{"id":29113,"date":"2024-09-27T10:57:32","date_gmt":"2024-09-27T07:57:32","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=29113"},"modified":"2024-12-29T18:04:59","modified_gmt":"2024-12-29T15:04:59","slug":"covid-19-tanili-olgularda-igg-antikor-yanitini-etkileyen-faktorlerin-incelenmesi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2024\/09\/27\/covid-19-tanili-olgularda-igg-antikor-yanitini-etkileyen-faktorlerin-incelenmesi\/","title":{"rendered":"COVID-19 Tan\u0131l\u0131 Olgularda IgG Antikor Yan\u0131t\u0131n\u0131 Etkileyen Fakt\u00f6rlerin \u0130ncelenmesi"},"content":{"rendered":"

\"\"<\/a>Bu makaleye ili\u015fkin\u00a0bir d\u00fczeltme<\/span><\/a><\/strong><\/span>\u00a029 Aral\u0131k 2024\u2019de yay\u0131nland\u0131.<\/p>\n

\n

 <\/p>\n

G\u0130R\u0130\u015e<\/h2>\n

Koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) ge\u00e7iren ki\u015filerde imm\u00fcnglobulin M (IgM) ve IgG antikor yan\u0131t\u0131 olu\u015ftu\u011fu bilinmektedir. Yap\u0131lan \u00e7al\u0131\u015fmalarda akut infeksiyondan sonra IgM antikorlar\u0131n\u0131n ortalama 6-12 g\u00fcnde saptanabildi\u011fi ve 12 haftaya kadar kal\u0131c\u0131 olabildi\u011fi g\u00f6sterilmi\u015ftir. IgG antikorlar\u0131 ise infeksiyondan sonra en erken 10. g\u00fcnde saptanabilir d\u00fczeye eri\u015firler; bir y\u0131la kadar da pozitif kald\u0131klar\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir. Serokonversiyon oranlar\u0131 ise %91-99 aras\u0131ndad\u0131r (1-4).<\/p>\n

Asemptomatik veya hafif COVID-19 hastalar\u0131nda IgG titresinde iki ila d\u00f6rt ay i\u00e7erisinde h\u0131zl\u0131 bir d\u00fc\u015f\u00fc\u015f g\u00f6r\u00fclmekle birlikte hastalar\u0131n \u00e7o\u011funda infeksiyondan 13 ay sonras\u0131na kadar SARS-CoV-2 antikor yan\u0131t\u0131 mevcuttur (5-8). \u00d6zellikle \u015fiddetli COVID-19 ge\u00e7iren hastalarda \u00f6l\u00e7\u00fclen antikor titreleri hafif ge\u00e7iren hastalara k\u0131yasla daha y\u00fcksek bulunmu\u015ftur (9-12).<\/p>\n

Serokonversiyonu de\u011ferlendirmek i\u00e7in incelenen primer viral antijenler, spike (S) ve n\u00fckleokapsid (N) proteinleridir. N proteini, n\u00fckleokapsidi olu\u015fturan ve RNA\u2019ya ba\u011flanma i\u015flevi g\u00f6ren bir proteindir. Virusu h\u00fccre i\u00e7i savunma sistemlerine kar\u015f\u0131 korur ve viral RNA\u2019n\u0131n replikasyonunda g\u00f6rev al\u0131r. S proteini tip 1 membran glikoproteinidir; resept\u00f6r ba\u011flanma alan\u0131n\u0131 (receptor-binding domain – RBD) i\u00e7erir ve virus ile hedef h\u00fccre membran\u0131n\u0131n f\u00fczyonuna arac\u0131l\u0131k eder (13).<\/p>\n

IgG antikor titrelerinin d\u00fc\u015f\u00fc\u015f h\u0131z\u0131 antijene g\u00f6re farkl\u0131l\u0131k arz etmektedir. Anti-S seviyeleri, ge\u00e7irilmi\u015f infeksiyon sonras\u0131 en az \u00fc\u00e7 ay stabil kal\u0131p 5-8 ay sonra d\u00fc\u015f\u00fc\u015f g\u00f6sterirken, anti- RBD ve anti-N antikorlar\u0131 daha h\u0131zl\u0131 azal\u0131r (5,14-16). <\/span><\/p>\n

Anti-S veya anti-N antikorlar\u0131n\u0131n en az alt\u0131 ay kal\u0131c\u0131 oldu\u011fu ve re-infeksiyon riskinin azalmas\u0131yla ili\u015fkili oldu\u011fu bildirilmi\u015ftir (17). Bu antikorlar\u0131n n\u00f6tralizan antikor karakterinde oldu\u011funu bildiren yay\u0131nlar da mevcuttur (18). Ancak SARS-CoV-2\u2019ye kar\u015f\u0131 geli\u015fen bu antikor yan\u0131t\u0131n\u0131n kal\u0131c\u0131 olup olmayaca\u011f\u0131 bilinmemektedir. Re-infeksiyona kar\u015f\u0131 koruma i\u00e7in n\u00f6tralize edici antikorlar\u0131n s\u0131n\u0131r seviyeleri hen\u00fcz a\u00e7\u0131kl\u0131\u011fa kavu\u015fturulmam\u0131\u015ft\u0131r (19).<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda COVID-19 ge\u00e7iren olgularda IgG antikor yan\u0131t\u0131n\u0131n geli\u015fip geli\u015fmedi\u011fi incelendi ve antikor yan\u0131t\u0131 geli\u015fen hastalarda toplam bir y\u0131l s\u00fcre ile antikor d\u00fczeyleri kantitatif olarak takip edildi. B\u00f6ylece SARS-CoV-2\u2019ye kar\u015f\u0131 geli\u015fen antikor yan\u0131t\u0131n\u0131n kal\u0131c\u0131 olup olmayaca\u011f\u0131, antikor titre d\u00fczeyi ve antikor pozitifli\u011fi s\u00fcresinin hangi de\u011fi\u015fkenlerden etkilendi\u011fi sorular\u0131na yan\u0131t bulunmas\u0131 ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

11 Mart-11 A\u011fustos 2020 tarihleri aras\u0131nda hastanemize ba\u015fvurmu\u015f ve COVID-19 tan\u0131s\u0131 alm\u0131\u015f olgular \u00e7al\u0131\u015fmaya davet edildi. D\u00e2hil olma kriterleri; 18 ya\u015f\u0131ndan b\u00fcy\u00fck olmak ve T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 COVID-19 Rehberi\u2019ne g\u00f6re olas\u0131 veya kesin COVID-19 tan\u0131s\u0131 alm\u0131\u015f olmak idi (20). D\u0131\u015flama kriterleri ise takip s\u0131ras\u0131nda semptomatik COVID-19 ge\u00e7irme ve a\u015f\u0131lanmakt\u0131. A\u015f\u0131 olan olgular, a\u015f\u0131 yan\u0131t\u0131n\u0131 g\u00f6zlemlemek i\u00e7in ayr\u0131ca de\u011ferlendirildi.<\/p>\n

