Işeme bozuklukları ve stres eksenleri
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İşeme Bozuklukları ve Stres Eksenleri Amaç: İşeme bozuklukları, yaşlanmayla birlikte insan yaşamını olumsuz etkilemektedir. Erkeklerde yaşlanmayla görülme sıklığı artan benign prostat hiperplazisi (BPH) ile kadınlarda erkeklere göre daha çok görülen üriner inkontinans en önemli işeme bozukluklarıdır. İşeme bozukluklarının stres eksenleriyle ilişkileri yeterince bilinmemektedir. İnsan vücudunda stresi yöneten iki ana eksen bulunmaktadır: Otonom sinir sistemi (OSS) ve hipotalamo-pitüiter-adrenal (HPA) ekseni. OSS, idrar kesesinin ve sfinkterinin kontrolünde önemli olup aynı zamanda ''vur ya da kaç'' yanıtını yönetmektedir. HPA ise kortizol hormonunu salgılayarak stres yanıtını oluşturmaktadır. Mevcut tez çalışmasının amacı, işeme bozukluğu olan hastalarda bu iki ekseninin aktivitelerini belirlemekti. Materyal ve Metot: OSS aktivitesini veya sempato-vagal dengeyi ölçmek için kalp hızı değişkenliği (KHD), HPA eksen aktivitesini ölçmek için ise tükürük kortizolü kullanıldı. Bu bağlamda aşağıdaki soruların cevapları arandı: I-Ani sıkışma hissi (urge) olan ve ani sıkışma hissi olmayan (non-urge) BPH erkek hastalarında kortizol ve KHD düzeyleri farklı mıdır? II-İnkontinans gözlenen erkek ve kadınlarda kortizol ve KHD düzeyleri farklı mıdır? Ayrıca stres algısı da ölçeklerle ortaya kondu (STAI-I ve STAI-II). Yapılan bu tez çalışmasında grupların total prostat-spesifik antijen (PSA), tam idrar testi, üre, kreatinin, tükürük kortizolü, KHD, üroflowmetre, yaş, kilo, boy ve vücut kitle indeksi (BMI) parametreleri de incelendi. Bulgular: BPH olan erkekler, kontrollere göre daha yüksek üre ve PSA düzeyine (p<0.05), benzer kreatinin ve kortizol düzeylerine (p>0.05) ve daha düşük KHD parametrelerine sahiplerdi (p<0.05). İnkontinans olan kadın ve erkek hastalar daha yüksek üre ve kreatinin düzeylerine (p<0.05), benzer kortizol düzeylerine (p>0.05) ve daha düşük KHD parametrelerine (p<0.05) sahiplerdi. Sempatovagal dengeyi yansıtan KHD parametrelerinden LF/HF, hem BPH hem de inkontinans hastalarında daha yüksekti (p<0.01). Her iki hastalıkta da (BPH ve inkontinans) uluslararası ölçekler her iki hastalığı da etkili bir şekilde yansıttı (p<0.05). Sonuç: Elde edilen bulgular, işeme bozukluğu olan hastalarda HPA ekseninin etkilenmediği fakat otonom sinir sisteminin işemeyi teşvik eden parasempatik dalının aktivitesinin yüksek olduğunu göstermiştir. Bu açıdan yaklaşıldığında, KHD gibi ucuz ve kolay uygulanabilen bir test protokolü işeme bozukluğu olan kişilerde kullanılarak otonom denge hakkında bilgi edinilebilir ve bu sayede parasempatik aktivitenin baskılanmasına yönelik uygulamaların veya tedavilerin etkinliği araştırılabilir. Anahtar kelimeler: İşeme bozukluğu, bening prostat hiperplazisi, inkontinans, stres, kortizol, kalp hızı değişkenliği.
