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ID naloge: 147 Letnik: 2003 Predmet: nevrologija
POMEN IN VLOGA ANTIFOSFOLIPIDNIH PROTITELES PRI MLADIH Z MIGRENSKIM GLAVOBOLOM
Avtor: Gašper Markelj, Vesna Nikšic
Mentor: doc. dr. Dušan Butinar
Somentor: asist. mag. Tadej Avcin
IZHODIŠCE: Antifosfolipidna protitelesa (aPL) so avtoprotitelesa, ki so usmerjena proti fosfolipidom ali kompleksom fosfolipidov z beljakovinami. Med najbolj poznanimi aPL so antikardiolipinska protitelesa (aCL) in lupusni antikoagulanti (LA), ki so vkljucena tudi med laboratorijska merila za postavitev diagnoze antifosfolipidni sindrom (APS). Zadnja leta posebno pozornost namenjajo protitelesom, usmerjenim proti 2-glikoproteinu I (anti- 2GPI), za katera je dokazano, da se vežejo na strukture živcnega tkiva in endotelijske celice možganskih žil ter so lahko povezana z razlicnimi nevrološkimi motnjami. Številni bolniki z APS porocajo o migrenskih glavobolih, ki so se jim pojavljali predvsem v mladosti, zato domnevajo, da bi imela lahko aPL pomembno vlogo tudi pri nastanku migrene.
NAMEN: Do sedaj še ni bilo objavljenih vecjih prospektivnih študij, ki bi pokazale povezavo med aPL in migreno pri mladostnikih. Namen naše študije je bil ugotoviti prisotnost aPL v skupini otrok z migrenskimi glavoboli ter opredeliti njihovo specificnost. Poleg tega smo nameravali s prospektivnim sledenjem aCL, anti- 2GPI in LA oceniti klinicni pomen in vlogo teh protiteles pri patogenezi migrene.
HIPOTEZA: Antifosfolipidna protitelesa se pogosteje pojavljajo pri otrocih z migreno kot pri otrocih s tenzijskim glavobolom in pri zdravih otrocih. Znacilno se pri otrocih z migreno pojavljajo predvsem protitelesa, usmerjena proti 2GPI.
METODE: V prospektivno raziskavo smo vkljucili 52 otrok z migreno in 22 otrok s tenzijskim glavobolom, ki so predstavljali kontrolno skupino. Dobljene rezultate smo primerjali z vrednostmi aPL, ki so bile ugotovljene pri domnevno zdravih otrocih in so predstavljali drugo kontrolno skupino. Preiskovancem smo dvakrat odvzeli kri v razmaku najmanj treh mesecev ter dolocilli vrednosti aCL, LA in anti- 2GPI. Za ugotavljanje razlik v prevalenci posameznih protiteles med skupinami smo uporabili test ?2.
REZULTATI: Stalno povecane vrednosti aPL smo ugotovili pri 16,3% otrok z migreno in 16,7% otrok s tenzijskim glavobolom. Med obema skupinama nismo našli statisticno znacilnih razlik (p>0,9). Tudi pri posameznih podtipih aPL ni bilo zaznavnih statisticno znacilnih razlik med skupinama (p>0,8 za aCL, p>0,8 za anti- 2GPI). Prav tako nismo našli statisticno znacilnih razlik v primerjavi z zdravimi otroki. Štirje otroci so imeli stalno povecane vrednosti aPL: dva sta imela aCL v srednje visokem obmocju, druga dva pa povecane vrednosti anti- 2GPI nad zgornjo mejo normalne vrednosti.
ZAKLJUCEK: Pri otrocih z migreno se aPL ne pojavljajo pogosteje kot pri otrocih s tenzijskim glavobolom in domnevno zdravih otrocih. Naši rezultati ne potrjujejo delovne hipoteze in ne kažejo na neposredno patogenetsko vlogo aPL pri migrenah. Na podlagi posameznih primerov preiskovancev s stalno povecanimi vrednostmi aPL v srednjem obmocju in hkrati hudo obliko migrenskih glavobolov domnevamo, da lahko obstaja posebna podskupina otrok z migrenami, pri katerih je možna tesnejša povezava med prisotnostjo aPL in glavobolom.
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[Abstract / English version]
POMEN IN VLOGA ANTIFOSFOLIPIDNIH PROTITELES PRI MLADIH Z MIGRENSKIM GLAVOBOLOM
Author: Gašper Markelj, Vesna Nikšic
Mentor: doc. dr. Dušan Butinar
Co-mentor: asist. mag. Tadej Avcin
BACKGROUND: Antiphospholipid antibodies (aPL) are auto-antibodies directed against phospholipids and phospholipid-binding proteins. Among aPL anticardiolipin antibodies (aCL) and lupus anticoagulant (LA) antibodies are the most well known. They both are included in the laboratory criteria for the classification of the antiphospholipid syndrome (APS). In recent years, particular attention has been turned to the antibodies directed against 2 glycoprotein I (anti- 2GPI). It has been demonstrated, that they adhere to structures of the nervous tissue and to endothelial cells of brain vessels, and could be involved in various neurological manifestations. Many patients with APS have been reported having migraine in teenage years. These findings suggest the possible pathogenic role of aPL in migraine
AIM: There have as yet been no longitudinal studies on aPL in pediatric migraine and no study has addressed the presence of anti- 2GPI antibodies. The aim of our study was to evaluate the prevalence of aPL in children with migraine and to determine their fine antigen specificity. In addition, with prospective follow-up of aCL, anti- 2GPI and LA we intended to determinate their clinical significance and possible pathogenic role in children with migraine.
HYPOTHESIS: Antiphospholipid antibodies are present more frequently in children with migraine than in children with tension type headache and apparently healthy children in particular, anti- 2GPI are characteristically present in children with migraine.
METHODS: In our prospective study, 52 children with migraine and 22 children with tension type of headache were included. The group of children with tension type headache represented the control group. Results were compared to the values of aPL reported in the study with group of apparently healthy children, which represented second control group. Blood samples were collected twice in interval from 3 to 6 moths. We determined the values of aCL, LA and anti- 2GPI. The statistical significance of intergroup frequency rate was determined by Chi-square analysis.
RESULTS: Persistently positive aPL were observed in 16.3% children with migraine and in 16.7% in children with tension type headache. No statistically significant differences were found between these two groups of children (p>0.9). No statistically significant differences were also found among different aPL subtypes (p>0.8 for aCL, p>0.8 for anti- 2GPI) and between these two groups in comparison to healthy children. Four children had persistently positive values of aPL: two of them had aCL in moderate levels, the other two had positive anti- 2GPI.
CONCLUSIONS: In children with migraine antiphospholipid antibodies are not present more frequently than in children with tension type headache and apparently healthy children. Our results do not support our hypothesis and don't suggest direct pathogenic role of aPL in migraine. Individual cases with severe headaches and persistently positive values of aPL in moderate levels suggest possible subgroup of children with migraine whose disease could be associated with aPL.
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