\u00c7al\u0131\u015fmaya kat\u0131lmay\u0131 kabul eden hastalar\u0131n; SARS-CoV-2 ger\u00e7ek zamanl\u0131 polimeraz zincir reaksiyonu (real-time polymerase chain reaction- RT-PCR) test sonu\u00e7lar\u0131, toraks bilgisayarl\u0131 tomografi (BT) bulgular\u0131, gebelik ve e\u015flik eden hipertansiyon (HT), diabetes mellitus (DM), koroner arter hastal\u0131\u011f\u0131 (KAH), kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131 (KOAH) ve kronik b\u00f6brek yetmezli\u011fi (KBY) gibi kronik hastal\u0131klar\u0131 kaydedilerek Charlson komorbidite indeksi (CCI) skorlar\u0131 hesapland\u0131. COVID-19 a\u00e7\u0131s\u0131ndan klinik bulgular\u0131 ve tedavide kulland\u0131klar\u0131 ila\u00e7lar (hidroksiklorokin, favipiravir, steroid, tocilizumab) kaydedildi. Hastalar\u0131n ilk vizitte al\u0131nan boy, kilo bilgileri ile v\u00fccut kitle indeksi (VK\u0130) hesapland\u0131.<\/p>\n

Amerikan Ulusal Sa\u011fl\u0131k Enstit\u00fcleri (The National Institutes of Health – NIH)\u2019nin COVID-19 Tedavi Rehberi\u2019ne g\u00f6re hastalar\u0131n klinik a\u011f\u0131rl\u0131k skorlar\u0131 belirlendi (21). \u00c7al\u0131\u015fmam\u0131zda asemptomatik infeksiyonu olan olgu yoktu; kritik hastal\u0131\u011fa sahip olan ise sadece yedi olgu vard\u0131. Kritik hasta grubunun say\u0131ca az olmas\u0131 nedeniyle bu hastalar istatistiksel hesaplamalarda a\u011f\u0131r hasta grubu i\u00e7inde de\u011ferlendirildi. Hastalar a\u011f\u0131rl\u0131k skoruna g\u00f6re \u201chafif\u201d, \u201corta\u201d ve \u201ca\u011f\u0131r\u201d \u015feklinde \u00fc\u00e7 grup olarak s\u0131n\u0131fland\u0131r\u0131ld\u0131. Antikor titre takibi i\u00e7in bir y\u0131ll\u0131k takip s\u00fcrecinde d\u00f6rt vizit yap\u0131lmas\u0131 planland\u0131. Vizitler aras\u0131nda re-infeksiyon a\u00e7\u0131s\u0131ndan hastalar\u0131n semptomlar\u0131 sorguland\u0131. Her vizitte, hastalardan SARS-CoV-2 anti-N IgG titresinin \u00f6l\u00e7\u00fclmesi amac\u0131yla kan numunesi al\u0131nd\u0131. Toplam 584 serum \u00f6rne\u011fi, Amerika Birle\u015fik Devletleri (ABD) G\u0131da ve \u0130la\u00e7 Dairesi (U.S. Food and Drug Administration \u2013 FDA) onayl\u0131, kemil\u00fcminesans mikropartik\u00fcl imm\u00fcnoanaliz (chemiluminescent microparticle immunoassay \u2013 CMIA) y\u00f6ntemini kullanan SARS-CoV-2 IgG Quant testi (Abbott Laboratories, ABD) ile \u00fcreticinin talimatlar\u0131na uygun olarak Abbott Architect i1000sr (Abbott, ABD) cihaz\u0131nda SARS-CoV-2 n\u00fckleokapsid proteinine kar\u015f\u0131 IgG antikorlar\u0131n\u0131 \u00f6l\u00e7mek i\u00e7in kullan\u0131ld\u0131. Testin pozitif e\u015fik de\u011feri, \u00fcretici firma taraf\u0131ndan sinyal\/e\u015fik de\u011fer indeksi (signal\/cut-off index \u2013 S\/C) \u22651.4 olarak belirlenmi\u015fti.<\/p>\n

D\u00fcnya Tabipler Birli\u011fi Helsinki Bildirgesi\u2019ne uygun olarak y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fma i\u00e7in hastalar\u0131n onam\u0131 ve Bezmialem Vak\u0131f \u00dcniversitesi T\u0131p Fak\u00fcltesi \u0130la\u00e7 D\u0131\u015f\u0131 Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 22 Haziran 2020 tarihinde 7208 karar numaras\u0131yla onay al\u0131nd\u0131. <\/span><\/p>\n

\u0130statistiksel Analizler<\/h3>\n

\u00c7al\u0131\u015fma sonunda vizitlerdeki SARS-CoV-2 anti-N IgG pozitiflik oranlar\u0131, titreleri ve bunlar\u0131 etkileyen fakt\u00f6rler (demografik \u00f6zellikler, VK\u0130, CCI, COVID-19 a\u011f\u0131rl\u0131k skorlar\u0131, kullan\u0131lan tedaviler, imm\u00fcns\u00fcpresif ila\u00e7lar, vb.) istatistiksel analizlerle incelendi. Verilerin analizi, SPSS (Statistical Package for the Social Sciences) versiyon 26.0 program\u0131 (IBM Corp., Armonk, NY, ABD) ile yap\u0131ld\u0131. Tan\u0131mlay\u0131c\u0131 analizlerde kategorik de\u011fi\u015fkenler i\u00e7in frekans (n) ve y\u00fczde (%), s\u00fcrekli de\u011fi\u015fkenler i\u00e7in ortalama ve standart sapma, medyan ve \u00e7eyrekler a\u00e7\u0131kl\u0131\u011f\u0131 (interquartile ranges \u2013 IQR) kullan\u0131ld\u0131. Gruplar aras\u0131 kar\u015f\u0131la\u015ft\u0131rmalar, s\u00fcrekli de\u011fi\u015fkenler i\u00e7in t-test, Mann-Whitney U, Kruskal-Wallis, Friedman, Wilcoxon testleri ve varyans analizi; kategorik de\u011fi\u015fkenler i\u00e7in Pearson \u03c72 ve Fisher kesin testleri kullan\u0131larak yap\u0131ld\u0131. \u201cPost hoc\u201d analizlerde Dunn ve Bonferroni kullan\u0131ld\u0131. De\u011fi\u015fkenler aras\u0131ndaki korelasyonu de\u011ferlendirmek i\u00e7in Spearman korelasyon analizi kullan\u0131ld\u0131. \u00c7ok de\u011fi\u015fkenli lojistik regresyon analizleri i\u00e7in \u201cforward LR\u201d metodu kullan\u0131ld\u0131. T\u00fcm testler iki y\u00f6nl\u00fcyd\u00fc ve p<\/i><0.05 de\u011ferleri istatistiksel olarak anlaml\u0131 d\u00fczey kabul edildi.\u00a0 \u00a0<\/span><\/p>\n

