İnflamatuar bağırsak hastalığının aktivasyonunun değerlendirilmesinde adenosin deaminaz düzeyinin kullanımı

Yıl 2020, , 654 - 659, 01.08.2020

Yasemin Gökden Semih Hot , Can Gönen Semih Kalyon , Züleyha Akkan Çetinkaya

https://doi.org/10.28982/josam.769877

Cited By: 1

Öz

Amaç: Günümüzde, inflamatuar barsak hastalığı (İBH) hastalarda hastalığın türünü, aktivitesinin derecesini belirleyebilen, seyrini tahmin edebilen ve tedavi yanıtını izleyebilen ideal bir laboratuvar testine hala ihtiyaç vardır. Bu çalışmada İBH olan hastalarda hastalık aktivitesi ile adenozin deaminaz ADA düzeyleri arasındaki ilişki araştırıldı.
Yöntemler: Bu vaka-kontrol çalışmasına toplam olarak 92 IBH hastası [43 Crohn hastalığı (CD) ve 49 ülseratif kolit (UC)] ve 31 sağlıklı kontrol (HC) gönüllüsü dahil edildi. Hastaların yaşı, cinsiyeti, vücut kitle indeksi, hastalığın yeri ve şiddeti, ilaç tedavisi, endoskopik muayene, hemogram, C-reaktif Protein (CRP) ve ADA sonuçları retrospektif olarak değerlendirildi.
Bulgular: Ortalama ADA seviyesi IBH grubunda 24,87 (9,6 - 74,9) IU/L ve HC grubunda 20,8 (13,7 - 38,9) IU/L idi. IBH ve HC grubu arasındaki fark istatistiksel olarak anlamlıydı (P<0,013), ancak UC ve CD grubu arasındaki fark istatistiksel olarak anlamlı değildi(P=0,76). Ortalama ADA düzeyi aktif UC hastalarında inaktif olanlardan anlamlı olarak yüksekti (P<0,001). Aktif UC hastalarını remisyonda UC hastalarından ayırt etmek için, eğer ADA düzeyinin eşik değeri 77,6 güven aralığında 21,64 U/L olarak kabul edilirse, duyarlılık %89 ve özgüllük %60 olarak hesaplandı. Ortalama ADA düzeyi CD grubunda HC grubuna göre anlamlı derecede yüksekti.
Sonuç: ADA seviyesi, hastalığın bulunduğu yere ve etkilenen alanın boyutuna bakılmaksızın, aktif UC hastalarını remisyondaki UC hastalarından ayırmak için alternatif bir belirteç olarak kullanılabilir.

Anahtar Kelimeler

Crohn hastalığı, Ülseratif kolit, Adenozin deaminaz

The value of adenosine deaminase level in assessing activation of inflammatory bowel disease

Öz

Aim: There is still a need for an ideal laboratory test that can determine the type of disease, the degree of its activity, predict its course, and monitor treatment response in patients with inflammatory bowel disease (IBD). This study aims to investigate the relationship between disease types and activity with Adenosine deaminase (ADA) levels in patients with IBD.
Methods: A total of 92 patients with IBD [43 with Crohn’s disease (CD) and 49 with ulcerative colitis (UC)] and 31 healthy control (HC) volunteers were included in this case-control study. Patients’ age, gender, body mass index, location and severity of the disease, medication, endoscopic examination, hemogram, C-reactive Protein (CRP), and ADA results were evaluated.
Results: The mean ADA level was 24.87 (9.6 - 74.9) IU/L in the IBD group and 20.8 (13.7 - 38.9) IU/L in the HC group. The difference between the IBD and HC groups was statistically significant (P<0.013), while that between UC and CD groups was not (P=0.76). Mean ADA level was significantly higher in active UC patients than in inactive ones (P<0.001). To distinguish active UC patients from those in remission, a cut-off level of 21.64 U/L was determined for ADA with 77.6% confidence interval, 89% sensitivity and 60% specificity. Mean ADA level was significantly higher in the CD group compared to the HC group.
Conclusion: ADA level may be used as an alternative marker to distinguish active UC patients from those in remission, regardless of the disease location and the extent of the affected area.

