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Uticaj nivoa mokraćne kiseline u serumu na zamor kod pacijenata sa multiplom sklerozom

The impact of sera uric acid on fatigue in patients with multiple sclerosis

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2019
Disertacija.pdf (4.483Mb)
Izvestaj Katarina Vesic Medicina.pdf (939.5Kb)
Author
Vesić, Katarina
Mentor
Tončev, Gordana
Committee members
Drulović, Jelena
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Abstract
Oksidativni stres i neuroinflamacija imaju značajnu ulogu u patogenezi multiple skleroze (Multiple Sclerosis-MS). Kod obolelih od MS zamor je jedan od najčešćih uzroka neurološke onesposobljenosti. Zamor se može javiti kao samostalni simptom ali može biti i manifestacija depresije. U ovoj studiji merili smo nivo mokraćne kiseline (Uric Acid- UA) u serumu, kao marker oksidativnog stresa i nivo C-reaktivnog proteina (C – Reactive Protein -CRP) u serumu, kao marker neuroinflamacije. U studiju je uključeno 98 MS bolesnika u fazi relapsa i remisije. Kontrolnu grupu je sačinjavalo 35 zdravih dobrovoljaca. Stepen depresivne simptomatologije je meren pomoću Bekove skale depresivnosti (Beck’s Depression Inventory - BDI) a stepen zamora pomoću Krupove skale zamora (Fatigue Severity Scale- FSS). Glavni cilj istraživanja je bio da se ispita da li nivoi UA i CRP u serumu koreliraju sa depresivnom simptomatologijom i zamorom. MS oboleli u relapsu i remisiji su imali značajno niže nivoe UA... u serumu u odnosu na zdrave (236.97±9.25μmol/L vs. 268.27±0.09 μmol/L vs 314.82±11.02μmol/L; p=0.000). Nivo CRP u serumu je bio značajno viši u MS grupi u relapsu u poređenju sa MS grupom u remisiji (4.46±0.40mg/L vs. 1.01±0.38mg/L; p=0.000). Srednje vrednosti BDI skora su bile značajno veće kod MS grupe u relapsu (15.68±16.62 vs. 8.36±7.10; p=0.045). Opservirana je slaba negativna korelacija između nivoa UA u serumu i prisustva osećaja tuge, kao i otežanog obavljanja svakodnevnih životnih aktivnosti. Uočena je pozitivna korelacija između nivoa CRP u serumu i depresivne simptomatologije, kao i između depresivne simptomatologije i zamora (p<0.05). Neuroinflamacija i oksidativni stres imaju uticaja na zamor i depresiju kod MS. Niže vrednosti UA u serumu mogu precipitirati osećaj tuge i uticati na sposobnost obavljanja svakodnevnih životnih aktivnosti a svako povećanje serumskog nivoa CRP tokom relapsa, na ovom terenu može dalje precipitirati nastanak depresije. Zbog mogućnosti da zamor predstavlja prodromalni simptom depresije veoma je važna njegova rana detekcija i primena adekvatnih terapijskih mera, moguće čak i antidepresiva.

Oxidative stress and neuroinflammation have a role in the pathogenesis of Multiple Sclerosis (MS) and in depression. Fatigue is the most disabling symptom in patients with MS and could also be a part of depressive symptomatology.In this study we measured the serum levels of Uric Acid (UA) as a marker of oxidative stress and C – Reactive Protein (CRP) as an inflammatory marker, in 98 patients with MS in relapse and remitting phase of illness and 35 healthy subjects. Degree of depressive symptomatology and fatigue were assessed with Beck’s Depression Inventory (BDI) and Fatigue Severity Scale (FSS). Further we examined the possible correlation of these biomarkers with symptoms of depression and fatigue. Relapse and remitting MS had a lower serum UA levels than controls (236.97±9.25μmol/L vs. 268.27±0.09 μmol/L vs 314.82±11.02μmol/L; p=0.000), while sera levels of CRP were higher in relapse than remitting- 125 - patients (4.46±0.40mg/L vs. 1.01±0.38mg/L; p=0.000). Patients in relaps...e had higher BDI scores (15.68±16.62 vs. 8.36±7.10; p=0.045). Decreased UA levels showed weak negative correlation with presence of sadness and disturbed daily activities, higher CRP levels positively correlated with severe depression and the correlation between depression and fatigue was also observed (p<0.05). It is possible that decreased UA levels lead to sadness, disturbed daily activities and sever disability. Every attack of CRP elevation in relapse could additionally precipitate the depression onset. The clinicians must pay special attention to fatigue early detection, because it could precede depression and improve further treatment.

Faculty:
University of Kragujevac, Faculty of Medical Sciences
Date:
18-03-2019
Keywords:
MS / MS / UA / CRP / zamor / depresija / UA / CRP / fatigue / depression
[ Google Scholar ]
URI
http://eteze.kg.ac.rs/application/showtheses?thesesId=6716
http://nardus.mpn.gov.rs/handle/123456789/11186
https://fedorakg.kg.ac.rs/fedora/get/o:1133/bdef:Content/download

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