D vitamin eksikliğinde aşil tendonunun B mode us ve elastografi ile değerlendirilmesi
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
D vitamininin kalsiyum, magnezyum, fosfat homeostazında ve kemik metabolizmasında önemli bir rol oynadığı bilinmektedir[1]. Kas ve tendon dokusunda vitamin D reseptör (VDR) varlığı ile vitamin d eksikliğinde artmış proteoliz sonucunda kasta atrofi ve tendinopati gelişimini etkileyebileceği doğrulanmıştır[4,5]. Bu çalışmada, vitamin d eksikliği olan hastalarda aşil tendonu elastografi ile değerlendirilmesi, böylece tendon yapısında öncü değişikliklerinin önceden tahmin edilebilir hale gelmesi ve tespiti amaçlanmaktadır. Çalışma, Ocak 2023 – Haziran 2023 tarihleri arasında Kırıkkale Tıp Fakültesi Radyoloji Anabilim Dalına ultrasonografi için gelen, yaşları 18-45 arasında değişen D vitamin eksikliği olan 30, D vitamin değeri normal olan 28 toplam 58 kişiyle tasarlandı. B mod ultrason (US) incelemesi ile her iki aşil tendonda kalınlık ölçümü yapıldı. Shear wave elastografi (SWE) ve strain elastografi (SE) ile aşil tendonu elastisitesine yönelik kalitatif ve kantitatif değerlendirme yapıldı. Çalışma grubunda aşil tendon kalınlık ortalamaları solda 0.44 cm, sağda 0.45 cm ölçülürken kontrol grubunda kalınlık ortalamaları solda 0.47 cm, sağda 0.46 cm ölçüldü. Çalışma grubunda tendon kalınlığında bilateral incelme olduğu tespit edildi; ancak bu veri sol tendonda anlamlı (p<0.03) bulundu. SWE değerlendirilmesinde, çalışma grubunda elastisite değerleri sol aşil tendonunda 66 kPa, sağ aşil tendonunda 64 kPa; kontrol grubunda sol aşil tendonunda 84 kPa, sağ aşil tendonunda 85 kPa olarak ölçülmüş olup D vitamin eksikliği olan grupta anlamlı olarak (p<0.001) azalma saptandı. SE incelemesinde ise çalışma grubunda her iki aşil tendonda yumuşama saptandı. Literatürde daha önce D vitamininin aşil tendonu üzerindeki etkilerini elastografik olarak inceleyen bir çalışma tespit edemedik. Çalışmamızda D vitamini eksikliği olan hastalarda her iki bacakta aşil tendonu kalınlığı ve elastikiyetinin azaldığı gözlendi. Hasta sayısının az olması kısıtlayıcı bir faktör olsa da D vitamini eksikliği olan hastalarda sonoelastografik değerlendirme ile aşil tendon etkileniminin olası ilerleyici morbidite ve komplikasyonları önlemek ve azaltmak açısından katkı sağlayacağı düşünülmektedir. Anahtar kelimeler: D vitamini, ultrason, elastografi, shear wave, strain, aşil tendonu, tendinopati
It is known that vitamin D plays an important role in calcium, magnesium, phosphate homeostasis and bone metabolism. [1]. It has been confirmed that the presence of vitamin D receptor (VDR) in muscle and tendon tissue may affect the development of muscle atrophy and tendinopathy as a result of increased proteolysis in vitamin D deficiency [4,5]. This study aims to evaluate the achilles tendon in patients with vitamin d deficiency by elastography, so that the leading changes in the tendon structure can be predicted and detected. The study was designed with a total of 58 people, 30 with vitamin D deficiency and 28 with normal vitamin D values, aged between 18-45, who came to Kırıkkale Faculty of Medicine Department of Radiology for ultrasonography between January 2023 and June 2023. Thickness measurement was made in both Achilles tendons with B-mode ultrasound (US) examination. Quantitative and qualitative evaluation of achilles tendon elasticity was performed by shear wave elastography (SWE) and strain elastography (SE). Bilateral achilles tendon thicknesses were evaluated in B-mode US. In the study group, the mean thickness of the Achilles tendon was measured as 0.44 cm on the left and 0.45 cm on the right, while in the control group, the mean thickness was measured as 0.47 cm on the left and 0.46 cm on the right. Bilateral thinning of tendon thickness was detected in the study group, however, this data was found to be significant (p<0.03) in the left tendon. In the evaluation of SWE, elasticity values in the study group were 66 kPa in the left achilles, 64 kPa in the right achilles; It was measured as 84 kPa in the left achilles ,85 kPa in the right achilles in the control group tendon. There was a significant (p<0.001) decrease in elasticity values in the vitamin D deficiency group. In SE examination, signifant softening was detected in both achilles tendons in the study group. We could not find any previous study in the literature that elastographically examined the effects of vitamin D on the Achilles tendon. In our study, it was observed that achilles tendon thickness and elasticity decreased in both legs in vitamin D deficient patients. Although the small number of patients is a limiting factor, it is thought that sonoelastographic evaluation and Achilles tendon involvement in patients with vitamin D deficiency will contribute to preventing and reducing possible progressive morbidity and complications. Keywords: Vitamin D, ultrasound, elastography, shear wave, strain, achilles tendon, tendinopathy
It is known that vitamin D plays an important role in calcium, magnesium, phosphate homeostasis and bone metabolism. [1]. It has been confirmed that the presence of vitamin D receptor (VDR) in muscle and tendon tissue may affect the development of muscle atrophy and tendinopathy as a result of increased proteolysis in vitamin D deficiency [4,5]. This study aims to evaluate the achilles tendon in patients with vitamin d deficiency by elastography, so that the leading changes in the tendon structure can be predicted and detected. The study was designed with a total of 58 people, 30 with vitamin D deficiency and 28 with normal vitamin D values, aged between 18-45, who came to Kırıkkale Faculty of Medicine Department of Radiology for ultrasonography between January 2023 and June 2023. Thickness measurement was made in both Achilles tendons with B-mode ultrasound (US) examination. Quantitative and qualitative evaluation of achilles tendon elasticity was performed by shear wave elastography (SWE) and strain elastography (SE). Bilateral achilles tendon thicknesses were evaluated in B-mode US. In the study group, the mean thickness of the Achilles tendon was measured as 0.44 cm on the left and 0.45 cm on the right, while in the control group, the mean thickness was measured as 0.47 cm on the left and 0.46 cm on the right. Bilateral thinning of tendon thickness was detected in the study group, however, this data was found to be significant (p<0.03) in the left tendon. In the evaluation of SWE, elasticity values in the study group were 66 kPa in the left achilles, 64 kPa in the right achilles; It was measured as 84 kPa in the left achilles ,85 kPa in the right achilles in the control group tendon. There was a significant (p<0.001) decrease in elasticity values in the vitamin D deficiency group. In SE examination, signifant softening was detected in both achilles tendons in the study group. We could not find any previous study in the literature that elastographically examined the effects of vitamin D on the Achilles tendon. In our study, it was observed that achilles tendon thickness and elasticity decreased in both legs in vitamin D deficient patients. Although the small number of patients is a limiting factor, it is thought that sonoelastographic evaluation and Achilles tendon involvement in patients with vitamin D deficiency will contribute to preventing and reducing possible progressive morbidity and complications. Keywords: Vitamin D, ultrasound, elastography, shear wave, strain, achilles tendon, tendinopathy
Açıklama
Tıp Fakültesi, Radyoloji Ana Bilim Dalı
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
