endodont ik immünoloj ii

Bölüm 14
ENDODONTøK øMMÜNOLOJø
$\GÕQ0(QGRGRQWLNLPPQRORML(G$ODoDP7(QGRGRQWL%|OP6D%DUÕú\D\ÕQHYL$QNDUD
2000
$QDGROX
QXQNX]H\LQGH\DúD\DQ3RQWXVNUDOÕ0LWKULGDWHV06- 163), Roma ile
\DSWÕ÷Õ EDúDUÕVÕ] ELU VDYDú YH NHQGL DVNHUOHULQLQ D\DNODQPDVÕQÕ WDNLEHQ LQWLKDU HWPHN
DPDFÕLOH]HKLUOLRWODUÕ|UGHNNDQÕLOHNDUÕúWÕUDUDNVDEDKODUÕDoNDUQÕQDLoPH\HEDúODPÕúWÕU
gOPH\LQFHGDKDID]ODPLNWDUGDLoPLú\LQH|OPH\LQFHSDUDLOHDGDPWXWDUDNNHQGLVLQL
EÕoDNOD|OGUWPHN]RUXQGDNDOPÕúWÕU%|\OHFHIDUNÕQGDROPDGDQEL]OHUHLON\D]ÕOÕED÷ÕúÕNOÕN
ELOJLVLQLEÕUDNPÕúWÕU+RZDUGYH0D\HU
%D÷ÕúÕNOÕN VLVWHPLPL]LQ GR÷UX KLND\HVL JHQHWLN OLVDQÕ LOH NURPR]RPODUÕPÕ]GD
\D]ÕOÕGÕU%XJQLPPQRORMLNPHNDQL]PDODUÕQSHND]ÕQÕELOPHNWH\L]YHGDKDNHúIHGLOHFHN
HQ D] \]OHUFH NDWÕ GDKD ID]OD ELOJL ROGX÷X ]DQQHGLOPHNWHGLU %HONLGH |QP]GHNL
\]\ÕOODUGDHQLOJLoHNHQWÕSGLVLSOLQLLPPQRORMLRODFDNWÕU
3XOSD GRNXVXQGD YH SHULDSHNVWH RUWD\D oÕNDQ LPPQRORMLN UHDNVL\RQODU GLúLQ YH
KDVWDQÕQNOLQL÷LQLEHOLUOH\HQ|QHPOLROD\ODUGÕU'LúKHNLPLQLQHQGRGRQWLNPGDKDOHGHQ|QFH
EXNRQXGDILNLUVDKLELROPDVÕIHYNDODGH|QHPOLGLU
1RW%XE|OPGHPHWLQLoHULVLQGHNXOODQÕODQNÕVDOWPDODUÕQQHDQODPDJHOGL÷LE|OP
VRQXQGDELUOLVWHKDOLQGHYHULOPLúWLU
Genel immünolojik kavramlar:
$NDQ %LOJHKDQ *OPH]R÷OX YH (UJYHQ 7URZEULGJH 5RLWW5RLWWYHDUNDGDúODUÕ
øPPQRORML WHULPL HVNL 5RPD
GD DVNHUOLN YH YHUJL JLEL NDPX J|UHYOHULQGHQ
ED÷ÕúODQDQ NLúLOHU LoLQ NXOODQÕODQ LPPXQLWDV ED÷ÕúODPD ,PPXQLV ED÷ÕúÕNOÕN
kelimesinden gelmektedir. Genelde enfeksiyon etkenlerine ve zehir etkisi gösteren
PDGGHOHUH NDUúÕ GLUHQo ROXúPDVÕQÕ LIDGH HGHU øPPQRORML WHULPL GLOLPL]H EDúÕúÕNOÕN ELOLPL
olarak çevirilebilir. Bugün, allerjLYHRWRLPPXQKDVWDOÕNODUGDEXWHULPHGDKLO
HGLOPLúWLU
+HUKDQJLELUNLP\DVDOPDGGHNRQDNLOHWHPDVDJHoWL÷LQGHNHQGLVLQHNDUúÕ|]JOELU
cevap meydana getiriyor ve hem invitro hem de invivo reaksiyonlara giriyorsa bu maddeye
antijenDGÕYHULOLU%LUFHYDSRODUDNNRQDNWDUDIÕQGDQVHQWH]OHQHQNLP\DVDOPDGGHOHUHGH
antikorDGÕYHULOLU$QWLNRUODUDQWLMHQLODWHPDVHWWLNOHULQGHUHDNVL\RQDJLUHUOHUGDKDGR÷UX
ELU GH\LúOH HQ D]ÕQGDQ ELUOHúLUOHU $QWLMHQ YH DQWLNRU PROHNOOHUL ELUELUOHULQLQ JLULQWLOHULQL
oÕNÕQWÕ oÕNÕQWÕODUÕQÕ LVH JLULQWL LOH NDYUDUODU <DQL VWHDULN NRQILJUDV\RQODUÕ ELUELUOHULQLQ
NRPSOHPHQWHULGLU%|\OHELUOHúPLúPROHNOSDUoDODUÕQDantijen-antikor kompleksi denir.
(÷HU \DEDQFÕ PDGGH NRQDNWD FHYDS X\DQGÕUÕ\RU IDNDW ROXúDQ DQWLNRUODU ile
UHDNVL\RQDJLUPL\RUVDLPPQRMHQDGÕYHULOLU+HULPPQRMHQELUDQWLMHQGH÷LOGLU$QWLNRUODU
ELOKDVVDEHOLUOLELUDQWLMHQLoLQUHWLOPLúLVH|]JODQWLNRUDGÕYHULOLU(÷HUELUDQWLNRUELUGHQ
ID]ODDQWLMHQLN\DSÕ\ÕNHQGLVLQHED÷OD\DELOL\RUVD|]JOROPD\DQDQWLNRUDGÕYHULOLU.RQDNWD
E|\OHDQWLNRUODUÕQUHWLOPHVLQHQRQVSHVLILNDQWLNRUFHYDEÕGHQLU
%LUDQWLMHQHNDUúÕROXúWXUXODQ|]JODQWLNRUODUELUWHVDGIRODUDNEDúNDELUNLP\DVDO
maddenin herhangi bir molekül grubu ile reaksiyon verebilir. Bu antikorlara heterofil
antikor DGÕ YHULOLU +HGHI DOÕQPDGÕ÷Õ KDOGH PH\GDQD JHOHQ UHDNVL\RQODUD çarpraz
reaksiyonlar denir (Bkz. Post-VWUHSWRNRNVLNKDVWDOÕNODU%X\DQOÕúOÕNRWRLPPXQKDVWDOÕNODUÕ
WDULIHGHU(÷HUELUKHWHURILODQWLNRUXQ\DQOÕúOÕNODEDúODQGÕ÷ÕKHGHIGRNXNRQD÷ÕQNHQGLVLQH
DLW LVH R ]DPDQ PH\GDQD JHOHQ DQWLNRUODUD RWRDQWLNRU GHQLU E|\OH ROXúDQ KDVWDOÕNODUD
RWRLPPQ KDVWDOÕNODU GHQLU %XQODU PLNURRUJDQL]PDODUÕQ EDúODWDELOGLNOHUL DPD NHQGL
NHQGLQHGHYDPHGHQRWRLPPQKDVWDOÕNODUGÕU
Bir molekülüQELUE|OJHVLDQWLMHQOLN|]HOOL÷LWDúÕ\DELOHFH÷LJLELELUGHQID]ODE|OJHVLGH
DQWLMHQLNRODELOLU%|\OHNRQDNFHYDEÕ\DUDWDELOHQKHUE|OJH\Hantijenik determinant veya
epitop DGÕ YHULOLU 6Õ÷ÕU VHUXPXQGDNL DOEXPLQLQ PROHNOQGH WDQH HSLWRS YDUGÕU 7DYXN
\XPXUWDVÕ DOEPLQLQGH LVH WDQH HSLWRS EXOXQXU %LU DQWLMHQLN GHWHUPLQDQWÕ NDYUD\DELOHQ
DQWLNRU SDUoDVÕQD SDUDWRS DGÕ YHULOLU 2 DQWLMHQH |]JO ELOH ROVD ELU DQWLNRU PROHNOQQ
sadece bir bölgesi paratop görevi görür.
$QWLMHQOHU JHQHOOLNOH GRODúÕPGD WHN EDúODUÕQD EXOXQPD]ODU KHPHQ GDLPD ELU
SURWHLQHED÷OÕKDOGHEXOXQXUODU%XSURWHLQROD\ODUÕQoR÷XQDNDWÕOPD]VDGHFHWDúÕ\ÕFÕGÕUYH
FDUULHU WDúÕ\ÕFÕ SURWHLQ DGÕQÕ DOÕU 7DúÕ\ÕFÕ SURWHLQ 7 OHQIRVLWOHUL WDUDIÕQGDQ WDQÕQÕU YH
hücresel cevap üretilirken, anWLMHQLN PROHNOOHU % OHQIRVLWOHUL WDUDIÕQGDQ WDQÕQÕU YH VÕYÕVDO
FHYDS UHWLOLU (÷HU ELU DQWLMHQH NRQDN FHYDEÕQÕQ ROXúPDVÕ LoLQ 7 OHQIRVLWOHUL JHUHNL\RU LVH
EXGXUXPGDRDQWLMHQH7KFUHVLQHED÷ÕPOÕDQWLMHQDGÕYHULOLU0D\DYHPDQWDUODUÕQVHOOHU
ekstraktODUÕEROPLNWDUGD7KFUHVLQHED÷ÕPOÕDQWLMHQLKWLYDHGHU7OHQIRVLWOHULQHJHUHN
ROPDGDQNRQDNFHYDEÕROXúX\RUVD7ED÷ÕPVÕ]DQWLMHQYH\D7LQGDGÕYHULOLU+DSWHQOHUYH
HQGRWRNVLQ7ED÷ÕPVÕ]SHNoRNPLNURSDQWLMHQL7KFUHVLQHED÷ÕPOÕDQWLMHQGLU
BazÕ NLP\DVDO PDGGHOHU DQWLMHQ GH÷LOGLU DPD NRQDNWD PHYFXW |]JO ROPD\DQ
DQWLNRUODULOHNXYYHWOHUHDNVL\RQYHUHELOLU%|\OHNHQGLVLELUDQWLMHQROPDGÕ÷ÕKDOGHDQWLMHQ
gibi davranan maddelere hapten DGÕ YHULOLU +DSWHQOHU % OHQIRVLWOHUL WDUDIÕQGDQ WDQÕQÕU YH
JLUGL÷LNRQDNWDVÕYÕVDOFHYDSJ|UUOHU%XQODUÕWDúÕ\DQELUSURWHLQYDUVDFDUULHUSURWHLQR
]DPDQ 7 OHQGRVLWOHUL KDSWHQL GH÷LO WDúÕ\ÕFÕ SURWHLQL WDQÕU YH KFUHVHO FHYDS EDúODWÕUODU
*XWD SHUND NRQODU NUH]RIRUP LRGRIRUP YH GL÷HU N|N NDQDOÕ DQWLVHSWLNleri bir hapten gibi
GDYUDQDELOLUOHU 0RQR YH GLVDNNDULWOHU KDSWHQGLU 'LúKHNLPOHULQLQ JL\GL÷L ODVWLN HOGLYHQOHU
NDXoXNHVDVOÕGÕUYHELUKDSWHQJLELGDYUDQDELOLU%XHOGLYHQOHULNXOODQDQODUGD,J(DUDFÕOÕNOÕ
DOOHUMLN UHDNVL\RQODUÕQ J|UOPH VÕNOÕ÷Õ GXU .DWHODULV YH DUNDGDúODUÕ 6DIDGL YH
DUNDGDúODUÕNLúLGHQVLQLODVWLNHOGLYHQOHUHDOOHUMLNRODUDNEXOPXúODUGÕU)ULHVHQ
YHDUNDGDúODUÕVD÷OÕNSHUVRQHOLQLQJL\GL÷LYLQLOHOGLYHQOHUQHGHQL\OHROXúDQ
kontakt dermatit, kontakt ürtikHU YH ULQLWLV
LQ VRQXQGD EURQúL\DO DVWÕP
D G|QúHELOHFH÷LQL
VDYXQPDNWDGÕUODU
.RQDN LPPQ FHYDEÕQD |QFON HGHQ PHNDQL]PD H÷HU % OHQIRVLWOHUL LVH DQWLNRU
VHQWH]LQH GD\DQÕ\RU YH VRQXoWD DQWLMHQ-DQWLNRU NRPSOHNVOHUL ROXúX\RU LVH buna humoral
VÕYÕVDOFHYapDGÕYHULOLU(÷HUNRQDNLPPQFHYDEÕ7KFUHOHULLOHROXúX\RUVDVRQXoWD
KHGHIKFUHVLQGLULOL\RUVDEXGXUXPGDNRPDNWDROXúDQLPPQWHSNL\Hselüler (hücresel)
cevap DGÕYHULOLU
$QWLMHQOHUD\QÕDQGDD\QÕNRQDNWDEXOXQX\RUVDDQWLMHQLNUHNDEHWROXúWXrabilirler. Bu
GXUXPGDNRQDNEXDQWLMHQLN\DSÕODUGDQHQLPPQRMHQLNRODQÕQÕKHGHIWD\LQHGHUHNFHYDS
YHULU 'L÷HU DQWLMHQOHUH DLW NRQDN FHYDEÕ EDVNÕODQÕU $VOÕQGD EX ELU EDVNÕODQPD GH÷LO
ertelenmedir. Kendisine öncelikle ve kuvvetle cevap verilen antijeQOHUúX|]HOOLNOHULWDúÕU
%\N ELU PROHNO ROPDOÕGÕU NLORGDOWRQGDQ E\N PROHNOOHU NXYYHWOL
LPPQRMHQGLU 7HN EDúÕQD ELU DPLQRDVLW \D÷ DVLWOHUL SULQ SLULPLGLQ YH PRQRVDNNDULWOHU
LPPQRMHQLN ELOH GH÷LOGLU oQN PROHNO D÷ÕUOÕNODUÕ GDOWRQGDQ D]GÕU $OEPLQ kdalton) ve globülin (150 kdalton) iyi immünojendir.
.RQD÷D \DEDQFÕ ROPDOÕGÕU %D÷ÕúÕNOÕN VLVWHPLQLQ HQ |QHPOL |]HOOL÷L NHQGLVLQH DLW
RODQ YH\D ROPD\DQ PROHNOOHUL D\ÕUW HGHELOLU ROPDVÕGÕU 0ROHNOQ o ER\XWOX PLPDULVL
(stearik NRQILJUDV\RQ NRQDN WDUDIÕQGDQ |QFHGHQ UDVWODQÕOPDPÕú LVH R PDGGH L\L ELU
LPPQRMHQGLU.|NNDQDOÕLoHULVLQHNXOODQÕODQSHNoRNPDGGHNRQDNGRNXLoLQ\DEDQFÕGÕU
%D]HQ NRQD÷D \DEDQFÕOÕ÷Õ DUWÕUPDN JHUHNHELOLU gUQH÷LQ WRNVRLG YH\D DWHQH DúÕ
VROXV\RQODUÕQGD HQMHNWH HGLOHQ DQWLMHQH NDUúÕ NRQD÷Õ \DEDQFÕODúWÕUPDN JHUHNOLGLU %X
DPDoOD DúÕ VROXV\RQXQXQ LoHULVLQH $O32 YH\D $O2+ LODYH HGLOLU %|\OH NDWNÕODUD
DGMXYDQDGÕYHULOLU$GMXYDQODULPPQWDKULNYHNÕúNÕUWPDROXúWXUXU
3. Molekül mimarisi karmaúÕNROPDOÕGÕU<DQGDOODUYHKDONDOÕ\DSÕODUQHNDGDUID]OD
LVHRPROHNOQDQWLMHQLNGHWHUPLQDQWEDUÕQGÕUPDLKWLPDOLRNDGDUID]ODGÕUgUQH÷LQDNULOLN
monomeri, polimerinden daha az immünojendir.
=RUOXNODNDWDEROL]HROPDOÕGÕU%LUPDGGHKÕ]OD\ÕNÕOÕ\RUYHNRQDNWDQDWÕODELOL\RUVD
L\L DQWLMHQ GH÷LOGLU /HQIRVLWOHULQ EXQX \DNDOD\ÕS WDQÕPDVÕQD YDNLW ROPDOÕGÕU -HODWLQ ELU
SURWHLQGLU 6UDWOH PHWDEROL]H ROXU YH DQWLMHQLN GH÷LOGLU +DOEXNL EXQD WLURVLQ ED÷ODQDUDN
VWDELOKDOHJHWLULOGL÷LQGHNXYYHWOLELUDQWijendir.
d|]QU ROPDPDOÕGÕU 6X \D÷ YH\D DONROGH o|]QHELOHQ DQWLMHQOHU DQWLMHQLN
GHWHUPLQDQWODUÕQÕ ND\EHGHU 3DUoDFÕN KDOLQGH NDODELOHQOHU VDGHFH VVSDQVH RODELOHQOHU
NRPSOHNV \DSÕODUÕQÕ PXKDID]D HGHUOHU 1D\ORQ WHIORQ SROLVWUHQ o|]QPHGLNOHUL LoLQ ]D\ÕI
antijendir.
0ROHNO VHUW ROPDOÕGÕU 7LURVLQ YH SUROLQ JLEL DPLQRDVLWOHULQ ED÷ODQGÕ÷Õ
PROHNOOHUL VHUWOHúWLUGL÷LQH LQDQÕOPDNWDGÕU /LSLWOHU WHN EDúODUÕQD \XPXúDN PROHNOOHUGLU YH
L\LDQWLMHQGH÷LOGLUOHU
0ROHNOQ HOHNWULN \N ]D\ÕI ROPDOÕGÕU .XYYHWOL SRODU PROHNOOHU KHQ]
OHQIRVLWOHULQ NHQGLVLQL PXD\HQHVLQGHQ |QFH EDúND PROHNOOHUOH ELUOHúHUHN HSLWRSODUÕQÕ
kaybedebilirler.
(SLWRSODU \]H\GH ROPDOÕGÕU <XPDNVÕ JOREOHU ELU PROHNO ]HULQGH EXOXQDQ
antijenik determinantlar, içerL\H NDWODQÕS OHQIRVLWOHULQ WHPDVÕQGDQ NDoDELOLUOHU %|\OH
NLP\DVDOPDGGHOHUL\LDQWLMHQGH÷LOGLUYHVHVVL]DQWLMHQLNGHWHUPLQDQWODUDGÕQÕDOÕUODU$QFDN
PROHNO\ÕNÕOGÕ÷ÕQGDDoÕ÷DoÕNDUODUSHQLFLOOLQ
GHQSHQLFLOOLQLFDFLG
LQDoÕ÷DoÕNPDVÕJLEL
Çok büyüN PROHNOOHUGH \ÕNÕOPD VRQXFX DoÕ÷D oÕNDFDN RODQ SRWDQVL\HO GHWHUPLQDQWODUÕQ
ID]ODVD\ÕGDROPDVÕEHNOHQLU%XGHWHUPLQDQWODUGDKDoRNPROHNOQVHUW]LQFLUOHULQKLGURILO
VXVHYHQWDUDIÕQGD\HUOHúLU
Endo antijenler (doku antijenleri): Antijen kelimesiniQ LoHULVLQGH \DEDQFÕ ROPD
NDYUDPÕ JL]OLGLU %XUDGD HQGR |Q-HNL NXOODQPDN VXUHWL LOH DQODWÕOPDN LVWHQHQ DQWLMHQOHU
NRQD÷ÕQ NHQGL GRNX YH KFUHOHULQL WHPVLO HGHQ PROHNOHU \DSÕODUGÕU øPPQ KFUHOHU
ELUELUOHULQLWDQÕ\DELOPHNLoLQ|]HOYHRUWDNPROHNOHU\DSÕODUDLKWL\DoGX\DUODUEXQODUHQGR
DQWLMHQOHUGLU $\QÕ WDNÕPGD J|UHY DODQ ELUH\OHULQ RUWDNODúWÕNODUÕ NLPOLN ELOJLVL JLEL
GúQOPHOLGLU 7P oHNLUGHNOL KFUHOHULQ VLWRSOD]PLN ]DUÕQGD HQGRMHQ DQWLMHQOHU YDUGÕU
HLA (Human Leucocyte Antijen) A,B ve C tipleri lökositlere ait endo antijenlerdir. Bu
DQWLMHQOHULQDOWJUXSODUÕYDUGÕU0+&VÕQÕI0DMRU+LVWRFRPSDWLELOLW\&RPSOH[YH0+&
LQ
VÕQÕI DQWLMHQOHUL JLEL %XQODU % OHQIRVLWOHUL PDNURIDM YH OHQIRVLWOHULQ HWNLOHúLPLQGH NLPOLN
bilgisi olarak rol oynaUODU$\UÕFDHULWURVLWDQWLMHQOHUL$%2JLELNDQJUXEXDQWLMHQOHUL
GHQID]ODGÕUYHDOORDQWLMHQOHUELUHUHQGRDQWLMHQGLU
7 KFUHOHUL HQIODPDV\RQ VLQ\DOLQLQ KDQJL ND\QDNWDQ JHOGL÷LQL |÷UHQPHN LVWHUOHU
$QWLMHQL \DNDOD\ÕS 7 KFUHOHULQH VXQDQ LPPQ hücreler, bu antijeni bir endo antijen ile
0+& VÕQÕI YH\D 0+& VÕQÕI LOH ELUOLNWH LOHWPHN ]RUXQGDGÕU %X EDNÕPGDQ 0+&
antijenleri, T hücrelerine bir antijen sunulurken önemli rol oynarlar.
Mikrop antijenleri:
+HQ]EDúOD\DQYH\DNRQWUROHGLOHPH\HQenfeksiyonlarda mikrop hücresinin konak
GRNX\D WHPDV HGHQ DQWLMHQOHUL PLNURS KFUHVLQLQ VDGHFH HNVWUDVHOOHU \DSÕODUÕ YH
HN]RWRNVLQOHULGLU 3XOSLWLVWH YH DSLNDO HQIHNVL\RQODUGD LON GRNX FHYDEÕ EDNWHUL KFUHVLQLQ
GÕúGXYDU\DSÕODUÕQDNDUúÕJHOLúLU%DNWHUL\HO'1$51$VLWRSOD]PLN\DSÕODUYHKFUH]DUÕ
NRQDN LPPXQ FHYDEÕQÕQ LON KHGHIL GH÷LOGLU 3HULDSLNDO GRNXODUGD LON LPPXQ FHYDS
VÕUDVÕ\ODúXPLNURS|÷HOHULQHNDUúÕROXúPDNWDGÕU
(N]RWRNVLQOHU YH HNWUDVHOOHU YH]LNOOHU %DúWD 3RUSK\URPRQDV JLQJLYDOLV YH GL÷HU
3RUSK\URPRQDV\HOHULROPDN]HUHGL÷HUED]ÕN|NNDQDOSDWRMHQOHULHNVWUDVHOOHUYH]LNO
ROXúWXUXUODU +HU ELU PLNURS KFUHVL \DNODúÕN FLYDUÕQGD YH]LNO ROXúWXUXU %XQODU
OLSRSROLVDNNDULWWDEDNDLOHVDUÕOPÕúOLWLNHQ]LPSDNHWOHULGLU%N]Porphyromonas
JLQJLYDOLV 'L÷HU ED]Õ EDNWHULOHU KFUH GÕúÕQD NROODJHQD] YH K\DOURQLGD] VDODUODU %X
HN]RWRNVLQOHUGHQ ELUoR÷X NDQDOÕQ \ÕNDQPDVÕ LOH YH\D DOGHKLW N|N WDúÕ\DQ NDQDO
antiseptikleri ile temas edince detoksifiye olurlar.
2. Kapsül: Kök kanaOÕEDNWHULOHULQE\NELUE|OPNRQDNGRNXLOHWHPDVHGLQFHELUNDSVO
ROXúWXUXU%XNDSVOJOLNRNDOLNV\DSÕGDROXSDVOÕQGDELUSROLVDNNDULWWLUYHL\LELUDQWLMHQGLU.
DQWLMHQL %DFWHURLGHVOHULQ WDPDPÕQD \DNÕQ ELU E|OP NRQDN GRNXGD NDSVO \DSDUODU
StUHSWRFRFFXVODUÕQ ELOKDVVD & YH ' JUXEX RODQODUÕQÕQ NDSVOOHUL OHYDQ YH IUXNWR] LKWLYD
HGHU'ROD\ÕVÕLOHEXQODUÕQNDSVOOHULDQWLMHQLWHVL\NVHNELUSROLVDNNDULWNRPSOHNVWLU
.LUSLNSLOL3LOOLQLVLPOLNRPSOHNVELUSURWHLQGHQ\DSÕOPÕúWÕUDQWLMHQLNWir.
)ODMHO .|N NDQDOÕ EDNWHULOHULQLQ KHSVLQGH IODMHO EXOXQPD] 6DGHFH ED]Õ :ROLQHOOD
7UHSRQHPDYH&DPSK\OREDFWHU\HOHULQGHEXOXQXU)ODMHOLROXúWXUDQIODJHOOLQLVLPOLSURWHLQ
H÷HU ELU PRQRPHUGHQ LEDUHW LVH DQWLMHQLN ROPDGÕ÷Õ KDOGH SROLPHU LVH NXYYHtli antijenik
olabilir.
5. Bakteri hücresinin yüzeyindeki antijenleri:
D*UDPQHJDWLIOHULQGÕúGXYDUL%XJUXSEDNWHULOHULQGÕúGXYDUÕVRPDWLN2DQWLMHQLLOH
NDSOÕGÕU +HPHQ DOWÕQGD HQGRGRWRNVLQ /LSLW-$ YH |] SROLVDNNDULW WDEDNDVÕ EXOXQXU %N]
Endodotoksin).
E *UDP SR]LWLIOHULQ KFUH GXYDUÕ %X JUXS EDNWHULOHULQ GÕúGXYDUÕ SHSWLGRJOLNDQ
NRPSOHNVWHQROXúXU7HLNRLNDVLWYHRQXQWUHYOHULRODQPROHNOOHUEXNRPSOHNV]HULQGH
NRQDNVDYXQPDHOHPDQODUÕWDUDIÕQGDQNROD\FDWDQÕQDELOHFHNoÕNÕQWÕODUROXúWXUXU%X\DSÕODU
7
\HED÷ÕPOÕDQWLMHQOHUGLU
6LWRSOD]PLNPHPEUDQ)RVIROLSLWYHSURWHLQGHQROXúXU%DNWHUL\H|]JODQWLMHQLN\DSÕODU
WDúÕU
'L÷HU\DSÕODUEDNWHULKFUHVLQLQVLWRSOD]PLNPXKWHYL\DWÕSHNoRNYHQRQVSHVLILNDQWLMHQLN
\DSÕODUEXOXQGXUXU%Xnlar, glikolipit, fosfolipit, arabinogalaktan, lipoteikoik asit, teikoik asit,
VLNOLNDPLQRED]ODUEDNWHUL'1$VÕ51$
VÕYHGDKDSHNoRNNLP\DVDO\DSÕODU
.RQDNVDYXQPDVÕQÕQRUJDQYHGRNXODUÕ
(QIHNVL\RQGD EDNWHUL WDUDIÕQGDNL VDOGÕUÕ JHQHOOLNOH VDGHFH \DSÕVÕQGD DQWLMHQOHUL
EXOXQGXUPDNúHNOLQGHLNHQNRQDNVDYXQPDVÕROGXNoDSURIHV\RQHOGLU%XVDYXQPDGDURO
oynayan organ ve dokular iki gruptur:
1. 7LPLN RUJDQODU /HQIRLG RUJDQODU OHQI G÷POHUL UHWLNORHQGRWHO\DO VLVWHP GDODN
timus, damar endoteli, GRODúÕPGDNLYHGRNXGDNLLPPQKFUHWRSOXOX÷X
2. %XUVD IDEULFXV %X DQDRWRPLNROXúXPLQVDQGD\RNWXUVDGHFHNXúODUGDEXOXQXU
YHNX\UX÷D\DNÕQELUGRNXGXUøQVQODUGDNLNDUúÕOÕ÷ÕNDUDFL÷HUYHNHPLNLOL÷LGLU%XUVD
IDEULFXVGHQLOLQFHVDGHFHNHPLNLOL÷LYHNDUDFL÷HUDQODúÕOPDOÕGÕU
/HQIRLG RUJDQODU ERO OHQIRVLW LoHUHQ UHWLNOHU GRNX WUHYLGLU 9FXGXQ GH÷LúLN
\HUOHULQHLNLD\UÕG]HQLOHGD÷ÕOPÕúWÕU
A) Diffüz lenfoid dokular:
+HUKDQJL ELU RUJDQ ORMX oHYUHVLQGH \D\JÕQ VÕQÕUODUÕ EHOLUVL] NPHOHU \DSDUODU 'DOD÷ÕQ
SHULDUWHU\HO NÕOÕIODUÕ WRQVLOOHULQ LQWHUQRGOOHU DODQODUÕ PH]HQWHULQ YH PHGLDVWHQLQ PXKWHOLI
\HUOHULVROXQXPYHVLQGLULPPXNR]DVÕQÕQODPLQDSURSUL\DVÕWNUNEH]OHULYH\D
KHUKDQJL ELU VDKD\D VDoÕOPÕú YD]L\HWWH EXOXQDELOLUOHU øoOHULQGH UHWLNüler hücreler,
ILEUREODVWODU YH VDELW PDNURIDMODU EXOXQXU 6DELW PDNURIDMODU GRODúÕPGDNL PDNURIDMODUGDQ
IDUNOÕGÕU H÷HU DQWLMHQ SDUWLNO NHQGLVLQH NDQ YH\D OHQI \ROX LOH JHOLUVH IDJRVLWH HGHUOHU
IDNDW EX PDNURIDMODU GRODúÕPD JHoPH]OHU %|\OH GD÷ÕQÕN \HUOHúPLú OHQIRLG GRNXODUÕQ
içlerinde küçük lenfositler, lenfoblastlar, plazmositler ve serbest makrofajlar da
bulunur.
