Primer Dismenore Patogenezinde İskemi ve Oksidatif Stresin Rolü

Abstract

Amaç: Primer dismenore, menstrual dönemde patolojik nedenlere bağlı olmayan ve prostaglandin sentezi tarafından uyarılabilen pelvik ağrıdır. Son çalışmalarda, primer dismenore ile iskemi/hipoksi arasındaki ilişki göstermiştir. İskemi Modifiye Albumin (IMA) iskeminin erken döneminin saptanmasında kullanılan yeni bir belirteçtir. Bu çalışmada iskemi ve oksidatif, stresin primer dismenore etiyopatogenezindeki rolünü ve  semptomatolojisinin şiddeti ile ilişkisini araştırmayı planladık.

Gereç ve Yöntem: Bu çalışmaya primer dismenoreli 47 üniversite öğrencisi dahil edildi. Her öğrencinin tam bir fizik ve jinekolojik 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 skorlar hafif; 5-7 arası orta; ve 8-10 arası şiddetli ağrı olarak kabul edildi. Kan örnekleri, menstrüel döneminin üçüncü günü toplandı. Serum ayrıldıktan sonra analiz edilinceye kadar -80 °C'de saklandı. Serum IMA düzeyleri albumin kobalt bağlama (CAB) testi ile ölçüldü. Sonuçlar, serum albümin 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 ± 0.20 bulundu. Oneway ANOVA ile karşılaştırıldığında, grupların ortalamaları arasında anlamlı fark vardı (p <0.024). Tukey testi kullanılarak hafif ağrılı gruptaki C-IMA değerlerinin orta ağrılı olan grubun C-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 ± 1.97 bulundu. Oneway-ANOVA ile gruplar arasında istatistiksel anlamlı fark vardı (p <0.016). Tukey testi ile grup karşılaştırmaları, hafif dismenoreli grup ile şiddetli ağrılı grup arasında anlamlı fark olduğunu gösterdi (p <0.016).

Sonuçlar: Primer dismenore hastalarında C-IMA ve MDA düzeyleri artmaktadır. Ayrıca, bunların seviyeleri, ağrının şiddeti ile de ilişkiliydi. Bu bulgular, primer dismenorede iskemi ve oksidatif stresin rol oynadığını düşündürmektedir. Muhtemelen ağrı oluşturan mekanizmalar, aynı zamanda  oksidatif stres ve iskemiye de neden olmaktadır. İskemi ve ağrı ile birlikte oksidatif stres oluşturan bu mekanizmalar daha ileri araştırmalar ile aydınlatılmalıdır.

Keywords

• Primer dismenore,iskemi-modifiye albumin,malondialdehit

Role of Ischemia and Oxidative Stress in Primary Dysmenorrhea Pathogenesis

Abstract

Objective: Primary dysmenorrhea is pelvic pain without pathologic reasons during the menstrual period, induced by prostaglandin synthesis. Last studies have shown the relation of primary dysmenorrhea with ischemia/hypoxia. Ischemia-Modified Albumin (IMA) is a marker used for detecting the early period of ischemia. In this study we planned to investigate role of ischemia and oxidative stress in etiopathogenesis of primary dysmenorrhea according to the severity of its symptomatology.

Materials and Methods: 47 female university students with primary dysmenorrhea were included in this study. Each student passed through the full physical and gynecological examination. Visual Analog scale (VAS) was used to measure pain intensity (no pain-score of 0;worst imaginable pain-score of 10). VAS grading from 1-4 was accepted as mild; 5-7 as moderate; and 8-10 as severe pain. Blood samples 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 IMA levels were measured by albumin cobalt binding (CAB) test. The results were corrected by using serum albumin values-expressed as corrected IMA(C-IMA). Malondialdehyde (MDA) levels were measured by using thiobarbituric acid reactive substance (TBARS) and the results were expressed 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 in severe pain group. There were significant difference between the averages of groups with Oneway ANOVA (p<0.024). By using Tukey test the C-IMA values in group with mild pain found significantly lower than the C-IMA values of the group with moderate pain(p = 0,021). MDA results were: 9.01±0.64 in the mild; 11.78±1.97 in the moderate and 15.20± 6.86 severe pain group. The difference between groups with Oneway-ANOVA was statistically significant (p<0.016). Group comparisons with Tukey test showed significant difference between the group with mild dysmenorrhea and the group with severe pain (p<0.016).

Conclusions: C-IMA and MDA levels increased in patients with primary dysmenorrhea. Their levels were related with the severity of the pain, suggesting roles of ischemia and oxidative stress in primary dysmenorrhea. Probably pain-generating mechanisms also produce oxidative stress and ischemia. Molecular mechanisms which induce oxidative stress together with ischemia and pain should be investigated in further studies.

Keywords

• Primary dysmenorrhea,ischemia-modified albumin,malondialdehyde

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