Voiding Disorders and Stress Axes Aim: Voiding disorders negatively affect human life with aging. Benign prostatic hyperplasia (BPH), which is more common in men with aging, and urinary incontinence, which is more common in women than men, are the most important voiding disorders. The relationships between voiding disorders and stress axes are not well known. There are two main axes that manage stress in the human body: Autonomic nervous system (ANS) and hypothalamo-pituitary-adrenal (HPA) axis. ANS is important in controlling the bladder and sphincter and also manages the fight-or-flight response. HPA produces the stress response by secreting the cortisol hormone. The aim of the current thesis study was to determine the activities of these two axes in patients with voiding disorders. Meterial and Method: Heart rate variability (HRV) was used to measure ANS activity or sympatho-vagal balance, and salivary cortisol was used to measure HPA axis activity. In this context, answers to the following questions were sought: I-Are cortisol and HRV different in male BPH patients with and without urge? II-Are cortisol and HRV levels different in men and women with incontinence? Additionally, the perception of stress was recorded with scales (STAI-1 and STAI-2). In this thesis study, total prostate-specific antigen (PSA), complete urine test, urea, creatinine, salivary cortisol, HRV, uroflowmeter, age, weight, height and body mass index (BMI) parameters were examined in study groups. Results: Men with BPH had higher urea and PSA levels (p<0.05), similar creatinine and cortisol levels (p>0.05) and lower HRV parameters (p<0.05) compared to the control group. Male and female patients with incontinence had higher urea and creatinine levels (p<0.05), similar cortisol levels (p>0.05) and lower HRV parameters (p<0.05). LF/HF, one of the HRV parameters that reflect sympathovagal balance, was higher in both BPH and incontinence patients (p<0.01). In both diseases (BPH and incontinence), international scales effectively reflected both diseases (p<0.05). Conclusion: The findings revealed that the HPA axis was not affected in patients with urination disorders, but the activity of the parasympathetic branch of the autonomic nervous system, which promotes urination, was high. From this perspective, a cheap and easily applicable test protocol such as HRV can be used in people with voiding disorders to obtain information about autonomic balance, and thus the effectiveness of applications or treatments aimed at suppressing parasympathetic activity can be investigated. Key words: Voiding disorder, benign prostatic hyperplasia, incontinence, stress, cortisol, heart rate variability.
Voiding Disorders and Stress Axes Aim: Voiding disorders negatively affect human life with aging. Benign prostatic hyperplasia (BPH), which is more common in men with aging, and urinary incontinence, which is more common in women than men, are the most important voiding disorders. The relationships between voiding disorders and stress axes are not well known. There are two main axes that manage stress in the human body: Autonomic nervous system (ANS) and hypothalamo-pituitary-adrenal (HPA) axis. ANS is important in controlling the bladder and sphincter and also manages the fight-or-flight response. HPA produces the stress response by secreting the cortisol hormone. The aim of the current thesis study was to determine the activities of these two axes in patients with voiding disorders. Meterial and Method: Heart rate variability (HRV) was used to measure ANS activity or sympatho-vagal balance, and salivary cortisol was used to measure HPA axis activity. In this context, answers to the following questions were sought: I-Are cortisol and HRV different in male BPH patients with and without urge? II-Are cortisol and HRV levels different in men and women with incontinence? Additionally, the perception of stress was recorded with scales (STAI-1 and STAI-2). In this thesis study, total prostate-specific antigen (PSA), complete urine test, urea, creatinine, salivary cortisol, HRV, uroflowmeter, age, weight, height and body mass index (BMI) parameters were examined in study groups. Results: Men with BPH had higher urea and PSA levels (p<0.05), similar creatinine and cortisol levels (p>0.05) and lower HRV parameters (p<0.05) compared to the control group. Male and female patients with incontinence had higher urea and creatinine levels (p<0.05), similar cortisol levels (p>0.05) and lower HRV parameters (p<0.05). LF/HF, one of the HRV parameters that reflect sympathovagal balance, was higher in both BPH and incontinence patients (p<0.01). In both diseases (BPH and incontinence), international scales effectively reflected both diseases (p<0.05). Conclusion: The findings revealed that the HPA axis was not affected in patients with urination disorders, but the activity of the parasympathetic branch of the autonomic nervous system, which promotes urination, was high. From this perspective, a cheap and easily applicable test protocol such as HRV can be used in people with voiding disorders to obtain information about autonomic balance, and thus the effectiveness of applications or treatments aimed at suppressing parasympathetic activity can be investigated. Key words: Voiding disorder, benign prostatic hyperplasia, incontinence, stress, cortisol, heart rate variability.
Açıklama
Sağlık Bilimleri Enstitüsü, Fizyoloji Ana Bilim Dalı
Anahtar Kelimeler
Fizyoloji, Physiology