B) Toplu lenfoid dokular:
<XNDUÕGD DQODWÕODQ GLII] OHQIRLG GRNXODUÕQ L\L RUJDQL]H ROPXú YH ELU RUJDQ KDOLQH
G|QúPúúHNOLGLU%DúOÕFDODUÕúXQODUGÕU
0$/70XFRVD$VVRFLDWHG/\PSKRLG7LVVXH%LUD]VRQUDDQODWÕODFDNRODQWRSOX
OHQIRLGGRNXODUÕQHQLONHOKDOLGLU%LOKDVVDLQWHVWLQDOPXNR]DGDROPDN]HUHSHNoRN\HUGH
PXNR]D DOWÕQGD NPHOHU ROXúWXUXU EXQODUD SH\HU SODNODUÕ" da denir. Waldeyer'in lenf
KDONDVÕ DVOÕQGD ELU SH\HU SOD÷ÕGÕU %X WLS GRNXODU |]JO ,J$ VHNUHWH HGHU YH PXNR]DO
VDYXQPDEDUL\HULROXúWXUXU%LUDQWLMHQSDUHQWHUDO\ROGDQYHULOGL÷LQGHNXYYHWOLLPPQFHYDS
YHUL\RUNHQRUDOYHULOGL÷LQGHEHNOHQHQGHQGDKDD]LPPQWHSNLPeye sebep olabilir. Buna
RUDOWROHUDQVGHQLU2UDOWROHUDQV
ÕQPHNDQL]PDVÕQGD0$/7RULMLQOL,J$YHHUNHQX\DUÕ
VLVWHPLYDUGÕU
/HQIG÷POHUL'LII]OHQIRLGGRNXODUÕQILEU|]ELUNDSVOOHoHYULOLYD]L\HWWHRODUDN
YFXGXQ VWUDWHMLN \HUOHULQGH ROXúWXUGX÷X RYRLG RUJDQODUGÕU %LUELUOHULQH NoN NDSLOOHU
GDPDULOHED÷OÕGÕUODU.DVÕNNROWXNDOWÕoHQHDOWÕGLODOWÕYHSDURWLVoHYUHVLQGH\R÷XQRODUDN
EXOXQXUVD\ÕODUÕELUNDo\]GHQID]ODGÕU0DQGLEXOHUGLúOHULQOHQIDWLNG|QúOHULQLQELUNÕVPÕ
sublingual biU NÕVPÕ VXE DQJXOHU OHQI G÷POHUL LOH ROXUNHQ PDNVLOOHU GLúOHULQ OHQIDWLN
G|QúOHUL GDKD oRN VXEDQJOHU YH ELU NÕVÕPGD SDURWLV E|OJHVLQGHNL OHQI G÷POHUL
]HULQGHQ ROXU %\NONOHUL DQWLMHQLN X\DUÕ LOH SDUHOHO RODUDN DUWDU QRUPDOGH -25 mm
oDSÕQGDGÕUODU/HQIG÷POHULQLQNHQGLOHULQHDLWNDQGDPDUODUÕYDUGÕUYHEXNDQGDPDUODUÕ
LOHEHVOHQLUOHU%XUDGDUHWLOHQDQWLNRUODUNDQDEXNDQGDPDUODUÕYDVÕWDVÕLOHYH\DEXUDGDQ
D\UÕODQ HIIHUHQW OHQI GDPDUODUÕ YDVÕWDVÕ LOH JHoHUOHU /HQI G÷PQQ PHGXOODVÕQGD
NRUWHNVWH UHWLOHQ % OHQIRVLWOHUL YH SOD]PD KFUHOHUL EXOXQXU % KFUHOHULQLQ LON X\DUÕPODUÕ
EXUDGDROXU/HQIG÷POHULQLQNRUWHNVLDQWLMHQLQNRPSHWDQKFUHOHUHLONVXQXOGX÷X\HUGLU
øON |]JO DQWLNRU VHQWH]L PHGXOODGD WHVSLW HGLOLU 3HULDSLNDO OH]\RQXQ ilk dönemlerinden
LWLEDUHQHQ\R÷XQDQWLMHQWUDIL÷LEXUDGDGÕU
'DODN%DWÕQVROVWNDGUDQGDILEURHODVWLNRYRLGELURUJDQGÕU.DSVOGHQRUJDQ
LoHULVLQH X]DQDQ YH NDQGDPDUODUÕQÕ JHWLUHQ WUDEHNOHU JLULQWLOHU YDUGÕU %X JLULQWLOHU
merkezde kaybolur, buVÕQÕUOHQIRLGGRNXQXQEDúODGÕ÷Õ\HUGLU%XUD\Dbeyaz pulpaDGÕ
YHULOLU %XQXQ GÕú NÕVPÕQD NÕUPÕ]Õ SXOSD DGÕ YHULOLU %H\D] SXOSDGD NDQ GDPDUODUÕQÕQ
VRQODQGÕ÷Õ XoODUD 6FZHLQJHU NÕOÕIÕ GHQLU YH EX NDSLOHULQ XoODUÕ J|YGHVLQGHQ ELUD] GDKD
NDOÕQGÕU%XQXQVHEHELNDSLOHULQXoNÕVÕPODUÕQGDNPHOHúHQIDJRVLWOHUGLU%XUD\DED]Õ
kaynaklarda PALS (Peri Arteiolar Lymphoid Sheat) DGÕ GD YHULOLU %H\D] SXOSD
VLQ]RLWOHUGHQ ROXúXU 5HWLNOHU OLIOHU 0DOSLJKL FLVLPFLNOHUL GHQHQ QRGOOHUL \DSDUODU
Buradaki bütün gözeler fevkalade zengin makrofaj, plazmosit, B ve T lenfositleri,
PDNURIDMODU YH GL÷HU NRPSHWDQ VDYXQPD HOHPDQODUÕ LOH GROXGXU %DNWHULOHU NLUPL]L SXOSD
WDUDIÕQGDQ WXWXOXUODU YH EH\D] SXOSD\D JLUHPH]OHU $QWLMHQLQ OHQIRVLWOHUH VXQXOGX÷X ELU
EDúND\HUEXUDVÕGÕr.
7LPXVQFIDUHQJHDODUNWDQROXúXU0HGLDVWHQGHVWHUQXPXQVWDUNDVÕQGDGÕU
øOHUOH\HQ\DúODUGD\D÷OÕGHMHQHUDQVLOHNoOUøNLOREOXGXUGÕúDUÕGDQNDSVOLOHVDUÕOPÕúWÕU
%XNDSVORUJDQÕQLoHULVLQHJLULQWLOHU\DSDU3UHQNLPGRNXVXWDPDPHQYHGDima lenfositler
LOHGROXGXU%XUDGDNLKFUHOHULQ
X\HQLROXúPDNWDRODQoRNJHQo7OHQIRVLWOHULGLU
YHWLPRVLWDGÕQÕDOÕU%XQODU3UH-7KFUHVLQHG|QúWNOHULQGH\]H\OHULQGHKHP&'KHP
&'YDUGÕUPHGXOOD\DJHoWLNOHULQGHEXLúDUHWOHUGHQELUWDQHVLQL kaybederek ya CD4 veya
&'LúDUHWLWDúÕUODUhUHWLPOHULoRNKÕ]OÕGÕUYHNRUWHNVWHGLU.RRUGLQDV\RQWLPRVLQYH7+)
7\PLF KXPRUDO )DFWRU LOH \DSÕOÕU %X HQ]LPOHU VHUXPGDQ L]ROH HGLOHELOPLúWLU 2OJXQODúDQ
OHQIRVLWOHU EXUDGDNL |]HOOHúPLú KFUHOHU WDUDIÕQGDn adeta kalite kontrolundan geçirilerek
PHGXOOD\D JHoHU YH EXUDGDQ NDQ GDPDUODUÕ \ROX LOH GRODúÕPD NDWÕOÕU .XVXUOX EXOXQDQ 7
OHQIRVLWOHUL NRUWHNVWH EXOXQDQ PDNURIDMODU WDUDIÕQGDQ SDUoDODQÕU QHJDWLI VHOHNVL\RQ YH\D
timik seleksiyon). Bu mekanizma burada aQODWÕODQGDQoRNGDKDNDUPDúÕNWÕU
.HPLNLOL÷LYHNDUDFL÷HU'R÷XPXQLOND\ODUÕQGDQLWLEDUHQ%OHQIRVLWOHULQLQ\DSÕPÕ
NHPLNLOL÷LQGHYHNDUDFL÷HUGHROXU
.RQDNVDYXQPDKFUHOHUL.RQDNVDYXQPDVÕQGDURODODQKFUHOHUúXQODUGÕU
Hematopoetik stem (kök) hücreleri, lenfositler (B ve T cinsleri), megakaryosit, lökosit, mast
hücresi, monosit, makrofaj, Langerhans hücresi, dendritik hücreler, naturel killer hücreleri
YHGL÷HUED]ÕOHQIRLGJUXSODU%XQODUGDQHQGRGRQWLGH|QHPOLRODQODUÕQ|]HOOLNOHUL
ú|\OHGLU
1) Lenfositler: 6-PPE\NO÷QGHGLU+FUHQLQoHNLUGH÷LVLWRSOD]PDVÕQDSHN
D]\HUEÕUDNDFDNNDGDUE\NWU(ULúNLQLQGRODúÕPÕQGD\DNODúÕN12 lenfosit bulunur. Bir
JQGH WRSODP RODUDN \DNODúÕN 9 OHQIRVLWLQ NDQD G|NOG÷ ]DQQHGLOPHNWHGLU
'RODúÕPGDNL OHQIRVLWOHULQ GRNX\D JHoLúOHUL NDSLOHUOHULQ HEV (High Endotelial Venules)
DGÕ YHULOHQ |]HO E|OJHOHULQGHQ ROXU %XQODU DQWLMHQH |]JO FHYDS YHUHELOHQ VÕQÕUOÕ VD\ÕGD
X]PDQKFUHOHUGLUNDSLOHUSHUPLDELOLWHQLQHOYHUGL÷LKHUGRNX\DVDoÕODUDNGD÷ÕOPDODUÕ+(9
NRRUGLQDV\RQX LOH LVDEHWOL ELU úHNLOGH HQJHOOHQPLúWLU $QFDN LOWDKDS EXOXQDQ GRNXODUGD
\R÷XQODúÕUODU <]H\OHULQGH LPPQ KDEHUOHúPHGH NXOODQÕNODUÕ |]HO \DSÕODU EXOXQXU
%XQODUD&'&OXVWHURI'LIIHUDQWLDWLRQDGÕYHULOLU+HUOHQIRVLWLQ\]H\LQGHCD1, CD4, veya
&' JLEL IDUNOÕ \]H\ PDNHU
ODUÕ YDUGÕU (÷HU ELU OHQIRVLWWH &' PDUNHU
Õ \RN LVH &'RODUDN LIDGH HGLOLU (÷HU \]H\LQGH &' PDUNHU
Õ YDUVD &' RODUDN LIDGH HGLOLU +HU 7
lenfositi bu yüzey moleküllerinin hepsini bulundurmaz, sadece CD2, CD3 ve CD5
KHSVLQGH EXOXQXU RUWDN \]H\ PDUNHU
ODUÕQD 3DQ-T-cell markers" denir. CD4 ve CD8
\]H\ PDUNHU
ODUÕ JD\HW |]HOGLU /HQIRVLWOHU KDQJL RUJDQGD UHWLOGL÷LQH EDNÕODUDN
VÕQÕIODQÕUODU %XUVD IDEULFXV
WD UHWLOHQOHU %XUVD NHOLPHVLQLQ EDúKDUIL RODQ % lenfositleri
RODUDN LVLPOHQGLULOLU %XUVD )DEULFXV NXúODUGD NX\UX÷D \DNÕQ ELU GRNXGXU PHPHOLOHUGHNL
NDUúÕOÕ÷Õ NHPLN LOL÷L YH NDUDFL÷HUGLU 'L÷HU ELU JUXS OHQIRVLW WLPXVWD UHWLOLU 7LPXV
NHOLPHVLQLQ EDú KDUIL LODYH HGLOHUHN 7 OHQIRVLWOHUL DGÕQÕ DOÕU (÷HU LPPQ VLVWHP ELU
RUNHVWUD\D EHQ]HWLOVH\GL OHQIRVLWOHU EX RUNHVWUDQÕQ úHIL ROXUGX $\UÕFD VÕQÕIODQDPD\DQ
OHQIRVLWOHUGHYDUGÕUNK (Natural Killer) hücreleri böyle hücrelerdir.
A) B Lenfositleri: Toplam lenfositlerin %5-
LQL ROXúWXUXU <]H\ PHPEUDQODUÕQGD
VDGHFH ,J' YH ,J0 WLSLQGH DQWLNRU WDúÕUODU )DNDW KHU JUXSWDQ DQWLNRUX VHQWH] HGLS
VDODELOLUOHU % OHQIRVLWOHUL 0+& VÕQÕI ,, HQGR DQWLMHQL WDúÕUODU 'L÷HU LPPQ KFUHOHU LOH
HWNLOHúLPGHEXHQGRDQWLMHQOHUUROR\QDU$\UÕFD\]H\OHULQGH,J-a, Ig-ß, CD3, CD5, CD19,
&' &' &' &' &' &' &' PDUNHU
ODUÕ EXOXQXU $QWLMHQ LOH
NDUúÕODúWÕNODUÕQGD NHQGLOHULQH KHUKDQJL ELU VXQXOPD ROPDGDQ NDUDU YHUHUHN ,J0 WLSLQGH
|]JODQWLNRUKD]ÕUODUODU%XDQWLNRUODUÕKHPVDODUODUKHPGH\]H\OHULQGHWDúÕUODU+XPRUDO
VÕYÕVDOED÷ÕúÕNOÕNWDQVRUXPOXGXUODUùHNLO14.1).
% 7 /HQIRVLWOHUL øPPQ VLVWHPLQ
enflamasyonda görev alan en etkin
hücreleridir.
Yüzeylerinde
antijeni
WDQÕ\DQ TCR (T Cell Receptor)
PROHNOOHUL YDUGÕU %XQODU 7&5-1 ve
TCR-2 olmak üzere LNLIDUNOÕ\DSÕGDGÕU7
lenfositlerinin
%95'inde
TCR-2,
GL÷HUOHULQGH 7&5-1 bulunur. TCR-1
WDúÕ\DQODU GRODúÕPGD EXOXQPD]ODU 7
lenfositleri selüler(hücresel) ED÷ÕúÕNOÕNWDQ
sorumludur. Normalde T lenfositleri G0
ID]ÕQGDGÕU%XELULVWLUDKDWG|QHPLGLU%X
dönem lenfositleri küçüktür ve interlökin
\LWDúÕ\DFDNP51$
ODUÕ\RNWXU%XQODUD
ùHNLO +XPRUDO YH VHOOHU LPPQ antijen sunulunca ve interlökin-1 ile
mekanizmalar
X\DUÕOÕQFD KFUHOHU GHUKDO * ID]ÕQD
JHoHUOHU VLWRSOD]PDODUÕQGD LQWHUO|NLQ- WDúÕ\DELOHFHN P51$
ODU EHOLULU KFUH ER\XWODUÕ
artar, yüzeylerinde interlökin- UHVHSW|UOHUL EHOLULU øQWHUO|NLQ- VDOPD\D EDúODUODU .HQGL
VDOGÕNODUÕ LQWHUO|NLQ- NHQGL UHVHSW|UOHUL WDUDIÕQGDQ DOJÕODQÕU YH GDKD oRN LQWHUO|NLQ-2
VDODUODU%XHWNLOHúLPRQODUÕ6ID]ÕQDVUNOHUYHoR÷DOPD\DEDúODUODU
T lenfosLWOHUL\]H\PDUNHU
ODUÕQÕQoHúLWOLOL÷LQHJ|UHIRQNVL\RQ\DSDUODUYHEXQDJ|UH
VÕQÕIODQÕUODU
<DUGÕPFÕ 7 KFUHOHUL 7K %XUDGDNL + KDUIL LQJLOL]FHGHNL KHOSHU \DUGÕPFÕ
kelimesinden gelmektedir. Daima CD4+8- GLU 'RODúÕPGDNL 7 KFUHOHULQLQ LQL
ROXúWXUXU 7K YH 7K ROPDN ]HUH LNL WU YDUGÕU 7K KFUHOHUL 7V KFUHOHU JLEL
GDYUDQÕUNHQ 7K KFUHOHUL HQIODPDV\RQX DUWÕUPD \|QQGH J|UHY DOÕU 7K PDVW
hücrelerini ve eosinofilleri aktive eder.
Sitotoksik T hücreleri (Tc): C harfi cytotoxic (hücreye zarDUOÕ NHOLPHVLQGHQ JHOLU
<]H\OHUL &' GÕU 3RUILULQ LVLPOL NXYYHWOL SURWHROLWLN HQ]LPOHUL YDUGÕU %X HQ]LPOHULQL
salarak fedef hücrede delikler açer. IL-2 (interlökin-iki), IL-6 salarlar. Aktive edilmeleri
DQWLMHQVXQDQKFUHOHUWDUDIÕQGDQ0+&VÕQÕI1 endo antijeni ile olur.
6XSUHV|U 7 KFUHOHUL 7V %XUDGDNL 6 KDUIL LQJLOL]FHGHNL VXSUHVVRU EDVNÕOD\ÕFÕ
kelimesinden gelmektedir. Daima CD4- GLU 'RODúÕPGDNL 7 KFUHOHULQLQ LQL
ROXúWXUXU*|UHYOHULLPPQFHYDEÕEDVNÕODPDNWÕUYHLPPQWROHUDQVJHOLúWLUPHNWLU(÷HUEX
KFUHOHU ROPDVD\GÕ ELU PLNURS DQWLMHQLQH NDUúÕ JHOLúHELOHFHN KHUKDQJL ELU NRQDN FHYDEÕ
artarak ömür boyu devam edebilecekti. Halbuki bu hücreler iyice bilinmeyen bir
PHNDQL]PDLOHPXKWHPHOHQVLWRNLQOHULOHDQWLMHQHNDUúÕNRQDNFHYDEÕQÕ
GXUGXUDELOPHNWHGLUøNLWLS7VYDUGÕU7V-1 ve Ts-2. Bunlardan Ts-DQWLMHQWDUDIÕQGDEDVNÕ
\DUDWÕUNHQ 7V- LVH % OHQIRVLWOHUL YH 7K WDUDIÕQGD EDVNÕ \DUDWÕU 7V- DQWLMHQL WDQÕ\DUDN
ED÷ODU YH LPPQ NRPOHNVOHULQ ROXúPDVÕQÕ HQJHOOHU 76-2 ise, B lenfoVLW NORQODUÕQÕQ
ROXúPDVÕQÕHQJHOOHUIDJRVLWLNKFUHOHULQGRNX\DJHOPHOHULQLVD÷OD\DQHQ]LPOHULEORNHHGHU
$GHWDDUD\DJLUPHNVXUHWLLOHLNLWDUDIÕQPFDGHOHVLQLGXUGXUXUODU
C) NK hücreleri: NK (Natural Killer) hücreleri iri granülleri olan lenfositlerdir. Bu
KFUHOHU YLUXV LOH HQIHNWH ROPXú NRQDN KFUHOHULQL YH WP|U KFUHOHULQL |OGUUOHU &'
GÕUODU 7LPXVWD ROJXQODúPD]ODU ,/ LOH oR÷DOÕUODU ,)1 LQWHUIHURQ LOH OL]LV \HWHQH÷L
ND]DQÕUODU+DQJLKFUH\L|OGUHFHNOHULQHQDVÕONDUDUYHUGLNOHULWDPolarak bilinmemektedir,
IDNDW VD÷OÕNOÕ NRQDN KFUH\H ]DUDU YHUPH]OHU g]JO ,J LPPQ JOREXOLQ PROHNO LOH
ED÷ODQPÕúKFUHOHUL|OGUPHPHNDQL]PDVÕ7FKFUHOHULQLQNLQHEHQ]HUOLNJ|VWHULU
2. Polimorf nükleer lökosit (PNL): 'RODúÕPGDNL O|NRVLWOHULQ -
LQL ROXúWXUXU
.HPLN LOL÷LQGH ROXúXUODU oHNLUGHNOHUL OREOHU \DSÕGD ROGX÷XQGDQ EX LVPL DOPÕúWÕU $\UÕFD
VLWRSOD]PDODUÕQGD ERO JUDQO EXOXQGX÷XQGDQ JUDQORVLW DGÕ GD YHULOLU 0DNURIDMODUÕQ
ömürleri aylar-\ÕOODULOH|OoOUNHQO|NRVLWOHULQ|PUOHULLVHVadece 2-JQNDGDUGÕU
dRN KÕ]OÕ UHWLOLUOHU PLO\RQ KFUHGDNLND .RQDN VDYXQPDVÕQGD oRN |QHPOL \HUOHUL
YDUGÕU+HOHDQWLNRUYHNRPSOHPDQHúOL÷LQGHoRNHWNLOLELU\DEDQFÕFLVLPWHPL]OH\LFLVLGLUOHU
)DJRVLWR] \HWHQHNOHUL YDUGÕU YH DNXW ID]GD HNVWUDVHOOHU RUWDPD oÕNDUODU
6LWRSOD]PDODUÕQGDNL JUDQOOHULQ ER\DQPDODUÕQD J|UH Q|WURILO HRVLQRILO YH ED]RILO DGÕ
YHULOHQJUXEDD\UÕOÕUODU
1|WURILO 'RODúÕPGDNL O|NRVLWOHULQ ÕQÕ ROXúWXUXU %|OQHUHN oR÷DOPD
özellikleri yoktur. Ömürleri 6- VDDWWÕU IDNat dokuya geçerlerse 4-5 gün
\DúD\DELOLUOHU$NDQ(÷HUGRNXGDVHUXPYDUVD\DQLHQIODPDV\RQXQROGX÷X
doku ödemli ise, bu durumda ömürleri daha uzun olabilir. 10- PP oDSÕQGDGÕU
NDUúÕODúWÕUÕQÕ] ELU NRN KFUHVL \DNODúÕN PP oDSÕQGDGÕU .XYYHWOL kemotaktik
\HWHQHNOHUL YDUGÕU %X KFUHOHU ILEULQ YD]RDNWLI NLQLQOHU &D YH PLNURS VDOJÕODUÕQD
NDUúÕGX\DUOÕGÕUODU'L÷HU31/VHULOHULQGHROGX÷XJLELVLWRSOD]PDODUÕJUDQOOGU%X
granüller 3 tiptir. Birinci tip granüller, myeloperoxydase, lysozyme ve katyonik
SURWHLQOHU EXOXQXU øNLQFL WLS JUDQOOHUGH ODFWRIHUULQ O\VR]\PH YH % ELQGLQJ
protein bulunur. Üçüncü tip granüllerde ise acid hydrolase bulunur.
Eosinofil: Tüm lökosit serilerinin %2-
LQL ROXúWXUXU 6LWRSODPDVÕQGDNL
JUDQOOHULQ RUWDVÕ NULVWDOORLG úHNLOGHGLU %X O|NRVLWOHU IDJRVLWR] NDELOL\HWOLGLU IDNDW
JHQHOOLNOH IDJRVLWH HGLOPHVL PPNQ ROPD\DQ E\N SDUoDODUD \DNODúDUDN
VLWRSOD]PDVÕQGDNL JUDQOOHUL EXQXQ ]HULQH ERúDOWÕUODU HNVWUDVHOOHU OL]LV
(QIHNVL\RQ VDKDVÕQD \DNODúPDVÕ DQFDN 7 KFUHsi, bazofil ve mast hücrelerinden
VDOJÕODQDQ (&) (RVLQRSKLO &KHPRWDFWLF )DFWRU LOH PPNQGU (RVLQRILOOHU
arilsülfat salarak mast hücrelerini aktive edebilirler, fosfolipaz D salarak PAF
(Platellet Activating Factor)'ü inaktive ederler, histaminaz salarak histamin'leri
LQDNWLYHHGHUOHUNDW\RQLNSURWHLQOHULYDUGÕU
%D]RILO /|NRVLWOHULQ GHQ D]ÕQÕ ROXúWXUXU *UDQOOHULQGH (&) 3$)
seratonin, SRS (Slow Reacting Substance), histamin ve heparinaz bulunur. Mast
KFUHOHULLOHDNUDEDOÕNODUÕYDUGÕU,J(WLpinde antikorlar ile reaksiyon verirler.
3. Mast hücreleri:3HULNDSLOHUE|OJHGHVHUR]DODUGDPHPHEDúÕG]NDVoHYUHVLQGH
\D\JÕQ RODUDN EXOXQXUODU 3HULDSLNDO GRNXODUD LVH DQFDN X\DUDQ EXOXQGX÷XQGD JHOLUOHU
Pulpitisin ilk dönemlerinde pulpa dokusunda da bulunabilirler. Pulpa ve periapikal dokulara
girebilen mast hücreleri genellikle CTMC (Connective Tissue Mast Cell) tipindedir. Bunun
GÕúÕQGDPDVWKFUHOHULQLQ00&0XFRVD-DVVRFLDWHG0DVW&HOOWLSLGHYDUGÕUIDNDWGDKD
çok akut iltahapta ve periapeksWH UDVWODQÕUODU 0DVW KFUHOHUL ,J( WLSL DQWLNRUODU LOH
reaksiyon vererek histamin, SRS salarlar ve Tip- DúÕUÕ GX\DUOÕOÕN DQDILODNVL
UHDNVL\RQODUÕQD VHEHS ROXUODU 0DVW KFUHOHUL &D YH &D LOH ,J( LOH X\DUÕODELOLUOHU
X\DUÕOPÕúKFUHOHULQWUDVLWRSOD]PLNJUDQOOHULQLND\EHWWLNOHULQHJ|UHEXJUDQOOHULQDVOÕQGD
ELUHU KLVWDPLQ YH KHSDULQ GHSRVX ROGX÷X ]DQQHGLOPHNWHGLU +LVWDPLQLQ PDVW KUHOHULQH
WXWXQDELOPHVLLNLIDUNOÕUHVHSW|UFLQVLLOHPPNQGU0DVWKFUH\]H\LQGH+YH+DGÕ
YHULOHQ LNL IDUNOÕ UHseptör bulunur. Serbestleyen histamin, bu reseptörlerden H1'e
ED÷ODQÕUVD \XNDUÕGD DQODWÕODQ DQDILODNVL ROD\ODUÕQD VHEHS ROXU (÷HU + UHVHSW|UQH
WXWXQXUVD PDVW KFUHOHUL úXQODUD VHEHS RODFDN HQ]LPDWLN ELU IDDOL\HWH EDúODUODU 30/
(Polymorph Nuclear Leucocyte)'in ekstraselüler lizizini engellerler, 2. antikor sentezini
EDVNÕODUODU 7K OHQIRVLWOHULQL HQJHOOHUOHU 7LS- DúÕUÕ GX\DUOÕOÕN UHDNVL\RQODUÕQÕ
engellerler.