Anahtar Kelimeler

Ulcerative colitis, Crohn’s disease, Adenosine deaminase

Kaynakça

• 1. Bruce E. Sands and Corey A. Siegel. Crohn’s Disease. Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. Pathophysiology/Diagnosis/Management Philadelphia: Saunders Elsevier; 2010. P.1041-1973.
• 2. Pulat H, Yalaki S. Can red blood cell distribution width (RDW) predict clinical and endoscopic activity in ulcerative colitis patients? J Surg Med. 2020;4;271-5. doi: 10.28982/josam.712289.
• 3. Aziz K, El Marouni A, Belghali H, Souiki T, Ibn Majdoub K, Toughrai I, et al. Multiple enterogluteal fistulas, Crohn's disease: A case report. J Surg Med. 2019;3:763-5. doi: 10.28982/josam.547091.
• 4. Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut. 2006;55:426–31. doi: 10.1136/gut.2005.069476.
• 5. Fox IH, Kelley WN. The role of adenosine and 2’-deoxyadenosine in mammalian cells. Annu Rev Biochem. 1978;47:655-86. doi: 10.1146/annurev.bi.47.070178.003255.
• 6. Sullivan JL, Osbrne WR, Wedgewood RJ. Adenosine deaminase activity in lymphocytes. Br J Haematol. 1977;37:157-8. PMID: 412512
• 7. Piras MA, Gakis C, Budroni M, Andreoni G. Adenosine deaminase avtivity in pleural effusions: an aid to differential diagnosis. Br Med J. 1978;2:1751-2. doi: 10.1136/bmj.2.6154.1751-a.
• 8. Erer B, Yilmaz G, Yilmaz FM, Koklu S. Assessment of adenosine deaminase levels in rheumatoid arthritis patients receiving anti-TNF-alpha therapy. Rheumatol Int. 2009;29:651–4. doi: 10.1007/s00296-008-0750-1.
• 9. Oztürk ZA, Köklü S, Erol MF, Yılmaz FM, Basar O, Yuksel O, et al. Serum adenosine deaminase levels in diagnosis of acute appendicitis. Emerg Med J. 2008;25:583–5. doi: 10.1136/emj.2007.054452.
• 10. Hitoglou S, Hatzistilianou M, Gougoustamou D, Athanassiadou F, Kotsis A, Catriu D. Adenosine deaminase activity and its isoenzyme pattern in patients with juvenile rheumatoid arthritis and systemic lupus erythematosus. Clin Rheumatol. 2001;20:411– 6. doi: 10.1007/s100670170005.
• 11. Cakal B, Beyazit Y, Koklu S, Akbal E, Biyikoglu I, Yilmaz G. Elevated adenosine deaminase levels in celiac disease. J Clin Lab Anal. 2010;24:323–6. doi: 10.1002/jcla.20410.
• 12. Ibiş M, Köklü S, Yilmaz FM, Basar O, Yılmaz G, Yuksel O, et al. Serum adenosine deaminase levels in pancreatic diseases. Pancreatology. 2007;7:526–30. doi: 10.1159/000108970.
• 13. Canpolat F, Unver M, Eskioğlu F, Kösebalaban S, DurmazlarSP. Serum and erythrocyte adenosine deaminase activities in patients with Behçet's disease. Int J Dermatol. 2006;45:1053–6. doi: 10.1111/j.1365-4632.2006.02892.x.
• 14. Nishikawa Y, Nakamura M, Fukumoto K, Matsumoto M, Matsuda T, Tanaka Y, et al. Adenosine deaminase isoenzymes in patients with Graves' disease. Rinsho Byori. 1995;43:1057–60. PMID: 8531390.
• 15. Yordanova M, Gerova D, Atanassova A, Galunska B. Adenosine Deaminase as a Useful Biomarker for Diagnosis and Monitoring of Inflammatory Bowel Disease.Clin Lab. 2020 Jul 1;66(7). doi: 10.7754/Clin.Lab.2019.191124.
