YUZ NERVI NEVROPATIYASIDA KECHKI ASORATLARNI ERTA BASHORATLASHDA ELEKTRONEYROMIOGRAFIYA VA PROYALLIG'LANISH SITOKINLARI KO'RSATKICHLARINING PROGNOSTIK AHAMIYATI
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yuz nervi nevropatiyasi, Bell falaji, ENMG, IL-6, IL-8, TNF-alfa, House–Brackmann, prognoz, mo'miyo elektroforezi.##article.abstract##
Dolzarbligi. Yuz nervi nevropatiyasi (YNN) o'tkir davrida kechki asoratlar – yuz sinkineziyalari va mimik mushaklar kontrakturalarini erta hamda ob'ektiv bashoratlash zamonaviy nevrologiyaning dolzarb muammolaridan biri bo'lib qolmoqda.
Maqsad. Elektroneyromiografik (ENMG) va immunologik (IL-6, IL-8, TNF-α) ko'rsatkichlarni majmuaviy baholash asosida YNN asoratlari rivojlanishini erta bashoratlash hamda reabilitatsiya samaradorligini oshirish.
Material va usullar. Toshkent davlat tibbiyot universiteti 1-klinikasida 48 nafar YNN bemori (30 nafari 45 yoshgacha, 18 nafari 45 yoshdan yuqori; 20 erkak, 28 ayol) va 25 nafar amaliy sog'lom shaxs (nazorat guruhi) tekshirildi. Klinik holat House–Brackmann (HB) va FNGS 2.0 shkalalari, neyrofiziologik holat ENMG, sitokinlar miqdori immunoferment tahlil (IFA) usulida baholandi. Reabilitatsion potensiali past 21 nafar bemor ikki guruhga bo'linib, ulardan birida (n=11) an'anaviy davoga qo'shimcha 4% li mo'miyo elektroforezi qo'llanildi.
Natijalar. O'tkir davrda YNN bemorlarida IL-6 (18.6±1.8 pg/ml), IL-8 (34.2±3.1 pg/ml) va TNF-α (15.4±1.2 pg/ml) darajasi nazorat guruhiga nisbatan ishonchli yuqori bo'ldi (p<0.001). Kechki asoratlar rivojlangan bemorlarda (n=9; 18.8%) IL-6 (24.8 pg/ml), TNF-α (21.2 pg/ml) va M-javob amplitudasi pasayishi (78%) asoratsizlarga nisbatan yuqori edi. Prognostik cut-off qiymatlari sifatida M-javob pasayishi >75%, IL-6 >20 pg/ml, IL-8 >35 pg/ml va TNF-α >18 pg/ml belgilandi. Mo'miyo elektroforezi qo'llanilgan guruhda HB va FNGS 2.0 ballari ishonchli yaxshilandi (p<0.05); asoratlar ulushi an'anaviy davoda 30.0%, mo'miyo guruhida 9.1% ni tashkil etdi, biroq farq statistik jihatdan ishonchli emas (p=0.31).
Xulosa. ENMG va proyallig'lanish sitokinlari (IL-6, IL-8, TNF-α) ko'rsatkichlarini majmuaviy qo'llash YNN kechki asoratlarini erta bashoratlashda yuqori diagnostik aniqlikni ta'minlaydi. Mo'miyo elektroforezi istiqbolli usul bo'lib, uning samaradorligini kengroq tanlanmada tasdiqlash talab etiladi.
Библиографические ссылки
Gilden D. H. Bell's palsy // New England Journal of Medicine. – 2004. – Vol. 351, № 13. – P. 1323–1331.
Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies // Acta Oto-Laryngologica. – 2002. – Vol. 122, № 4. – P. 4–30.
Baugh R. F., Basura G. J., Ishii L. E. et al. Clinical practice guideline: Bell's palsy // Otolaryngology–Head and Neck Surgery. – 2013. – Vol. 149, № 3 (Suppl). – P. S1–S27.