%XVLVWHPHGLNNDWHGLQL]*|UOG÷JLELPDVWKFUHOHULD\QÕHQ]LPKLVWDPLQLKHm
VDOPDNWD KHP GH RQGDQ ELUELULQH ]ÕW LNL IDUNOÕ \|QGH HWNLOHQPHNWHGLU %X PHNDQL]PD
LPPQ VLVWHPLQ KHU NRPSDUWÕPDQÕQGD E|\OH ROXU %LU X\DUÕ ELUELULQH ]ÕW HWNL J|VWHUHQ LNL
D\UÕPHNDQL]PD\ÕELUGHQDNWLYHHGHU8\DUDQLOHPFDGHOHELUNXYYHWOHUGHQJHVLúHNOLQH
G|QúWUOUYHEXKDOL\OHLGDPHHWWLULOLU
4. Antijen Sunan hücreler (Antigen Presenting Cells, APC): .RQD÷ÕQ NHQGL
DQWLMHQOHULEDNÕPÕQGDQ]HQJLQRODQKHUOHQIRLGKFUHDQWLMHQVXQDQKFUHJ|UHYLJ|UHELOLU
Bu tip hücreler genellikle dalak, tiPXV OHQI G÷POHUL GHUL YH PXNR]D DOWÕQGD EXOXQXUODU
YH0+&DQWLMHQOHULWDúÕUODU(QELOLQHQ$3&JUXSODUÕGHULDOWÕQGDNLODQJHUKDQVKFUHOHULGLU
7HQLV UDNHWL ELoLPLQGH RODQ EX KFUHOHU DQWLMHQ LOH WHPDV HGHUHN HQ \DNÕQ OHQI
G÷POHULQH J|o HGHUOHU SDUPDNVÕ LQWHUGLJLWDWLQJ KFUHOHUH G|QúUOHU WDúÕGÕNODUÕ
DQWLMHQL EXUDGD 7 KFUHOHULQH VXQDUODU /HQI G÷POHULQLQ SDUDNRUWHNVLQGHNL GL÷HU ED]Õ
KFUHOHU GH HQGR DQWLMHQ WDúÕUODU 0+& DQWLMHQL \DQL DQWLMHQL OHQIRVLWOHUH VXQPD\D
yetkilidiriler. Bu hücrelere foliküler dentritik hücreler denir. B hücresinin kendisi de bir
DQWLMHQ VXQDQ KFUHGLU oQN 0+& VÕQÕI ,, DQWLMHQOHUL EXOXQGXUXU 'L÷HU ED]Õ KFUHOHU GH
HQIHNVL\RQXQ KHUKDQJL ELU G|QHPLQGH $3& KDOLQH G|QúHELOLU %XQODU JHQHOOLNOH
monositler, makrofaMODU PDUJLQDO E|OJH PDURIDMODUÕ GDPDU HQGRWHOLQGHNL |]HOOHúPLú
HQGRWHOKFUHOHULOHQIG÷POHULQGHNLGHQGULWLNKFUHOHUIROLNOHUGHQWULWLNKFUHOHUGLU
5. Trombositler (platelletler): .HPLN LOL÷L RULMLQOLGLU PP3 NDQGD \DNODúÕN 300000 tanediU6D\ÕODUÕLQDOWÕQDGúHUVHNDQDPDH÷LOLPLVD\ÕODUÕLQDOWÕQD
GúHUVHVSRQWDQNDQDPDODUJ|UOU$VÕOJ|UHYOHULNDQÕQSÕKWÕODúPDVÕQÕVD÷ODPDNROGX÷X
KDOGHHQIHNVL\RQVÕUDVÕQGD]DUDUJ|UHQGDPDUHQGRWHOLQH\DSÕúDUDNRE|OJH\HO|NRVLWOHUL
daYHWHGHU$\UÕFDNRPSOHPDQÕGDDNWLYHHGHU+DJHPDQIDNW|UQQDNWLYDV\RQXQGD
DQDKWDUUROR\QDU7URPERVLWOHUELUJUDQORVLWGH÷LOGLU
6. Monositler ve makrofajlar .HPLN LOL÷LQGHQ SURPRQRVLWOHU PRQRVLWOHUH
IDUNOÕODúDUDN NDQD G|NOUOHU GDKD VRQUD EXQODU PDNURIDMODUD IDUNOÕODúÕUODU %LU JQGHQ
GDKD NÕVD |PUOHUL YDUGÕU 0DNURIDMODU GRODúÕPGD \D\JÕQ RODUDN EXOXQVDODU ELOH GDKD oRN
NRQD÷D DQWLMHQLQ JLUHELOHFH÷L VWUDWHMLN \HUOHUGH \R÷XQODúÕUODU $NFL÷HU DOYHROOHULQLQ
çevresinde toplananlara "alveoler makroIDM NDUDFL÷HU GRNXVXQGDNLOHUH Kuppfer
hücreleriDGÕYHULOLUGDODNVLQVOHULQGHOHQIG÷POHULQGHE|EUHNJORPHUOOHULQGHEH\LQ
YH NHPLN GRNX LoHULVLQGH EXOXQXUODU )DJR]LWR] \DSÕFÕ IDJRVLWLN KFUHOHUGLU 0RQRVLW YH
makrofajlar, C5a, LTB4 (lökotrien-B-4), NCP (Nötrofil Cationic Proteins), bakteri antijenleri
YH 7 KFUH OHQIRNLQOHUL LOH JHOHQ VLQ\DOOHUH FHYDS YHULUOHU (÷HU IDJRVLWR]X \DSÕOPDVÕ
JHUHNHQ SDUWLNO NHQGL KJFHU E\NO÷QGHQ ID]OD LVH EX KFUHOHULQ ELU NDo WDQHVL
ELUOHúHUHNoRNE\NWHNELUPDNURIDMKDOLQHJHOLUOHUYHIDJRVLWR]XJHUoHNOHúWLULUOHU%|\OH
KFUHOHUH oRN oHNLUGHNOL GHY KFUHOHU GHQLU 0DNURIDMODUÕQ DVÕO J|UHYL |O YH\D |OPHNWH
RODQ KFUH\L GHEULVOHUL RUWDGDQ NDOGÕUPDN EDNWHULOHUH SULPHU GHIDQV VD÷ODPDNWÕU
Makrofajlar, IFN, C3b konvertaz, properdin, PG (prostoglandin), LT (lökotrien), PAF, MCSF (Macrophage-Colony Stimulating Factor), CF (Chemotactic Factors), IL-1, fibronektin
salarlar.
)$*26ø72=
%XWHULPELUKFUHQLQVLQGLULOPHVLDQODPÕQÕDúÕU
Sindiren hücreye fagosit DGÕ YHULOLU 2NX\XFX IDJRVLW EDúOÕ÷Õ DOWÕQGD VSHVLILN ELU KFUH
DUDPDPDOÕGÕU%XVLQGLULPROD\ÕQÕJHUoHNOHúWLUHQKHUKFUHELUIDJRVLWWLU)DJRVLWJHQHOOLNOH
\DELUQ|WURILOYH\DELUPDNURIDMGÕU%XROD\úXEDVDPDNODULOHPH\GDQDJHOLU
1. KemRWDNVLV+FUHQLQED]ÕNLP\DVDOPDGGHOHUHGR÷UXJ|oHGHELOPH\HWHQH÷LQH
NHPRWDNVLV GHQLU )DJRVLWOHU \DQL Q|WURILOOHU YH PDNURIDMODU PLNURS |÷HOHUL WDUDIÕQGDQ
NXYYHWOH FH]EHGLOLUOHU .RPSOHPDQÕQ &D &D SDUoDODUÕ ROXúPXú DQWLMHQ-antikor
kompleksleri, EDNWHULOHULQ DQWLMHQLN GHWHUPLQDQWODUÕ OHQIRNLQOHU PDVW KFUHOHULQGHQ DoÕ÷D
oÕNDQ(&)KLVWDPLQYHGL÷HUYD]RDNWLIPHGL\DW|UOHUD\UÕ-D\UÕELUHUNHPRWDNWLNIDNW|UGU
)DJRVLWLN KFUHOHUGH NRQWUDNWLO SURWHLQOHU EXOXQXU YH EX SURWHLQOHULQ NDVÕOPD\HWLVLYDUGÕU
(Q ELOQHQOHUL DNWLQ YH PL\RVLQ
GLU )DJRVLWOH DNWLQ \DUGÕPÕ\OD NDVÕOÕS JHYúH\HUHN KDUHNHW
HGHELOLUOHUSVHXGRSRG\DODQFÕD\DNX]DWDELOLUOHU1|WURILOOHUPPGDNLNDKÕ]LOHKDUHNHW
HGHUOHUPDNURIDMODULVHELUD]GDKD\DYDúKFUHOHUGLU
2. Adezyon: Kemotaksisi takiben, fagositik hücre, yutulacak partiküle en az 50-60 A
NDGDU \DNÕQODúPDOÕGÕU )DJRVLWLN KFUH LOH KHGHI SDUWLNO DUDVÕQGDNL oHNLP 1HZWRQ
XQ
JUDYLWDV\RQ SUHQVLSOHUL LOH DoÕNODQDPD\DFDN NDGDU NRPSOHNVWLU %X LNL SDUoD DUDVÕQGDNL
çekiP X]DNOÕNODUÕQÕQ LQFL NXYYHWOHUL LOH WHUV RUDQWÕOÕGÕU YH RUWDPÕQ \R÷XQOX÷X \]H\
JHULOLPLIDJRVLWLNKFUHQLQQHJDWLI\]H\HOHNWUL÷LRUWDPÕQÕVÕYHS+
VÕJLELELU
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EDNWHULKFUHVLQLQ\]H\LQGHNRPSOHPDQLOHED÷ODQPÕúDQWLMHQ-antikor kompleksleri
YDUVDYH\DRSVRQL]HHGLOPLúLVHIDJRVLWR]oRNNROD\YHJD\HWKÕ]OÕJHUoHNOHúLU
0HPEUDQDNWLYDV\RQX0LNURSDQWLMHQOHULIDJRVLWLNKFUHQLQ\]H\PHPEUDQODUÕQÕ
DNWLYH HGHU %DNWHUL PHPEUDQODUÕ ]HULQGH JOLNRNDOLNV NDSVO YDUVD EX DNWLYDV\RQX
frenlHQLU)DJRVLWLNKFUHQLQPHPEUDQÕ\DEDQFÕSDUWLNOHHQ\DNÕQROGX÷XQRNWDGDLoHUL\H
GR÷UX oXNXUODúÕU \DEDQFÕ SDUWLNOQ oHYUHVLQH GR÷UX SVHXGRSRWODU X]DWDUDN RQX NDYUDU
%XVÕUDGDIDJRVLWLNKFUHQLQNRQWUDNWLOSURWHLQOHULLoLQJHUHNOLHQHUML$73
GHQ
temin edilir.
)DJR]RPIRUPDV\RQX)DJRVLWLNKFUHQLQLoHUL\HGR÷UXoXNXUODúDQPHPEUDQÕELU
WRUED KDOLQH G|QúHUHN \DEDQFÕ SDUWLNO WDPDPHQ KFUH LoHULVLQH oHNHU 0LNURS
hücresini paketleyen bu torbaya "fagozomDGÕYHULOLU
5. Füsyon: Fagositik hücrelHULQ LoHULVLQGH EXOXQGXUGX÷X OLWLN HQ]LPOHU NHQGLVLQH
]DUDU YHUPHPHVL DPDFÕ LOH ELU NHVH LoHULVLQGH PXKDID]D HGLOLU EX NHVH\H fagolizozom
GHQLU %X EDVDPDNWD IDJROL]R]RPODU IDJR]RPD GR÷UX \DNODúÕU YH RQXQOD ND\QDúÕU
Böylece, litik enzimler, konaktan i]ROHHGLOPLúELUúHNLOGH\DEDQFÕSDUWLNOLOHWHPDVDJHOLU
gOGUPH)DJROL]R]RPODUÕQLoHULVLQGHúXQODUEXOXQXUD- be ß- glukozidaz, a- ve
ß- galatozidaz, a-mannozidaz, alkalen fosfataz, lizozim, asit ribonükleaz, asit fosfataz,
glukuronidaz, naftilamidaz, N-asetil-ß-glukozaminidaz, atil sulfataz, fosfodiesteraz,
nukleotidaz, peptidaz, esterazlar, lipaz, fosfolipaz A ve B, lesitinaz, lizolesitinaz, a-amilaz,
GHNVWUDQD] SUROLGD] HODVWD] NROODJHQD] YH GDKD ELUoRN \ÕNÕFÕ HQ]LP gOGUPH ROD\Õ LNL
farkOÕ\|QWHPLOHROXUùHNLO14.2):
ùHNLO)DJRVLWR]GD|OGUPH\ROODUÕ
A-2NVLMHQSDWODPDVÕ2[\JHQEXUVWLQJBu mekanizma, oksidatif öldürmeDGÕQÕ
GDDOÕU%XWLS|OGUPHVÕUDVÕQGDQ|WURILOLQIV\RQXQWDPDPODQPDVÕQÕEHNOHPHVLQHJHUHN
\RNWXU )DJR]RP Q|WURILOLQ NHQGL ]DUÕQGDQ ELU SDUoDGÕU )agozom formasyonunun erken
G|QHPLQGH YH KDWWD X\DUÕOPD G|QHPLQGH KFUH ]DUÕQGD KHNVR]-monofosfat yolu ile bol
RNVLMHQ HOGH HGLOPH\H EDúODQÕU =DUGDNL RNVLMHQ UHGNOHQHUHN SHURNVLW UDGLNDOOHUL YH
P\HORSHURNVLGD] DoÕ÷D oÕNDU )DJR]RP úHNLOOHQLU úHNLOOHQPH] RNVLMHQ VHUEHVWOHúLU
IDJR]RP LoHULVLQGH DQLGHQ oRN \NVHN ELU RNVLMHQ NRQVDQWUDV\RQX ROXúXU %WQ EX
LúOHPOHUELUNDoGDNLNDVUHU(÷HU\XWXODQSDUWLNORNVLMHQHWROHUDQVJ|VWHUHQELUPLNURS
KFUHVLLVHEX\ROLOH|OGUPH\HNÕVDELUVUHGLUHQHELOLU bu durumda enzimatik yol ile
öldürülür.
B- Enzimatik yol: )DJROL]R]RPODUÕQ IV\RQX LOH EXUD\D JHOHQ KDORMHQOHU NORU JLEL
WRNVLN KDORMHQL]DV\RQ \DSDUODU %X ELOHúLNOHU KLSRNDOLG
OHU YH\D +DOLG
OHU RODUDN ELOLQLU
)DJR]RP LoHULVLQGHNL GúN S+ NDW\Rnik proteinler, katepsin G, lizozimler, laktoferrin ve
\XNDUÕGDVD\ÕODQODUGDQEDúNDGDKDHQD]WDQHHQ]LPEDNWHULKFUHVLYHYLUXVX
öldürmek üzere görev yapar.
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seviyHGH SDUoDODU EXQD VLQGLUPH GLJHVWLRQ GHQLU (÷HU IDJRVLWH HGLOHQ SDUWLNO EX
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litLN HQ]LPOHUL NRQD÷ÕQ WROHUH HGHELOHFH÷L VHYL\HGH GLOXH HGHU YH KFUH GÕúÕQD EÕUDNÕU %X
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SDUDOL]L\DSDELOHQ|UQH÷LQ3RUphyromonas gingivalis veya Actinobacillus), veya kendisini
GRVWKFUHJLELWDQÕPDVÕQÕVD÷OD\DQHQ]LPOHULEXOXQDELOLU%D]ÕEDNWHULOHUIDJR]RPLoHULVLQH
DOÕQVDODUELOHIDJROL]R]RPODUÕQIV\RQXQXHQJHOOH\HELOLUOHU0\FREDFWHULXPODUJLEL
EXUDGD FDQOÕ RODUDN NDODELOLUOHU %D]Õ EDNWHULOHU IDJR]RPX \ÕUWDUDN IDJRVLWLN KFUHQLQ
VLWRSODPDVÕQD JHoHUOHU 7UHSRQHPDODU JLEL *OPH]R÷OX YH (UJYHQ %LU EDNWHUL
IDJRVLWLN KFUHQLQ LoHULVLQGH FDQOÕ RODUDN NDODELOPLúVH ELOLQPH\HQ ELU VHEHSOH 7K
lenfositleri bXQGDQ KDEHUGDU ROPDNWDGÕU (QIODPDV\RQXQ \|QHWLFLVL NRQXPXQGDNL 7
OHQIRVLWOHUL EX IDJRVLWLN KFUH\L LoHULVLQGHNL EDNWHULOHU LOH ELUOLNWH RUWDGDQ NDOGÕUÕOPDVÕ
JHUHNHQELUKHGHINDEXOHWPHNWHGLU:LOVRQYHDUNDGDúODUÕ%D]HQELUEDNWHULNRQDN
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EDNWHULOHUL J|UPH]OHU 6WUHSWRFRFFXV PLWLV E|\OH ELU EDNWHULGLU NRQDNWDQ DOGÕ÷Õ 71)
7XPRU 1HFURVLQJ )DFWRU
 \]H\LQGH WRSODU /XR YH DUNDGDúODUÕ )DJRVLWR]GDQ
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(QIHNWHN|NNDQDOÕIORUDVÕQÕQE\NE|OPDQDHURSEDNWHULOHUGHQROXúWX÷XQDJ|UH
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.|NNDQDOÕQDX\JXlanan bütün kortikosteroidler periapekste
JHUoHNOHúHQIDJRVLWR]XIUHQOHU
ø00h10(.$1ø=0$1,1.225'ø1$6<218
øPPQVLVWHPLQKFUHOHULELUELUOHULQLQQH\DSWÕNODUÕQGDQKDEHUGDUROPDN]RUXQGDGÕU
%X LOHWL\L WHPLQ HGHQ ED]Õ NLP\DVDO PDGGHOHU YDUGÕU %XQODUD topluca sitokin DGÕ YHULOLU
6LWRNLQOHUNLORGDOWRQKDILISROLSHSWLWOHUGLU(÷HUELUVLWRNLQ7YH\D%OHQIRVLWOHULWDUDIÕQGDQ
ROXúWXUXOPXúVD OHQIRNLQ DGÕQÕ DOÕU (QIHNWH NRQDN KFUHOHULQGHQ VDOÕQÕRUVD NHPRNULQ YH
interferon isimleri alabilir. MonositlerWDUDIÕQGDQROXúWXUXODQVLWRNLQOHUHPRQRNLQDGÕYHULOLU
6RQ \ÕOODUGD oRN \HQL ELU J|Uú NXYYHW ND]DQPD\D EDúODPÕúWÕU YH EX NRQXGD WHUPLQRORMLN
LODYHOHU\DSÕOPÕúWÕU%DNWHULOHULQGR÷UXGDQHWNLVLLOHNRQDNVDYXQPDHOHPDQODUÕQGDQVLWRNLQ
VDOÕQPDVÕQÕ VD÷OD\Dn bakteri enzimlerine topluca bakteriokin veya mikrokin ismi teklif
HGLOPLúWLU:LOVRQYHDUNDGDúODUÕùLPGLOLN\HQLROPDVÕQDUD÷PHQPXKWHPHOHQLOHULNL
\ÕOODUGDEXWHULPOHULGDKDoRNGX\DFD÷Õ]
Sitokinler, enflamasyon sinyallerinin iletiminde rol alan, otokrin ve parakrin
GDYUDQDQ NÕVD PHQ]LOOL HQGRNULQ KRUPRQ JLEL GúQOPHOLGLU 6LWRNLQOHU SHSWLG YH\D
JOLNRSURWHLQ\DSÕVÕQGDHQGRHQ]LPOHUGLUGRODúÕPDNDWÕOPD]ODUYH\DQDGLUHQVÕQÕUOÕELUVUH
LoLQ NDWÕOÕUODU 'RODúÕPD GDKD VÕNOÕNOD NDWÕODQODU ,/-1,2,6 ve 8 dir. Sitokinler, normal
NRúXOODUGD NHQGLOLNOHULQGHQ VDOÕQPD]ODU PXWODND ELU X\DUÕOPD VRQXFX VDOÕQÕUODU .HQGLVLQL
VDODQKFUHEDúWDROPDN]HUHoHYUHGHNLKFUHOHU]HULQHHWNLOLGLU+DQJLKFUHWDUDIÕQGDQ
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RODQ E|OJHGH WDPLU ROD\ÕQÕ EDúODWPDVÕQÕ VD÷ODUODU %LU VLWRNLQ ELU EDúND VLWRNLQLQ
VDOÕQPDVÕQÕ WHPLQ HGHELOLU YH\D HQJHOOH\HELOLU DNWLI YH GLQDPLN UHDNWDQWODUGDQ ROXúDQ
hassas kimyasal reaksiyonlara girerler. Bu reaksiyonlardan herbirisi bir öncekini frenler
YH\DELUVRQUDNLQLEHOLUOHUøOWDKDEÕQ\|QHWLPLQLWHPLQHGHU6LWRNLQOHUGHQKHUKDQJLELULVLQLQ
herhangi bir immün hücUH WDUDIÕQGDQ RUWDPD VDOÕQPDVÕ WHVDGIL GH÷LOGLU +HU ELU VLWRNLQ
EHOLUOL DPDoODU LOH YH SURJUDPOÕ ELU úHNLOGH VDOÕQÕU YH\D VDOÕQÕPÕ GXUGXUXOXU gQHPOL
VLWRNLQOHUúXQODUGÕU
interlökinler, CSF (Colony Stimulation Factor), G-CSF (Granulocytes-Colony
Stimulating Factor), M-CSF, interferonlar, TNF, TGF-ß (Transforming Growth Factor), CF,
MMIF (Monocyte Migration Inhibiting Factor), LIF (Leucocyte Migration Inhibiting Factor)
ve daha pek çok endo enzimler.
%XQODUÕQLoHULVLQGHSHULDSLNDOSDWRORMLOHUGH|QHPOLUROR\QD\DQVLWRNLQOHUúXQODUGÕU
øQWHUO|NLQOHU
Bu kelime, Inter-Leucocyte-&\WRNLQ N|NOHULQGHQ JHOLU O|NRVLWOHU DUDVÕ KDEHUOHúPD
VD÷OD\DQDQODPÕQGDGÕU%LOLQPHVLQGHID\GDRODQEDúOÕFDLQWHUO|NLQOHUúXQODUGÕU
IL-øQWHUO|NLQ-1): Önceden BAF (B Activating Factor) veya LAF (Leucocyte
$FWLYDWLQJ )DFWRU RODUDN DGODQGÕUÕOPÕúWLU %D]Õ ND\QDNODUGD KDOD EX WHUPLQRORML \HU
DOPDNWDGÕU ,/- PROHNO LPPQ KFUHOHU WDUDIÕQGDQ N'D D÷ÕUOÕ÷ÕQGD ELU
SROLSHSWLW SUHNUV|U RODUDN VHQWH] HGLOLU YH GRODúÕPD JHoHr, buna pre-IL-‰ DGÕ
YHULOLU %X PROHNO DNWLYH PRQRVLWOHUGHQ VDOÕQDQ ,&( ,QWHUOHXNLQH-1 Activating
(Q]\P WDUDIÕQGDQ $VS YH $OD DUDVÕQGDQ NHVLOLU ÕQFÕ NRQXPGDNL
DVSDUJLQH YH LQFL NRQXPGDNL DODQLQ PROHNOOHUL NDVWHGLOPHNWHGLU $UDODUÕQGD
koNNLP\DVDOIDUNOÕOÕNODURODQ,/-1a ve IL-‰DGÕQGDLNLDNWLIPROHNOROXúXU$NWLI
IL-‰ PROHNO N'D D÷ÕUOÕ÷ÕQGD ELU SROLSHSWLWWLU HQIODPD]VRQX D]GÕUÕU
6WUHSWRNRNODUÕQ ELU HNVRWRNVLQL RODQ 63(% 6WUHSWRFRFFDO 3\URJHQLF ([RWR[LQ %
pre-IL-1ß molekOQ \DQOÕúOÕNOD NHVHUHN DNWLYH HGHU %X NHVPH GR÷UX QRNWDGDQ
olmaz, His115-$VSDUDVÕQGDQNHVHUEXQDUD÷PHQELUWDQHVLDNWLI,/-
OHUROXúXU
øúWH EX VHEHSOH VWUHSWRNRN HQIHNVL\RQODUÕ JHQHOOLNOH SUODQGÕU YH HQIHNVL\RQ
\D\ÕOPD H÷LOLPLQGHGLU .DSXU YH DUNDGDúODUÕ 'HIHNWLI ,/- SDUoDVÕ NRQDN
WDUDIÕQGDQ DQWLMHQ PXDPHOHVL J|UU YH HQIODPDV\RQX VLVWHPDWL]H HGHU %WQ
çekirdekli hücreler pre-IL- VDODELOLUOHUVHGH DVÕO ND\QD÷Õ PRQRVLW YH PDNURIDMODUGÕU
Periapikal kemik rezorpsiyonunda IL-‰ GL÷HULQGHQ GHID GDKD DNWLI URO DOÕU
Lenfositleri uyaran bütün antijenler makrofajlardan IL-VDOÕQPDVÕQDVHEHSROXUODU
%X VWLPODV\RQXQ PHNDQL]PDVÕ WDP RODUDN D\GÕQODWÕODPDPÕúWÕU IDNDW &D
L\RQODUÕQÕQ URO DOGÕ÷Õ NHVLQGLU 8\DUÕODQ PDNURIDMGDQ DoÕ÷D oÕNDQ IL-1 lenfosit
yüzeyinde IL- UHVHSW|UOHULQH WXWXQDUDN OHQIRVLWLQ X\DUÕOPDVÕQÕ VD÷ODU 8\DUÕODQ
OHQIRVLW * ID]ÕQGDQ * ID]ÕQD JHoHUHN DNWLYDV\RQ G|QHPLQH JLUHU %|\OH
lenfositlerin yüzeyinde IL- LoLQ VSHVLILNUHVHSW|UOHUYDUGÕUYHRUWDPGDH÷HUYDUVD
IL-
\L \DNDOD\DUDN oD÷DOPD\D EDúODUODU $NWLYH RODQ OHQIRVLW JDPPD LQWHUIHURQ
VDODUDNPDNURIDMODUÕQGDKDoRN,/-VDOPDVÕQÕWHPLQHGHUE|\OHFH\HQLOHQIRVLWOHUL
* ID]ÕQD oHNHU ,/- 7F
OHUL GH DNWLYH HGHU 7V
OHUL LVH EDVNÕODU ELUoRN
hematopoetik hücreniQ oR÷DOPDVÕQÕ NDPoÕODU DNXW ID] SURWHLQOHULQLQ VHQWH]LQL
DUWÕUÕU HQIHNVL\RQODUGD QRQ VSHVLILN ELU VDYXQPD EDUL\HULQLQ ROXúXPXQD NDWNÕGD
bulunur. IL-1, B lenfositlerinin diferansiasyonunu ve antikor sentezini provoke eder,
SURVWRJODQGLQVDOÕQPDVÕQÕWHPELKHGHU3URVWRJODQGLQOHUVLVWHPLNGRODúÕPDNDWÕODUDN
WDODPXVWDNLWHUPRUHJODW|UPHUNH]OHULWHPELKHGHUYHNRQDNYFXWÕVÕVÕQÕ\NVHOWLU
Bu bir alarm durumudur. Kortikosteroidler ile engellenir.
IL-2 (interlökin-2): Önceleri TCGF (T Cell Growth Factor) veya TMF
7K\PRFLWH 0LWRJHQLF )DFWRU RODUDN DGODQGÕUÕOPÕúWÕU %X PDGGH 7 OHQIRVLWOHUL
WDUDIÕQGDQ ROXúWXUXOXU 1DGLUHQ EDúND OHQIRVLWOHU GH,/-2 yapabilirler. IL-ROXúPDVÕ
LoLQ 7 OHQIRVLWLQH ELU DQWLMHQLQ EDúND ELU KFUH WDUDIÕQGDQ VXQXOPDVÕ JHUHNOLGLU
Makrofajlardan gelen IL-1 enfeksiyona özgüldür. T lenfosit stimülasyonu yani IL-2
VDOÕQPDVÕ |]JO GH÷LOGLU \DQL EHOLUOL WHN ELU KHGHIL \RNWXU <]H\OHULQGH ,/-2
UHVHSW|UWDúÕ\DQEWQKFUHOHU|UQH÷LQ1.X\DUÕOÕUYHGDYHWHGLOLU,/-2 ile aktive
olan T lenfositleri IL- VDODUODU YH ELU VRQUDNL EDVDPD÷ÕQ VLWRNLQOHULQL VDODUODU
(interferon, CSF, LT, BCGF, LDCF gibi).
