Ailesel Akdeniz ateşinde akut faz yanıtı olarak prokalsitonin ve faktör VIII düzeylerinin değerlendirilmesi

Ailesel Akdeniz atesi (AAA) ataklar ve remisyonlarla karakteristik otozomal cekinik bir hastaliktir. Ataklar esnasinda artan akut faz yaniti siklikla ataksiz donemde normale doner. Prokalsitonin bakteriyel enfeksiyonlari diger inflamasyon nedenlerinden ayirmada C-reaktif protein'den (CRP) daha hassas bir testtir. Faktor VIII'de (FVIII) bilinen diger bir akut faz reaktanidir. Ailesel Akdeniz atesi hastalarinda daha onceden FVIII duzeyleri ile ilgili cok az bildiri varken, prokalsitonin ile ilgili calisma yoktur.Bu calismada AAA hastalarinin atak ve atak disi donemlerinde geleneksel akut faz reaktanlari ile birlikte serum prokalsitonin ve FVIII duzeylerinin degerlendirilmesi amaclanmistir.Calisma grubu 21 (10 erkek, 11 kiz) AAA hastasindan ve 19 saglikli cocuktan olusturuldu. Ailesel Akdeniz atesi hastaligi tanisinda tum hastalarda Tell-Hashomer kriterleri esas alindi. Calisma doneminde enfeksiyon bulgulari olanlar calisma disi birakildi.Kan ornekleri hastalarin tumunden atak baslangicinin ilk 72 saati icinde, atak gectikten 7 gun ve 2-3 ay sonra olacak sekilde 3 ayri donemde alindi. Orneklerde kan lokosit, serum CRP, eritrosit cokme hizi (ECH), fibrinojen, prokalsitonin ve FVIII duzeyleri calisildi. Ayni degiskenler saglikli kontrol grubunda da incelendi. Degiskenlerin karsilastirilmasinda Mann-Whitney U testi kullanildi.Atak donemindeki CRP ve fibrinojen duzeyleri ataksiz donemlerdeki ve kontrol grubundaki duzeylerine gore anlamli olarak yuksek saptandi. Prokalsitonin ve FVIII duzeyleri atak doneminde hafif bir artis gostermekle birlikte bu degerler bu testlerin cut-off degerleri uzerine cikmadi. Bu sonuclara gore Prokalsitonin ve FVIII'in AAA hastaliginin atak doneminde tani amacli kullanilamayacagi sonucuna varildi.AbstractFamilial Mediterranean fever (FMF) is an autosomal recessive disorder characterised by exacerbations and remissions. The increased acute phase response seen during the attacks usually returns to normal in attack free period. Procalcitonin (PCT) is more sensitive than C reactive protein (CRP) in differentiating a bacterial infection from other causes of inflammation. Factor VIII (FVIII) is also a well known acute-phase reactant. Procalcitonin values have not been studied and FVIII levels were determined in few studies previously in patients with FMF.The aim of the study is to investigate the serum levels of procalcitonin and factor VIII together with traditional acute phase reactants in patients with FMF during the attack and attack free period.The study group comprised 21 FMF patients and 19 healthy children. The diagnosis of FMF was established according to the Tell-Hashomer criteria. The children with documented infections were excluded from the study. Blood samples were obtained from all the patients in three periods as within the first 72 hours of the attack period, 7 days and two-three months later FMF attack. White blood cell count (WBC), C reactive protein (CRP) erythrocyte sedimentation rate (ESR), fibrinogen, PCT and FVIII were measured. The same parameters were also evaluated in the control group. Mann-Whitney U test was used for the comparison of the variables.CRP and fibrinogen levels of the attack period were found to be significantly higher than the levels of the attack-free period and control group. Although during the attacks of FMF PCT and FVIII were found to be increased, the increase in the levels of PCT and FVIII did not reach to the cut-off values. These results showed that FVIII and PCT cannot be used instead of other acute phase proteins during acute attacks of FMF patients.