Tablo 4.<\/strong> HIV Pozitif ve Negatif Bireylerin Z Skoru Durumu<\/p><\/div>\nHIV ile ya\u015fayan bireylerde azalm\u0131\u015f kemik yo\u011funlu\u011funa sahip olma olas\u0131l\u0131\u011f\u0131 (Z-skoru <-2), HIV negatif pop\u00fclasyona k\u0131yasla 2.73 kat daha y\u00fcksek bulundu (\u201codds ratio\u201d [OR]: 2.73) (Tablo 4).<\/p>\n
Hastalar\u0131n en y\u00fcksek HIV RNA ve en d\u00fc\u015f\u00fck CD4+ T h\u00fccre d\u00fczeyleri ile KMY aras\u0131nda anlaml\u0131 d\u00fczeyde bir ili\u015fki saptanmad\u0131. Ayr\u0131ca, D vitamini ve kalsiyum d\u00fczeyleri gibi laboratuvar parametrelerinin her iki grupta da d\u00fc\u015f\u00fck KMY ile ili\u015fkili olmad\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc.<\/p>\n
\u0130RDELEME<\/b><\/h2>\n
Bu \u00e7al\u0131\u015fmada, d\u00fc\u015f\u00fck KMY i\u00e7in ba\u015fka risk fakt\u00f6r\u00fc bulunmayan HIV ile ya\u015fayan gen\u00e7 bireylerin KMY de\u011ferleri, HIV negatif kontrol grubuyla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. Bulgular, HIV ile ya\u015fayan bireylerde d\u00fc\u015f\u00fck KMY prevalans\u0131n\u0131n (%16.7) HIV negatif bireylere (%6.8) k\u0131yasla 2.45 kat daha y\u00fcksek oldu\u011funu g\u00f6sterdi. Ayr\u0131ca, hem HIV infeksiyonu s\u00fcresinin hem de ART s\u00fcresinin KMY \u00fczerinde etkili oldu\u011fu g\u00f6r\u00fcld\u00fc.<\/p>\n
T\u00fcrkiye\u2019de ve d\u00fcnya genelinde HIV ile ya\u015fayan gen\u00e7 bireylerin kemik sa\u011fl\u0131\u011f\u0131na ili\u015fkin veriler olduk\u00e7a s\u0131n\u0131rl\u0131d\u0131r. HIV ile ya\u015fayan ve HIV negatif bireyleri kemik sa\u011fl\u0131\u011f\u0131 a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131ran bir meta-analizde; bu konuda yap\u0131lan \u00e7al\u0131\u015fmalar\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131n\u0131n kontrol grubu i\u00e7ermedi\u011fi belirtilmi\u015f ve bu nedenle analizde bir\u00e7ok \u00e7al\u0131\u015fma hari\u00e7 tutulmu\u015ftur (17). Bu ara\u015ft\u0131rma, kontrol grubu i\u00e7ermesi bak\u0131m\u0131ndan meta-analizlerde vurgulanan metodolojik standartlara uygundur (7). Kemik mineral yo\u011funlu\u011fu, risk fakt\u00f6rleri olmayan bireylerde de d\u00fc\u015f\u00fck saptanabilece\u011finden, ayn\u0131 \u00e7al\u0131\u015fma i\u00e7inde HIV pozitif ve HIV negatif gruplar\u0131n birlikte de\u011ferlendirilmesi \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n