• 16. Truelove SC, Witts LJ. Cortisone in ulcerative colitis: final report on a therapeutic trial. Br Med J. 1955;2:1041–48. doi: 10.1136/bmj.2.4947.1041.
• 17. Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis. BMJ. 1989;298:82–6. doi: 10.1136/bmj.298.6666.82.
• 18. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317:1625–9. doi: 10.1056/NEJM198712243172603.
• 19. Best WR, Becktel JM, Singleton JW, Kern F. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology. 1976;70:439–44. PMID: 1248701.
• 20. Daperno M, D'Haens G, Van Assche G, Baert F, Bulois P, Maunoury V, et al. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD Gastrointest Endosc. 2004;60:505-12. doi: 10.1016/s0016-5107(04)01878-4.
• 21. Giusti G, Galanti B. Adenosine deaminase: colorimetric method. Methods of Enzymatic Analysis. 5th ed. Edited by: Bergmeyer HU. Weinheim (Germany). Verlag Chemie 1984;315-23.
• 22. Maor I, Rainis T, Lanir A, Lavy A. Adenosine deaminase activity in patients with Crohn's disease: distinction between active and nonactive disease. Eur J Gastroenterol Hepatol. 2011;23:598-602. doi: 10.1097/MEG.0b013e328346e205.
• 23. Beyazit Y, Koklu S, Tas A, Purnak T, Sayilir A, Kurt M, et al. Serum adenosine deaminase activity as a predictorof disease severity in ulcerative colitis. J Crohns Colitis. 2012;6:102-7. doi: 10.1016/j.crohns.2011.07.010.
• 24. Ungerer JPJ, Oosthuizen HM, Bissbort SH, Vermaak WJH. Serum Adenosine Deaminase: Isoenzymes and Diagnostic Application. Clin Chem 1992;38:1322-6. PMID: 1623598.
• 25. Cristalli G, Costanzi S, Lambertucci C, Lupidi G, Vittori S, Volpini R, et al. Adenosine deaminase: functional implications and different classes of inhibitors. Med Res Rev. 2001;21:105-28. doi: 10.1002/1098-1128(200103)21:2<105::aid-med1002>3.0.co;2-u.
• 26. Lee SJ, Hwang HS, Kim BN et al. Changes in serum adenosine deaminase activity during normal pregnancy. J Korean Med Sci. 2007;22:718-21. doi: 10.3346/jkms.2007.22.4.718.
• 27. Baganha MF, Pego A, Lima MA, Gaspar EV, Cordeiro AR. Serum and pleural adenosine deaminase. Correlation with lymphocytic populations. Chest. 1990;97:605-10. doi: 10.1378/chest.97.3.605.
• 28. Khan K, Schwarzenberg SJ, Sharp H, Greenwood D, Weisdorf-Schindele S. Role of serology and routine laboratory tests in childhood inflammatory bowel disease. Inflamm Bowel Dis. 2002;8:325–9. doi: 10.1097/00054725-200209000-00003.
• 29. Sajjadi M, Gholamrezaei A, Daryani NE. No association between serum adenosine deaminase activity and disease activity in Crohn’s disease. Dig Dis Sci. 2015;60:1755–60. doi: 10.1007/s10620-014-3510-y.
• 30. Heidari B. C-reactive protein and other markers of inflammation in hemodialysis patients. Caspian J Intern Med. 2013;4:611–6. PMCID: PMC3762236.
• 31. Sproston NR, Ashworth JJ. Role of C Reactive Protein at Sites of Inflamation and Infection. Front Immunol. 2018;9:754. doi: 10.3389/fimmu.2018.00754.