BULGULAR<\/h2>\n
\"\"<\/a>

\u015eekil 1.<\/strong> Hasta Se\u00e7imi ve Takip Vizitleri<\/p><\/div>\n

\u00c7al\u0131\u015fmaya davet edilen ve onam al\u0131nan toplam 177 hasta olup \u00fc\u00e7\u00fcnc\u00fc vizite kat\u0131lmayan 29, d\u00f6rd\u00fcnc\u00fc vizite kat\u0131lmayan 106 hasta vard\u0131. Son vizitte serum \u00f6rne\u011fi al\u0131nm\u0131\u015f olan 71 hastan\u0131n 29 (%40.8)\u2019u SARS-CoV-2\u2019ye kar\u015f\u0131 a\u015f\u0131lanm\u0131\u015flard\u0131; a\u015f\u0131 olan hastalar analize al\u0131nmad\u0131 (\u015eekil 1). Vizitler aras\u0131nda semptomatik re-infeksiyona rastlanmad\u0131.<\/p>\n

Hastalar\u0131n 164 (%92.7)\u2019\u00fc PCR pozitifti; bu hastalar kesin COVID-19 hastas\u0131 olarak de\u011ferlendirildi. Kalan 13 olgu olas\u0131 COVID-19 tan\u0131s\u0131 alm\u0131\u015f hastalar olup ilk vizitteki \u00f6l\u00e7\u00fcmlerinde antikor yan\u0131t\u0131 geli\u015fti\u011fi i\u00e7in bu hastalar da kesin COVID-19 olgusu olarak kabul edildiler.<\/p>\n

Vizitlerin yap\u0131lma zaman\u0131, tan\u0131 tarihinden sonra medyan (IQR) g\u00fcn olarak s\u0131ras\u0131yla; birinci vizit 56 (42-64), ikinci vizit 92 (90-96), \u00fc\u00e7\u00fcnc\u00fc vizit 193 (183-199), d\u00f6rd\u00fcnc\u00fc vizit 371 (366-405) idi.\u00a0 <\/span>Klinik a\u011f\u0131rl\u0131k skoruna g\u00f6re hastalar\u0131n %33.3\u2019\u00fc hafif, %46.9\u2019u orta, %15.8\u2019i a\u011f\u0131r, %4\u2019\u00fc kritik gruptayd\u0131. Kritik hasta grubundaki yedi hasta, say\u0131n\u0131n az olmas\u0131 nedeniyle istatistiksel hesaplamalarda a\u011f\u0131r hasta grubuna d\u00e2hil edildi.<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> Hastalar\u0131n Demografik \u00d6zelliklerinin A\u011f\u0131rl\u0131k Skoruna G\u00f6re Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

Hastalar\u0131n demografik \u00f6zelliklerinin, VK\u0130 ve CCI skorlar\u0131n\u0131n a\u011f\u0131rl\u0131k skoruna g\u00f6re da\u011f\u0131l\u0131m\u0131 Tablo 1\u2019de verildi. \u0130kili analizlerde, erkek hastalar\u0131n klini\u011fi, anlaml\u0131 d\u00fczeyde daha a\u011f\u0131r seyretti (p<\/i>=0.009). A\u011f\u0131r hastalarda; HT, DM, KAH, KBY daha y\u00fcksek oranda saptand\u0131 (s\u0131ras\u0131yla p<\/i>=0.001, p<\/i>=0.028, p<\/i>=0.005, p<\/i>=0.03). Klinik a\u011f\u0131rl\u0131k skoru y\u00fcksek olan hastalarda ya\u015f, VK\u0130 ve CCI de\u011feri anlaml\u0131 d\u00fczeyde daha fazlayd\u0131 (s\u0131ras\u0131yla p<\/i><0.0001, p<\/i>=0.002, p<\/i><0.0001).<\/p>\n

\"\"<\/a>

\u015eekil 2.<\/strong> Hafif, Orta ve A\u011f\u0131r Hastalarda Antikor Titrelerinin Zaman \u0130\u00e7erisindeki De\u011fi\u015fimi<\/p><\/div>\n

On iki ayl\u0131k takip s\u00fcresince, d\u00f6rt vizitte al\u0131nan serum \u00f6rneklerinde \u00f6l\u00e7\u00fclen antikor titrelerinin zaman i\u00e7erisindeki de\u011fi\u015fimi de\u011ferlendirildi. SARS-CoV-2 anti-N IgG titrelerinin medyan (IQR) g\u00fcn de\u011ferleri birinci vizitte 5.9 (3.45-7.66), ikinci vizitte 3.88 (2.08-6.44), \u00fc\u00e7\u00fcnc\u00fc vizitte 1.36 (0.58-2.83) ve d\u00f6rd\u00fcnc\u00fc vizitte 0.84 (0.38-1.22) olarak \u00f6l\u00e7\u00fcld\u00fc. Antikor titrelerinin hafif, orta ve a\u011f\u0131r hasta gruplar\u0131nda zaman i\u00e7erisindeki de\u011fi\u015fimi \u015eekil 2\u2019de verildi.<\/p>\n

Zaman i\u00e7erisinde medyan antikor seviyesindeki d\u00fc\u015f\u00fc\u015f istatistiksel olarak anlaml\u0131 d\u00fczeyde bulundu (p<\/i><0.0001). \u201cPost hoc\u201d analizde birinci ve ikinci vizit aras\u0131nda anlaml\u0131 d\u00fczeyde fark yoktu (p<\/i>=0.068); bunun d\u0131\u015f\u0131ndaki t\u00fcm vizitler aras\u0131ndaki ikili analizler istatistiksel olarak anlaml\u0131yd\u0131 (s\u0131ras\u0131yla p<\/i><0.0001, p<\/i><0.0001, p<\/i><0.0001, p<\/i><0.0001, p<\/i>=0.003).<\/p>\n