T\u00fcrk Endokrinoloji ve Metabolizma Derne\u011fi k\u0131lavuzlar\u0131, DEXA \u00f6l\u00e7\u00fcmlerinin yorumlanmas\u0131nda 50 ya\u015f alt\u0131 erkekler ve menopoz \u00f6ncesi kad\u0131nlar i\u00e7in Z-skoru kullan\u0131lmas\u0131n\u0131 \u00f6nermektedir. Ancak Z-skoru, tek ba\u015f\u0131na osteopeni veya osteoporoz i\u00e7in do\u011frudan bir g\u00f6sterge de\u011fildir; destekleyici bir parametredir (1). Literat\u00fcrdeki bir\u00e7ok \u00e7al\u0131\u015fmada T-skoru kullan\u0131lm\u0131\u015f ve \u00f6l\u00e7\u00fcmleri yorumlanm\u0131\u015ft\u0131r. Bir meta-analizde, T-skoru esas al\u0131narak de\u011ferlendirilen 884 HIV ile ya\u015fayan ve 654 HIV negatif birey kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f; HIV pozitif bireylerde d\u00fc\u015f\u00fck KMY (T-skoru < -1) riskinin 6.4 kat, osteoporoz (T-skoru < -2.5) riskinin ise 3.7 kat artt\u0131\u011f\u0131 bildirilmi\u015ftir (17). \u00c7al\u0131\u015fmam\u0131zda, 50 ya\u015f alt\u0131 pop\u00fclasyonda, HIV ile ya\u015fayan bireylerin ya\u015fa g\u00f6re ayarlanm\u0131\u015f d\u00fc\u015f\u00fck KMY\u2019ye (Z-skoru <-2) sahip olma olas\u0131l\u0131\u011f\u0131 2.73 kat daha y\u00fcksek bulundu. Yukar\u0131da an\u0131lan, meta-analizdeki OR de\u011ferlerinin \u00e7al\u0131\u015fmam\u0131za k\u0131yasla daha y\u00fcksek olmas\u0131, 18 ya\u015f \u00fcst\u00fc t\u00fcm hastalar\u0131n dahil edilmesinden ve DEXA \u00f6l\u00e7\u00fcmlerinin T-skoru kullan\u0131larak yorumlanmas\u0131ndan kaynaklan\u0131yor olabilir.<\/p>\n
Kemik metabolizmas\u0131n\u0131 etkileyen hastal\u0131klar, kemi\u011fin farkl\u0131 b\u00f6lgelerinde bask\u0131n demineralizasyonla seyredebilir. HIV infeksiyonu \u00f6zellikle kemi\u011fin trabek\u00fcler k\u0131sm\u0131n\u0131 etkiler (18). Trabek\u00fcler alan\u0131 temsil eden \u00f6l\u00e7\u00fcm lomber vertebra DEXA \u00f6l\u00e7\u00fcm\u00fcd\u00fcr. \u00c7al\u0131\u015fmam\u0131zda, HIV ile ya\u015fayan bireylerde, HIV negatif bireylere k\u0131yasla lomber vertebra T- ve Z- skorlar\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde bir azalma saptand\u0131 (p<\/i><0.05).<\/p>\n
T\u00fcrkiye\u2019de 22\u201370 ya\u015f aral\u0131\u011f\u0131ndaki 126 HIV pozitif bireyle yap\u0131lan bir \u00e7al\u0131\u015fmada, DEXA sonu\u00e7lar\u0131 de\u011ferlendirilmi\u015f ve osteopeni oran\u0131 %53.9 ve osteoporoz oran\u0131 %23.8 olarak bildirilmi\u015ftir (11). Bu y\u00fcksek oran, \u00f6rneklemde 50 ya\u015f \u00fczeri bireylerin bulunmas\u0131yla a\u00e7\u0131klanabilir. \u00c7in\u2019deki bir kohortta da benzer \u015fekilde olgular\u0131n %53\u2019\u00fcnde hem T- hem de Z-skorlar\u0131yla tan\u0131mlanan azalm\u0131\u015f KMY bildirilmi\u015ftir (19). S\u00f6z konusu \u00e7al\u0131\u015fmada hem T- hem de Z-skorlar\u0131 i\u00e7in e\u015fik de\u011fer -1 olarak belirlendi\u011fi i\u00e7in y\u00fcksek prevalans g\u00f6zlenmi\u015f olabilir. Buna kar\u015f\u0131l\u0131k, Romanya\u2019da 22\u201349 ya\u015f