Psoriazis Hastalarında Serum Neopterin, İdrar Neopterin ve Serum Il-6 Düzeylerinin Hastalık Şiddeti ile Olan İlişkisi
Özet
Psoriasis is an inflammatory skin disorder characterized by epidermal proliferation. IL-6 has a pivotal role in initiation of acute phase response and furthermore has been reported to be an inflammatory marker for psoriasis and reduced levels were proposed to be correlated with response to therapy. Neopterin is increased as a result of activated cellular immune response to IFN? stimulation. It is secreted by monocytes and macrophages. Increased serum and urinary levels of neopterin have been detected autoimmune diseases, malignity, cardiac and renal failure. Currently, there is no standard laboratory marker that can be used in predicting severity of inflammation, severity of disease, response to therapy and comparison of different treatment modalities in psoriasis. The present study was designed to determine IL-6 and neopterin levels before and after the treatment modalities and comparing these results with the PASI scores before and after therapy. The aim of the present study was to evaluate the efficacy of IL-6 and neopterin as a standard laboratory marker in predicting the severity of inflammation, severity of disease and response to different therapeutic modalities. Sixty patients with psoriasis that included 42 patients that received narrow band phototherapy and 18 patients that received systemic therapy (cyclosporine, acitretin, biologic agents) constituted the patients groups. The results of the patients group were compared to the control group that constituted of 30 healthy subjects that volunteered for the study. In the patients group before the initiation of the therapy; mean serum neopterin level was 6.56±3.12nmol/L; mean urinary neopterin level was 284.21±137.24 ?mol/mol creatinine and mean serum IL-6 level was 23.23±15.89. Control group had mean serum neopterin level was 6.95±3.47nmol/L, mean urinary neopterin level was 252.52±149.02 ?mol/mol creatinine and mean serum IL-6 level was 24.47±8.31. There were no statistically significant difference in terms of serum/urinary neopterin levels among the patients and control groups (p>0.05). vii However; serum IL-6 levels of the control groups were significantly lower than patients group (p<0.05). Furthermore; patients group were further subdivided in to narrow band UVB phototherapy and systemic therapy groups and were independently compared to the control group in terms of serum/urinary neopterin, serum IL-6 before the therapy. There were no statistically significant difference in terms of serum and urinary neopterin difference among the groups (p>0.05). On the other hand systemic therapy group had significantly lower serum IL-6 when compared to the control group (p<0.05). PASI scores were 23.47±13.57 in the patients group before the initiation of the therapy. There was no statistically significant correlation between the pretreatment PASI scores, serum IL-6, serum/urinary neopterin level (p>0.05). In the patients group in 3 months following the initiation of the therapy, mean serum neopterin level was 6.64±3.68 nmol/L, mean urinary neopterin level was 367.49±172.15 ?mol/mol creatinine and mean serum IL-6 level was 22.19±16.08. The mean PASI scores were reduced to 5.54±4.64. The PASI scores following the treatment showed a statistically significant reduction (p<0.05). However serum/urinary neopterin levels and serum IL-6 level after the therapy did not show a statistically significant change (p>0.05). There was no significant correlation between PASI score and serum IL-6 and serum/urinary neopterin levels (p>0.05). In addition to all, when narrow band phototherapy and systemic therapy subgroups were independently evaluated; there were no statistically significant reduction in serum/urinary neopterin and serum IL-6 levels (p>0.05). The results of the present study suggest that serum/urinary neopterin and serum IL-6 levels cannot be a reliable marker for determination of severity of inflammation, severity of disease or response to therapy in patients with psoriasis.