Vizitlerde \u00f6l\u00e7\u00fclen medyan SARS-CoV-2 anti-N IgG titreleri, klinik a\u011f\u0131rl\u0131k skoruna g\u00f6re kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda istatistiksel olarak anlaml\u0131yd\u0131 (s\u0131ras\u0131yla p<\/i><0.0001, p<\/i><0.0001, p<\/i><0.0001, p<\/i>=0.004). \u201cPost hoc\u201d analizde, hafif hasta grubunda antikor titreleri orta ve a\u011f\u0131r hasta grubuna g\u00f6re anlaml\u0131 d\u00fczeyde daha d\u00fc\u015f\u00fckt\u00fc (p<\/i><0.0001) (\u015eekil 2).<\/p>\n

E\u015fik de\u011ferin \u00fcst\u00fcnde antikor yan\u0131t\u0131 olan hastalar\u0131n oran\u0131 birinci vizitte %88.7 (157\/177), ikinci vizitte %80.8 (143\/177), \u00fc\u00e7\u00fcnc\u00fc vizitte %45.9 (73\/159) ve d\u00f6rd\u00fcnc\u00fc vizitte %21.4 (9\/42) saptand\u0131. Pozitif antikor testi sonucunun; klinik a\u011f\u0131rl\u0131k skoru, ya\u015f, cinsiyet, VK\u0130, CCI, hastane yat\u0131\u015f\u0131, DM\/HT varl\u0131\u011f\u0131, steroid\/tocilizumab kullan\u0131m\u0131 ile ili\u015fkisi de\u011ferlendirildi.<\/p>\n

Spearman korelasyon analizinde; ya\u015f (r=0.346, p<\/i><0.0001), CCI skoru (r=0.262, p<\/i>=0.001) ve HT \u00f6yk\u00fcs\u00fc (r=0.306, p<\/i><0.0001) birinci vizitte antikor titre de\u011feri ile orta derecede pozitif korelasyon g\u00f6sterdi. Benzer \u015fekilde hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k skoru artt\u0131k\u00e7a birinci vizitteki antikor titresi de artmaktayd\u0131 (r =0.400, p<\/i><0.0001). V\u00fccut kitle indeksi ile birinci vizitteki antikor titresi aras\u0131nda zay\u0131f pozitif korelasyon g\u00f6r\u00fcld\u00fc (r=0.181, p<\/i>=0.022).<\/p>\n

\u00dc\u00e7\u00fcnc\u00fc vizitte ya\u015f (r=0.351, p<\/i><0.0001), HT \u00f6yk\u00fcs\u00fc (r=0.295, p<\/i>=0.004) ve hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k skoru (r=0.447, p<\/i><0.0001) antikor titresi ile orta derecede pozitif y\u00f6nde korelasyon g\u00f6sterdi. Charlson komorbidite indeksi (r=0.192, p<\/i>=0.02) ve VK\u0130 (r=0.177, p<\/i>=0.036) de\u011ferleri ile \u00fc\u00e7\u00fcnc\u00fc vizitteki antikor titresi aras\u0131nda ise zay\u0131f pozitif korelasyon saptand\u0131.<\/p>\n

\"\"<\/a>

Tablo 2.<\/strong> Vizitlerde Antikor Testi Pozitifli\u011fi \u00dczerine Etki Eden Fakt\u00f6rler<\/p><\/div>\n

D\u00f6rd\u00fcnc\u00fc vizitte 177 hastan\u0131n 71\u2019inin antikor titre \u00f6l\u00e7\u00fcmleri yap\u0131ld\u0131 ve bunlar\u0131n %40.85 (29\/71)\u2019inde a\u015f\u0131lama sonras\u0131 serum \u00f6rne\u011fi al\u0131nd\u0131. D\u00f6rd\u00fcnc\u00fc vizitte a\u015f\u0131 olmam\u0131\u015f olan hasta grubunda (n=42) tek de\u011fi\u015fkenli analizler yap\u0131ld\u0131. A\u015f\u0131lanm\u0131\u015f olan hastalar, daha sonra a\u015f\u0131n\u0131n antikor yan\u0131t\u0131 \u00fczerine etkisini g\u00f6rmek amac\u0131yla ayr\u0131ca de\u011ferlendirildi. D\u00f6rd\u00fcnc\u00fc vizitte antikor titresi ile pozitif y\u00f6nde korelasyon g\u00f6steren tek parametre hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k skoru idi (r=0.392, p<\/i>=0.01). Birinci, \u00fc\u00e7\u00fcnc\u00fc ve d\u00f6rd\u00fcnc\u00fc vizitlerde antikor testi pozitifli\u011fini etkileyen fakt\u00f6rler Tablo 2\u2019de verildi.<\/p>\n

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Tablo 3.<\/strong> Birinci ve \u00dc\u00e7u\u0308ncu\u0308 Vizitte Antikor Pozitifli\u011fine Etki Eden Fakt\u00f6rler<\/p><\/div>\n

Birinci ve \u00fc\u00e7\u00fcnc\u00fc vizitte antikor pozitifli\u011fi \u00fczerine etkisini de\u011ferlendirmek amac\u0131yla ya\u015f, VK\u0130, CCI, HT ve a\u011f\u0131rl\u0131k skoru parametrelerinin d\u00e2hil edildi\u011fi lojistik regresyon modelinde, a\u011f\u0131rl\u0131k skorunda her bir birim art\u0131\u015f, birinci ve \u00fc\u00e7\u00fcnc\u00fc vizitte antikor testinin pozitif olma oran\u0131n\u0131 s\u0131ras\u0131yla 6.453 ve 3.169 kat\u0131 kadar art\u0131rmaktayd\u0131. Charlson komorbidite indeksi skorunda her bir birim art\u0131\u015f, \u00fc\u00e7\u00fcnc\u00fc vizitte antikor testinin pozitif olma oran\u0131n\u0131 0.537 kat\u0131 kadar azaltt\u0131. Ya\u015f\u0131n bir birim artmas\u0131, \u00fc\u00e7\u00fcnc\u00fc vizitte antikor testinin pozitif olma oran\u0131n\u0131 1.078 kat\u0131 kadar art\u0131rm\u0131\u015ft\u0131 (Tablo 3).<\/p>\n