aral\u0131\u011f\u0131ndaki HIV pozitif bireyler \u00fczerinde yap\u0131lan bir \u00e7al\u0131\u015fmada, d\u00fc\u015f\u00fck KMY s\u0131kl\u0131\u011f\u0131 Z-skoruna g\u00f6re %21.7 olarak bildirilmi\u015ftir (12). T\u00fcrkiye\u2019de 18\u201350 ya\u015f aral\u0131\u011f\u0131nda yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada, HIV ile ya\u015fayan bireylerin %19.4\u2019\u00fcn\u00fcn lomber vertebra Z-skoru temel al\u0131narak d\u00fc\u015f\u00fck KMY\u2019ye sahip oldu\u011fu bildirilmi\u015ftir (13). \u00c7al\u0131\u015fmam\u0131zda bulunan %16.7\u2019lik prevalans bu verilerle uyumludur.<\/p>\n
Antiretroviral tedavinin KMY \u00fczerindeki etkisi yap\u0131lan \u00e7al\u0131\u015fmalarda g\u00f6sterilmi\u015ftir. Randomize kontroll\u00fc \u00e7al\u0131\u015fmalarda, kemik k\u00fctlesi kayb\u0131n\u0131n \u00f6ncelikle ART ba\u015flang\u0131c\u0131ndan sonraki ilk 6\u201312 ay i\u00e7inde ger\u00e7ekle\u015fti\u011fi ve sonras\u0131nda ise sabitlendi\u011fi bildirilmi\u015ftir (20). Baz\u0131 \u00e7al\u0131\u015fmalarda non-n\u00fckleozit ters transkriptaz inhibit\u00f6rleri (NNRTI) ve proteaz inhibit\u00f6rleri (PI) gibi baz\u0131 ART rejimlerinin 3 y\u0131ll\u0131k kullan\u0131m sonras\u0131 lomber vertebra T-skorlar\u0131n\u0131 d\u00fc\u015f\u00fcrd\u00fc\u011f\u00fc bildirilmi\u015ftir (12). Bu nedenle \u00e7al\u0131\u015fmam\u0131zda kat\u0131l\u0131mc\u0131lar ART s\u00fcresine g\u00f6re 3 y\u0131ldan uzun s\u00fcredir ART alanlar ve ART-naif bireyler olarak iki gruba ayr\u0131lm\u0131\u015ft\u0131r. Bulgular\u0131m\u0131z, uzun s\u00fcreli ART kullananlarda KMY\u2019nin daha d\u00fc\u015f\u00fck oldu\u011funu g\u00f6stermektedir.<\/p>\n
Cazanave ve arkada\u015flar\u0131 (21) azalm\u0131\u015f KMY\u2019nin HIV tan\u0131 s\u00fcresi ile ili\u015fkili oldu\u011funu bildirmi\u015ftir. Bizim \u00e7al\u0131\u015fmam\u0131zda da 3 y\u0131ldan uzun s\u00fcredir HIV tan\u0131s\u0131 alan bireylerin yeni tan\u0131 alanlara g\u00f6re anlaml\u0131 derecede daha d\u00fc\u015f\u00fck femur boynu T- ve Z-skorlar\u0131na sahip oldu\u011fu belirlendi (p<\/i><0.05). Proteaz inhibit\u00f6rleri ve TDF tedavilerinin, KMY azalmas\u0131yla ba\u011flant\u0131s\u0131 olmakla birlikte \u00e7al\u0131\u015fmam\u0131zda PI tedavisi alan sadece birka\u00e7 hasta olmas\u0131 nedeniyle yaln\u0131zca TDF tedavisinin etkileri incelendi. Tenofovir disoproksil fumarat tedavisi ile KMY aras\u0131ndaki ili\u015fki istatistiksel olarak anlaml\u0131 d\u00fczeyde olmamakla birlikte T- ve Z-skorlar\u0131 TDF almayanlarda daha y\u00fcksekti. Yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada da benzer \u015fekilde TDF kullananlarda T- ve Z- skorlar\u0131 daha d\u00fc\u015f\u00fck olmakla birlikte KMY \u00fczerindeki etkisi istatistiksel olarak anlaml\u0131 bulunmam\u0131\u015ft\u0131r (22).<\/p>\n
