MY) ve aort yetmezliği (AY) birlikte olanlarda HLA DQ8, birinci yıldan sonra MY+AY kalanlarda HLA DR7, DR8 ve DQ8 daha yüksek sıklıkta bulundu. Bu alt grupta birinci yıldan sonra izole MY'si kalanlarda HLA B27 kontrollerden daha yüksek sıklıkta idi. Poliartrit+kardit birlikteliği olup AY+MY olanlarda ilk atakta HLA-B57 ve HLA-B61 daha yüksek sıklıkta saptandı. Bu grupta bir yıldan uzun süreli izlemde izole MY kalanlarda HLA-Cw3, izole AY kalanlarda HLA-DRB1*04 ve DQB1*08 ve AY+MY birlikte devam edenlerde HLA-DRB1*07 daha yüksek sıklıktaydı.Kore+kardit alt grubunda ilk atakta yalnız MY'si olanlarda HLA-B13, AY+MY'si olanlarda HLA-A1 ve B49 daha yüksek sıklıktaydı. Bu grupta bir yılın üzerinde izlemi olup MY sebat edenlerde HLA-B27 sıklığı daha yüksek bulundu.Sonuç: Çalışmamızın sonuçları romatizmal kapak hastalığı gelişmesinde HLA sınıf II antijenlerinin daha belirleyici olabileceğine işaret etti. Her alt grupta daha fazla sayıda hastanın olacağı geniş çalışmalarla sonuçlarımızın doğrulanması gerektiği kanaatine varıldı.

Keywords

• HLA antijenleri, kapak tutulumu, romatizmal kalp hastalığı

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