D\u00f6rd\u00fcnc\u00fc vizite kat\u0131lm\u0131\u015f olan a\u015f\u0131l\u0131 hastalar\u0131n 22\u2019sine inaktif tam virus a\u015f\u0131s\u0131 olan CoronaVac (Sinovac Life Sciences, \u00c7in) ve yedisine mRNA a\u015f\u0131s\u0131 olan Comirnaty (BioNTech, Almanya-Pfizer, ABD) a\u015f\u0131s\u0131 uygulanm\u0131\u015ft\u0131. A\u015f\u0131n\u0131n ilk dozundan \u00f6rnek al\u0131m\u0131na kadar ge\u00e7en s\u00fcre medyan (IQR) olarak 64 (25-84) g\u00fcn idi; a\u015f\u0131 olan grupta antikor titresi \u00fc\u00e7\u00fcnc\u00fc vizitte 2.57 (1.92-4.31) ve d\u00f6rd\u00fcnc\u00fc vizitte 3.81 (2.51-5.83) g\u00fcn idi. A\u015f\u0131 olmayan grupta ise antikor titresi \u00fc\u00e7\u00fcnc\u00fc vizitte 2.30 (1.82-3.97) ve d\u00f6rd\u00fcnc\u00fc vizitte 0.84 (0.38-1.22) g\u00fcn saptand\u0131. A\u015f\u0131 olanlarda \u00fc\u00e7\u00fcnc\u00fc ve d\u00f6rd\u00fcnc\u00fc vizitler aras\u0131nda antikor titrelerindeki art\u0131\u015f, a\u015f\u0131 olmayanlara k\u0131yasla istatistiksel olarak anlaml\u0131 d\u00fczeyde bulundu (p<\/i>=0.002).<\/p>\n

Anti-N IgG titresini y\u00fckseltmesi beklenen CoronaVac a\u015f\u0131s\u0131n\u0131 olan 22 hasta i\u00e7inde, a\u015f\u0131dan en az dokuz g\u00fcn ve sonras\u0131nda antikor titresi \u00f6l\u00e7\u00fclen 19 hastan\u0131n 17\u2019sinde antikor titrelerinde art\u0131\u015f oldu\u011fu g\u00f6r\u00fcld\u00fc. A\u015f\u0131 sonras\u0131 ilk sekiz g\u00fcnde \u00f6rnek al\u0131nm\u0131\u015f olan \u00fc\u00e7 hastada antikor titrelerinde y\u00fckselme g\u00f6zlenmedi; ancak sonraki g\u00fcnlerde tekrar \u00f6l\u00e7\u00fcm yap\u0131lmad\u0131. \u0130lgin\u00e7 bir \u015fekilde Comirnaty a\u015f\u0131s\u0131 olan yedi hastan\u0131n \u00fc\u00e7\u00fcnde anti-N IgG titrelerinde art\u0131\u015f oldu. \u00c7al\u0131\u015fmam\u0131zda anti-S IgG titresi \u00f6l\u00e7\u00fclmedi\u011finden spike mRNA i\u00e7eren Comirnaty a\u015f\u0131s\u0131na kar\u015f\u0131 antikor yan\u0131t\u0131 tam olarak de\u011ferlendirilemedi. Bu nedenle iki farkl\u0131 a\u015f\u0131 grubu olu\u015fturduklar\u0131 antikor yan\u0131t\u0131 a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131lamad\u0131.<\/p>\n

\u0130RDELEME<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, COVID-19 ge\u00e7iren hastalarda bir y\u0131ll\u0131k s\u00fcre zarf\u0131nda antikor d\u00fczeylerini takip ederek, SARS-CoV-2\u2019ye kar\u015f\u0131 geli\u015fen antikor yan\u0131t\u0131n\u0131n seviyesini, kal\u0131c\u0131l\u0131k s\u00fcresini ve antikor d\u00fczeyine etki eden fakt\u00f6rleri de\u011ferlendirmeyi ama\u00e7lad\u0131k. Ayr\u0131ca, birinci y\u0131l \u00f6l\u00e7\u00fcmlerinde a\u015f\u0131 olan ve olmayan iki grubu kar\u015f\u0131la\u015ft\u0131rarak, a\u015f\u0131lama sonras\u0131 geli\u015fen antikor cevab\u0131n\u0131 de\u011ferlendirdik.<\/p>\n

Dan ve arkada\u015flar\u0131n\u0131n (15) ABD\u2019de yapt\u0131\u011f\u0131 ve COVID-19 sonras\u0131 sekiz ay boyunca antikor yan\u0131tlar\u0131n\u0131 takip etti\u011fi \u00e7al\u0131\u015fmada, hastalar\u0131n medyan ya\u015f\u0131 40 olup %57\u2019si kad\u0131n ve %90\u2019\u0131 hafif hastal\u0131k derecesine sahipti. Gallais ve arkada\u015flar\u0131n\u0131n (8) Fransa\u2019da yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada ise hasta pop\u00fclasyonunun medyan ya\u015f\u0131 39, %76.8\u2019i kad\u0131n, VK\u0130 medyan (IQR) de\u011feri 23.6 (21.3-26.9) idi. Hastalar\u0131n %4.1\u2019inin hastaneye yat\u0131\u015f gereksinimi oldu\u011fu buna kar\u015f\u0131l\u0131k a\u011f\u0131r hastal\u0131k derecesinde olgu saptanmad\u0131\u011f\u0131 bildirilmi\u015ftir. \u00dclkemizde 135 hasta ile yap\u0131lan \u00e7al\u0131\u015fmada ise hastalar\u0131n %42.2\u2019si kad\u0131n, ya\u015f ortalamalar\u0131 52.5\u00b116.1, VK\u0130 medyan (IQR) de\u011feri 27.7 (24.1-31.2) olup hastal\u0131k a\u011f\u0131rl\u0131k skorlamas\u0131na g\u00f6re yakla\u015f\u0131k %11\u2019i a\u011f\u0131r hastal\u0131k olarak bildirilmi\u015ftir (22).\u00a0 <\/span>\u00c7al\u0131\u015fmam\u0131zda da benzer \u015fekilde hastalar\u0131m\u0131z\u0131n medyan ya\u015f\u0131 47 (33.5-55) y\u0131l, %46.9\u2019u kad\u0131n ve VK\u0130 medyan\u0131 27.74 (24.97-30.89) idi; %33.3\u2019\u00fc hastal\u0131\u011f\u0131 hafif, %46.9\u2019u orta, %15.8\u2019i a\u011f\u0131r olarak ge\u00e7irmi\u015fti. \u00c7al\u0131\u015fmam\u0131z\u0131n ya\u015f ve VK\u0130 de\u011ferleri benzer \u00e7al\u0131\u015fmalara g\u00f6re daha y\u00fcksek olmakla birlikte \u00fclkemizin demografik verileri ile uyumludur. Ancak orta ve a\u011f\u0131r kliniklere sahip hastalar\u0131n oran\u0131, di\u011fer \u00e7al\u0131\u015fmalara g\u00f6re daha y\u00fcksek olup bu grup hastalardaki antikor d\u00fczeyinin ve antikor seviyesini etkileyen fakt\u00f6rlerin ortaya konulmas\u0131 ad\u0131na \u00e7al\u0131\u015fmam\u0131z\u0131n de\u011ferli\u00a0oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyoruz.<\/p>\n