D\u00fc\u015f\u00fck VK\u0130, sigara ve alkol t\u00fcketimi osteopeni\/osteoporoz i\u00e7in bilinen risk fakt\u00f6rleridir (23,24). \u00c7al\u0131\u015fmam\u0131zda, d\u00fc\u015f\u00fck VK\u0130\u2019nin d\u00fc\u015f\u00fck KMY ile ili\u015fkili oldu\u011fu saptanm\u0131\u015ft\u0131r. Tayvan\u2019da yap\u0131lan bir \u00e7al\u0131\u015fma da d\u00fc\u015f\u00fck VK\u0130\u2019nin HIV ile ya\u015fayan bireylerde azalm\u0131\u015f KMY ile ili\u015fkili oldu\u011fu bildirilmi\u015ftir (25).<\/p>\n
Yap\u0131lan baz\u0131 \u00e7al\u0131\u015fmalarda HIV infeksiyonu s\u00fcresi, d\u00fc\u015f\u00fck CD4+ T h\u00fccre say\u0131s\u0131 ve y\u00fcksek viral y\u00fck KMY azalmas\u0131yla ili\u015fkilendirilmi\u015ftir (4). Ancak, bu fakt\u00f6rlerin KMY ile ili\u015fkili olmad\u0131\u011f\u0131n\u0131 savunan \u00e7al\u0131\u015fmalar da mevcuttur. Kesitsel olarak ger\u00e7ekle\u015ftirilen 107 hastal\u0131k prospektif bir kohort \u00e7al\u0131\u015fma, d\u00fc\u015f\u00fck CD4+ T h\u00fccre say\u0131s\u0131n\u0131n ve y\u00fcksek HIV RNA d\u00fczeyinin KMY\u2019yi azaltmada etkisiz oldu\u011fu bildirilmi\u015ftir (26,27). \u00c7al\u0131\u015fmam\u0131zda CD4+ T h\u00fccre say\u0131s\u0131 <200 olan hastalar \u00f6rneklem i\u00e7inde k\u00fc\u00e7\u00fck bir grubu (%15.2) olu\u015fturdu\u011fundan ve hastalar\u0131n \u00e7o\u011funda HIV RNA bask\u0131lanm\u0131\u015f oldu\u011fundan, KMY ile CD4+ T h\u00fccre say\u0131s\u0131 ve HIV RNA d\u00fczeyi aras\u0131nda bir ili\u015fki kurulamad\u0131.<\/p>\n
Azalan KMY\u2019nin en \u00f6nemli nedeni ya\u015flanmad\u0131r (28). \u00d6te yandan DEXA \u00f6l\u00e7\u00fcmlerinin yorumlanmas\u0131 50 ya\u015f alt\u0131 ve \u00fcst\u00fc bireylerde farkl\u0131l\u0131k g\u00f6sterir (1). HIV ve KMY \u00fczerine yap\u0131lan \u00e7al\u0131\u015fmalarda, genellikle 50 ya\u015f alt\u0131 ve \u00fcst\u00fc hastalar\u0131n DEXA \u00f6l\u00e7\u00fcmleri bir arada yorumlanm\u0131\u015ft\u0131r (25). \u00c7al\u0131\u015fmam\u0131zda, 50 ya\u015f ve \u00fcst\u00fc bireyler hari\u00e7 tutuldu. Bu nedenle, HIV infeksiyonunun KMY \u00fczerindeki etkisi daha belirgindi ve bu durum \u00e7al\u0131\u015fmam\u0131z\u0131n g\u00fc\u00e7l\u00fc y\u00f6nlerinden birini olu\u015fturdu. Literat\u00fcrdeki daha y\u00fcksek oranda d\u00fc\u015f\u00fck KMY bildiren \u00e7al\u0131\u015fmalar metodolojik olarak T-skorlar\u0131na dayanmaktad\u0131r. Elli ya\u015f alt\u0131 HIV pozitif bireylerin Z-skorlar\u0131na g\u00f6re analiz edildi\u011fi \u00e7al\u0131\u015fmalarda, d\u00fc\u015f\u00fck