IL-3 (interlökin- .HPLN LOL÷LQGHNL JHQo KFUHOHULQ JHOLúHUHN NDQD
G|NOPHOHULQL KÕ]ODQGÕUÕU 2VWHRNODVWODUÕQ DNWLYH ROPDVÕQÕ VD÷ODU $NXW DSLNal apse
G|QHPLQGH SHULDSHNVWH ERO PLNWDUGD EXOXQXU 5RPDWRLG DUWULW KDVWDOÕ÷ÕQÕQ
ROXúPDVÕQGDGDUROYDUGÕU
IL-4 (interlökin- 7K KFUHOHUL WDUDIÕQGDQ ROXúWXUXOXU % OHQIRVLWOHULQL DNWLYH
eder, IL-
\HVLQHUMLNHWNLJ|VWHULU,J(UHVHSW|UOHULQLDUWÕUÕU00&&70&
OHULX\DUÕU
PDVWKFUHOHULQLQSUROLIHUDV\RQXQXKÕ]ODQGÕUÕU7FKFUHOHULQLDNWLYHHGHU
IL-5 (interlökin- 7K KFUHOHUL WDUDIÕQGDQ ROXúWXUXOXU % OHQIRVLWOHULQL DNWLYH
eder, IL-3 ve IL-2'ye sinerjik etki gösterir. B lenfositlerinin IgA tipinde antikor
ROXúXPXQXDUWÕUÕU.HPLNLOL÷LQGHHR]LQRILOOHULQJHOLúLPLQLDUWÕUÕU7OHQIRVLWOHULQHD]ELU
X\DUÕFÕHWNLVLYDUGÕU
IL-6 (interlökin-6): Fibroblastlar, T ve B lenfositleri, monositler, endotel ve
HSLWHOKFUHOHULWDUDIÕQGDQROXúWXUXOXUdRNoHúLWOLKFUHWRSOXOXNODUÕQDX\DUÕFÕHWNLVL
YDUGÕU IDNDW % OHQIRVLWOHUL ]HULQH HWNLVL GDKD ID]ODGÕU % OHQIRVLWOHULQL ,J$
VHQWH]OH\HQ SOD]PD KFUHOHULQH G|QúWUU .DUDFL÷HUGHQ DNXW ID] SURWHLQOHULQLQ
VHQWH] HGLOHUHN VDOÕQPDVÕQÕ VD÷ODU EXQODUÕ GRNX\D GDYHW eder. Romatoid artrit ve
SHULDSLNDOSHULRGRQWLWLVLQSDWRJHQH]LQHNDWÕOÕU
IL-7 (interlökin- .HPLN LOL÷L GDODN YH E|EUHN KFUHOHUL WDUDIÕQGDQ
ROXúWXUXOXU7YH%OHQIRVLWOHULQLQJHOLúLPLQLVD÷ODU
'DKDEDúNDLQWHUO|NLQOHUGHYDUGÕU,/-10, Th hücrelerLQLEDVNÕDOWÕQDDODUDN
enflamasyonu frenler.IL-8 (interlökin-30/YHO|NRVLWOHULGDYHWYHDNWLYHHGHU(÷HU,/-1
LOHELUOLNWHROXUVDNLJHQHOOLNOHELULYDUVDGL÷HULGHYDUGÕUEXGXUXPGDHWNLVLSRWDQVL\HOL]H
ROXU (QIODPDV\RQ X]DPÕúVD ,/-8, monosiWOHUL X\DUÕU 9LULGDQV VWUHSWRNRNODUÕQ ,/-8
VDOÕQPDVÕQÕX\DUDQPLNURNLQOHULYDUGÕU6WUHSWRFRFFXVPXWDQVÕQDGH]\RQXQXVD÷OD\DQELU
ramnoz-glikoz polimeri, konak hücreden IL- VDOÕQPDVÕQÕ X\DUÕU (QWHURFRFFXV IDHFLXP
bunu yapmaz, çünkü yüzeyinde "Yop proteiQDGÕYHULOHQ,/-LQKLELW|UELUPDGGHYDUGÕU
TNF (Tumor Nechrosis Factor):
%DúWD PRQRQNOHHU IDJRVLWLN KFUHOHU ROPDN ]HUH * ID] 7 KFUHOHUL DNWLYH 1.
KFUHOHUL YH DNWLYH PDVW KFUHOHUL WDUDIÕQGDQ VDOÕQDQ ELU HQ]LPGLU %X HQ]LPLQ VDOÕQPDVÕ
için GUDP QHJDWLI EDNWHUL GXYDUÕQÕQ WHPHO \DSÕWDúÕ RODQ /36 OLSRSROLVDNNDULW HQ LGHDO
X\DUDQGÕU %X VHEHSOH HVNLGHQ OHQIRWRNVLQ DGÕ YHULOLUGL 71) WP|U KFUHOHULQGH OL]LVH
VHEHSROGX÷XLoLQEXLVLPYHULOPLúWLU'úNNRQVDQWUDV\RQGD71)úXQODUDVHEHSROXU.
31/ PRQRVLW YH OHQIRVLWOHULQ KDVDUOÕ GRNXQXQ GDPDU HQGRWHOLQH WXWXQPDVÕQÕ VD÷ODU IDJRVLWLNKFUHOHULDNWLYHHGHULPPQKFUHOHULQELUoR÷XQXX\DUDUDN,/-1, IL-6 ve IL-8
VDOPDODUÕQÕVD÷ODUEXQODUGDQ,/-]DWHQ71)VDOÕQÕPÕQÕDUWÕUGÕ÷ÕQGDQE|\OHce bir immün
DPSOLILNDV\RQ ROXúXU % OHQIRVLWOHULQLQ SOD]PD KFUHOHULQH G|QúPHOHULQL KÕ]ODQGÕUÕU
(÷HU 71) VDOJÕVÕ DUWDUVD úX HWNLOHU J|UOU 71)
QLQ SLURMHQ HWNLVL QHGHQL\OH DWHú
yükselir, 2. IL-LOHLúELUOL÷LLoHULVLQGHVHUXPGDDNXWID]SURWHLQOerini yükseltir, 3. dissemine
LQWUDYDVNOHUNRDJODV\RQDVHEHSROXU3URVWRJODQGLQVHQWH]LQLDUWÕUDUDNRVWHRNODVWODUÕ
X\DUÕU
APP (Acute Phase proteins):
(QIHNVL\RQ\DQÕNWUDYPDJLELX\DUÕODULOHVHUXPGDED]ÕSURWHLQOHULQDUWWÕ÷ÕJ|UOU
Bunlar IL-6 DUDFÕOÕNOÕ RODUDN NDUDFL÷HU WDUDIÕQGDQ VHQWH]OHQHQ SURWHLQOHUGLU 6ÕFDN ELU
G]OHP ]HULQH NRQXODQ GHQH\ KD\YDQODUÕQÕQ VHUXPODUÕQGD WHVSLW HGLOGL÷L LoLQ ÕVÕ úRN
SURWHLQOHUL YH\D VWUHV SURWHLQOHUL DGÕ GD YHULOPHNWHGLU <DúODQPDQÕQ VHEHSOHULQGHQ ELU
tanesi ROGX÷X LOHUL VUOPHNWHGLU %DúOÕFD $33
OHU úXQODUGÕU &53 & UHDNWLI SURWHLQ D-2mikroglobulin, anti-proteinaz'lar, fibrinojen ve amiloid-$ %XQODUÕQ VDOÕQGÕ÷Õ G|QHPGH
DOEXPLQYHWUDQVIHUULQVHQWH]LD]DOÕU
CRP (C Reaktif Protein):
Normalde serumda belirli miktarlarda bulunan bir akut faz proteinidir. IL-6 ile
VDOÕQPDVÕ DUWDU $VÕO |GHYL EDNWHUL PHPEUDQODUÕQD ED÷ODQDUDN RSVRQL]DV\RQ WHPLQ
HWPHNWLU <DQL &53 DVOÕQGD ELU RSVRQLQGLU &53 WHVDGIL RODUDN 3QHXPRFRFFXVODUÕQ
\]H\LQGHNL & SURWHLQLQH ED÷ODQPD LVWH÷LQGHGLU %X VHEHSOH EX LVPL DOPÕúWÕU
$VSHUJLOOXVODUDGDED÷ODQPD\DPH÷LOOLGLU5RPDWL]PDODWHúVWUHSWRNRNVLNHQIHNVL\RQODUYH
IRNDO HQIHNVL\RQODUGD &53
QLQ VHUXP NRQVDQWUDV\RQX QRUPDOLQ NDWÕQD NDGDU
\NVHOHELOLU&53NDQÕQVHGLPDQWDV\RQKÕ]ÕQÕGDDUWÕUÕU
+DJHPDQIDNW|U3ÕKWÕODúPDIDNNW|U;,,
.DQÕQ SÕKWÕODúPDVÕ WURPERVLWOHULQ LQFLQHQ NDSLOHU HQGRWHOH \DSÕúPDVÕ\OD EDúOD\DQ
YHILEULQRMHQLQILEULQHG|QúPHVL\OHGHYDPHGHQ]LQFLUOHPHUHDNVL\RQODUVÕUDVÕQGDRUWD\D
oÕNDQ SÕKWÕODúPD IDNW|U ;,, +DJHPDQ IDNW|U DGÕQÕ DOÕU .XYYHWOL O|NRVLW NHPRWDNVLVL
\DSDU PDNURIDMODUÕ DNWLYH HGHUHN |]JO YH |]JO ROPD\DQ IDJRVLWR]X DUWÕUÕU +DJHPDQ
IDNW|UQ GR÷UXGDQ DNWLYH HGHELOHQ PDGGHOHU úXQODUGÕU FDP NDROLQ NROODMHQ ED]DO
PHPEUDQODUÕQ YH GDPDU HQGRWHO KFUHOHULQLQ \ÕNÕP UQOHUL HQGRWRNVLQ VRG\XP UDW
kristalleri, tripsin, kallikrein, plasmin, lipopolisakkaritler ve faktör XI.
+DJHPDQIDNW|UDNWLYHROXQFD|QHPOLROD\JHUoHNOHúLUùHNLO
1.
Kinin konversiyonu: Hageman faktörü damar endoteline temas eder
HWPH] SUHNDOOLNUHLQ
LQ NDOOLNUHLQ
H G|QúWUU 6HUEHVWOH\HQ NDOOLNUHLQ
NLQLQRMHQ
L NLQLQ
OHUH G|QúWUU 'RNXGD DoÕ÷D oÕNDQ EUDGLNLQLQOHULQ
PDNURIDMODUÕQGÕúÕQGDELUND\QD÷ÕGDEXGXU.LQLQOHULQHQEHOLUJLQ|GHYOHUL
damar permiabilitesinin aUWÕUÕOPDVÕ YH YD]RGLODWDV\RQ %X VÕUDGD DoÕ÷D
oÕNDQ DUD EDVDPDN UQOHULQGHQ NDOOLNUHLQ KHP NHPLN \ÕNÕPGD URO R\QDU
KHP GH \HQLGHQ +DJHPDQ IDNW|UQ DNWLYH HGHU %X VLVWHP X\DUÕOÕQFD
iyice bilinmeyen bir sebeple mast hücreleri ve bazofillerden histamin
sDOÕQPDNWDGÕU
2.
3OD]PLQILEULQROL]LQLQGNVL\RQX3OD]PLQRMHQQRUPDOGHNDQGRODúÕPÕQGD
EXOXQXU .DQ SÕKWÕODúWÕ÷ÕQGD SOD]PLQRMHQ SOD]PLQ
H G|QúU 3OD]PLQ
HQIODPDV\RQGD |QHPOL UROHUL RODQ ELU PHGL\DW|U JLEL GDYUDQÕU ILEULQ
örtüsünü sindirir, böylecH ILEULQLQ YD]RGLODW|U HWNLVLQL RUWDGDQ NDOGÕUÕU NLQLQRMHQ ]HULQH HWNL HGHUHN NLQLQ ROXúXPXQX DUWÕUÕU NRPSOHPDQÕ
aktive eder. Plazmin indüksiyonuna sebep olan yegane faktör Hageman
IDNW|U GH÷LOGLU D\UÕFD 03$ 0DFURSKDJH 3ODVPLQRJHQ DFWLYDWRU
URNLQD]YHWULSVLQVWUHSWRNRNODUÕQVWUHSWRNLQD]
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LLQGNOHU
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$UDúLGRQLNDVLWPHWDEROLWOHUL
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GXUXPXQGDWDPLUROD\ODUÕDUDúLGRQLNDVLWDUDFKLGRQLFDFLG
LQPHWDEROL]PDVÕLOH\UWOU
%X PHWDEROL]PDQÕQ ELU SDUoDVÕ RODUDN DUDúLGRQLN DVLW IDUNOÕ PDGGH\H G|QúHELOLU
protoglandin, lökotrien (leukotrien) ve tromboksan (thromboxane). Hücrenin hasar
J|UPHVLQH JHUHN NDOPDGDQ IRVIROLSD] LVLPOL HQ]LPOHU JHUHNWL÷LQGH DUDúLGRQLN DVLWL
RNVLWOH\HUHN EX PDGGHOHULQ RUWD\D oÕNPDVÕQÕ VD÷OD\DELOLU %XUDGD |QHPOL URO R\QD\DQ
IRVIROLSD]
GÕUIRVIROLSD]
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PHPEUDQÕQGDNL DUDúLGRQLN DVLWL VDQL\HOHU LoHLVLQGH RNsitleyebilecek kabiliyettedir.
)RVIROLSD]
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dQN /7' /7& /7( PXNXV VHNUHV\RQXQX DUWÕUÕU YH EURQNRVSD]P \DSDU %XQXQ
GR÷DO VRQXFX RODUDN 16$,' NXOODQDQ KDVWDODUGD |NVUN Q|EHWOHUL EDúODPDNWDGÕU %X
EURQú VSD]PÕQGDQ O|NRWULHQOHU VRUXPOXGXU hUHWLFL ILUPDODU LVH EXQXQ EDVLW ELU DOOHUML
ROGX÷XQXLGGLDHWPHNWHGLU
Kortikosteroidler fosfolipaz aktivasyonunu bloke ettikleri için, hem lökotrienlerin hem
de prostRJODQGLQOHULQ ]HULQH HQJHOOH\LFL HWNL J|VWHULU %HONLGH EX VHEHSOH VD\ÕVÕ] N|N
NDQDO GROJX PDGGHVLQLQ \DSÕVÕQD NRUWLNRVWHURLG LODYH HGLOPLúWLU %XUDGD ELU VRUX LúDUHWL
EXOXQPDOÕGÕU .|N NDQDOÕ GROJX PDGGHOHUL NRUWLNRVWHURLG LKWLYD HWPHOL PLGLU" <RUXP
okuyXFX\DEÕUDNÕOPÕúWÕU
TGF-ß (Transforming Growth Factor):
%X PDGGH QRUPDOGH VHUXPGD SHN D] PLNWDUGD EXOXQXU (QIHNVL\RQ VÕUDVÕQGD
NRQVDQWUDV\RQX \NVHOLU *|UHYL \HQL GDPDU ROXúXPXQX VD÷ODPDNWÕU $\UÕFD EDúND ELU
|]HOOL÷L GH JD\HW VSHVLILN ELU HWNL LOH ED]Õ KFUHOHULQ oR÷DOPDVÕQÕ DPD ED]ÕODUÕQÕQ
D]DOPDVÕQÕ WHPLQ HWPHNWLU $GHWD LPPQ FHYDEÕ GXUGXUDELOPHN LoLQ JHUHNHQ KHU HWNL\L
J|VWHUHFHN ELU |]HOOL÷L YDUGÕU 7 KFUHOHULQLQ PLWRWLN DNWLYLWHVLQL D]DOWÕU PDNURIDM
aktivasyonunu engeller, pekçok sitokini nötUDOL]HHGHUHNKHGHIGRNX\DYDUPDODUÕQDHQJHO
ROXU 7F KFUHOHULQL SDVLI KDOH JHWLULU øPPQ VLVWHPLQ IUHQ PHNDQL]PDODUÕQGDQ ELULVLGLU
.URQLNSHULDSLNDOHQIHNVL\RQGDYHSHULDSLNDONLVWROXúXPXQGDSHULDSLNDOGRNXODUGDYDUOÕ÷Õ
WHVSLWHGLOPLúWLU
MIF (Migration Inhibition Faktor):
øOWDKDS VDKDVÕQD XODúDQ PDNURIDMODUÕ KDUHNHW HGHPH] KDOH JHWLULU 0XKWHPHOHQ
PDNURIDMODUÕQEXUDGDQNDoPDODUÕQDHQJHOROPDNWDGÕU
øQWHUIHURQ
øPPQ KFUHOHU YH LPPQ VDYXQPD\D NDWÕOPD\DQ KFUHOHU WDUDIÕQGDQ VDOÕQDQ
polipeptitlerdLU.D\QD÷ÕQÕDOGÕ÷ÕKFUH\HYHYD]LIHOHULQHJ|UHVÕQÕIODQÕUODU
ILF-a (Alfa interferon): Lökositlerde ve monositlerde sentezlenir, virus
KDVWDOÕNODUÕQGD|QHPOLJ|UHYOHUDOÕUODU
ILF-‰ %HWD LQWHUIHURQ )LEUREODVWODUGD VHQWH]OHQLU YLUXV KDVWDOÕNODUÕQGD
öQHPOL J|UHYOHU DOÕUODU +HP D KHP GH ‰ LQWHUIHURQ YLUXV WHPDVÕ LOH VHQWH]OHQLU
YLUXVD GH÷LO NRQDN KFUH\H |]JOGU <DQL ELU YLUXVD NDUúÕ UHWLOHQ IDUH
LQWHUIHURQODUÕLQVDQKFUHOHULQLEXYLUXVNDUúÕNRUX\DPD]ODU
ILF-G (Gamma interferon): T hücreleri tDUDIÕQGDQ VHQWH]OHQLU LPPQ
NRRUGLQDV\RQ VÕUDVÕQGD |QHPOL J|UHYOHUL YDUGÕU 0DNURIDMODUGDQ 71) YH ,/-1
VDOÕQPDVÕQÕ UHJOH HGHUOHU 2VWHRNODVWODUÕQ X\DUÕOPDODUÕQÕ HQJHOOHUOHU 3HULDSLNDO
dokuda kronik enfeksiyon döneminde bulunur.
<XNDUÕGDDQODWÕODQODUGÕúÕQGDSHNoRNVLWRNLQHQIODPDV\RQGDURODOÕU*0&6)*UDQXORF\WH
Macrophage Colony Stimulating Factor), MMCSF (Monocyte Macrophage Colony
Stimulating Factor), G-&6) *UDQXORF\WH &RORQ\ 6WLPXODWLQJ )DFWRU YH GDKD SHN D]Õ
WDQÕPODQDELOPLú VD\ÕVÕ |QFHGHQ NHVWLULOHPH\HFHN NDGDU ID]OD RODQ HQIODPDV\RQ VDOJÕVÕ
YDUGÕU+HSVLQLQD\UÕELU|QHPLYHUROXEXOXQGX÷X]DQQHGLOPHNWHGLU
.203/(0$16ø67(0ø
\ÕOÕQGD WHVDGIHQ \DSÕODQ ELU J|]OHP VÕUDVÕQGD PHPHOLOHULQ WD]H VHUXPODUÕQÕQ ED]Õ
EDNWHULOHUL HULWWL÷L RUWD\D NRQPXúWXU 6HUXP NDQÕQ úHNLOOL HOHPHQW LKWLYD HWPH\HQ VÕYÕ
NÕVPÕGÕUYHEDNWHULOHULVHoHUHN|OGUHFHNVDYXQPDKFUHOHULQGHQ\RNVXQGXU7D]HVHUXP
LoHULVLQGH EDNWHULOHULQLQ OL]LV ROPDODUÕQÕ VD÷OD\DQ QHGLU" øOJLQoWLUNL VHUXP ÕVÕWÕOGÕ÷ÕQGD C, 30 dakika) EDNWHULOHU OL]LVROPDPDNWDGÕU2KDOGHVHUXPLoHULVLQGHÕVÕWÕOPDNODLQDNWLYH
RODQELUEDúNDVDYXQPDPHNDQL]PDVÕGDKDEXOXQPDOÕGÕU%XJQEXVLVWHPHkompleman
(complement) sistemi diyoruz.
.RPSOHPDQ VLVWHPLQGH GHQ \H NDGDU QXPDUDODQGÕUÕOPÕú ‰-globXOLQ \DSÕGD
SURWHLQOHU URO R\QDU %X SURWHLQOHU FRPSOHPHQW NHOLPHVLQLQ EDú KDUIL RODQ & LOH
DGODQGÕUÕOÕU %DNWHUL\ROL]LV ROD\ÕQÕ VD÷OD\DQ LON WDQHVLGLU YH & && & RODUDN
QXPDUDODQGÕUÕOÕU .RPSOHPDQ VLVWHPL NÕVPHQ KFUHGHQ ED÷ÕPVÕ] |]JO ROPayan konak
VDYXQPDVÕQÕROXúWXUXU1RUPDOGHVHUXPLoHULVLQGHEXOXQDQKHUELUNRPSOHPDQSURWHLQLELU
oRN PROHNOGHQ ROXúXU %X SDUoDODU &D WDUDIÕQGDQ ELU DUDGD WXWXOXU .RPSOHPDQ
SURWHLQOHUL PLNURS DQWLMHQOHULQLQ X\DUÕVÕ LOH ED÷OÕ ROGXNODUÕ PROHNOGHQ Noparak
VHUEHVWOHúLUOHU YH ]LQFLUOHPH ELU UHDNVL\RQX EDúODWÕUODU %X UHDNVL\RQ XQFX KDPOHGH
PLNURSKFUHVLQLQOL]LVLLOHVRQXoODQÕU.RPSOHPDQVLVWHPLQDNWLYDV\RQXLNL\ROGDQROXU
Klasik yol ve 2. alternatif yol.
Klasik aktivasyon yolu: .RPSOHPDQÕQ Eu yöntem ile aktive edilebilmesi için
DQWLMHQLQ|]JODQWRNRUODULOHED÷ODQPÕúROPDVÕNROD\OÕNVD÷ODUøON|QFH&
LROXúWXUDQT
SDUoDVÕ DQWLMHQ DQWLNRU NRPSOHNVLQL WDQÕU EXOXQGX÷X & NRPSOHNVLQGHQ NRSDU YH DQWLMHQ
DQWLNRU NRPSOHNVLQH \DSÕúÕU & \DSÕVÕQGD EXOXQDQ U YH V SDUoDODUÕ VHUEHVW KDOH JHOLU
$oÕNWDNDODQEXSDUoDODUD&VYH&UGL\HOLP%XQODUGDQ&VDVOÕQGDL\LELU&DYFÕVÕGÕU
& PROHNOQ EXOXU YH RQGDQ NoN ELU SDUoD NRSDUÕU .RSDQ SDUoD &D
GÕU YH KÕ]OD
bozunarak yok olur. C4'ün geridHNDODQ&ESDUoDVÕDQWLMHQHED÷ODQÕU%XQGDQVRQUD&
GHYUH\H JLUHUHN &E
\H ED÷ODQÕU )DNDW EX ED÷ODQPD LoLQ RUWDPGD PXWODND 0J
EXOXQX\RU ROPDOÕGÕU ùLPGL &
QLQ DQWLMHQ WDúÕ\DQ SDUoD\D PHVHOD PLNURS KFUHVLQH
ED÷ODQPDVÕJHUHNOLGLU2VÕUDGDRUWDPGDEXOXQDQ&VPROHNO&
GHQELUSDUoDNRSDUWÕU
2UWDPGDNL &V
QLQ QHGHQ VHUEHVW &
GHQ SDUoD NRSDUWPDGÕ÷Õ ELOLQPHPHNWHGLU &V
VDGHFHDQWLMHQH\DSÕúPÕúRODQ&
GHQSDUoDNRSDUWDELOPHNWHGLU&
GHQJHUL\HNDODQ&D
SDUoDVÕGÕU YH DQWLMHQL WDúÕ\DQ PHPEUDQÕ VÕNÕFD NDYUDU ùLPGL DUWÕN DQWLMHQLN \]H\GH
&ED NRPSOHNVL YDUGÕU øúWH EX NRPSOHNV C3 konvertaz DGÕQÕ DOÕU FRQYHUWDVH G|QúWUF
2OD\ ]LQFLUOHPH RODUDN GHYDP HGHU 6LVWHPDWLN YH oRN KÕ]OÕGÕU %X GHID &
NRQYHUWD] & SURWHLQLQGHQ &D SDUoDVÕQÕ NRSDUWÕU JHULGH NDODQ &E SDUoDVÕ DQWLMHQLN
\]H\H |QFHGHQ \DSÕúPÕú EXOXQDQ NRPSOHNVL VDUDU YH RQX JHQLú ELU \]H\GH |UWHU %X
]LQFLUOHPH UHDNVL\RQXQ EX KDONDVÕQÕ DNOÕQÕ]GD WXWXQX] 7DP EXUDGD NRPSOHPDQ
VLVWHPLQLQJoOELUILUHQPHNDQL]PDVÕYDUGÕU
%X \HQL ROXúDQ PROHNO &EDE NRPSOHNVLGLU YH GL÷HU DGÕ & NRQYHUWD]GÕU %X
NRPSOHNV&PROHNOQGHQDSDUoDVÕQÕNRSDUWDUDNX]DNODúWÕUGÕNWDQVRQUDJHULGHNDODQE
SDUoDVÕQÕ NHQGL ]HULQH oHNHU &EDEE NRPSOHNVLQL ROXúWXUXU %XQXQ DGÕ &
NRQYHUWD]
GÕUYHEXSDUoDQÕQ|PUVDQL\HGLU%XNRPSOHNV&
QLQESDUoDVÕQՁ]HULQH
DODUDN & NRQYHUWD]Õ ROXúWXUXU %X PROHNO OLSRILOLNWLU DQWLMHQ WDúÕ\DQ KFUHQLQ
PHPEUDQÕQGDNL OLSLW WDEDND\D WXWXQXU YH KDILIoH LoHUL J|oHUHN SROLPHUL]H ROXU %X DUDGD
C8b'yi kendi üzerine çeker.
1RW%XUDGDDoÕ÷DoÕNDQ&DKLoELU\HUHED÷ODQPD]YHDPLQRDVLWWHQROXúDQELU
SROLSHSWLWWLU 3HSWLW ]LQFLULQLQ VRQ KDONDVÕQGD DUMLQLQ EXOXQXU 'RODúÕPD NDWÕODQ EX PDGGH
DúÕUÕGX\DUOÕOÕNWHSNLPHOHULQHVHEHSROXU&D
GDE|\OHGDYUDQÕU%XLNLNRPSOHPDQDUWÕ÷ÕQD
anafilatoksinDGÕYHULOLU
0HPEUDQD KFXP NRPSOHNVL 6ÕUD &
D JHOGL÷LQGH ]DUDU YHULOHFHN KFUH ]DUÕQGD
&EDEEEEE NRPSOHNVL YDUGÕU YH ]DU oXNXUODúPÕú YD]L\HWWHGLU & PROHNO EX
NRPSOHNVH\DSÕúÕUYHKHGHIPHPEUDQGDELQOHUFHGHOLNDoDU%XGHOLNOHUGHQKHUELULQLQoDSÕ
100-115 A 'dür. Hedef hücrenin osmotik dengesi bozulur ve lizis olur.
