NOVEL BIOMARKERS AND ECHOCARDIOGRAPHIC FINDINGS IN ACUTE RHEUMATIC FEVER PATIENTS

Öz

Aim: Acute rheumatic fever (ARF) is an inflammatory disease that develops after Group A Streptococcal (GAS) tonsillopharyngitis in genetically susceptible individuals. We aimed to examine the clinical, laboratory, and echocardiographic findings of the patients diagnosed and followed up with ARF. Methods: 55 patients under the age of 18 who were hospitalized and followed up with the diagnosis of ARF between January 2017 and January 2019 were included in this retrospective study. All cases were diagnosed with ARF according to the 2015 revised Jones criteria according to the intermediate-risk group. Gender, age, time of admission, physical examination findings, laboratory findings, echocardiographic findings, and data meeting major and minor diagnostic criteria of all patients diagnosed with ARF were recorded. Echocardiography and electrocardiography were performed on all patients. Inflammatory biomarkers were calculated using laboratory parameters. The data before the treatment and at the 8th week of the treatment were compared. Results: 31 (56.4%) of the patients were female and 24 (43.6%) were male, the mean age was 13.70±2.44 years (7-18 years). The highest number of patients was in the 9-14 age group. The most frequent hospital admission season was winter. Arthritis and carditis were the most common major criteria. Post-treatment body weight, height, body mass index, and systolic and diastolic blood pressure values of the patients were statistically significantly higher than before treatment (p<0.001). WBC, NE, MO, EO, PLT, MPV, MCHC, PCT, CRP, ESH, NLR, NMO, TLO, SII values were significantly decreased after treatment. MCH, RDW, PDW, L/CRP values increased significantly after treatment. Pre-treatment MPV and TLR (p: 0.045, r: -0.2712), MPV and LMO (p: 0.041, r: -0.2762), MPV/L were moderately positive (p: 0.001, r: 0.431), WBC with pretreatment SII (p: 0.001, r: 0.652), NE with SII (p: 0.001, r: 0.759). There was a positive high (p: 0.001, r: 0.882) correlation between SII and NLR, and a moderate (p: 0.001, r: 0.598) positive correlation between TLR. Aortic valve regurgitation was shown to be significantly reduced with treatment. There was no significant difference in LVM and LVMI values after treatment (p:0.143, p: 0.672, respectively). Conclusion: Our results suggests that there is no adverse effect on LV remodeling after treatment in patients with ARF. We believe that inflammation can be followed easily by using inflammatory parameters in the acute and post-treatment periods of the disease.

Anahtar Kelimeler

• Acute Rheumatic Fever
• Childhood
• Echocardiography
• Inflammation
• Rheumatic Heart Disease.
• Akut Romatizmal Ateş
• Çocukluk Çağı
• Ekokardiyografi
• Romatizmal Kalp Hastalığı.

AKUT ROMATİZMAL ATEŞ HASTALARINDA YENİ BİYOMARKERLER VE EKOKARDİYOGRAFİK BULGULAR

Öz

Amaç: Akut romatizmal ateş (ARA) Grup A Streptokok (GAS) tonsillofarenjiti geçiren genetik olarak duyarlı bireylerde, enfeksiyonu takiben gelişen inflamatuvar bir hastalıktır. Bu çalışmada ARA tanısı ile takip edilen hastaların klinik, laboratuar ve ekokardiyografik bulgularının incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif çalışmaya Ocak 2017-Ocak 2019 tarihleri arasında 18 yaş altı ARA tanısı ile yatırılarak takip edilen 55 hasta dahil edildi. Tüm olgularda ARA tanısı 2015 yılı revize Jones kriterleri ile orta-risk grubuna göre konuldu. ARA tanısı konan tüm hastaların; cinsiyeti, yaşı, başvuru zamanı, fizik muayene bulguları, laboratuar bulguları, ekokardiyografi bulguları, major ve minör tanı kriterleri sağlayan verileri kaydedildi. Tüm hastalara ekokardiyografi ve elektrokardiyografi yapıldı. Laboratuvar parametreleri kullanarak inflamatuar biyobelirteçler hesaplandı. Tedavi öncesi ve tedavinin 8. haftasındaki veriler kıyaslandı. Bulgular: Hastaların 31’i (%56,4) kız ve 24’ü (%43,6) erkek, yaş ortalaması 13,70±2,44 yıl (7-18 yıl) idi. En fazla hasta 9-14 yaş arasında görüldü. En sık hastaneye başvuru mevsimi kış idi. Major kriterlerden en sık kardit ve artrit görüldü. Hastaların tedavi sonrası vücut ağırlığı, vücut kitle indeksi, sistolik ve diyastolik kan basıncı değerleri tedavi öncesine göre istatistiksel olarak anlamlı yüksek bulundu (p<0,001). WBC, NE, MO, EO, PLT, MPV, MCHC, PCT, CRP, ESH, NLO, NMO, TLO, SII değerleri tedavi sonrasında anlamlı olarak azalmıştı. MCH, RDW, PDW, L/CRP değerleri tedavi sonrasında anlamlı olarak artmıştı. Hastaların tedavi öncesi MPV ile TLO (p: 0,045, r: -0,2712), MPV ile LMO (p: 0,041, r: -0,2762), MPV/L arasında pozitif yönde orta (p: 0,001, r: 0,431), tedavi öncesi SII ile WBC (p: 0,001, r: 0,652), SII ile NE (p: 0,001, r: 0,759). SII ile NLO arasında pozitif yönde yüksek (p: 0,001, r: 0,882), TLO arasında pozitif yönde orta (p: 0,001, r: 0,598) korelasyon görüldü. Tedavi ile aort kapak yetmezliğinin anlamlı olarak azalmış olduğu gösterildi. Tedavi sonrasında LVM ve LVMI değerlerinde ise anlamlı fark tespit edilmedi (sırasıyla p:0,143, p: 0,672). Sonuç: Çalışmamızdakı hastaların klinik bulgularının sıklığı literatürle benzerdir. ARA’lı hastalarda tedavi sonrası LV remodeling üzerinde olumsuz etki olmadığını düşündürmektedir. Hastalığın akut ve tedavi sonrası sürecinde inflamatuar parametreler kullanılarak inflamasyon takibinin kolaylıkla yapılabileceğini düşünmekteyiz.

Anahtar Kelimeler

• Akut Romatizmal Ateş
• Çocukluk Çağı
• Ekokardiyografi
• Romatizmal Kalp Hastalığı.

Kaynakça

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