Literat\u00fcre bak\u0131ld\u0131\u011f\u0131nda, SARS-CoV-2 infeksiyonundan sonra antikor yan\u0131tlar\u0131n\u0131n takibinde pozitiflik s\u00fcresi ve antikor titre de\u011ferleri de\u011fi\u015fkenlik arz etmektedir. \u00c7al\u0131\u015fmalarda IgG titre \u00f6l\u00e7\u00fcm\u00fc i\u00e7in farkl\u0131 antikorlar (anti-N, anti-S) ve farkl\u0131 test kitleri kullan\u0131ld\u0131\u011f\u0131ndan sonu\u00e7lar\u0131n olduk\u00e7a farkl\u0131 oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Fransa\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada, 393 COVID-19 hastas\u0131 semptom ba\u015flang\u0131\u00e7 tarihinden bir ay, 3-6 ay, 7-9 ay ve 11-13 ay sonra \u00f6rnek al\u0131narak takip edilmi\u015f olup ELISA ile \u00f6l\u00e7\u00fclen anti-N IgG pozitifli\u011fi oran\u0131 birinci ayda %85 iken 11.-13. aylardaki \u00f6l\u00e7\u00fcmlerde
\n%20.1\u2019e geriledi\u011fi bildirilmi\u015ftir. S\u00f6z konusu \u00e7al\u0131\u015fmada, \u201clateral flow immunoassay\u201d (LFIA) kullan\u0131larak \u00f6l\u00e7\u00fclen anti-RBD IgG pozitiflik oran\u0131 birinci ayda %83.7, 11-13. ayda ise %5.8; \u201ccarbonyl metallo immunoassay\u201d (CMIA) kullan\u0131larak \u00f6l\u00e7\u00fclen anti-RBD IgG ise hem birinci ayda hem de 11.-13. aylarda hastalar\u0131n %97.1\u2019inde pozitif saptanm\u0131\u015ft\u0131r (8). Dan ve arkada\u015flar\u0131n\u0131n (15) 188 hasta ile yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, sekiz aya kadar antikor titreleri takip edilmi\u015f ve anti-S IgG seropozitiflik oran\u0131 20.-50. g\u00fcnde %98 (54\/55), 6.-8. ayda (\u2265178 g\u00fcn) %90 (36\/40) olarak bildirilmi\u015ftir.<\/p>\n

Kayal\u0131 ve arkada\u015flar\u0131n\u0131n (23), COVID-19 ge\u00e7iren sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ile yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, alt\u0131nc\u0131 ayda anti-N IgG seropozitiflik oran\u0131 %88.6 saptanm\u0131\u015ft\u0131r. \u00c7al\u0131\u015fmam\u0131zda CMIA y\u00f6ntemi ile anti-N IgG titreleri bir y\u0131l boyunca takip edildi ve antikor pozitiflik oran\u0131 birinci vizitte (medyan 56 g\u00fcn) %88.7, ikinci vizitte (medyan 92 g\u00fcn) %80.8, \u00fc\u00e7\u00fcnc\u00fc vizitte (medyan 193 g\u00fcn) %45.9 ve d\u00f6rd\u00fcnc\u00fc vizitte (medyan 371 g\u00fcn) %21.4 bulundu. Klinik a\u011f\u0131rl\u0131k skorundan ba\u011f\u0131ms\u0131z \u015fekilde, \u00f6zellikle \u00fc\u00e7\u00fcnc\u00fc vizitte (medyan 193 g\u00fcn) antikor titrelerinde g\u00f6r\u00fclen d\u00fc\u015f\u00fc\u015f, COVID-19 a\u015f\u0131lar\u0131n\u0131n hat\u0131rlatma dozlar\u0131n\u0131n alt\u0131 ay sonras\u0131nda yap\u0131lmas\u0131 i\u00e7in destekleyici bir veri olabilir.<\/p>\n

Literat\u00fcrde COVID-19 hastalar\u0131nda antikor yan\u0131tlar\u0131n\u0131n ve pozitiflik s\u00fcrelerinin hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k skoruyla korele oldu\u011funu g\u00f6steren pek \u00e7ok yay\u0131n mevcuttur. Ibarrondo ve arkada\u015flar\u0131n\u0131n (5) \u00e7al\u0131\u015fmas\u0131nda, 34 COVID-19 hastas\u0131, yakla\u015f\u0131k d\u00f6rt ay boyunca anti-S IgG titre takibi ile de\u011ferlendirilmi\u015f ve hafif klini\u011fe sahip hasta grubunda h\u0131zl\u0131 bir antikor kayb\u0131 bildirilmi\u015ftir. Tan ve arkada\u015flar\u0131n\u0131n (9) 67 COVID-19 hastas\u0131 ile yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k skoru artt\u0131k\u00e7a antikor titresinde de anlaml\u0131 d\u00fczeyde art\u0131\u015f oldu\u011fu g\u00f6sterilmi\u015ftir. R\u00f6ltgen ve arkada\u015flar\u0131n\u0131n (24) 254 COVID-19 hastas\u0131n\u0131, infeksiyon sonras\u0131 yakla\u015f\u0131k be\u015f ay kadar takip ettikleri \u00e7al\u0131\u015fmada, hafif hastalarda daha d\u00fc\u015f\u00fck antikor titreleri ve antikor titrelerinde daha h\u0131zl\u0131 d\u00fc\u015f\u00fc\u015f g\u00f6zlenmi\u015ftir. T\u00fcrkiye\u2019de yap\u0131lan ve COVID-19 hastalar\u0131nda antikor yan\u0131tlar\u0131n\u0131n alt\u0131 ay boyunca takip edildi\u011fi \u00e7al\u0131\u015fmada (25), akci\u011fer tutulumu olan olgularda antikor titreleri anlaml\u0131 d\u00fczeyde daha y\u00fcksek bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda 177 hastan\u0131n antikor titre de\u011ferleri bir y\u0131l boyunca d\u00f6rt kez de\u011ferlendirildi. Literat\u00fcre benzer olarak, takiplerde \u00f6l\u00e7\u00fclen ortalama antikor titreleri klini\u011fi hafif hastalarda, orta ve a\u011f\u0131r hastalara g\u00f6re anlaml\u0131 d\u00fczeyde daha d\u00fc\u015f\u00fck saptand\u0131. Antikor titresinin klinik a\u011f\u0131rl\u0131k skoru ile orta derecede korele oldu\u011fu g\u00f6sterildi. \u00c7ok de\u011fi\u015fkenli analizle de\u011ferlendirildi\u011finde, hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k skoru artt\u0131k\u00e7a birinci ve \u00fc\u00e7\u00fcnc\u00fc vizitlerde antikor pozitifli\u011fi oran\u0131n\u0131n yakla\u015f\u0131k \u00fc\u00e7 ila alt\u0131 kat artt\u0131\u011f\u0131 g\u00f6sterildi. \u00dc\u00e7\u00fcnc\u00fc vizit ve sonras\u0131nda, \u00f6zellikle hastal\u0131\u011f\u0131 hafif ge\u00e7iren hastalarda, anlaml\u0131 d\u00fczeyde titre d\u00fc\u015f\u00fc\u015f\u00fc oldu\u011fu g\u00f6r\u00fcld\u00fc. \u00c7al\u0131\u015fmam\u0131zda, literat\u00fcre benzer \u015fekilde hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k derecesi daha y\u00fcksek antikor titresi ve seropozitiflik oran\u0131 ile ili\u015fkili bulundu.<\/p>\n