KMY\u2019nin \u00e7al\u0131\u015fmam\u0131za benzer \u015fekilde yakla\u015f\u0131k %20 oldu\u011fu bildirilmi\u015ftir (12,13). Z-skoruna dayal\u0131 ve benzer ya\u015f grubuna sahip ortak komorbiditelere sahip HIV negatif kontrol grubu i\u00e7eren \u00e7al\u0131\u015fmalar literat\u00fcrde olduk\u00e7a s\u0131n\u0131rl\u0131d\u0131r; T\u00fcrkiye\u2019de bu tasar\u0131mla yap\u0131lm\u0131\u015f ba\u015fka bir \u00e7al\u0131\u015fmaya rastlanmam\u0131\u015ft\u0131r.<\/p>\n
\u00c7al\u0131\u015fmam\u0131z\u0131n ba\u015fl\u0131ca s\u0131n\u0131rl\u0131l\u0131klar\u0131 retrospektif tasar\u0131m nedeniyle baz\u0131 verilere eri\u015fim sa\u011flanamamas\u0131 ve \u00f6zellikle HIV negatif kontrol grubunda DEXA \u00f6l\u00e7\u00fcmlerine eri\u015filen ve dahil etme kriterlerini kar\u015f\u0131layan kat\u0131l\u0131mc\u0131 say\u0131s\u0131n\u0131n d\u00fc\u015f\u00fck olmas\u0131d\u0131r. Osteoporoz, yeti\u015fkinlerde d\u00fc\u015f\u00fck KMY\u2019nin ana nedenidir. Ancak, d\u00fc\u015f\u00fck KMY\u2019li hastalar\u0131 tedavi ederken di\u011fer nedenleri de g\u00f6z \u00f6n\u00fcnde bulundurmak \u00f6nemlidir. Hafif osteogenezis imperfekta, osteomalazi, kronik b\u00f6brek hastal\u0131\u011f\u0131yla ili\u015fkili mineral ve kemik bozukluklar\u0131 ve baz\u0131 nadir hastal\u0131klar da d\u00fc\u015f\u00fck KMY\u2019ye yol a\u00e7abilir (29). \u00c7al\u0131\u015fmam\u0131z\u0131n retrospektif tasar\u0131m\u0131 nedeniyle olgular\u0131m\u0131zdaki d\u00fc\u015f\u00fck KMY\u2019nin di\u011fer olas\u0131 nedenleri incelenemedi.<\/p>\n
Kemik kayb\u0131n\u0131n erken d\u00f6nemlerinde genellikle klinik belirti g\u00f6r\u00fclmez; ancak, osteoporoz geli\u015fti\u011finde d\u00fc\u015f\u00fck KMY k\u0131r\u0131klara yol a\u00e7abilir. S\u0131rt a\u011fr\u0131s\u0131, omurga k\u0131r\u0131klar\u0131 veya \u00e7\u00f6km\u00fc\u015f kemik nedeniyle olu\u015fan boy k\u0131salmas\u0131 gibi belirtiler zamanla ortaya \u00e7\u0131kabilir. D\u00fc\u015f\u00fck KMY\u2019nin HIV ile ya\u015fayan bireylerdeki klinik etkisi incelenebilir.<\/p>\n
HIV ile ya\u015fayan bireyler, HIV negatif bireylere k\u0131yasla kardiyovask\u00fcler hastal\u0131k, tip 2 diyabet, kas g\u00fc\u00e7s\u00fczl\u00fc\u011f\u00fc ve bili\u015fsel bozukluk gibi ya\u015flanmayla ili\u015fkili komorbiditelere daha erken ya\u015fta maruz kalmaktad\u0131r (30). HIV infeksiyonunun ikincil osteoporozun nedenlerinden biri oldu\u011fu g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, \u00e7e\u015fitli \u00e7al\u0131\u015fmalarda \u00f6nerildi\u011fi gibi HIV ile ya\u015fayan bireylerde DEXA taramas\u0131n\u0131n yap\u0131lmas\u0131 makul g\u00f6r\u00fcnmektedir (19,31).