House J. W., Brackmann D. E. Facial nerve grading system // Otolaryngology–Head and Neck Surgery. – 1985. – Vol. 93, № 2.
– P. 146–147.
Vrabec J. T., Backous D. D., Djalilian H. R. et al. Facial Nerve Grading System 2.0 // Otolaryngology–Head and Neck Surgery.
– 2009. – Vol. 140, № 4. – P. 445–450.
Eviston T. J., Croxson G. R., Kennedy P. G. E. et al. Bell's palsy: aetiology, clinical features and multidisciplinary care // Journal of Neurology, Neurosurgery & Psychiatry. – 2015. – Vol. 86, № 12. – P. 1356–1361.
Zhang W., Xu L., Wang T. et al. The role of inflammatory cytokines in the pathogenesis of Bell's palsy // Cytokine. – 2020. – Vol. 128. – Art. 154989.
Li W., Liu X., Zhang Y. Elevated serum levels of IL-6, IL-8, and TNF-alpha in patients with acute facial neuritis // Journal of Neuroimmunology. – 2018. – Vol. 320. – P. 77–81.
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects // JAMA. – 2013. – Vol. 310, № 20. – P. 2191–2194.
Fisch U. Prognostic value of electrical tests in acute facial paralysis // American Journal of Otology. – 1984. – Vol. 5, № 6. –
P. 494–498.
Engvall E., Perlmann P. Enzyme-linked immunosorbent assay (ELISA). Quantitative assay of immunoglobulin G // Immunochemistry. – 1971. – Vol. 8, № 9. – P. 871–874.
Dattner L., Eigler G. Clinical evaluation of natural biogenic stimulators in peripheral neuropathy recovery // Physical Therapy Research. – 2017. – Vol. 20, № 1. – P. 15–22.
Glantz S. A. Primer of Biostatistics. – 7th ed. – McGraw-Hill Education, 2011. – 320 p.
Kim T. H., Yeo S. G., Byun J. Y. Role of biomarkers as prognostic factors in acute peripheral facial palsy // International Journal of Molecular Sciences. – 2021. – Vol. 23, № 1. – Art. 307.
Ronchetti S., Ricci E., Migliorati G. et al. How glucocorticoids regulate the inflammatory response in neural tissues // Frontiers in Immunology. – 2018. – Vol. 9. – Art. 3120.
Coulson S. E., Croxson G. R., Adams R. D. et al. Prognostication in Bell's palsy: a review of methods // Otology & Neurotology. – 2011. – Vol. 32, № 6. – P. 1038–1043.
Wang X., Chen Y., Zhang H. Electrophysiological findings and cytokine profiles in patients with severe Bell's palsy // Muscle & Nerve. – 2019. – Vol. 60, № 3. – P. 285–291.
Sullivan F. M., Swan I. R. C., Donnan P. T. et al. Early treatment with prednisolone or acyclovir in Bell's palsy // New England Journal of Medicine. – 2007. – Vol. 357, № 16. – P. 1598–1607.
Pereira L. M., Obara K. F., Dias J. M. et al. Facial exercise therapy for facial nerve paralysis: a systematic review // Clinical Rehabilitation. – 2011. – Vol. 25, № 7. – P. 587–593.
Cankaya H., Uyanik M., Erden M. Efficacy of physical therapy modalities and adjunct treatments in facial nerve palsy rehabilitation // Journal of Back and Musculoskeletal Rehabilitation. – 2016. – Vol. 29, № 4. – P. 811–816.
Zhao Y., Li H., Wang J. Inflammatory mechanisms and therapeutic targets in peripheral nerve injury // Journal of Neuroinflammation. – 2022. – Vol. 19, № 1. – Art. 142.
Omer S., Beqaj S., Gjoneni E. Cytokine biomarkers in neuroinflammatory and neurodegenerative disorders // Biomarkers in Medicine. – 2020. – Vol. 14, № 8. – P. 651–663.
Altman D. G. Practical Statistics for Medical Research. – CRC Press, 1990. – 611 p.