Literat\u00fcrde antikor pozitifli\u011fi \u00fczerine etki eden di\u011fer fakt\u00f6rleri ara\u015ft\u0131ran pek \u00e7ok \u00e7al\u0131\u015fma mevcuttur. Daha \u00f6nce do\u011frulanm\u0131\u015f SARS-CoV-2 infeksiyonu olan 2547 hastada yap\u0131lan bir \u00e7al\u0131\u015fmada, imm\u00fcns\u00fcpresif tedavi alan olgularda seronegatiflik oran\u0131 daha fazla iken VK\u0130\u2019si y\u00fcksek, obez hastalarda daha d\u00fc\u015f\u00fck oranda bildirilmi\u015ftir (26). Staines ve arkada\u015flar\u0131n\u0131n (27) \u00e7al\u0131\u015fmas\u0131nda, ya\u015fl\u0131larda, HT \u00f6yk\u00fcs\u00fc olanlarda ve VK\u0130\u2019si y\u00fcksek olanlarda serokonversiyon oran\u0131 daha y\u00fcksek bulunmu\u015ftur. Gallais ve arkada\u015flar\u0131n\u0131n (8) 393 COVID-19 hastas\u0131n\u0131 13 aya kadar takip etti\u011fi \u00e7al\u0131\u015fmada, \u00e7ok de\u011fi\u015fkenli analizle; ya\u015f, cinsiyet, VK\u0130, kan grubu, Rh durumu, hastaneye yat\u0131\u015f ve ilk al\u0131nan PCR testinin d\u00f6ng\u00fc e\u015fik de\u011ferinin (cycle threshold – Ct) 3.-6. ay ile 7.-9. ay aras\u0131nda antikor titresindeki d\u00fc\u015f\u00fc\u015f h\u0131z\u0131 \u00fczerine etkisi ara\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. Anti-RBD IgG antikorlar\u0131n\u0131n d\u00fc\u015f\u00fc\u015f h\u0131z\u0131 erkeklerde ve Rh (-) hastalarda daha y\u00fcksek; anti-N IgG antikor d\u00fc\u015f\u00fc\u015f h\u0131z\u0131 erkeklerde ve ya\u015fl\u0131larda daha yava\u015f bulunmu\u015ftur. \u00dclkemizde yap\u0131lan benzer bir \u00e7al\u0131\u015fmada, IgG antikor titreleri ya\u015fla pozitif korelasyon g\u00f6stermi\u015ftir (28). Bizim \u00e7al\u0131\u015fmam\u0131zda tek de\u011fi\u015fkenli analizde; ya\u015f, HT \u00f6yk\u00fcs\u00fc, VK\u0130 ve CCI de\u011ferleri birinci vizitte antikor pozitifli\u011fi \u00fczerine etkili bulundu. Alt\u0131nc\u0131 ayda antikor pozitifli\u011fi \u00fczerine etki eden fakt\u00f6rler ise ya\u015f, HT \u00f6yk\u00fcs\u00fc ve CCI skorunun y\u00fcksek olmas\u0131d\u0131r. Birinci ve \u00fc\u00e7\u00fcnc\u00fc vizitte, ya\u015f antikor pozitifli\u011fi ile orta derecede korelasyon g\u00f6stermi\u015fken, CCI skoru birinci vizitte orta, \u00fc\u00e7\u00fcnc\u00fc vizitte zay\u0131f korelasyon g\u00f6sterdi. \u00c7ok de\u011fi\u015fkenli analizde; \u00fc\u00e7\u00fcnc\u00fc vizitte antikor testinin pozitif olma olas\u0131l\u0131\u011f\u0131, ya\u015fl\u0131larda ve CCI skoru d\u00fc\u015f\u00fck olan hastalarda daha y\u00fcksek bulundu. Charlson komorbidite indeksi skorunun hesaplanmas\u0131nda, 50 ya\u015f\u0131n alt\u0131nda olan hastalar s\u0131f\u0131r puan al\u0131rken, sonraki her 10 y\u0131l i\u00e7in bir puan eklenmektedir. \u00c7al\u0131\u015fmam\u0131zda hastalar\u0131n medyan ya\u015f\u0131 47 (33.5-55) y\u0131l idi; 70 ya\u015f\u0131n \u00fczerinde yaln\u0131zca iki olgu vard\u0131. Bu nedenle CCI skoru, hastalar\u0131m\u0131z\u0131n ya\u015flar\u0131ndan ziyade komorbiditelerini de\u011ferlendirmi\u015f olabilir. Lojistik regresyon analizinde ya\u015f artt\u0131k\u00e7a antikor pozitifli\u011fi artarken; CCI skoru azald\u0131k\u00e7a antikor pozitifli\u011finin artmas\u0131 komorbiditesi fazla olan hastalarda antikor yan\u0131t\u0131n\u0131n daha zay\u0131f olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrd\u00fc. \u0130leri ya\u015fta hastal\u0131\u011f\u0131n daha a\u011f\u0131r ge\u00e7iriliyor olmas\u0131 daha g\u00fc\u00e7l\u00fc antikor yan\u0131t\u0131 olu\u015fmas\u0131 ile ili\u015fkili olabilir. Ancak bu durumu a\u00e7\u0131klamak i\u00e7in daha fazla \u00e7al\u0131\u015fmaya ihtiya\u00e7 vard\u0131r. Obez hastalarda ise imm\u00fcn yan\u0131t\u0131n daha zay\u0131f oldu\u011fu bilinmektedir. Ancak \u00e7al\u0131\u015fmam\u0131zda, \u00f6zellikle erken d\u00f6nemde (ilk vizitte), y\u00fcksek VK\u0130 de\u011feri antikor pozitifli\u011fi ile ili\u015fkili bulundu. Bu durum VK\u0130\u2019si y\u00fcksek hastalar\u0131n hastal\u0131\u011f\u0131 daha a\u011f\u0131r ge\u00e7irmesi ve a\u011f\u0131r hastalarda antikor pozitifli\u011finin daha y\u00fcksek olmas\u0131 nedeniyle a\u00e7\u0131klanabilir. Nitekim ilerleyen aylarda VK\u0130 de\u011ferinin antikor pozitifli\u011fi \u00fczerinde etkisi saptanmad\u0131. Obez hastalarda antikor yan\u0131t\u0131n\u0131n erken d\u00f6nemde hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131\u011f\u0131 ile ili\u015fkili olarak daha y\u00fcksek oldu\u011fu ancak takip s\u0131ras\u0131nda d\u00fc\u015ft\u00fc\u011f\u00fc s\u00f6ylenebilir. \u00d6zetle, \u00e7al\u0131\u015fmam\u0131zda antikor pozitifli\u011fi \u00fczerine etkili en \u00f6nemli fakt\u00f6r hastal\u0131\u011f\u0131n a\u011f\u0131rl\u0131k skoru oldu. G\u00fc\u00e7l\u00fc antikor yan\u0131t\u0131n\u0131 etkileyebilecek di\u011fer fakt\u00f6rler ise ileri ya\u015f, d\u00fc\u015f\u00fck CCI skoru, y\u00fcksek VK\u0130 ve HT \u00f6yk\u00fcs\u00fc idi. Sonu\u00e7lar\u0131m\u0131z genel olarak literat\u00fcrle benzer olup cinsiyet ve DM \u00f6yk\u00fcs\u00fcn\u00fcn antikor pozitifli\u011fi \u00fczerine anlaml\u0131 bir etkisi bulunmad\u0131.<\/span><\/p>\n