%XUD\D NDGDU JHUoHNOHúHQ ROD\ODU ]LQFLUL NODVLN \ROGXU %X ]LQFLUOHPH UHDNVL\RQXQ
ELUEDúNDWHWLNPHNDQL]PDVÕGDKDYDUGÕU
Alternatif aktivasyon yolu: Kompleman sisteminin aktivasyonu C3 proteininin
SDUoDODQPDVÕ\OD EDúODU & GH÷LO )DNDW KDQJL & NRQYHUWD] & PROHNOQ X\DUDUDN
ROD\ÕQ LoHULVLQH oHNPHNWHGLU" 2OD\ NHQGL QRUPDO VÕUDVÕ LOH EDúODVD YH GHYDP HWVH\GL
C4b2a kompleksi C3 konvHUWD]J|UHYLJ|UHFHNWLIDNDW&QDVÕOGR÷UXGDQX\DUÕOPDNWDGÕU"
%XUDGD &
 WHWLNOH\HQ EDúND PROHNOOHU ROGX÷X ]DQQHGLOPHNWHGLU 0HNDQL]PDVÕ
JD\HWNDUPDúÕNIDNDWJD\HWVLVWHPDWLNWLU%XUDGDNLPHNDQL]PDVHUXPGDNL)DNW|U$%&
'DGÕYHULOHQED]ÕSURWHLQOHULQD\QHQNRPSOHPDQVLVWHPLQGHROGX÷XJLELELUELUOHULQLDNWLYH
HGHUHN ]LQFLUOHPH UHDNVL\RQODU LOH %E PROHNOQ ROXúWXUPDVÕ LOH VRQ EXOXU %X PROHNO
(Bb), C3 konvertaz gibi etki ederek, C3'ü tetikler. Daha sonra bu molekül serum properdini
ile birleúLU YH\D \ÕNÕOÕU &E ]DUD JLGHUNHQ &D DQDIODWRNVLQ VHUEHVW NDOÕU 2OD\ODUÕQ
GHYDPÕ D\QHQ \XNDUÕGD DQODWÕOGÕ÷Õ JLELGLU VDGHFH EDúODQJÕFÕ & GHQ GH÷LO & GHQ ROXU
'LNNDW%X\ROLOHNRPSOHPDQX\DUÕOPÕúVD&&YH&UHDNVL\RQGÕúÕQGDEÕUDNÕOÕU
%D]Õ EDNWHUL DQWLMHQOHUL GR÷UXGDQ & NRQYHUWD] HWNLVL J|VWHUHUHN & SURWHLQ
kompleksi içerisinden C3b'yi kendi üzerlerine çekerler. Bunlar talihsiz bakterilerdir, çünkü
NHQGLVLQL \RN HGHFHN NRPSOHPDQ UHDNVL\RQXQX NHQGLVL EDúODWPDNWDGÕU 'L÷HU ED]Õ
bakteriler ELOKDVVD 1HLVVHULD JUXEX LVH & SDUoDVÕQÕ NXYYHWOH LWHUOHU YH \ÕNDUODU EX
EDNWHULOHU LOH ROXúDQ HQIHNVL\RQODUGD NRPSOHPDQ VLVWHPLQLQ & SDUoDVÕ ]DUDU J|UU
PHQHQMLWEHOVR÷XNOX÷XJLEL
.RPSOHPDQ VLVWHPLQGH ]LQFLUOHPH UHDNVL\RQODU VÕUDVÕQGD ELU oRN PRlekül bir
GL÷HULQLWHWLNOHPHNWHGLU%XROD\ODUSURIHV\RQHOELUHNLSoDOÕúPDVÕQDEHQ]HU<HQLPH\GDQD
JHOHQ PROHNOOHU ELU |QFHNLQLQ HWNLVLQL DUWÕUPDNWDGÕU 'ROD\ÕVÕ\OD NHQGL NHQGLVLQLQ HWNLVLQL
DUWÕUPDNWDGÕU%XVWHOELUIRQNVL\RQGXUYHROD\ODUÕQLYPHVLQLKÕ]ODQPDKÕ]OÕOÕ÷ÕDUWÕUÕU
E|\OH UHDNVL\RQODU ELU SDWODPD úHNOLQH G|QúU %XQD LPPQ DPSOLILNDV\RQ GHQLU %X
|]HOOLN NRQDN LoLQ ELU WHKOLNHGLU .RPSOHPDQ VLVWHPL ELU GHID KDUHNHWH JHoHUVH QDVÕO YH
QHUHGHGXUDFDNWÕU"
Serumda "C1 inaktivatör" ve "&E LQDNWLYDW|U DGÕ YHULOHQ LNL SURWHLQ EXOXQXU øúWH
EXQODU NRPSOHPDQ VLVWHPLQLQ ILUHQ PHNDQL]PDODUÕQÕ WHPLQ HGHU &E LQDNWLYDW|U VDGHFH
alternatif aktivasyon yolunu inhibe eder. C1 inaktivatör, klasik aktivasyon yolunda
GXUDNVDPD \DUDWÕU DOWHUQDWLI DNWLYDV\RQD ELU HWNLVL \RNWXU & LQDNWLYDW|U D\QÕ ]DPDQGD
NLQLQ NDOOLNUHLQ PHWDEROL]PDVÕQD YH +DJHPDQ IDNW|UQQ X\DUÕOPDVÕ ]HULQH GH LQKLELW|U
HWNL J|VWHULU %D]Õ LQVDQODUÕQ VHUXPXQGD & LQDNWLYDW|U GR÷XPVDO GHIHNWOLGLU YH\D KLo
yoktur (herediter anjiyRQ|URWLN |GHP %X SURWHLQOHU VD÷OÕNOÕ NLúLOHULQ VHUXPODUÕQGD HVHU
miktarda bulunurlarken, kompleman aktive olduktan sonra ve zara hücum kompleksi
ROXúWXNWDQVRQUDVHUXPNRQVDQWUDV\RQODUÕQGDDUWÕúROXUKDWÕUODWPDLNL]ÕWPHNDQL]PDQÕQ
ELUGHQEDúODWÕOPDVÕNXUDOÕøPPQVLVWHPLoHULVLQGHVD\ÕVÕ]LPPQDPSOLILNDV\RQODUYDUGÕU
Hepsinin birer feed-EDFNPHNDQL]PDLOHoDOÕúDQGXUGXUXFXVLVWHPOHULGHYDUGÕU
.RPSOHPDQDNWLYDV\RQXLOHúXQODUVD÷ODQÕU
1.
2.
3.
4.
+HU ELU NRPSOHPDQ SDUoDVÕ ELU GL÷HULQH ED÷ODQGÕ÷ÕQGD 7 OHQIRsitleri,
fagositler ve NK hücreleri için daha cazip olurlar. Fagositik hücreler için
KHGHIWHúNLOHGHUOHUYHIDJRVLWLNKFUHOHULQEXDQWLMHQLN\DSÕ\ÕWDQÕPDODUÕQD
\DUGÕP HGHUOHU %|\OH |QFHGHQ LúDUHWOHQPLú DQWLMHQLN \DSÕODUÕQ IDJRVLWLN
KFUHOHU WDUDIÕQGDQ \XWXOPDVÕQD opsonizasyon denir. Opsonizasyonda
IDJRVLWOHUH GDYHWL\H DQODPÕQGD URO DODQ NRPSOHPDQ SDUoDODUÕQD WRSOXFD
opsonin denir.
.RPSOHPDQ SURWHLQOHULQLQ NRPSOHNV ROXúWXUPD\DQ SDUoDODUÕ GRODúÕPGDNL
VDYXQPD HOHPDQODUÕQÕ EXUD\D oHNHU YH LOWLKDEÕQ JLGLúLQL etkileyecek
PHGLDW|UOHULQVDOÕQPDVÕQÕX\DUÕUDUWÕUÕU
.XOODQÕOPD\DQ SDUoDODU NHQGL EDúODUÕQD ELU YD]RDNWLI PHGLDW|UGU NDSLOHU
SHUPLDELOLWH\L DUWÕUDUDN EXUD\D GDKD ID]OD VHUXP JHOPHVLQL VD÷ODUODU
(anaflatoksin gibi).
%XQODUÕ \DSDELOPHN LoLQ NRQDN VDYXQPa hücrelerine büyük ölçüde
LKWL\DoODUÕ\RNWXU
$ù,5,'8<$5/,/,.5($.6ø<21/$5,
Antijenin kabulu ile tetiklenen immün sistem ne zamana kadar cevap vermeye
GHYDP HGHU" $QWLMHQ WDPDPHQ ND\EROXQFD RUWDPGDNL DQWLNRU ID]ODVÕ DQWLMHQ-antikor
kompleksleri ne ROXU"øPPQDPSOLILNDV\RQQHGHQL\OHJLWWLNoHDUWDQFHYDSQDVÕOGXUXU"
(÷HU LPPQ VLVWHPLQ ELU IUHQ VLVWHPL EXOXQPDVD\GÕ EX UHDNVL\RQODU PXKWHPHOHQ
NRQD÷ÕQKD\DWÕER\XQFDDUWDUDNGHYDPHGHUGL$QWLMHQLQNRPSHWDQKFUHOHUHVXQXOPDVÕQÕ
hemen takiben immün VLVWHPLQ EDVNÕOD\ÕFÕ KFUHOHUL GH DNWLYH ROXUODU %XQODU 7V
OHQIRVLWOHUGLU $\UÕFD 7*)-‰ VDOÕQÕPÕ GD DUWPD\D EDúODU GDKD ELU oRN PHNDQL]PD LPPQ
sistemin artan faaliyetlerine engelleyici yönde etki gösterir. O halde, immün cevap bir
"kuvvetler dengesi úHNOLQGH EDúODU |\OH GHYDP HGHU YH VRQ EXOXU %XUDGD LPPQ
faaliyetleri destekleyen ve onu durduran iki antagonist mekanizmadan bahsetmek gerekir.
øNL NXYYHW DUDVÕQGDNL HWNLOHúLP RUWDPGDNL DQWLMHQ NRQVDQWUDV\RQX LOH NRRUGLQH HGLOLU
$QWLMHQLN X\DUÕQÕQ DUWPDVÕ LPPQ IDDOL\HWOHUL GHVWHNOH\HQ PHNDQL]PDODUÕX\DUPDNWDIDNDW
HQJHOOH\HQPHNDQL]PDODUÕGR÷UXGDQX\DUPDPDNWDGÕUgUQH÷LQDQWLMHQOHUGR÷UXGDQ%
hücrelerini ve fagositleri uyarabilirler ama Ts hücrelerini uyaramazlar. Bu da
göstermektedirki immün sistemi dXUGXUDQ PHNDQL]PDODU HNVRMHQ X\DUÕODUD VD÷ÕUGÕU
VDGHFHHQGRMHQNRPXWODULOH\|QHWLOLU%|\OHROPDVÕGDJHUHNLU
Bu koordinasyon bozulursa ne olur ? Engelleme lehine immün koordinasyon
ER]XNOXNODUÕ LPPQ WROHUDQV JHOLúWLULUNHQ GHVWHNOH\LFL VLVWHPLQ OHKine bozulan dengeler
DúÕUÕGX\DUOÕOÕNUHDNVL\RQODUÕQÕJHOLúWLULU
'|UW WLS DúÕUÕ GX\DUOÕOÕN UHDNVL\RQX ELOLQPHNWHGLU YH KHSVLQGH GH HQJHOOH\LFL
PHNDQL]PDODUVXVNXQGXUYH\D\HWHUVL]GLUYH\D\DQOÕúKHGHIHEDVNÕ\DSPDNWDGÕU
7ø3- DúÕUÕ GX\DUOÕOÕN .RQD÷D Jiren antijen, dakikalar hatta saniyeler ile ölçülebilecek
NDGDU NÕVD ELU VUH LoHULVLQGH DEDUWÕOPÕú ELU LPPQ FHYDS J|UU %XQD DQDILODNVL YH\D
DWRSLN DOOHUML GH GHQLU H÷HU NRQDN LQVDQ LVH DWRSLN DOOHUML WHULPL WHUFLK HGLOLU $QWLMHQ
hiçbir hücreye sXQXOPDGDQKHPHQJLULú\HULQGHYH\DGRODúÕPDJHoHUJHoPH]ED]RILOYH
PDVWKFUHOHULWDUDIÕQGDQ\DNDODQÕUYHNDEXOHGLOLU+HPHQROXúDQDQWLNRUODUNDQDG|NOU
Bunlar IgE tipindedir. Normalde IgE tipi antikorlar serumda 50 mg/ml konsantrasyonda
bulunurlaUIDNDWDQDILODNVLGXUXPXQGDNRQVDQWUDV\RQODUÕ-PJPO
\HXODúÕU0DVW
KFUHOHUL NHQGL VDOGÕNODUÕ ,J( DQWLNRUODUÕQD GX\DUOÕGÕUODU .HQGL VDOGÕNODUÕ ,J( LOH WHPDVD
JHOLQFH X\DUÕOÕUODU YH GDKD oRN DQWLNRU VDODUODU $UWDQ X\DUÕ LOH PDVW KFUHOHULQLQ
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mast hücreleri ve bazofiller bol miktarda IL-1, IL-2 ve IL-6 salarlar. 'L÷HULPPQKFUHOHUL
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bahsedilebilmektedir. Hangi maddenin, hangi konakta, ne zaman anafilaksi
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lenfositleri, trombosit, nötrofil, makrofaj, monosit, eozinofil'lerdir. Bunlar (bilhassa
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molekülüdür, sekonder hedef ise antijen-antikor kompleksleridir.
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benzemezini mi seçip, tespit etmektedir?, daha önemlisi bu antijenin kendisine ait bir
PROHNOROXSROPDGÕ÷ÕQÕQHUHGHQDQODPDNWDYHQH\HJ|UHNDUDUYHUPHNWHGLU"
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OHUWDUDIÕQGDQ0+&
VÕQÕI DQWLMHQLQH ED÷ODQDUDN 7K
ODUD VXQXOPDNWD LNHQ D\QL DQWLMHQ NRQDNWD oR÷DODUDN
\D\ÕOPDNWD RODQ ELU PLNURRUJDQL]PDGDQ JHOL\RUVD R ]PDQ 0+& VÕQÕI DQWLMHQOHUH
ED÷ODQDUDN7FKFUHOHULQHVXQXOXU%XD\ÕUÕPÕQQDVÕO\DSÕOGÕ÷ÕELOLQPHPHNWHGLU
$3&
OHUWDUDIÕQGDQL\LFHWDQÕPÕ\DSÕODQYHKDWWDQDVÕO\RNHGLOHFH÷LGDKLWHVSLWHGLOHQ
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WDUDIÕQGDQ\DNDODQÕUODU0DNURIDMYH%OHQIRVLWOHULQLQ\]H\OHULQGHGHD\QÕUHVHSW|UOHUGHQ
EXOXQGX÷XLoLQEXKFUHOHUGH7OHQIRVLWOHULQHVXQXODQDQWijenden haberdar olurlar.
0DNURIDMODU&6)VDODUODULúDUHWOHQPLúDQWLMHQWDúÕ\DQKHUSDUoD\ÕVLQGLUPHN]HUHVD\ÕFD
DUWPD\D EDúODUODU $\UÕFD 7K WDUDIÕQGDQ VDOJÕODQDQ VLWRNLQOHU ,/-1, IL- NHPLN LOL÷LQGHQ
yeni monosit serilerinin kana dokulmesini temin eder. Bu monositler süratle makrofajlara
G|QúUYHLúDUHWOLDQWLMHQL|÷UHQLU%XDQWLMHQLYHRQXWDúÕ\DQKHUPDNURPROHNOELUKHGHI
kabul ederek fagositoz yapar.
0+& VÕQÕI DQWLMHQOHUL 7K OHQIRVLWLQLQ \]H\LQGHNL &' PROHNOQQ R\X÷XQD
oturabilir ve ELOL\RUX]NL&'VDGHFH7KKFUHOHULQLQ\]H\LQGHEXOXQXU6RQ\ÕOODUDNDGDU
0+& VÕQÕI PROHNO YH LPPQRMHQLN SURWHLQLQ D\UÕ D\UÕ WDQÕQGÕ÷Õ ]DQQHGLOL\RUNHQ VRQ
\ÕOODUGD EX LNLVLQL D\QÕ DQGD WDQÕ\DQ ELU UHVHSW|UQ 7&5-2) Th lenfositlerinin yüzeyinde
buOXQGX÷XJ|VWHULOPLúWLU7K\]H\LQGHD\UÕFD&'PROHNOGHEXOXQXU%XPROHNO
SHSWLW ]LQFLULQGHQ ROXúXU 0ROHNOQ JDPPD HSVLORQ YH GHOWD ]LQFLUOHUL KFUHQLQ GÕúÕQD
ELUHUGRPDLQLOPLNKDONDLOHX]DQÕUODUYH7&5-2 ile temas halindedirler. ZincirinGL÷HUXFX
hücre içerisine girerek negatif yüklü aspartik asit kökleri ile son bulur. Bu molekül, Th
KFUHVLQLQLoLYHGÕúÕDUDVÕQGDELUN|SUYD]L\HWLQGHGLUYH7&5-
OHULQ]HULQH0+&VÕQÕI
LPPQRMHQSURWHLQNRPSOHNVLQLQED÷ODQGÕ÷ÕELOJLVLQLKFUH içerisine iletir, aspartik asit
N|NOHUL IRVIRULOH ROXU %X IRVIRULODV\RQ 7K KFUHVLQL NXYYHWOH X\DUÕU IDNDW oR÷DOPD\Õ
EDúODWDPD] 2OD\ÕQ EX VDIKDVÕQGD GL÷HU ED]Õ NLP\DVDO PHGL\DW|UOHULQ GH URO R\QDGÕ÷Õ
WHVSLW HGLOPLúWLU +DWWD JHUHNLUVH $3&
QLQ 7K KFUHVLQH GR÷UXGDQ WHPDV HGHUHN EDúND
ELOJLOHU DNWDUPDVÕ JHUHNHELOLU 0XKWHPHOHQ EX GLUHNW WHPDV LOH ,J VSHU JHQ DLOHVL YH\D
LQWHJULQJHQDLOHVLQHDLWNURPR]RPDOELOJLOHUDNWDUÕOPDNWDGÕU$\QÕDQWLMHQ\ÕOODUVRQUDWHNUDU
7K KFUHOHULQH VXQXOGX÷XQGD $3& - Th adezyonuna gerek olmadan Th hücresi
oR÷DOPD\DEDúODGÕ÷ÕQDJ|UHEXELOJLOHUVXQXODQDQWLMHQKDNNÕQGDLOHULELOJLOHUYH\DEHOOHN
ELOJLOHULRODELOLU'DNLNDODUVRQUDKFUHQLQS+
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$UWÕN7KKFUHOHULNROD\FDGXUGXUXODPD\DFDNúHNLOGHDNWLYHROXUODUNRUWLNRVWHURLGOHU
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EDúODPDVÕGÕU %X 6 ID]ÕGÕU +HU \DYUX KFUH NHQGLVLQH VXQXODQ DQWLMHQL oRN L\L WDQÕ\DQ
UHVHSW|UOHU LOH GRQDWÕOPÕúWÕU %LU \DQGDQ GD ,/-2,4,5,6 salarlar, bu ise yeni lenfositleri, NK
YHPDNURIDMODUÕDNWLYHHGHU%X\HQLROXúDQDQWLMHQH|]JOOHQIRVLWDLOHVLLoLQPRQRNORQDO
teriPLNXOODQÕOÕU%|OQPHOHUVÕUDVÕQGDPRQRNORQDO7KVHULOHULYHEHOOHNPHPRU\KFUHOHUL
ELUOLNWH ROXúXUODU %X VÕUDGD KFUHGH JHQ WUDQVNULSVL\RQODUÕ ROXU %LULQFL VDIKD KHPHQ
dönemi" (immediate phase), ilk 15-GDNLNDGDJHUoHNOHúLU3URWR-onkogenler sentezlenir.
øNLQFL VDIKD HUNHQ G|QHP HDUO\ SKDVH -45 dakika sürer ve interlökin ve interferon
JHQOHUL VHQWH]OHQLU 6RQ VDIKD JHo G|QHP ODWH SKDVH X\DUÕQÕQ LNLQFL YH\D oQF
JQWDPDPODQÕU%|OQHQ7KKFUHOHULQLQED]ÕODUÕEHOOHNKFUHOHULQHIDUNOÕODúÕUEXQODU
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]HUH NDQD G|NOUOHU .HQGLVLQH VXQXODQ DQWLMHQLN \DSÕ\Õ \]H\LQGH EXOXQGXUDQ KHU
makromolekül veya hücre, bu hücreler için cazip bir hedeftir.
B- Endojen antijen muamelesi:$QWLMHQVXQDQKFUHEXGHID\DNDODGÕ÷ÕDQWLMHQL7F
KFUHOHULQHVXQPD\DNDUDUYHUPLúWLU<XNDUÕGDDQODWÕODQROD\ODUD\QHQWHNUDUHGHUIDNDWEX
GHID0+&VÕQÕIDQWLMHQLNXOODQÕOÕU7FKFUHOHULNRQD÷DDLWKFUHOHULQYLUXVlar ile enfekte
RODQODUÕQÕRUWDGDQNDOGÕUPD\DSURJUDPOÕGÕUD\UÕFDNRQD÷DDLWWP|UKFUHOHULQLGHRUWDGDQ
NDOGÕUDELOLUOHU $3&
OHU 0+& VÕQÕI DQWLMHQL LOH LúDUHWOHGL÷L DQWLMHQLN \DSÕ\Õ VDGHFH 7F
OHQIRVLWOHUL DOJÕODU dQN 0+& VÕQÕI DQWLMHQL VDGHFH &'
LQ NRYX÷XQD RWXUXU YH
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eksojen antijen muamelesi). Bu hücreler aktive olduktan sonra, Th, NK ve fagositik
hücreleri aktive eden sinyaller (sitokinler) yollarlar. Bunlar IL-GÕU'X\DUOÕ7F
OHUKHGHI
KFUH\H \DNODúDUDN |QFH WHPDV HGHUOHU GDKD VRQUD IDJRVLWR]XQ DGH]\RQXQD EHQ]HU
úHNLOGH KHGHI KFUH\H WXWXQXUODU YH perforin DGÕ YHULOHQ Nuvvetli proteolitik enzimleri ile
hedef hücrede delikler açarlar. Buradaki mekanizma NK hücrelerinin öldürme
PHNDQL]PDVÕQDEHQ]HUOLNOHUJ|VWHULU
+XPRUDOFHYDEÕQROXúPDVÕ
%OHQIRVLWOHULNHQGLEDúODUÕQDNDUDUYHUPH\H\HWNLOLGLUKDWWD%OHQIRVLWOHULELU APC'dir.
% OHQIRVLWOHUL \]H\OHULQGH ,J \DSÕVÕQGDNL |]JO DQWLNRUODU LOH HQ D] IDUNOÕ \DSÕGDNL
DQWLMHQLWDQÕUODUYHED÷ODQÕUODU'DKDVRQUDLQWHUQDOL]HHGHUOHU\DQLED÷ODQGÕ÷ÕUHVHSW|U
KFUHLoHULVLQHG|QGUUOHUHOGLYHQLQYH\DoRUDEÕQLoLQLQGÕúÕQDoÕNPDVÕJLELGúQQ]
%XQD FDSSLQJ ROD\Õ GHQLU +FUH LoHULVLQH G|QG÷ LoLQ DQWLMHQ LOH KHQ] WDQÕúDQ %
lenfositlerinin yüzeylerinde Ig reseptörler görülmez. Bu reseptörler, Capping'i takiben ilk 24
saate yeniden sentezlenir ve B lenfositinin yüze\LQGHEHOLULU(÷HULQWHUQDOL]HHGLOHQ
DQWLMHQSDUoDVÕELUSURWHLQLVH%OHQIRVLWLELU$3&JLELGDYUDQDUDNGXUXPX7OHQIRVLWOHULQH
KDEHUYHULUYHDQWLMHQHSULPHUPGDKDOH\DSPD](÷HUJOLNROLSLWYH\DSROLVDNNDULW\DSÕGD
ELUDQWLMHQROGX÷XQXIDUNHGHUVH*UDPQHJDWLIEDNWHULGXYDUÕHQGRWRNVLQNDSVOPDWULNVL
somatik O antijeni gibi), bu durumda bu molekülün komplementerini sentez eder. Bu
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VDGHFHKHGHIOHGL÷LDQWLMHQL\DNDOD\DELOLUOHU8\DUÕOPÕú%OHQIRVLWOHULEXDQWLNRUODUGDQEROFD
sentez ederek kana dökerler, bunlara monoklonal antikorlar denir. Tind antijenler
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özgül7OHQIRVLWNORQODUÕROXúPD]%|\OHLPPQFHYDEDVÕYÕVDOKXPRUDOLPPQFHYDSDGÕ
YHULOLU +XPRUDO LPPQ FHYDSWD 7 OHQIRVLWOHUL ROD\D VRQUDGDQ LúWLUDN HGHELOLUOHU )DNDW
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YHYH\D,J$WDELDWÕQGDGÕU
(QGRWRNVLQ YH GL÷HU EWQ SURWHLQ ROPD\DQ DQWLMHQOHU VÕYÕVDO ED÷ÕúÕNOÕN ROXúWXUXU
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|PUER\XNDODQED÷ÕúÕNOÕNROXúXUDúÕODPDJLEL
$QWLMHQ LOH WHPDV HGHQ % KFUHVL DNWLYH RODUDN oR÷DOÕU % KFUHOHULQLQ EDúND
X\DUÕOPD \ROODUÕ GD YDUGÕU ,/-1, IL- YH 7 KFUH DNWLYDV\RQX % KFUHOHULQL X\DUÕU <HQi
ROXúDQ % KFUHOHUL SOD]PD KFUHVL DGÕQÕ DOÕU R DQWLMHQH NDUúÕ DQWLNRU VDOPD\D GHYDP
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$NWLYHROGXNWDQVRQUDNÕVD|PUQQVRQXQDNDGDUGDLPDD\QÕDQWLNRUXVDODU
GenelliNOH KHU KDVWDOÕNWD LON|QFH WHVSLW HGLOHQ DQWLNRUODU ,J0 WLSLQGHGLU oRN DNXW
HQIHNVL\RQODUGD ,J(
GLU +DVWDOÕ÷ÕQ LOHUOH\HQ G|QHPOHULQGH -10 hafta sonra) T
KFUHOHULQGHQ JHOHQ ,J* DQWLNRUODUÕ NDQGD WHVSLW HGLOLU %X DQWLNRUODUGDQ LON ND\ERODQ ,J0
tipindeRODQODUGÕU,J*WLSLDQWLNRUODULVHD\ODUFDED]HQ\ÕOODUFDNDODELOLUOHU
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0HPHRU\ &HOO YH\D KDIÕ]D KFUHOHUL GHQLU %LU KFUHQLQ DLW ROGX÷X VÕQÕIÕ WHUN HGHUHN
EDúND ELU KFUH WLSLQH G|QúPHVLQH switching denir. MC'lerin ömürleri en çok bir kaç
D\GÕU %X G|QHPGH 0&
OHU D\QÕ DQWLMHQ LOH \HQLGHQ X\DUÕOÕUODUVD VHNRQGHU LPPQ FHYDS
ROXúXUdRNKÕ]OÕRODUDNPRQRNORQDO%OHQIRVLWVHULOHULUHWLUOHUE|\OHVHNRQGHUFHYDSODUGD
aQWLNRU VHQWH]L LON GHID \DSÕODQGDQ GDKD EROGXU 3ULPHU LPPQ FHYDEÕQ EDúODPDVÕ -10
JQVUHUNHQVHNRQGHULPPQFHYDEÕQEDúODPDVÕVDDWOHULOH|OoOHELOHFHNNDGDUNÕVDELU
VUHGHEDúODUøNLQFLGHIDNRQD÷DJLUHQDQWLMHQOHU0&
OHUWDUDIÕQGDQDOJÕODQÕUYHEXhücreler
GDODNYHGL÷HUOHQIRLGGRNXODUGDGHUKDO|]JODQWLNRUVDODQSOD]PDKFUHOHULQHG|QúHUHN
oR÷DOÕUODU%|\OHELUGXUXPGDPRQRNORQDO%KFUHVHULOHULDQLGHQYHGDKDERORODUDNNDQGD
WHVSLWHGLOHELOLUEXQDUD÷PHQDQWLNRUVHYL\HVL|OoOG÷QGHGúNolarak bulunur. Bunun
VHEHEL ROXúDQ DQWLNRUODUÕQ DQWLMHQ LOH ELUOHúPHVL YH VHUEHVW KDOGH EXOXQPDPDVÕGÕU 'DKD
VRQUDDQWLNRUID]ODOÕ÷ÕROXúXUYH|OoOHELOHQDQWLNRUVHYL\HVL\NVHOLU
$FDED ELU NRQD÷D oRN \NVHN PLNWDUGD DQWLMHQL ELU GHIDGD YHULUVHN oRN ID]OD PÕ
DQWLNRU FHYDEÕ DOÕUÕ]" %|\OH ELU GXUXPGD % OHQIRVLWOHULQLQ GDYUDQÕúODUÕ EHNOHQHQGHQ IDUNOÕ
ROPDNWDGÕU +XPRUDO LPPQ PHNDQL]PD DQWLMHQ LOH PFDGHOHGHQ YD]JHoPHNWHGLU %XQD
immüntolerans denir.