\u00a0<\/span><\/p>\nBu \u00e7al\u0131\u015fmada, HIV ile ya\u015fayan bireylerin HIV negatif pop\u00fclasyona g\u00f6re daha d\u00fc\u015f\u00fck KMY\u2019ye sahip olma olas\u0131l\u0131\u011f\u0131n\u0131n 2.4 kat daha y\u00fcksek oldu\u011fu g\u00f6sterildi. Bulgular, HIV infeksiyonunun yaln\u0131zca ileri ya\u015fta de\u011fil, gen\u00e7 bireylerde de KMY azalmas\u0131na yol a\u00e7abilece\u011fini ortaya koymaktad\u0131r. Bu durum, 50 ya\u015f alt\u0131 ve KMY d\u00fc\u015f\u00fcr\u00fcc\u00fc risk fakt\u00f6rleri bulunan HIV pozitif bireylerde DEXA ile kemik mineral yo\u011funlu\u011fu taramas\u0131n\u0131n dikkate al\u0131nmas\u0131 gerekti\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. Ancak \u00e7al\u0131\u015fmam\u0131zda, DEXA verilerine eri\u015filebilen 50 ya\u015f alt\u0131 kat\u0131l\u0131mc\u0131 say\u0131s\u0131n\u0131n s\u0131n\u0131rl\u0131 olmas\u0131, sonu\u00e7lar\u0131n daha geni\u015f \u00f6rneklemli ve \u00e7ok merkezli \u00e7al\u0131\u015fmalarla do\u011frulanmas\u0131 gereklili\u011fini ortaya koymaktad\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"
G\u0130R\u0130\u015e Metabolik bir kemik hastal\u0131\u011f\u0131 olan osteoporoz, kemik mikromimarisinin bozulmas\u0131na neden olarak k\u0131r\u0131k duyarl\u0131l\u0131\u011f\u0131n\u0131n artmas\u0131na ve d\u00fc\u015f\u00fck kemik k\u00fctlesine yol a\u00e7ar (1). T\u00fcrkiye\u2019de 50 Ya\u015f \u00dcst\u00fc N\u00fcfusta Osteoporotik K\u0131r\u0131klar\u0131n ve Osteoporozun Prevalans\u0131 (FRACTURK) \u00e7al\u0131\u015fmas\u0131n\u0131n sonu\u00e7lar\u0131na g\u00f6re; 50 ya\u015f ve \u00fczerindeki bireylerden erkeklerin %7.5\u2019inde, kad\u0131nlar\u0131n %12.9\u2019unda osteoporoz g\u00f6r\u00fclmektedir (2). HIV infeksiyonunda, virusun kendisi ve antiretroviral tedavi […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5163,4945,4943],"class_list":["post-31076","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-hiv-2","tag-kemik-yogunlugu","tag-osteoporoz"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31076","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\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=31076"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31076\/revisions"}],"predecessor-version":[{"id":31440,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31076\/revisions\/31440"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=31076"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=31076"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=31076"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![\"\"](\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/12\/KLM-5272-Sekil1.png\")
<\/a>