Ge\u00e7irilmi\u015f COVID-19 sonras\u0131 antikor seviyelerinin takip edildi\u011fi \u00e7al\u0131\u015fmalarda kullan\u0131lan antikor tipi, analiz y\u00f6ntemi ve test kiti farkl\u0131l\u0131klar\u0131 nedeniyle heterojenite olduk\u00e7a y\u00fcksektir. Kullan\u0131mda olan antikor testlerinin pozitif e\u015fik de\u011ferleri de de\u011fi\u015fkenlik g\u00f6stermektedir. Ayr\u0131ca bizim \u00e7al\u0131\u015fmam\u0131zda oldu\u011fu gibi bu \u00e7al\u0131\u015fmalar\u0131n bir\u00e7o\u011funda asemptomatik veya semptomatik re-infeksiyonu tespit edebilmek i\u00e7in objektif bir de\u011ferlendirme (rutin rt-PCR testi gibi) yap\u0131lmam\u0131\u015f sadece semptomlara dayal\u0131 tarama yap\u0131lm\u0131\u015ft\u0131r. COVID-19 nekahet d\u00f6neminde anti-N ve anti-S IgG titrelerinin uzun d\u00f6nem takip edildi\u011fi \u00e7e\u015fitli \u00e7al\u0131\u015fmalarda anti-N antikorlar\u0131n\u0131n daha h\u0131zl\u0131 azald\u0131\u011f\u0131 g\u00f6zlenmi\u015ftir (14,15). Bizim \u00e7al\u0131\u015fmam\u0131zda anti-S antikorlar\u0131na bak\u0131lmad\u0131; bu nedenle antikor yan\u0131t\u0131n\u0131n kal\u0131c\u0131l\u0131k s\u00fcresi daha k\u0131sa bulunmu\u015f olabilir. Ancak bulgular\u0131m\u0131z literat\u00fcrde anti-N antikorlar\u0131n\u0131n de\u011ferlendirildi\u011fi \u00e7al\u0131\u015fmalar\u0131n sonu\u00e7lar\u0131 ile benzerdir. \u0130ki antikor alt tipinin birlikte \u00f6l\u00e7\u00fclmemi\u015f olmas\u0131 ve re-infeksiyonun objektif bir \u015fekilde de\u011ferlendirilmemi\u015f olmas\u0131 \u00e7al\u0131\u015fmam\u0131z\u0131n s\u0131n\u0131rl\u0131klar\u0131d\u0131r.<\/p>\n

Sonu\u00e7 olarak; SARS-CoV-2\u2019ye kar\u015f\u0131 geli\u015fen antikorlar\u0131n kal\u0131c\u0131l\u0131k s\u00fcresinin yan\u0131 s\u0131ra, seropozitiflik ile re-infeksiyona kar\u015f\u0131 koruyucu ba\u011f\u0131\u015f\u0131kl\u0131k aras\u0131ndaki ili\u015fkiyi ayd\u0131nlatmak ve koruyucu antikor titre d\u00fczeylerini belirleyebilmek i\u00e7in daha fazla \u00e7al\u0131\u015fmaya ihtiya\u00e7 vard\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

Bu makaleye ili\u015fkin\u00a0bir d\u00fczeltme\u00a029 Aral\u0131k 2024\u2019de yay\u0131nland\u0131.   G\u0130R\u0130\u015e Koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) ge\u00e7iren ki\u015filerde imm\u00fcnglobulin M (IgM) ve IgG antikor yan\u0131t\u0131 olu\u015ftu\u011fu bilinmektedir. Yap\u0131lan \u00e7al\u0131\u015fmalarda akut infeksiyondan sonra IgM antikorlar\u0131n\u0131n ortalama 6-12 g\u00fcnde saptanabildi\u011fi ve 12 haftaya kadar kal\u0131c\u0131 olabildi\u011fi g\u00f6sterilmi\u015ftir. IgG antikorlar\u0131 ise infeksiyondan sonra en erken 10. g\u00fcnde saptanabilir d\u00fczeye eri\u015firler; bir […]<\/p>\n","protected":false},"author":4,"featured_media":29370,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[4362,5174,5941],"class_list":["post-29113","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-antikor-yaniti","tag-covid-19","tag-sars-cov-2-anti-n-igg"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29113","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=29113"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29113\/revisions"}],"predecessor-version":[{"id":30004,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29113\/revisions\/30004"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/29370"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=29113"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=29113"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=29113"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}