Sekonder immün cevaptan arta kalan MC'ler, bu antijenleri daha çabuk
KDWÕUOD\DELOHFHN|]HOOLNWHGLUYH|QFHNL0&
OHUGHQGDKDX]XQ|PUOGU%XQDUD÷PHQD\QÕ
DQWLMHQ D\QÕ NRQD÷D GHIDODUFD YHULOGL÷LQGH GDKD ID]OD DQWLNRU FHYDEÕ DOÕQPDPDNWDGÕU
'HQH\KD\YDQODUÕQDGHIDODUFDWHNUDUODQDQD\QÕDQWLMHQLNX\DUÕOar neticesinde monoklonal B
OHQIRVLWOHULQLQ WNHQHELOGL÷LQL YH DUWÕN EHNOHQHQ KÕ]OÕ FHYDEÕ JHOLúWLUPHGL÷L J|UOPHNWHGLU
'HPHNNL YHULOHQ DQWLMHQLQ PLNWDUÕ YH X\JXODPD DGHGL DUWÕUÕOÕUVD KXPRUDO FHYDSWD DUWÕú
olmayabilmektedir. Bu bilgi periapikal enfeksiyRQXQNURQLNOHúPHVLQGHOD]ÕPRODFDNWÕU
%D]Õ PLNURRUJDQL]PDODU NRQD÷ÕQ LPPQ VLVWHPLQ WHWL÷LQL oHNPHVLQL HQJHOOH\HFHN
HQ]LPOHU VDODUODU %X GXUXPGD NRQDN LPPQ VLVWHPLQGH ELU \DQÕWVÕ]OÕN YH\D LPPQ
SDUDOL]L ROXúXU $FWLQREDFLOOXV DFWLQRP\FHWHPFRPLWDQVÕQ N'D D÷ÕUOÕ÷ÕQGDNL
HNVWUDVHOOHUSURWHLQOHULNRQDNGRNXGD7KYH7K]HULQGHGX\DUVÕ]OÕNROXúWXUXUD\UÕFD
IL-2, IL-4, IL-5, IFN-JDPDYHGL÷HUVLWRNLQOHULQVDOÕQÕPÕQÕGXUGXUDUDNKHPKXPRUDOKHPGH
VHOOHU LPPQ FHYDEÕ HQJHOOHU 2FKLDL YH 2FKLDL . Actinobacillus
actinomycetemcomitans periodontitlerinde ne ödem, ne hiperemi ve ne de kanama
ROPDGDQ GR÷UXGDQSHULRGRQWDONHPLNND\EÕYHGLúVDOODQPDODUÕQÕQEDúODPDVÕQÕQVHEHEL
NRQDNLPPQVLVWHPLQLEDVNÕOD\DELOL\RUROPDVÕGÕU3RUSK\URPRQDVJLQJLYDOLVLn 80 kDa'luk
ELU SURWHD]Õ LQVDQ ,J* PROHNOQGHQ )F SDUoDVÕQÕ NRSDUDELOLU YH ,/-6, IL-8 ve TNF-a
VDOÕQPDVÕQÕ WHPLQ HGHU (QJHO YH DUNDGDúODUÕ 6RQXoWD HQIODPDV\RQ DUWDU IDNDW
LPPQ VLVWHP EDNWHUL\L \DNDOD\DPD] ROXU %X EDNWHULQLQ HNVWUDNWODUÕQGDQ olan Arg-1 ve
Arg-1A isimli iki proteaz, IL-1ß, IL-6, ve IL-1 reseptörlerini hidrolize eder. Normalde IL-1ß,
periapikal dokuda fibroblastlardan IL-VDOÕQPDVÕQÕVD÷ODGÕ÷ÕKDOGHRUWDPGD3JLQJLYDOLV
varsa, IL-‰
QÕQEX|]HOOL÷LD]DOÕUND\EROXU)OHWFKHUYHDUNDGDúODUÕ%HQ]HUROD\ODUD
VHEHS RODQ GDKD EDúND EDNWHULOHU GH YDUGÕU )XVREDFWHULXP QXFOHDWXP LQMHNWH HGLOHQ
IDUHOHUGH $33 VHYL\HVLQGH DUWÕú 7K 7V YH PDNURIDMODUÕQ DNWLYH ROPDVÕ DoÕNoD L]OHQLUNHQ
D\QÕ GHQH\ $FWLQREDFLOOXV DFWLQRP\FHWHPFRPLWDQV LOH \DSÕOGÕ÷ÕQGD EHOLJLQ KLo ELU LPPQ
FHYDSL]OHQPH]6DLWRYHDUNDGDúODUÕ
$17ø.25/$5
6HUXPGD JOREXOLQ DGÕ YHULOHQ ELU SURWHLQ EXOXQXU %X SURWHLQLQ HOHNWURIRUH] LOH
WDQÕPODQDELOHQ ELU IUDNVL\RQX JDPPD JOREXOLQ DGÕQÕ DOÕU %D÷ÕúÕNOÕN PHNDQL]PDVÕQGD URO
alan bu globulinlere immünglobulin ,J DGÕ YHULOLU øPPQJOREXOLQOHULQ DVÕO UH]HUYXDUÕ
VHUXPGXU IDNDW GRNX VÕYÕODUÕQGD GD EXOXQXU øPPQJOREXOLQOHU PROHNOHU \DSÕVÕQGDNL
IDUNODU QHGHQL\OH $ ' ( 0 YH * RODUDN VÕQÕID D\UÕOÕU %X LPPQJORbulinler, plazma
KFUHOHUL WDUDIÕQGDQ LúOHQHUHN WHNUDU VHUXPD EÕUDNÕOÕU E|\OHFH ,J$ ,J' ,J( ,J0 YH ,J*
úHNOLQGH \D]ÕOÕU YH LIDGH HGLOLU %X \HQL ROXúDQ PROHNOOHU DQWLNRUODUGÕU $QWLNRUODUÕQ DVÕO
UH]HUYXDUÕ SOD]PRVLWOHUGLU SOD]PRVLWOHU X\DUÕOPÕú % OHQIRVLWOHULQLQ IDUNOÕODúPDVÕ LOH
PH\GDQDJHOLUOHU%LUDQWLNRUKDQJL,J
GHQVHQWH]OHQGL\VHRLVLPLOHLIDGHHGLOLUgUQH÷LQ
H÷HU ELU DQWLNRU ,J* PROHNOQGHQ VHQWH]OHQPLúVH R DQWLNRUD ,J* DQWLNRUX GHQLU
Antikorlar hedef molekülün, yani antijenin, komplementeridir. Antijen üzerindeki girinti,
DQWLNRUGDELUoÕNÕQWÕúHNOLQGHROXúXUE|\OHFHKHGHIPROHNOVÕNÕFDNDYUDU
ùHNLO$QWLNRUODUÕQPROHNOHU\DSÕVÕ
$QWLNRUODUÕQ PROHNOHU \DSÕVÕ <KDUILúHNOLQGHGLU<XNDUÕ\DEDNDQLNLNROXROXúturan
PROHNO ]LQFLUOHULQH KDILI ]LQFLU DGÕ YHULOLU +HU DQWLNRUXQ WDQH KDILI ]LQFLUL YDUGÕU %XQODU
\XPXúDNYHX]XQPROHNO]LQFLUOHULGLUNHQGLDUDODUÕQGDLQDQÕOPD]oHúLWOLOLNWHYDU\DV\RQODU
\DSDUDN KHGHI PROHNO NDYUD\DFDN úHNLOOHU ROXúWXUXUODU ùHNLO4.5). Ig'nin bu hafif
zincirlerine Fab (Fragment Anti Body) DGÕ YHULOLU (÷HU ELU ,J ELOKDVVD EHOLUOL ELU DQWLMHQL
NDYUD\DFDN úHNLOGH UHWLOPLúVH |]JO DQWLNRUGXU YH JHQHOOLNOH KDILI ]LQFLUOHUL VDELWWLU ,J
PROHNOQQ DúD÷Õ\D GR÷UX X]DQDQ ELU NROX GDKD YDUGÕU EXQD D÷ÕU ]LQFLU YH\D Fc
(Fragment Cristalizable)DGÕYHULOLU6HUWELUPROHNOGUJHQHOOLNOH,JWLSLQHYHRNRQD÷D
DLWRODQELUXoLOHVRQODQÕU%XXoLPPQUHDNVL\RQODUVÕUDVÕQGDoRN|QHPOLGLU
%XPROHNOQ)FSDUoDVÕULMLWROXSDQWLNRUJ|UHYLJ|UPH]QHEDNWHULKFUHVLQHYHQH
GHDQWLMHQHED÷ODQDPD])DNDWLPPQKFUHOHULQ\]H\OHULQGHNLUHVHSW|UOHUHED÷ODQDELOLU
'ROD\ÕVÕ LOH ELU DQWLNRU PROHNO )DE SDUoDODUÕ LOH DQWLMHQL WXWDU )F SDUoDVÕ LOH LPPQ
KFUHOHUHWXWXQXU%|\OHFHLPPQKFUHOHULQDQWLMHQLNSDUWLNO\DNDODPDVÕQÕWHPLQHGHU
FagositR]GDQ NDoDELOHQ EDNWHULOHULQ \]H\LQH H÷HU |]JO DQWLNRUODU )DE SDUoDODUÕ LOH
ED÷ODQPÕúODUVDEXEDNWHULOHULQIDJRVLWR]GDQNDoPDúDQVODUÕ\RNJLELGLU
$QWLNRUDQWLMHQHED÷ODQPÕúVDúXQODUPH\GDQDJHOLU
1. Antijen-DQWLNRU NRPSOHNVL DGÕ YHULOHQ E\N ELU PROHNO \XPD÷Õ ROXúXU %X
NRPSOHNVLQ ELU WDUDIÕQGD DQWLMHQ PROHNO YDUGÕU GL÷HU WDUDIÕQGD DQWLNRUXQ )F SDUoDVÕ
ERúWD GXUPDNWDGÕU 3HNoRN LPPQ KFUH EX )F SDUoDVÕQÕ ELU VDS JLEL NXOODQDUDN
kompleksi yakalar ve fagosite eder. Bu bir opsonizasyon 'dur.
'RODúÕPGDNL DQWLMHQ-DQWLNRU NRPSOHNVLQLQ DoÕNWD NDODQ )F SDUoDVÕ E|EUHN
WEOVOHULQLQED]DOPHPEUDQODUÕWDUDIÕQGDQ\DNDODQÕUYHEXNRPSOHNVLGUDUDLOHWLOLU
$QWLNRUODU ED]HQ ELU WDQH )DE SDUoDVÕ\OD ELU EDNWHUL\L \DNDODUNHQ GL÷HU )DE
SDUoDVÕ LOH GL÷HU ELU EDNWHUL\L \DNDODU %X GXUXPGD ELU oRN EDNWHUL\L ELU DUD\D JHWLULU YH
NPHOHUROXúWXUXU%XQDaglütinasyon denir. Böyle antikorlara bivalan antikorlar denir.
$QWLMHQo|]QHELOLUELUPDGGHLVHDQWLNRULOHED÷ODQGÕ÷ÕQGDDUWÕNo|]QHPH]KDOH
gelir. Buna presipitasyon denir.
$QWLMHQLN PDGGHQLQ DQWLNRU LOH ED÷ODQPDVÕ GXUXPXQGD LPPQRMHQLN PROHNO
NÕVPÕ DQWLNRU LOH |UWOG÷ LoLQ DUWÕN R PDGGH DQWLMHQLN ROPD |]HOOL÷LQL ND\EHGHU %XQD
nötralizasyon denir.
$QWLMHQ LOH ED÷ODQPÕú LPPQ JOREXOLQ molekülünün C-gamma-2 zinciri,
NRPSOHPDQÕQ &T PROHNOQH DIILQLWH J|VWHULU %X NRPSOHPDQ DNWLYDV\RQX GHPHNWLU
.RPSOHPDQ DNWLYH ROGX÷X ]DPDQ )F SDUoDVÕQÕQ LúDUHW HWWL÷L PROHNO KDQJL SDUWLNOQ
üzerinde bulunuyorsa, o partikül, "membrana hücum kompleksi"nin bir hedefidir. (Bu
PHNDQL]PD\DIRNDOHQIHNVL\RQEDKVLQGHWHNUDUGH÷LQLOHFHNWLU
%HúLPPQJOREXOLQGHQKHUELULVLQLQIDUNOÕ|]HOOLNOHULYDUGÕU
IgA: 472 aminoasit ve 7 domain (ilmik)den meydana gelen 150-160 kilodaltonluk bir
globulindir. Serumdaki konsantrasyonu 50-100 mg/100 ml dir, toplam Ig'lerin %15-20 sini
ROXúWXUXU<HGLYH\D6YHGEHUJQLWHVLLOHVDQWULIMHGLOGL÷LQGHo|NHUOHU6YH\D6OLN
SURWHLQ\DSÕODUGÕU,J$YH,J$ROPDN]HUHLNLIDUNOÕoHúLGLYDUGÕU,J$PLNURSVDOJÕODUÕQD
daha GLUHQoOLGLU %WQ ,J$ WLSL DQWLNRUODUÕQ RUWDN |]HOOLNOHUL YFXW VDOJÕODUÕQGD
EXOXQPDODUÕGÕU 'LúHWL ROX÷X OLNLWL WNUN NRORVWXP DQQH VW VROXQXP \ROX YH JHQLWR
ULQHU VDOJÕODUGD GDLPD YH ERO PLNWDUGD ,J$ WLSL DQWLNRU EXOXQXU 0$/7 LoHULVLQGHNL
plazPRVLWOHUWDUDIÕQGDQUHWLOLU
IgD: % OHQIRVLWOHULQLQ \]H\LQGH EXOXQXU YH JHQHOOLNOH GRODúÕPD NDWÕOPD]ODU YH\D
DQFDN RUDQÕQGD VHUXPD JHoHUOHU 1-acetyl-JDODFWRVDPLQH SDUoDODUÕGÕU ELU DQWLNRU
ROPDNWDQ GDKD oRN DQWLNRU ROXúXPXQX VD÷ODGÕ÷Õ ]DQQHGLOPHNWHGLU 0ROHNO D÷ÕUOÕ÷Õ kilodaltondur, serum konsantrasyonu 3 mg/100 ml dir.
IgE:DPLQRDVLWWHQYHGRPDLQ
GHQROXúXU1RUPDOúDUWODUGDVHUXPGDEXOXQPD]
YH\D HVHU PLNWDUGD PJ PO EXOXQXU 0ROHNO D÷ÕUOÕ÷Õ NLORGDOWRQGXU
5H]HUYXDUÕ ED]RILO YH PDVW KFUH \]H\OHULGLU $VWÕP VDPDQ QH]OHVL HQGRWRNVLN úRN
6ZDUW]PDQUHDNVL\RQXGH÷LODNXWWRNVLNDV\RQODUÕQSDWRJHQH]LQGHoRN|QHPOLUROR\QDU
,J$NDGDUGH÷LODPDGDKDD]PLNWDUGDYFXWVDOJÕODUÕQDJHoHUOHU,J(WLSLDQWLNRUODUÕQRUWDN
özelliklHUL DQLGHQ ROXúPDODUÕGÕU GDNLNDODU LoHULVLQGH VHQWH]OHQHUHN NDQD G|NOU DQL YH
NXYYHWOL VÕYÕVDO FHYDS ROXúWXUXUODU (Q HQGLúH \DUDWDQ HWNLOHUL NDQD G|NOGNOHULQGH
DQDILODNWLNúRNDVHEHSWHúNLOHWPHOHULGLU
IgG: 'RODúÕPGDNL ,J
OHULQ -75'ini IgG oOXúWXUXU '|UW GRPDLQ
L YDUGÕU gPU
\DNODúÕN RODUDN JQ RODQ 6 OLN ELU JOLNRSURWHLQGLU +LoELU LPPQJOREXOLQ JHoHPHGL÷L
KDOGH,J*SODVHQWDGDQJHoHELOLU$÷ÕU]LQFLUOHULELUDUDGDWXWDQGLVOILWED÷ODUÕQÕQVD\ÕODUÕQD
EDNDUDND\UÕJUXEDD\UÕOPÕúODUGÕU,J*,J*,J*YH,J*0ROHNOD÷ÕUOÕNODUÕ-185
NLORGDOWRQ DUDVÕQGD GH÷LúLU %X VÕQÕIWDQ RODQ DQWLNRUODUÕQ RUWDN |]HOOLNOHUL JHo RUWD\D
oÕNPDODUÕ YH ]RU ND\EROPDODUÕGÕU $QWLMHQLN X\DUÕ\Õ WDNLEHQ KDIWDODU VRQUD RUWD\D oÕNDUODU
GRNXODUD \D\JÕQ ELoLPGH GD÷ÕOÕUODU VHUXPGDNL VHYL\HOHUL DQWLMHQLN X\DUÕ ND\EROVD ELOH
aylarca devam eder.
IgM: 'RODúÕPGDNL ,J
OHULQ XQX ROXúWXUXU 6 YH -1000 kilodaltonluk
SHQWDPHU úHNOLQGH ELU JOLNRSURWHLQGLU gPU - JQ NDGDUGÕU ,J0 DQWLNRUODUÕ SULPHU
VÕYÕVDO FHYDSWD ,J*
GHQ |QFH RUWD\D oÕNDUODU YH ,J* DQWLNRUODU NDQD G|NOQFH\H NDGDU
LPPQFHYDSWDURODOÕUODUDQWLMHQH|]JO,J*DQWLNRUODUJHOGLNWHQVRQUDND\EROXUODU
%XUD\D NDGDU DQODWÕODQODU WHPHO LPPQRORMLN ROD\ODUGÕU %WQ EX ROD\ODU SXOSD YH
peULDSLNDOGRNXODUGDGDJHUoHNOHúPHNWHGLU)DNDWSXOSDYHSHULDSLNDOGRNXODUDJHOHELOHFHN
ELU DQWLMHQLN X\DUÕ LOH PH\GDQD JHOHQ ROD\ODUÕQ KHSVLQL \XNDUÕGDNL PHNDQL]PDODU LOH
DoÕNODPDNPPNQGH÷LOGLU%LOKDVVDSXOSDQÕQLPPQFHYDEÕELUD]GDKD|]HOGLU
PulSD\DDQWLMHQOHULQJLULúLNDEXOHGLOPHVLWDQÕQPDVÕ
3XOSDGRNXVXQDXODúDQDQWLMHQOHULQJLULú\ROODUÕLNLWUOGU
%LULQFLVLGHQWLQNDQDOFÕNODUÕ\ROXGXUGL÷HULKHPDWRMHQYHUHWURJUDW\ROGXU
'HQWLQNDQDOFÕNODUÕ\ROX3XOSDGRNXVXNDSDOÕELURUJDQGÕU ve yüzeyinin büyük bir
E|OPGHQWLQNDQDOFÕNODUÕLOHoHYULOPLúWLU%XVHEHSOHDQWLMHQOHUoRNE\NELUVÕNOÕNODEX
\RO LOH SXOSD\D XODúÕUODU .|N \]H\L SHULRGRQWDO GRNXODU WDUDIÕQGDQ QLVSHWHQ NRUXPD
DOWÕQGDROGX÷XQGDQDQWLMHQOHULQJLULúQRNWDVÕGDKDoRNNXURQSXOSDVÕQGDGÕU
$÷Õ]RUWDPÕLOHX]XQVUHWHPDVWDNDODQoÕSODNGHQWLQGRNXVXYHGHQWLQNDQDOFÕNODUÕ
LoHULVLQH VDGHFH EDNWHULOHULQ DQWLMHQOHUL GH÷LO D\QÕ ]DPDQGD DQWLMHQLN X\DUÕ \DSDELOHFHN
QLWHOLNWHNLP\DVDOPDGGHOHUGHJ|oHGHELOPHNWHGLU'úPúYH\DVÕ]GÕUDQELUGROJXYH\D
VLPDQÕ o|]QPú ELU NXURQ UHVWRUDV\RQX YDUVD EX GLúLQ GHQWLQ NDQDOFÕNODUÕ LoHULVLQH
EDNWHUL KFUHVL YH EDNWHUL DQWLMHQOHUL NROD\FD JLUHELOLUOHU %UXNVL]P YH\D EDúND VHEHSOHUOH
PLQH GRNXVX DúÕQPÕú ELU GLú NXURQ SUHSDUDV\RQX \DSÕOPÕú ELU GLúLQ DoÕNWD EÕUDNÕOPÕú
GHQWLQ GRNXVX DQWLMHQOHUL D÷Õ] RUWDPÕQGDQ SXOSD\D NROD\FD WUDQVIHU HGHELOPHNWHGLU
%LOKDVVD NRPSUHVLI |Oo WHNQLNOHUL LOH DOÕQDQ |OoOHU RUWDPGDNL DQWLMHQLN \DSÕODUÕ YH KDWWD
EDNWHULJ|YGHVLQLELOHGHQWLQNDQDOFÕNODUÕLoHULVLQHGR÷UXLWHU
*LQJLYLWLV YH\D SHULRGRQWLWLV JLEL VHEHSOHU LOH SHULRGRQWDO DWDúPDQÕQ KDUDEROGX÷X
bölgelerde hasar gören sement dokusu antijenlere ve bakteri hücrelerine geçirgen bir hale
JHOHELOLU%D]HQEXUDGDNLSDWRORMLNROD\ODUHQIHNVL\RQGH÷LOGHMHQHUDWLIRULMLQOLRODELOLU+DWDOÕ
RODUDN\DWD\\|QGHGLúIÕUoDOD\DQELUH\OHUGHSHULRGRQWDODWDúPDQDúD÷Õ\DGR÷UXKDUHNHW
ederek mine-VHPHQWVÕQÕUÕQÕVHUEHVWEÕUDNÕU'LúHWL]HULQGH9KDUILúHNOLQGHPLNUR\ÕUWÕNODU
ROXúDELOLU 6WLOOPDQ \DUÕ÷Õ %XUDODUGD VHPHQW LOH D÷Õ] RUWDPÕ WHPDV KDOLQGHGLU YH E|\OH
KDWDOÕ GLú IÕUoDODPDVÕ GHYDP HWWLNoH DoÕ÷D oÕNDQ VHPHQW DúÕQDUDN GHQWLQ NDQDOFÕNODUÕQÕ
VHUEHVWEÕUDNÕU$oÕ÷DoÕNDQGHQWLQNDQDOFÕNODUÕD÷Õ]RUWDPÕQGDNLDQWLMHQLN\DSÕODUÕ
buradan kolayca pulpaya taúÕ\DELOLU
7UDYPD VRQXFX ROXúDQ NÕUÕN YH oDWODNODU DQWLMHQOHULQ SXOSD GRNXVXQD XODúPD
\ROODUÕQGDQELUWDQHVLGLU0LQHQLQPRUIRORMLNEWQO÷ER]XOPDVDELOHDQWLMHQOHULSXOSD\D
LOHWHELOHFHNJHoLWOHULEXOXQDELOLUODPHOWX÷YHSLVWRQJLEL'DKDVÕNUDVWODQDQJLULú\ROXELU
oU÷Q WDEDQÕGÕU %DNWHULOHU KHQ] SXOSD GRNXVXQD XODúPDGDQ |QFH RQODUÕQ DQWLMHQLN
\DSÕODUÕXODúÕU
2. Hematojen ve Retrograt yol: Pulpaya antijenler foramen apikaleden kan
GDPDUODUÕ \ROX LOH JLUHELOLUOHU %X oRN QDGLUGLU 3XOSD\D Eu yol ile antijenlerin girmeleri
GXUXPXQGDVHSWLVHPLEDNWHUL\HPLEXOXQPDOÕGÕU+DVWDGDELUVLVWHPLNHQIHNVL\RQYHYH\D
DWHúYDUGÕU+HPDWRMHQ\RO
Retrograt yol ise periodontal membran iledir. Böyle durumlarda ciddi bir periodontal
KDVDU EXOXQPDVÕ ]RUXQOX GH÷LOGLU $VHPSWRPDWLN VH\UHGHQ ELU SHULRGRQWLWLV QHGHQL\OH
NHPLN LoL FHSOHULQ WDEDQÕQGDQ SHULRGRQWDO PHPEUDQ ER\XQFD \D\ÕODQ EDNWHUL VDOJÕODUÕ
foramen apikaleye kolayca varabilir.
(NVSR]H GHQWLQ DQWLMHQLN X\DUÕODUÕQ SXOSD\D XODúPDVÕQGD HQ ELOLQHQ YH HQ VÕN
UDVWODQDQ JLULú NDSÕVÕGÕU 'HQWLQ NDQDOFÕNODUÕ LOH LPPQRSDWRORMLN UHDNVL\RQODUÕQ
EDúODWÕODELOHFH÷LJ|VWHULOPLúWLU%HUJHQKROW]YHDUNDGDúODUÕ
8\DUÕQÕQ SXOSD WDUDIÕQGDQ DQWLMHQLN RODUDN NDEXOHGLOHELOPHVLLoLQX\DUÕ\ÕROXúWXUDQ
en az bir NRPSRQHQWLQRNRQDNGRNXLoLQ\XNDUÕGDEHOLUWLOHQL\LDQWLMHQWDQÕPÕQDX\PDVÕ
JHUHNLU $NVL KDOGH NRQDN FHYDEÕ J|UOPH\HFHNWLU )DON YH DUNDGDúODUÕ WHUPLN
GX\DUOÕOÕ÷ÕRODQGLúOHULQSXOSDHNVWUDNWODUÕQGDN|NNDQDOÕSDWRMHQOHULQHNDUúÕROXúPXú
özgO DQWLNRU EXOXQXS EXOXQPDGÕ÷ÕQÕ DUDúWÕUPÕúWÕU 6 PXWDQV $ QDHVOXQGLL / FDVHL (
DODFWRO\WLFXP $ LVUDHOLL 3 PLFURV YH 9 SDUYXOD\D NDUúÕ DQWLNRUODUÕQ EXOXQGX÷XQX
J|VWHUPLúWLU6D÷OÕNOÕSXOSDGDLVHEXOXQPDGÕ÷ÕQÕJ|VWHUPLúWLU
%LU GL÷HU oDOÕúPDGD 5RVHQJUHQ IDUH SXOSDODUÕQD 6 PXWDQV 6 DXUHXV &
SHUIULQJHQV YH / DFLGRSKLOOXV LQRNOH HWPLúWLU 6DGHFH 6 PXWDQV LOH úLGGHWOL SHULDSLNDO
KDUDEL\HW EXOPXú GL÷HU EDNWHULOHUOH LVH KDILI YH\D RUWD G]H\GH SHULDSLNDO GH÷LúLPOHU
VDSWDPÕúWÕU %X GXUXP EL]H SXOSDQÕQ VDGHFH GX\DUOÕ ROGX÷X DQWLMHQOHUH FHYDS YHUGL÷LQL
J|VWHUPHNWHGLU*HUoHNWHQGH\XNDUÕGDVD\ÕODQEDNWHULOHULoHULVLQGHVDGHFH6PXWDQVL\L
ELUN|NNDQDOÕSDWRMHQLGLU
3XOSDGDNRQDNFHYDEÕJ|UOPHVLLoLQSXOSD\DEDNWHULOHULQDQWLMHQOHULQLQWHPDVÕúDUW
GH÷LOGLU %DúND ELU GH\LúOH SXOSD EDNWHUL DQWLMHQOHUL GÕúÕQGD NLP\DVDOODUD GD DQWLMHQ
muamelesi yapabilir. Pulpa için standart bir antijenik kimyasal madde listesi yoktur. Hatta
EX PDGGH VLPDQ ELOH RODELOLU 'Lú WHGDYLVL VÕUDVÕQGD NXOODQÕODELOHFHN GH÷LúLN VLPDQODU
PXPODU UHVWRUDWLI PDWHU\DOOHU VLOLNDWODU UHVLQOHU L\RQRPHUOHU ODVWLN YH\D NDXoXN HVDVOÕ
PDGGHOHU LODo ELOHúLNOHUL IHQRO NDIXU SDUDIRUPDOGHKLW IRUPRNUH]RO WLPRO NUH]DWLQ
NUHR]DWL\RWLUULJDV\RQVROXV\RQODUÕVRGyum hipoklorit, hidrojen peroksit, benzalkonium
NORULW UH oHúLWOL ORNDO DQHVWH]LNOHU ('7$ N|N NDQDO SDWODUÕQÕQ ELOHúHQOHUL URVLQ SHUX
EDOVDPÕ =Q %D %L IRUPDOGHKLW +J ELOHúLNOHUL NRUR]\RQ UQOHUL KDWWD JXWWD SHUND ELOH
pulpa dokusunda antijeQLNX\DUÕ\DVHEHSRODELOLU%LUKDVWDGDDQWLMHQLNX\DUÕ\DVHEHS
ROPD\DQKHUKDQJLELUNLP\DVDOPDGGHELUEDúNDKDVWDGDNXYYHWOLDQWLMHQLNRODELOPHNWHGLU
%XUDGDNRQD÷ÕQVHoLFLOL÷LV|]NRQXVXGXU
%LUNRQD÷ÕQSURWHLQOHULYH\DKFUHOHULELUEDúNDNRQDNLoLQ antijenik olabilir. Maymun
GLúOHULQLQ N|N NDQDOODUÕ LoHULVLQH EÕUDNÕODQ VÕ÷ÕU DOEPLQL YH NR\XQ HULWURVLWOHUL |]JO
DQWLNRUODUROXúWXUXU%DUQHVYH/DQJHODQG7DYúDQGLúOHULQLQSXOSDODUÕQDOL\RILOL]HDW
VHUXPX X\JXODQGÕ÷ÕQGD SHULDSLNDO GRNXODUD Oenfosit infiltrasyonu ve kemik rezorpsiyonu
görmek mümkündür (Okado, 1967). Bu bir Arthus reaksiyonudur. Pulpada arthus
UHDNVL\RQX ROXúWXUPDN OLWHUDWUGH DGHWD JHOHQHNVHO ELU oDOÕúPD ROPXúWXU 'HQH\
KD\YDQODUÕQDDQWLMHQLNPDGGHELUNDoGHIDGHULDOWÕ\ROLOHYHULOLUGDKDVRQUDD\QÕPDGGH
GHQH\ KD\YDQÕQÕQ VWHULO SXOSDVÕQD EÕUDNÕOÕU RWRSVLGH SHULDSLNDO OH]\RQ DUDQÕU GDLPD
bulunur (Torabinejad ve Kiger, 1980).
+DWWD SXOSD NHQGLVLQH \DEDQFÕODúDUDN NHQGL KFUH YH GRNXODUÕQÕ DQWLMHQLN NDEXO
edebilir ve pulSD GRNXVXQD NDUúÕ NRQDN LPPQ FHYDEÕ J|UOHELOLU 7DYúDQODUÕQ NHQGL GLú
SXOSDODUÕ IRUPDOLQ LOH PXDPHOH HGLOHUHN D\QÕ KD\YDQD GHUL DOWÕ \ROGDQ YHULOGL÷LQGH E|EUHN
YHNDUDFL÷HUGHSXOSDGRNXVXQD|]JORWRDQWLNRUODUWHVSLWHGLOHELOPHNWHGLU1LVKLGD
Bu antijen-DQWLNRUNRPSOHNVOHULGHULDOWÕQGDGDWRSODQÕU'LVWHIDQR
%HQ]HUGHQH\OHUGHD\QÕVRQXFXYHUPLúWLU.|SHNOHULQNHQGLGLúSXOSDVÕQÕQHNWUDNWÕ
1 SDWÕ\OD NDUÕúWÕUÕOÕS OHQI G÷POHULQGH HQMHNWH HGLOGL÷LQGH RWR DQWLNRUODU ROXúXU %ORFN
1977A).
