Yanık İmmünolojisi

Op. Dr. Ahmet Erkılıç1
Op. Dr. Bayram Burulday2

1Gaziantep Şehir Hastanesi Yanık Merkezi, Genel Cerrahi, Gaziantep, Türkiye
2Gaziantep Şehir Hastanesi Yanık Merkezi, Çocuk Cerrahisi, Gaziantep, Türkiye

ÖZET

Yanık yaralanması, henüz tam olarak çözülmemiş ve anlaşılmamış, lokal ve sistemik karmaşık bir inflamatuar yanıta neden olur. Doğru tedavi seçeneklerinin geliştirilmesini sağlamak için, yanık sonrası immünolojiyi tam olarak anlamak büyük önem taşımaktadır. Son yıllarda yapılan araştırmalar, hem şiddetli hem de daha hafif yanık travmasından sonra ortaya çıkabilecek uzun süreli ve aşırı inflamatuar yanıta ilişkin görüşler; bu yanı- tın yanıksız akut travmadan farklı olduğunu göstermektedir. Komplemanların, akut faz proteinlerinin (AFP) ve pro ve anti-inflamatuar mediatörlerin kalıcı aktivitesi, lenfosit aktivitesindeki değişiklikler, stres yanıtının aktivasyonu ve immün hücrelerin infiltrasyonu, yanık sonrası lokal ve sistemik patoloji ile ilişkilendirilmiştir. Yaralanmanın ciddiyetine bağlı olarak, yanıklar; sepsis, tek veya çoklu organ yetmezliği, hatta ölüme ve uzun vadede fiziksel, psikolojik ve sosyal sonuçları olan sorunlu skarlara yol açabilir. Major yanıklar genellikle hem yanık yarasında lokal hem de sistemik olarak büyük ve uzun süreli bir immün yanıta neden olur; bu sadece yara iyileşmesini olumsuz etkilemekle kalmaz, aynı zamanda çoklu organ sistemleri üzerinde sistemik uzun vadeli yıkıcı bir etkiye neden olabilir. Akut yanık bakımındaki önemli gelişmeler mortalite oranlarını azaltmış olsa da, yanık travmasının lokal olarak gecikmiş yara iyileşmesi, patolojik skarlaşma, sekonder derinleşme, sis- temik trombozis, sepsis, endokrin ve metabolik etkiler gibi uzun vadeli sonuçlarının tedavisi hala zordur. Klinik sonucu tahmin etmek, daha etkili tedaviler geliştirmek ve yanığa bağlı sonuçların yükünü azaltmak için yanık- ların patofizyolojisini çözmek son derece önemlidir. Son yıllarda, şiddetli yanık travmasının lokal ve sistemik fizyolojiyi etkileyen masif inflamasyona neden olduğu ve yaralanmadan sonra aylarca ve yıllarca devam ettiği gösterilmiştir. Yanık sonrası hücresel ve moleküler süreçlerle ilgili ayrıntılı verilere rağmen, yanıklardan sonra bu abartılı ve uzun süreli inflamasyonun anlaşılması ve tedavisinde çok az ilerleme kaydedilmiştir.

Anahtar Kelimeler: Yanıklar; İmmün cevap; İnflamasyon; SIRS, Netosis

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