3XOSD GRNXVX |QFHGHQ NHQGLVLQGH EXOXQPD\DQ ELU GX\DUOÕOÕ÷Õ VRQUDGDQ GD
ND]DQDELOPHNWHGLU.|SHNSXOSDODUÕ|MHQROFRPSKRUHGPRQRFKORURSKHQROYHIRUPRNUH]RO
LOHGX\DUOÕODúWÕUÕOGÕNWDQVRQUDSXOSDGRNXVXQGD,JYHDONDOHQIRVIDWD]VHYL\HOHUL|OoOPú
ve QRUPDOGHQ \NVHN EXOXQPXúWXU %XQODU SXOSD GRNXVXQXQ EX NLP\DVDO PDGGHOHUL
UHGHWPH\HKD]ÕUROGX÷XQXJ|VWHULU%ORFN&
3XOSDQÕQSXOSDDQWLMHQOHULLOHLONVÕFDNWHPDVÕRGRQWREODVWLNX]DQWÕODU7RPHVOLIOHUL
ile olur. Burada pulpa antijenleri terimi ile kastedilmek istenen genellikle bir mikrop
antijenidir (Bkz. Mikrop Antijenleri).
3XOSLWLVLQøPPQRORMLVL
3XOSD GRNXVXQD XODúDQ PLNURS DQWLMHQOHUL KDQJL \RO LOH JHOLUVH JHOVLQ EXUDGD
EXOXQDQ LPPQ PHNDQL]PD\Õ WHWLNOH\HFHN X\DUÕODU ROXúWXUXUODU 3XOSD HVDV LWLEDUÕ\OD ED÷
GRNXVXQGDQ ROXúPDVÕQD UD÷PHQ DQWLMHQH NDUúÕ JHQHO LPPQRORML ELOJLVL LOH NROD\FD
DoÕNODQDPD\DFDNUHDNVL\RQODUJ|VWHULU
6D÷OÕNOÕ SXOSDGD 7 OHQIRVLWOHUL * ID]ÕQGDGÕU YH 7K7V RUDQÕ GLU VD÷OÕNOÕ
ELUH\OHULQ GRODúÕPÕQGDNL 7K7V RUDQODUÕ GD GLU 3XOSD GRNXVX LoHULVLQGH D] PLNWDUGD
GHQGULWLNKFUHOHUILEUREODVWODUPDNURIDMODU%OHQIRVLWOHULYHPDVWKFUHOHULEXOXQPDNWDGÕU
$QÕO%OHQIRVLWOHULSOD]PDKFUHOHULQHG|QúPH]OHUEXVHEHSOHVD÷OÕNOÕSXOSDGD
plazmosit \RNWXU .RPSOHPDQ SURWHLQOHUL YH VÕQÕUOÕ VD\ÕGD PDVW KFUHOHUL GDLPD YDUGÕU
IDNDWLQDNWLISR]LV\RQGDEXOXQXUODU$QQHURWKYH%UDQQVWU|P$\UÕFDNDQGDPDUODUÕ
ER\XQFD 80&
OHU GL]LOLUOHU %XQODU NDQ GDPDUODUÕQÕQ WXQLFD DGYHQWLVLD
VÕQD ]D\ÕIoD
tutunXUODU YH ED÷ GRNXVXQXQ KHUKDQJL ELU KFUHVLQH G|QúHELOHFHN GXUXPGDGÕUODU
Gerekirse damar endoteline invaze olarak, pulpa içerisinde göç edebilirler. Bunlara
SXOSDQÕQ UH]HUY KFUHOHUL GHQLU +LVWL\RVLWOHU GDKD oRN NDSLOHUGHQ QLVSHWHQ X]DN
NRQXPODQÕUODU YH RQODU GD ELUHU UH]HUY KFUH J|UHYL VWOHQLUOHU JHUHN GX\XOGX÷XQGD
IDJRVLWLN NDELOL\HW ND]DQDELOLUOHU YH\D GRNX PDNURIDMODUÕQD G|QúHELOLUOHU EX PDNURIDMODU
GRODúÕPGDNLQGHQ IDUNOÕGÕU EXOXQGX÷X GRNXGDQ GÕúDUÕ oÕNDPD]ODU %X VHOOHU
kompozisyondan anlaúÕODFD÷Õ JLEL VD÷OÕNOÕ SXOSD KXPRUDO GH÷LO VHOOHU FHYDS YHUPH\H
GDKDPH÷LOOLGLU
2GRQWREODVWODUÕQ KHPHQ DOWÕQGD SXOSDQÕQ $3&
OHUL \HU DOÕU %XQODU ED÷ GRNXVX
ND\QDNOÕ ROXS +/$ HQGR DQWLMHQOHUL LKWLYD HGHUOHU -RQWHOO YH DUNDGDúODUÕ 3XOSDGD
APC J|UHYL \DSDELOHFHN EDúND KFUHOHU GH YDUGÕU %XQODU % OHQIRVLWOHUL PDNURIDMODU
nötrofiller ve damar endotel hücreleridir. Odontoblastlar da antijen sunabilirler.
*HQHOOLNOH EDNWHUL DQWLMHQOHUL SXOSD\D EDNWHULOHUGHQ GDKD |QFH XODúÕUODU %|\OHFH
SXOSDQÕQYHUGL÷LLPPQ\DQÕWÕQHQIODPDV\RQYHHQIHNVL\RQG|QHPOHULYDUGÕU
(÷HU GR÷UXGDQ ELU EDNWHUL LVWLODVÕ \RN LVH \DQL SXOSDQÕQ LULWDV\RQX PHNDQLN
NLP\DVDOYH\DWHUPLNWUDYPDLOHROX\RULVHSXOSDGDNLVLQLUOLIOHULX\DUÕOPD\ÕWDNLEHQ&*53
(Calcitonin Gene Related Peptide) ve P substance (P maddesi) isimli iki enzim salar. Az
bilinen bu nöroimmün mekanizmaya nörojenik enflamasyon denir. CGRP ve P maddesi
LVHQ|URMHQLNHQIODPDV\RQPHGL\DW|UOHULDGÕQÕDOÕU
Pulpa dokusunda A grubu delta lifleri ve C grubu OLIOHUL D÷UÕ LPSXOVXQX WDúÕPDNOD
J|UHYOLGLU %X OLIOHU D÷UÕ OLIOHUL RODUDN ELOLQLU 6DGHFH SXOSD YH SHULDSHNVWH GH÷LO D\QÕ
]DPDQGD DOYHRO NHPL÷L GLúHWL \DQDN oL÷QHPH NDVODUÕ OLJDPDQODU YH DOW oHQH HNOHPL GH
böyle lifler ile inerve olurlar. Bunlardan $ JUXEX GHOWD OLIOHUL PL\HOLQOLGLU GDKD KÕ]OÕ LOHWLP
\DSDUODU GDKD oRN PHNDQLN YH WHUPLN X\DUÕODUÕ LOHWLU 'L÷HU OLIOHU & JUXEX PL\HOLQVL]GLU
\DYDú LOHWL \DSDUODU &-SRO\PRGDO OLIOHUL DGÕQÕ DOÕUODU oQN PHNDQLN WHUPLN NLP\DVDO
IL]LNVHOX\DUÕODUÕLOHWHELOLUOHU&-SRO\PRGDOOLIOHUEUDGLNLQLQDVHWLONROLQGúNS+SRWDV\XP
O|NRWULHQJLELGH÷LúLNX\DUÕODUÕDOJÕOD\DELOLUOHU%XVLQLUOLIOHULQLQWDúÕGÕ÷ÕD÷UÕLPSXOVX16$,'
ile durdurulamaz. Bu liflerin her iki tipi de pulpada bulunur. Bu sinir lifOHUL NDQ GDPDUODUÕ
HúOL÷LQGH DSLNDO IRUDPHQGHQ JLUHUOHU YH NDQ GDPDUODUÕQÕQ WXQLFD YDVNODULV
LQH VDUÕODUDN
KDWWD DUWHULROOHUGH WXQLFD LQWHPD
\D NDGDU GDO YHUHUHN LOHUOHU .DQ GDPDUODUÕ oHYUHVLQGH
Q|UDOELUSOHNVXVROXúWXUXUODU
øOJLQoWLUNL PDNURIDMODUÕ KDUHNHWH JHoLUHQ EX VLQLU OLIOHULGLU 6LQLU OLIOHULQLQ NÕOÕIODUÕ
PDNURIDMEHQ]HULKFUHOHULOHWDPELUWHPDVLoHULVLQGHGLUYHEXPDNURIDMODUÕQVLWRSOD]PDODUÕ
içerisinde 100- QP oDSÕQGD YH]LNOOHU YDUGÕU %X Q|UR-LPPQ \DNÕQODúPD HOHNWURQ
mikroskopundD J|VWHULOPLúWLU 0DQWKRV YH DUNDGDúODUÕ %|\OH ELU WHPDV
PDNURIDMODUÕQ LON DNWLYDV\RQXQXQ VLQLUVHO X\DUÕODUOD ROGX÷XQX GR÷UXODU %XQX GHVWHNOH\HQ
EDúND LSXoODUÕ GD YDUGÕU %X PDNURIDMODUÕQ LoHULVLQGH EXOXQDQ YH]LNOHU \DSÕODU VDGHFH
nöral dokuya DLWNDUHNWHULVWLNELUROXúXPGXU0DNURIDMKFUHOHULQLQVLWRSOD]PDODUÕQGDWHVSLW
HGLOHQEXVUSUL]RUJDQHOOHUSXOSDGDNLPDNURIDMODUDQ|UDOELUNLPOLNND]DQGÕUÕU
Nörojenik enflamasyon mediyatörleri salan pulpal sinir lifleri, sensitif liflerden
IDUNOÕGÕU YH GDKD oRN RWRQRP WDELDWOÕGÕU %XUDGDQ D\UÕODQ GDKD LQFH GHPHWOHU SXOSD
periferinde (pulpodentinal membranda) yeni bir pleksus yaparlar (odontoblastik nöral
SOHNVXV2GRQWREODVWODUEXSOHNVXVLoHULVLQGH\HUDOÕUODUEXVLQLUOLIOHULQLQELUNÕVPÕ7RPHV
liIOHULQL WDNLS HGHUHN SUHGHQWLQH JLUHU +HU LNL OLILQGH $ YH & JUXEX VRQODQPD XoODUÕQGD
EXOXQDQ Q|URQODU Q|URMHQLN HQIODPDV\RQ PHGL\DW|UOHUL VHQWH] HGHUOHU YHX\DUÕOGÕNODUÕQGD
CGRP ve P maddesi salarlar.
P maddesi 15 kilodaltonluk bir proteindir ve kan GDPDUODUÕQÕQ WXQLFD YDVFXODULV
L
]HULQH GLODW|U HWNL J|VWHULU %X VXUHWOH NDSLOHU GLODWDV\RQ JHUoHNOHúLU $\UÕFD GDPDU
HQGRWHOLQL YD]RDNWLI PHGLDW|UOHUH YH LPPQ KFUHOHUH NDUúÕ JHoLUJHQ KDOH JHWLULU
+DUJUHDYHVYHDUNDGDúODUÕNHQGLJHOLúWLUGLNOHULELUPLNURGLDOL]SUREXQX\DUDOÕGRNX
LoHULVLQHVRNDUDNEXHQ]LPOHULWHVSLWHWPLúOHUGLU'HQH\VHORODUDNHQMHNWHHGLOHQ3
PDGGHVLRE|OJHGHNXYYHWOLELU|GHPROXúWXUPDNWDGÕUYHKLVWDPLQ3*(NROODJHQD],/-1,
IL- YH 71) VDOÕQPDVÕQÕ VD÷ODPDNWDGÕU %X oDOÕúPDFÕODU LQGLID HGHPH\HQ \LUPL\Dú
GLúOHULQLQSHULNRURQHUHQIHNVL\RQODUÕQÕQEXOXQGX÷XGRNXODUGD3*(-7 nmol/l), bradikinin
(12-17 nmol/l), P maddesi (1 nmol/l), Lökotrien B4 (2- QPROO EXOXQGX÷XQX WHVSLW
HWPLúOHUGLU $\QÕ oDOÕúPDFÕODU VWHULO IUH]OHU LOH YLWDO VÕ÷ÕU SXOSDVÕQD IDUNOÕ VD\ÕGD GHOLNOHU
DoPÕúODU YH \DUDODQPDQÕQ HQ ID]OD ROGX÷X GLú SXOSDVÕQGD 3 PDGGHVLQLQ HQ ID]OD
VDOÕQGÕ÷ÕQÕ J|VWHUPLúOHUGLU 3XOSDO \DUDODQPD\Õ WDNLEHQ WULJHPLQDO JDQJOL\RQODUGD GD 3
PDGGHVLQH UDVWODPÕúODUGÕU $NXW HQIODPDV\RQODUGD WULJHPLQDO JDQJOL\RQODUGD ELOH D÷UÕ
ND\QD÷Õ RODQ 3 PDGGHVLQH UDVWODQDELOGL÷LQH J|UH QHGHQ DNXW HQIHNWH GLúOHULQ ORNDO
LQILOWUDWLIDQHVWH]LLOHWDPRODUDNX\XúPDGÕ÷ÕGDKDNROD\DQODúÕOÕU
3XOSD 3 PDGGHVL VDOÕQÕPÕQÕ J|VWHUPHN LoLQ LGHDO ELU GRkudur. Pulpa, eksternal
X\DUÕODUD JD\HW EHOLUJLQ Q|URLPPQ FHYDSODU YHUPHNWHGLU +DUJUHDYHV YH DUNDGDúODUÕ
&*53 QLQ 3 PDGGHVLQH EHQ]HU HWNLOHUL YDUGÕU IDNDW EDúOLFD HWNLVL Q|WURILO
NHPRWDNVLVLQLNROD\ODúWÕUPDVÕGÕU
CGRP ve P maddesi, NGF (Nerve Growth Factor) ile kompetasyon halindedirler ve
P\HOLQVL] OLIOHULQ PHPEUDQODUÕ ]HULQGH D\QÕ UHVHSW|UH WXWXQDELOLUOHU &*53 RUWDPGDNL
SRWDV\XPNDSVLNDLQYHNDOVL\XPYDUOÕ÷ÕQGDQHWNLOHQHQELUQ|URSHSWLWWLUøOJLQoWLUNLOLGRNDLQ
ve adrenerjik maddeler (epinefrin, norepinefrin, clonidine, salbutamol), pulpada CGRP
EORNDMÕ \DSPDNWDGÕU +DUJUHDYHV YH DUNDGDúODUÕ %HONLGH NXDIDM PDGGHVL NDYLWH\H
\HUOHúWLULOPHGHQ |QFH OLGRNDLQ YH\D DGUHQHUMLN SDQVXPDQODU \DSPDN SRVWRS
HQIODPDV\RQXYHGX\DUOÕOÕ÷ÕHQJHOOeyebilecektir.
3XOSDGD X\DUÕODU VÕUDVÕQGD VLQLU OLIOHULQGHQ VDOÕQDQ EDúND Q|URSHSWLWOHU úXQODUGÕU
dopamine-2-hydrolase ve neuropeptide-Y. Bunlar, sempatik sinir liflerinden eser miktarda
VDOÕQÕUODUYH3PDGGHVLQHEHQ]HU\DSÕGDGÕUODU3XOSDVLQLUOHULQGHQD\UÕFD9,39DVRDFWLYH
,QWHVWLQDO 3RO\SHSWLGH VDOÕQGÕ÷Õ WHVSLW HGLOPLúWLU 9,3 SURVWRJODQGLQOHUH ED÷ÕPOÕ ROPD\DQ
bir mekanizma ile kemik erimesine sebep olur. Sempatik trigeminal gangliyonu operasyon
LOH oÕNDUÕODQ GHQH\ KD\YDQODUÕQGD KDVDUOÕ SXOSDGDNL 9,3 VDOÕQPDVÕ GHYDP HWWL÷LQH J|UH
9,3SDUDVHPSDWLNRWRQRPOLIOHUGHQVDOÕQPDNWDGÕU7RUDELQHMDG
Predentine giren sinir liflerinin ve nörojenik enflamasyon mediyatörlerinin görevi,
DQWLMHQLNX\DUÕ\ÕKHQ]GHQWLQNDQDOFÕNODUÕLoHULVLQGHLNHQWHVSLWHtmek ve antijen, pulpaya
JLUGL÷LQGHSXOSD\ÕVDYXQPD\DKD]ÕUEXOXQGXUPDNWÕU2GRQWREODVWODUÕQ\]H\LQGHQ|URMHQLN
HQIODPDV\RQPHGL\DW|UOHULQLDOJÕOD\DQUHVHSW|UOHUEXOXQXU'ROD\ÕVÕ\ODEXPDGGHOHUSXOSD
GRNXVX LoHULVLQH VDOÕQGÕ÷ÕQGD VDGHFH NDSLOHU HQGRWHOL YH LPPQ KFUHOHUL GH÷LO D\QÕ
]DPDQGDRGRQWREODVWODUÕGDHWNLOHU$NWLYHHGLOHQRGRQWREODVWODUUHSHUDWLIGHQWLQUHWLPLQL
EDúODWÕU'L÷HU\DQGDQKLVWL\RVLWOHUYHILEUREODVWODUÕQELUHURGRQWREODVWKDOLQHG|QúPHVLQL
VD÷ODU%XVHEHSOHQ|URMHQLNHQIODPDV\RQELU\DQGDQSXOSD\DDODUPQLWHOL÷LQGHVLQ\DOOHU
\ROODUNHQGL÷HU\DQGDQUHSHUDWLIGHQWLQROXúXPXQXEDúODWÕUEDúODPÕúVDKÕ]ODQGÕUÕU
5HSHUDWLI GHQWLQLQ ROXúPDVÕQÕ EDúODWDQ EDúND WHWLN PHNDQL]PDODU GD YDUGÕU
2GRQWREODVWODU NHQGL KFUH X]DQWÕODUÕ RODQ 7RPHV OLIOHUL DUDFÕOÕ÷Õ LOH DQWLMHQLN X\DUÕ\Õ
GR÷UXGDQ DOJÕOD\DELOLUOHU %X GXUXPGD Q|URMHQLN HQIODPDV\RQ PHGL\DW|UOHULQH JHUHN
NDOPDGDQ UHSHUDWLI GHQWLQ ROXúXPX EDúOD\DELOLU IDNDW EX FHYDS ORNDOGLU \DQL VDGHFH
X\DUÕQLQ JHOGL÷L E|OJHGHNL RGRQWREODVWODU etkilenir ve oradaki odontoblastlar sadece o
E|OJHGH UHSHUDWLI GHQWLQ ROXúWXUXUODU +DOEXNL Q|URMHQLN HQIODPDV\RQ PHGL\DW|UOHUL WP
RGRQWREODVWLNWDEDND\ÕX\DUDELOLU
(QIODPDV\RQ VLQ\DOLQLQ RGRQWREODVW WDEDNDVÕ ER\XQFD \D\ÕOPD PHNDQL]PDVÕ LNL
türlüdür. %LULQFL PHNDQL]PDGD Q|UDO \RO LOH VLQLU OLIOHU DQWLMHQLN X\DUÕ\D DLW VLQ\DOOHUL WP
RGRQWREODVWLN SOHNVXV ER\XQFD GD÷ÕWPDNWDGÕU <DQL HOHNWULNVHO HVDVOÕ ELU \D\ÕOÕP YDUGÕU
øNLQFLPHNDQL]PDQ|URLPPQLVHHQ]LPDWLNWLU/LIOHUER\XQFDDoÕ÷DoÕNDQ&*53Ye
3 PDGGHVL RGRQWREODVWODUÕ NLP\DVDO RODUDN X\DUPDNWDGÕU %X NLP\DVDO X\DUÕ ELU GL÷HU
RGRQWREODVWDELUELUOHULLOHRODQVÕNÕWHPDVODUÕVD\HVLQGHHQ]LPDWLN\ROODUODLOHWLOPHNWHYH\D
JDSMXQFWLRQDGÕYHULOHQ|]HOWHPDVE|OJHOHULYDVÕWDVÕ\ODLOHWLOPHNWHGLU
3XOSDGDNLEXPHNDQL]PDJHQHOLPPQRORMLSUHQVLSOHULLOHWDPRODUDNDoÕNODQDPD]
dQNHQIODPDV\RQXQLONGDNLNDODUÕQGDLOWDKDSKFUHOHULQLQGDPDUGDQSXOSDGRNXVXQDLON
GHID JHoLúOHULQGH YD]RDNWLI PHGLDW|UOHULQ URO oRN D]GÕU %X LON EDVDPDNWD PDVW
hücrHOHULQGHQ DoÕ÷D oÕNDQ KLVWDPLQ HQIODPDV\RQXQ HQ DNWLI NRPSRQHQWL GH÷LOGLU oQN
VD÷OÕNOÕSXOSDGDPDVWKFUHOHULHVHUVD\ÕGDGÕUYHGDPDUSHUPLDELOLWHVLPDVWKFUHOHULQGHQ
ND\QDNODQDQ PHGL\DW|UOHU QHGHQL\OH GH÷LO 3 PDGGHVL QHGHQL\OH GLODWH ROXU 9DVNOHU
GLODWDV\RQXQEDúODWÕOPDVÕQGDURODODQPHNDQL]PDVLQLUVHOGLU0DVWKFUHOHULQLQVD\ÕVÕGDKD
VRQUDKÕ]ODDUWDFDNWÕU
8\DUÕOPÕú YHYH\D KDVDU J|UPú SXOSD VLQLUOHULQGHQ VDOÕQDQ &*53 YH 3 PDGGHVL
PDVW KFUHOHUL SROLPRUIODUÕ PRQRVLWOHUL ILEUREODVWODUÕ ROD\ \erine davet eder, damar
HQGRWHOKFUHOHULQLHWNLOH\HUHNE]úWUU%XE]úPHGHLQWHUO|NLQOHULQYHPDNURIDMODUGDQ
VDOÕQDQ SURVWRJODQGLQOHULQ GH UROX YDUGÕU 'DPDUÕQ OPHQLQL G|úH\HQ HQGRWHO KFUHOHUL
büzülünce, damar lümeninde interselüler bölgelerde mikrR DoÕNOÕNODU ROXúXU 'DPDU
\DWD÷ÕQGDNL VHUXP EX DUDOÕNODUGDQ SXOSD\D oÕNDU VHUXP GL\DSHWHVL 3XOSD LoL EDVÕQo
\NVHOPH\H EDúODU %X EDVDPDNWD SXOSD\D JHOHQ KFUHOHULQ oR÷X DNXW HQIODPDV\RQ
hücreleri (PML, makrofaj, bazofil, mast hücreleri) olup, bu iki enzim (CGRP ve P maddesi)
sayesinde hem dokuya davet edilir ve hem de aktive edilirler.
3XOSD LULWDV\RQXQGD D÷UÕQÕQ EDúODPDVÕ YH Q|URMHQLNPHGL\DW|UOHULQVDOÕQPDVÕD\QÕ
DQGD JHUoHNOHúLU %XUDGD FHYDS JHUHNWLUHQ ELU VRUX YDUGÕU KDQJLVLQLQ GL÷HULQL
EDúODWPDNWDGÕU" $÷UÕ LPSXOVXQXQ PHUNH]L VLQLU VLVWHPLQLQ NRUWLNDO PHUNH]OHULQH D÷UÕQÕQ
DGUHVLQLELOGLUPHVLQGHQVRQUDWHUVELULPSXOVLOHEXPDGGHOHUVDOÕQÕ\RURODELOLU%XQXQWHUVL
GH PPNQ RODELOLU EX PHGL\DW|UOHU VLQLU OLIOHUL WDUDIÕQGDQ VDOJÕODQÕ\RU DUDúLGRQLN DVLW
PHWDEROLWOHULQLQ VDOÕQPDVÕQÕ VD÷OÕ\RU YH E|\OHFH EUDGLNLQLQOHULQ D÷UÕ X\DQGÕUPD |]HOOL÷LQL
SRWDQVL\HOL]H HGL\RU GD RODELOLUOHU $VOÕQGD EUDGLNLQLQOHU YH GL÷HU GRNX DPLQOHUL WHN
EDúODUÕQD EXOXQGX÷XQGD FLGGL ELU D÷UÕ ND\QD÷Õ ROPD\DELOHFHNOHUL KDOGH GL÷HU DUDúLGRQLN
DVLWPHWDEROLWOHUL\OHELUOLNWHEXOXQGX÷XRUWDPGDoRNNXYYHWOLELUD÷UÕVHEHELROXúWXUDELOLUOHU
0DGHPNL Q|URMHQLN HQIODPDV\RQ PHGL\DW|UOHUL D÷UÕ VWLPXOXVXQX HQIODPDV\RQD
oHYLUHELOPHNWHGLU R KDOGH EX PHNDQL]PDQÕQ JHUHNVL] \HUH X\DUÕOPDVÕQGDQ NDoÕQPDN
JHUHNLU 9LWDORPHWUH FLKD]ODUÕ HOHNWULN DNÕPÕ X\JXOD\DELOHQ FLKD]ODUGÕU EXQODUÕ NXOODQÕUNHQ
DQ D] DNÕP VHYL\HVLQGHQ EDúODQPDOÕGÕU 'LNNDW HGLOPHVLQGH ID\GD RODQ ELU EDúND QRNWD
/RNDODQHVWH]L\DSÕOGÕ÷ÕLoLQYHKDVWDQDVÕOROVDD÷UÕGX\PDPDNWDROGX÷XLoLQYLWDOGHQWLQH
VHUW PGDKDOHOHUGH EXOXQPDNWDQ NDoÕQÕOPDOÕGÕU $QHVWH]L HWNLVLQGH ROVD ELOH SXOSD
LoHULVLQGH VDOÕQDQ &*53 YH 3 PDGGHVL SRVWRS D÷UÕODUÕQ YH EHONLGH X]XQ VUHQ SRVWRS
hassasiyetinin sebebi olabilmektedir.
(÷HU GR÷UXGDQ ELU EDNWHUL LVWLODVÕ YDU LVH EX GXUXPGD GHQWLQ NDQDOFÕNODUÕ
LoHULVLQH PLNURS YH\D PLNURS |÷HOHULQLQ VÕ]Õ\RU ROGX÷X ELU GXUXPGDQ EDKVHGLOLU .ODVLN
J|UúOHUH J|UH SXOSD WDYDQÕ YH oUN WDEDQÕ DUDVÕQGDNL PHVDIH - PP ROGX÷XQGD
UHYHUVLEÕO HQIODPDV\RQ J|]OHQLUNHQ EX PHVDIH PP ROGX÷XQGD DNXW HQIHNVL\RQ
J|]OHQPHVL NXYYHWOH PXKWHPHOGLU %X JQN ELOJLOHULPL]H J|UH WEOHU \DSÕVÕ JHUH÷L
RODUDNGHQWLQLQNDOÕQOÕ÷ÕPLNURSLVWLODVÕQDHQJHORODPDPDNWDGÕU'HQWLQPLNURSYHPLNURS
antijenleri için kötü bir bariyerdir (Pashley, 1996).
<DYDú LOHUOH\HQ oUN NDYLWHVLQLQ DOWÕQGDNL GHQWLQ GRNXVXQGD VNOHURWLN GH÷LúLP
EDúODUGHQWLQNDQDOFÕNODUÕNDUERQDW-apatit ve whitlockite kristalleri ile dolar. Burada anahtar
PHNDQL]PD GÕú ND\QDNOÕ X\DUÕODU LOH HNVLWH RODQ RGRQWREODVWODUGÕU YH KHQ] SXOSDQÕQ
LPPQ PHNDQL]PDVÕ SULPHU RODUDN ROD\D NDWÕOPDPÕú RODELOLU <DYDú YH NXUX oUNOHU LoLQ
VNOHURWLN GHQWLQ ROXúXPX LON FHYDSWÕU 'DKD VRQUD KHPHQ DUNDVÕQD UHSHUDWLI GHQWLQ
ELULNWLULOLU 'ROD\ÕVÕ\OD VNOHURWLN GHQWLQ LNL GHQWLQ WDEDNDVÕ DUDVÕQGD \HU DOÕU 3XOSD\Õ
NRUX\DELOHQ HQ L\L EDUL\HU VNOHURWLN GHQWLQGLU %X VÕUDGD SULPHU RGRQWREODVWODU |OU YH
oU÷Q LOHUOHPH KÕ]Õ \HWHUL NDGDU \DYDú LVH UHSHUDWLI GHQWLQ ROXúXPX EDúODU 5HSHUDWLI
GHQWLQ ROXúXPXQXQ WHWL÷LQL oHNHQ |O RGRQWREODVWODUGDQ VÕ]DQ HQ]LPOHUGLU %|\OH
VDYXQPDODUÕQPPNQROPDGÕ÷ÕGXUXPODUGD\DQLSXOSLWLVJHOLúWL÷LQGHROD\ODUú|\OHGHYDP
eder:
$NXWHQIODPDV\RQYHSXOSLWLVWHSXOSDGDJ|UOHQLPPQFHYDSVÕUDVÕú|\OHGLU
1. vasküler hiperemi,
2. PML marjinasyonu (bu terim, 30/
OHULQ NDQ DNÕQWÕVÕQÕQ PHUNH]LQGHQ D\UÕODUDN
GDPDU GXYDUÕQD \DNÕQODúPDVÕQÕ LIDGH HGHU $NÕúNDQODU NLQHWL÷LQH WHUV GúPHVLQH
UD÷PHQ DNÕQWÕQÕQ HQ KÕ]OÕ ROGX÷X WUDVH\L WHUNHGHUOHU YH GDPDU OPHQLQH \DNÕQ
NRQXPODQÕUODU%XROD\NRUWLNRVWHURLGOHUWDUDIÕQGDQ engellenir),
3. polimorf nüveli lökositlerin kemotaksis ile pulpaya göç etmesi,
4. kompleman aktivasyonu,
5. %KFUHOHULQLQSOD]PRVLWOHUHG|QúHUHN|]JODQWLNRUVHQWH]LQHEDúODPDODUÕ
6. 7KFUHOHULQLQGX\DUOÕODúPDVÕYHPRQRNORQDO7KFUHVHQWH]L
Kamal ve arkDGDúODUÕEXVÕUD\ÕIDUNOÕWHVSLWHWPLúOHUGLU'HQH\VHOoUNOHUGH
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döneminde olur. Genel
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önce humoral, sonra
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aktiYH
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YH
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odontoblastlar ve UMC'lerdir. Erken pulpitiste, antijenler, subanguler veya sublingual lenf
G÷POHULQH WDúÕQPDGDQ KHPHQ SXOSD SHULIHULQGH 7 OHQIRVLWOHULQH VXQXOXU ùHNLO ).
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hücUHOHUWHVSLWHGLOHELOLUOHUøONPRQRNORQDO7OHQIRVLWVHULOHUL+(9
GHYH\DNDSLOHUOHUH\DNÕQ
yerde tespit edilir. Bunlar, çok miktarda IL-1, IL-2 ve IL-6 salarlar, bu sitokinler periapekse
oÕNDUDN \HQL 7 KFUHOHULQLQ YH GL÷HU KFUHOHULQ EXUD\D WRSODQPDVÕQÕ VD÷ODU øúWH WDP EX
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yüzeylerindeki IL-2 reseptörleri ile, pulpadaki IL-
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,J( WDELDWÕQGD DQWLNRUODU YH KLVWDPLQ VDOPD\D EDúOarlar. Bu lokal bir Tip- DúÕUÕ GX\DUOÕOÕN
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SXOSLWLV SROLSRVD YH SDUVL\HO QHNUR] E|\OH GXUXPODUGD ROXúXU 9DVNODUL]DV\RQX DUWDQ
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bir granülasyon dokusudur, damardan zengindir ve dokunmakla kanar \D\JÕQ Q|WURILO
ILEUREODVW YH PDNURIDM LQILOWUDV\RQX YDUGÕU HQIHNVL\RQODUD GDKD GLUHQoOLGLU 3XOSD SROLSL
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akantozlar gösterir. Bu durumda, dokunun enfeksiyona direnci daha da artar.
<DYDú LOHUOH\HQ SXOSDO HQIODPDV\RQGD LQWHUQDO UH]RUSVL\RQ GD J|UOHELOLU $VOÕQGD
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SXOSDO HQIODPDV\RQXQ LQWHUQDO UH]RUSVL\RQD VHEHS ROGX÷XQX GúQGUPHNWHGLU ,/-1,
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zannedilmektedir (Trowbridge ve Emling, 1989).
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SXOSDKFUHYHOLIOHULQHDLWNDUERQKLGUDWYHSURWHLQOHULVLQGLUPH\HEDúODU
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sadece bir tanesi bakteri ve toksinlerine aittir, bu mekanizma mikrobiyoloji bölümünde
DQODWÕOPÕúWÕU 'L÷HU LNL PHNDQL]PD LVH YDVNOHU \ÕNÕP YH DQWLMHQ-antikor komplekslerinin
harabiyetidir:
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YD]RGLODWDV\RQ \DSDQ PHGL\DW|UOHU VDOÕQÕU %LU \DQGDQ EXQD ED÷OÕ RODUDN NDQ GDPDUODUÕ
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VDOÕQDQbradikinin, seratonin, histamin, lökotrienler, prostasiklin ile amplifiye edilir.
%X G|QHPGH ED]HQ SXOSDGD KLo D÷UÕ EXOXQPD\DELOLU %XQXQ VHEHEL WDP RODUDN
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özetlenebilir:
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enflamasyon sebebidir.
Pulpa dokusu içerisindeki antijen-antikor komplekslerinin arthus reaksiyonunu
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\DSÕúÕU 3OD]PDGDNL SOD]PLQRMHQL SOD]PLQ
H ILEULQROL]LQ
H G|QúWUU 3OD]PLQ ILEULQ
|UW\ROXúWXUDELOPHNLoLQ+DJHPDQIDNW|UQDNWLYHHGHU%XVXUHWOH]DWHQX\DUÕOPÕúRODQ
30/
OHU GDKD ID]OD X\DUÕOÕUODU %X GXUXP HQIODPDV\RQX D]GÕUÕU .|N NDQDOÕ WHGDYLVL
yaparNHQDúÕUÕHQVWUPDQWDV\RQQHGHQL\OHDSHNVWHQGÕúDUÕoÕNDQNDQDODOHWOHUL
SHULDSHNVWH NDQDPD\D VHEHS RODUDN HQIODPDV\RQX EDúODWDELOPHNWHGLU PXKWHPHOHQ EX
ROD\ÕQ PHNDQL]PDVÕ NRQWDPLQDV\RQ RODELOHFH÷L JLEL SHULDSHNVWH +DJHPDQ IDNW|UQQ
DNWLYHROPDVÕQDED÷OÕGÕU7RUDELQHMDG
'DPDUVDO KDUDEL\HW QHGHQL\OH GDKD ID]ODLPPQKFUHQLQSXOSDRGDVÕQDJHOPHVL
|QFH \DYDúODU YH VRQUD WDPDPHQ GXUXU 3XOSLWLVLQ HUNHQ G|QHPLQGH % OHQIRVLWOHULQLQ 7
OHQIRVLWOHULQHRUDQÕWÕU+DOEXNLúLPGLSXOSDGDKXPRUDOLPPQFHYDSVÕQÕUOÕGÕU77
RUDQÕ
GÕU<DQL7VYH7FVD\ÕVՁVWQGU%XGXUXPSXOSDQÕQWHVOLPL\HWLQLJ|VWHULU
3XOSD RGDVÕQGD GHYDP HGHQ ROD\ODUÕQ ELU EHQ]HUL NÕVD ]DPDQ DUDOÕ÷Õ LOH N|N
SXOSDVÕQGD ROXU YH LNLQFL ELU YHQ|] VWD] LOH SXOSD YDVNOHU NROODSVÕ WDNLEHQ QHNUR]H ROXU
Antijen-DQWLNRU NRPSOHNVOHULQLQ ROXúPDVÕ EDNWHULOHU YH DUWÕNODUÕ GDPDUVDO \HWPH]OLN YH
\ÕNÕP UQOHUL SXOSDQÕQ |OP YH OL]LVL LOH VRQXoODQÕU %X G|QHPLQ NOLQL÷H \DQVÕPDVÕ
KDVWDQÕQ VSRQWDQ D÷UÕODUÕQÕQ ND\EROPDVÕ GLúLQ SHUNV\RQD GX\DUOÕ ROPDVÕ YH VR÷XN LOH
rahatlama hissi'dir.
%D]HQoRNN|NOGLúOHUGHWHNELUN|NSXOSDVÕQHNUR]HROXUNHQGL÷HUOHULVDYXQPDN
LoLQ IÕUVDW EXODELOLUOHU %X GXUXP EHONLGH SDUVL\HO QHNUR]X HQ L\L DoÕNODU 1HNURWLN YH YLWDO
SXOSD GRNX VÕQÕUÕQD ILEUREODVWLN DNWLYLWH VRQXFX ELU EDUL\HU KD]ÕUODQÕU %X EDUL\HULQ YLWDO
WDUDIÕQGDVUHNOLELU7OHQIRVLWDNWLYLWHVLYDUGÕU+LVWL\RVLWOHUILEUREODVWODUDG|QúU3DUVL\HO
SXOSDQHNUR]XX]XQ\ÕOODUFDEXúHNLOGHNDODELOLU
'X\DUOÕODúPÕú7/HQIRVLWOHULYHGL÷HULPPQKFUHOHUSHULDSNHVWHELULNPH\HEDúODU
)RUDPHQDSLNDOHGHNLVHUXPWUDIL÷LQGHQLVWLIDGHHGHUHNHQoRNELUNDoPLOLPHWUHNDGDUN|N
NDQDOÕQGDQ LoHUL\H JLUHELOLUOHU %X VHEHSOH N|N NDQDOODUÕ LoHULVLQGH JHQHOOLNOH NXURQ
SXOSDVÕQGDQ GDKD ID]OD VDvunma hücresi bulmak mümkündür. Pulpa ölmezden önce
burada biriken IL- VD\HVLQGH PRQRVLWOHU PDNURIDMODUD G|QúU 2OXúDQ LPPQ
NRPSOHNVOHUL RUWDGDQ NDOGÕUDELOPHN LoLQ JD\UHW J|VWHULUOHU IDNDW |PUOHUL NÕVDGÕU YH
VDOGÕNODUÕ ,/-6, damarsal yetmezlik nedeni\OH NHPLN LOL÷LQH XODúDPD] YH \HQL PRQRVLW
DNWLYDV\RQXJHUoHNOHúPH]JHUoHNOHúVHELOHJHQoPRQRVLWOHUHQIHNWHSXOSD\DXODúDPDGDQ
IRUDPHQ DSLNDOH\H NDGDU JHOHELOLUOHU YH SHULDSLNDO GRNXGD ELULNLUOHU $VOÕQGD EX ELULNPH
ilerleyen enfeksiyonun periapkese varGÕ÷ÕQGDKÕ]ÕQÕNHVHFHNELUIDNW|UGU
.XURQSXOSDVÕQDYDVNOHUNROODSVEDúODGÕ÷ÕQGDN|NSXOSDVÕQGD&'LúDUHWWDúÕ\DQ
OHQIRVLWOHUVD\ÕFDDUWDUYH77RUDQÕROXU<DQL7KDNWLYLWHVLWHNUDUJ|UOU+D\UHW
Th aktivitesi, ölen pulpada yeni bir enfODPDV\RQEDúODGÕ÷ÕQÕPÕJ|VWHUL\RU"+D\ÕU%XQODU
SXOSDQÕQNHQGL7KFUHOHULGH÷LOGLUSHULDSLNDOGRNXODUGDQJHOHQGHVWHNNXYYHWOHUGLU7K
DNWLYLWHVL EDúOD\ÕQFD N|N SXOSDVÕQGD KLVWDPLQ YH EUDGLNLQ VHYL\HVLQGH DUWÕú ROXU 6DYDú
giderek periapikal dokulara GR÷UX \HU GH÷LúWLUHFHNWLU $UWÕN ROD\ODU SHULDSNHVWH GHYDP
eder:
3HULDSLNDO3HULRGRQWLWLVLQøPPQRORMLVL
3XOSDGDQ SHULDSHNVH LOHWLOHQ HQIHNVL\RQ VÕUD\OD DNXW DSLNDO SHULRGRQWLVLV NURQLN
apikal periodontis, akut periapikal apse ve kronik periapikal apse (radiküler kist) ile devam
HGHU1DLU%XVDIKDODUÕQELULVLQGHQGL÷HULQHJHoHUNHQNOLQLNWHIDUNWHVSLWHGLOVHELOH
KLVWRSDWRORMLN RODUDN LPPQ KFUH VD\ÕVÕ YH SURILOL GÕúÕQGD EHOLUJLQ ELU LúDUHW \RNWXU %X
sebeple, kronik periapikal apse harioGL÷HUOHULQLD\QÕEDúOÕNDOWÕQGDLQFHOH\HFH÷L]
2OD\ SHULDSHNVH YDUGÕ÷ÕQGD SXOSDGD ERO PLNWDUGD EDNWHUL YH EDNWHUL UQOHUL
\ÕNÕOPÕúPDNURIDMODU31/
OHU1.KLVWL\RVLWSOD]PDKFUHOHUL%YH7OHQIRVLWOHULEXQODUÕQ
\ÕNÕPÕQGDQ RUWD\D oÕNDQ OLWLN DUWÕNODU SXWULIL\H ED÷ GRNXVX DUWÕNODUÕ DQWLMHQ DQWLNRU
NRPSOHNVOHULVHUXPYHHNVXGDEXOXQXU%XX\DUDQODUÕQWHVLULLOHJHoSXOSLWLVG|QHPLQGHQ
LWLEDUHQSHULDSHNVWHEDúODPÕúRODQQ|URMHQLNHQIODPDV\RQ\HULQLNRQYDQVL\RQHOLPPQ
UHDNVL\RQODUD EÕUDNÕU 3HULDSHNVH J|UOHQ ROD\ODUÕQ LON GHID WHWL÷LQL oHNHQ X\DUÕQ|URMHQLN
RODELOHFH÷L JLEL NDQDOGDQ VÕ]DQ DQWLMHQLN X\DUÕQÕQ SHULDSHNVL HWNLOHPHVL úHNOLQGH GH
RODELOLU%XUDGDRUWD\DoÕNDQQ|URMHQLNHQIODPDV\RQXQVH\ULQGHELU|]HOOLNYDUGÕU1|URMHQLN
mediyatörler (CGRP ve P maddesi) bu defa epitelizasyonu tetikler (Torabinejad, 1994),
KDWÕUODWPD D\QÕ X\DUÕ SXOSD LoHULVLQGH RGRQWREODVWODUÕ DNWLYH HGL\RUGX 1|URMHQLN
HQIODPDV\RQXQ SHULDSLNDO GRNXGD HSLWHOL]DV\RQX EDúODWÕ\RU ROPDVÕ X]D\DQ DSLNDO
enflamasyonun neden fibro-HSLWHO\DONLVWLNOH]\RQODUDG|QúW÷QDoÕNODUQLFHOLNWHGLU
3URFKD]NRYD YH DUNDGDúODUÕ DSLNDO SHULRGRQWLWLVH NDWÕODQ
PLNURRUJDQL]PDODUÕQGHQWDOSODNWDQJHOGL÷LQLYHEXPLNURRUJDQL]PDODUÕQO|NRVLWOHULNXYYHWOH
X\DUDELOPH |]HOOL÷LQH VDKLS ROGX÷XQX J|VWHUPLúOHUGLU 8\DUÕODQ O|NRVLWOHUGHQ /)$-1a
/HXFRF\WH )DFWRU $VVRFLDWH VDOÕQGÕ÷ÕQÕ YH EX HQ]LPLQ SURJQR]X D÷ÕUODúWÕUGÕ÷ÕQÕ
VDYXQPXúODUGÕU 3XOSD QHNUR]XQD VHEHS RODQ EDNWHULOHU RQODUÕQ DWÕNODUÕ GRNX \ÕNÕP
ürünleri ve litik pulpa periapekstHQVÕ]PD\DEDúODGÕ÷ÕQGDSHULDSHNVGX\DUOÕODúPÕú%YH7
OHQIRVLWOHUL\OH oHYULOL YD]L\HWWHGLU 'ROD\ÕVÕ\OD SHULDSHNV DQWLMHQLN X\DUÕODUD SXOSD NDGDU
KD]ÕUOÕNVÕ] \DNDODQPD] SXOSLWLV YH SXOSD |OPQQ GHYDP HWWL÷L JQOHU ER\XQFD
monoklonal B ve T hücre diziOHUL EXUD\D J|o HWPLú ROXU +DWWD ,/-1, IL-2, prostoglandin,
KLVWDPLQ VHUDWRQLQ JLEL YD]RDNWLI PHGL\DW|UOHU DUWHUL\ROOHUL JHQLúOHWPLú YH N|N NDQDOGDQ
EXUD\DVÕ]DELOHFHN\DSÕODULOHPFDGHOH\HKD]ÕUODPÕúROXUùHNLO%XGXUXPGD
kapiler permeabilite veEXQDED÷OÕRODUDNVHUXPGLDSHWHVLDUWDU3HULDSHNVWHVHUXPELULNLU
.RPSDNWNHPLNGRNXVXDQLHNVSDQVL\RQODUDPVDLWROPDPDVÕQDUD÷PHQSHULDSLNDOGRNX
VSRQJL|] WDELDWWDGÕU YH JUDGHO GLODWDV\RQODUD PVDLWWLU %XQD UD÷PHQ LON JHQLúOHPH HQ
]D\ÕI\|QHGR÷UX\DQLSHULRGRQWDOPHPEUDQDGR÷UXROXU3HULRGRQVL\XPXQELOKDVVDDSLNDO
\DUÕVÕQGD OLIOHULQ DUDVÕQD VHUXP YH FDUDKDW ELULNPHVL ROXU %X VÕUDGD HQIHNWH N|N NDQDOÕ
JOLNRSURWHLQ IHUPHQWDV\RQ ID]ÕQGDGÕU 'Lú NHQGLVRNHWLQGHKDILIoH\NVHOLU%XGXUXPXQ
NOLQL÷H \DQVÕPDVÕ SHUNV\RQ GX\DUOÕOÕ÷Õ úHNOLQGHGLU %X G|QHPGH VR÷XN X\JXODPDODUÕ
VRUXQOXE|OJHGHELULNPLúVÕYÕQÕQNRQWUDNVL\RQXQDVHEHSRODUDNUDKDWODPDVD÷OD\DELOLU
Dokuda serum birikmesi, daha fazla kompleman reaksiyonu demektir. Kanaldan
SHULDSHNVH VÕ]DQ DQWLMHQLN \DSÕODU NRPSOHPDQ UHDNVL\RQX LOH ED÷ODQDUDN DQWLMHQ-antikor
NRPSOHNVOHUL ROXúXU %|\OHFH GDKD ID]OD DQDILODWRNVLQ &D &D DoÕ÷D oÕNDU $\UÕFD %
OHQIRVLWOHUL KÕ]OD SOD]PD KFUHOHULQH G|QúUOHU YH ,J0 WLSLQGH |]JO DQWLNRU VDODUODU
(humoral cevap). Özgül antikorlar, birbirlerine daha kuvvetli tutunabilen antijen-
DQWLNRU NRPSOHNVOHUL ROXúWXUXU g]JO ROPD\DQ NRPSOHPDQ DNWLYDV\RQX YH |]JO RODQ
humoral cevap ile meydana gelen antijen-DQWLNRUNRPSOHNVOHULQLQ|QHPOLELUNÕVPÕEXUDGD
fagositik hücreOHUWDUDIÕQGDQRUWDGDQNDOGÕUÕOÕUùHNLO'L÷HUELUNÕVPÕJHQLúOH\HQYHQOHU
YHOHQIDWLNOHU\DUGÕPÕLOHEXUDGDQX]DNODúWÕUÕOÕU%XQODUÕQJLWWLNOHULLNL\HUYDUGÕUGRODúÕPD
NDWÕODQODU UHQDO WEOVOHUGHQ DWÕOÕU %X NRPSOHNVOHU GX\DUOÕ ELUH\OHUGH RWRimmün
KDVWDOÕNODUÕ EDúODWDELOPHNWHGLU OHQI G÷POHULQH G|QHQOHU EXUDGD IDJRVLWH HGLOLU
%XUDGDQX]DNODúWÕUÕODPD\DQELUNÕVÕPDQWLMHQ-DQWLNRUNRPSOHNVOHULLVHLOHULGHRVWHRNODVWODUÕ
WHWLNOH\HFHNOHUGLU =DWHQ EX NRPSOHNVOHU JLGHUHN GDKD ]RU X]DNODúWÕUÕOPD\D EDúODU 2OD\
DNXWSHULDSLNDODSVH\HGR÷UXLOHUOHU
ùHNLO3HULDSHNVWHLPPQUHDNVL\RQODU
3HULSLNDO$SVHQLQøPPQRORMLVL
(÷HU IRUDPHQ DSLNDOHGHQ VÕ]DQ OLWLN DUWÕNODU LoHULVLQGH GDKD |QFH 7 OHQIRVLWOHULQH
VXQXOPD\DQDQWLMHQLN\DSÕODUYDUVDEXQODUVXEDQJOHUOHQIG÷POHULQHWDúÕQÕU%XLúOHP
LoLQDUDFÕOÕNHGHFHNKFUHVD\ÕYHoHúLWOLOL÷LJD\HWID]ODGÕUYHSXOSDGDNLJLELVÕQÕUOÕN\RNWXU
1RUPDO NRúXOODU DOWÕQGD \DQL SHULDSHNV DODUP GXUXPXQGD GH÷LONHQ KHUKDQJLELUDQWLMHQLQ
\DNDODQÕS OHQI G÷POHULQH WDúÕQPDVÕQD JHUHN \RNWXU oQN PLQ|U antijenler, lenf
G÷POHULQFH]DWHQWXWXOPDNWDGÕU)DNDWSHULDSLNDOLPPQFDYDEÕQDUWWÕ÷ÕGXUXPGDEXLúL
HSLWRSXQWDúÕQPDVÕQÕJHQHOOLNOHPDNURIDMODUYHYH\D%OHQIRVLWOHULEL]]DW\DSDUODU
6XEDQJOHUOHQIG÷POHULQHSHNoRNDIIHUHQWOHQIGDPDUODUÕJLUHUIDNDWoÕNÕúELUNDo
HIIHUHQW OHQI GDPDUÕ LoHULVLQGHQ ROXU ùHNLO %X GDPDUODU NDSDNoÕNOÕ ROXS VÕYÕ WUDIL÷L WHN
\|QOGU 6R\GDQ $QWLMHQLN \DSÕODU OHQI G÷POHULQH XODúWÕ÷ÕQGD EXUDGD GHYDP
HWPHNWH RODQ OHQIRVLW WUDIL÷L VDDW NDGDU ELU VUH LoLQ GXUXU %X VÕUDGD OHQIRVLWOHULQ OHQI
G÷PQGHQ GÕúDUÕ oÕNÕúÕ HQJHOOHQLU DPD JLULúOHUL VHUEHVWWLU %XQXQ VHEHEL $3& OHU
WDUDIÕQGDQ VDOÕQDQ VLWRNLQOHULQ HIIHUHQW OHQI GDPDUODUÕQGD VHEHS ROGX÷X VWD]GÕU 6RUXQOX
GLúLQ EXOXQGX÷X E|OJH LOH OHQI G÷POHUL DUDVÕQGDNL OHQI GDPDUODUÕ GLODWH YD]L\HWWHGLU
GHELOHULDUWPÕúWÕUVUHNOLRODUDNOLWLNDUWÕNODUÕYHPDNURPROHNOOHULOHQIG÷POHULQHJHWLULUOHU
/HQI G÷PQQ VHUWOL÷L DUWDU oDSÕ E\U NROD\FD SDOSH HGLOHELOLU ER\XWODUD JHOLU %X
dönemde antijenler, TOHQIRVLWOHULQHEXUDGDVXQXOXU%XVÕUDGDOHQIG÷POHULQGHOHQIRVLW
oR÷DOPDVÕROXU0RQRNORQDO7VHULOHULYHEODVWKFUHOHULQHG|QúHQ%OHQIRVLWOHULNDQD
G|NOUOHUhUHWLOHQDQWLMHQLQGR÷UXGDQSHULDSLNDOGRNXODUDG|Qú\DSPDVÕQDLPNDQ\RNWXU
Önce dolaúÕPD oÕNDUODU VRQUD ,/- LQ YH GL÷HU NHPRWDNWLN IDNW|UOHULQ FD]LS NÕOGÕ÷Õ GR÷UX
adresi, kemotaksis ile bulurlar. Bu sebeple özgül antikor ve T hücre serileri enfeksiyon
VÕUDVÕQGDVLVWHPLNGRODúÕPGDVHUXPGDWHVSLWHGLOHELOLU%ORFN%
T hücre aktivasyonu için önce
UHWLNOHU KFUHOHULQ VDOGÕ÷Õ YH GDKD VRQUD
DNWLYH 7 KFUHVLQLQ NHQGLNORQDOJHOLúLPLLoLQ
NHQGLVLQLQ VDOGÕ÷Õ ,/- YH GL÷HU VLWRNLQOHU
GúN NRQVDQWUDV\RQGD GRODúÕPD VÕ]DUDN
KDVWDQÕQ DWHúLQL \NVHOWLU %X G|QHPGH HQ
belirgin olaylar, lenI G÷POHULQGH YH
SHULDSHNVWH JHUoHNOHúLU /HQI G÷POHULQGH
KÕ]OÕ ELU OHQIRVLW WUDIL÷L YH IDJRVLWR] YDUGÕU
%DNWHULOHU DQWLMHQLN \DSÕODU YH OLWLN ED÷GRNX
\ÕNÕP UQOHUL VUHNOL RODUDN N|N NDQDOÕQGDQ
SHULDSHNVWHVÕ]DUSHULDSLNDOGRNXODUGD|]JO
antikorlaU LOH ED÷ODQÕU RUWD\D oÕNDQ HNVXGD
ùHNLO 6XE DQJOHU OHQI EH]OHULQGH OHQIDWLNOHUOHOHQIG÷POHULQHWDúÕQÕU
HIIHUHQWYHDIIHUHQWOHQIGDPDUODUÕ
Bu dönemde, periapeks, bakteriden
HQ ]HQJLQ ROGX÷X G|QHPLQGHGLU %X E|OJHQLQ LGGLDOÕ VDYXQPDVÕ QHGHQL\OH EDNWHULOHULQ
SHULDSHNVHoÕNVDODUELOHEXUDGDX]XQVUHFDQOÕNDOPDúDQVODUÕ\RNWXU%XG|QHPGH,/-1a,
IL-6, IL-8, periapekse egemen sitokinlerdir. Monosit ve makrofajlardan gelen IL-D
QÕQ
aktivitesi nedeniyle lenfositler stimüle edilirler, nötrofiller potansiyelize edilir, damar
endoteline lökosit adezyonu en üst seviyededir. %X SURIHV\RQHO ELU VDYXQPDGÕU YH HNLS
LúLGLU
+DVDUJ|UHQHQGRWHOYHLPPQKFUHOHULQPHPEUDQODUÕQGDQEROPLNWDUGDDUDúLGRQLN
DVLW RUWD\D oÕNDU +DVDU J|UHQ KFUHQLQ WDPLU UHIOHNVL LOH VLNORRNVLMHQD] \ROX ]HULQGHQ
prostoglandinler üretilir. Bunlardan PGE2, PGD2, PGF2a, PGI2, periapikal dokularda en
ID]ODRODQODUÕGÕU$UDúLGRQLNDVLWOLSRRNVLMHQD]\ROXLOHO|NRWULHQOHUHG|QúU/7&/7'
YH /7' SHULDSHNVWH WDEOR\D KDNLP RODQ HQ |QHPOL O|NRWULHQOHUGLU %N] $UDúLGRQLN DVLW
metabolitleri). Bu maddeler, nötrofillerin davet edilmesi, damar endoteline adezyonu,
GRNX\D JHoHQ Q|WURILOOHULQ DNWLYDV\RQX YH D÷UÕ HúL÷LQLQ GúUOPHVLQGHQ VRUXPOXGXU ELU
PLNWDU SURVWRJODQGLQOHU NDQD JHoHUHN DWHúLQ \NVHOPHVLQH NDWNÕGD EXOXQXU %X
prostoglandinler ve lökotreinlerDNXWSHULDSLNDOSHULRGRQWLWLVOLYHDNXWDSVHOLGLúOHULQ
SHULDSLNDO GRNXODUÕQGD oRN \NVHN NRQVDQWUDV\RQODUGD WHVSLW HGLOPLúWLU 1DLU NSAID, lökotrienleri engelleyemez, fakat siklooksijenaz yolunu engelleyerek PG'lerin
RUWD\D oÕNPDVÕQÕ GXUGXUDELOLr. Bu durumda, IL-1ß, IL- *0&6) YH (*) JLEL ED]Õ
VLWRNLQOHULQGRNXNRQVDQWUDV\RQODUÕQGDD]DOPDROXU%XD]DOPDLNL\|QOWHKGLWROXúWXUXU
%LULQFL WHKGLW NRQDN VDYXQPDVÕQÕQ D]DOPDVÕGÕU øNLQFL WHKGLW EDNWHUL UHPHVLQL DUWÕUÕU %X
bir sürprizdir. IL-1ß
QÕQ GRNXGDNL NRQVDQWUDV\RQX QJPO
QLQ DOWÕQD GúW÷ ]DPDQ
EDNWHULUHPHVLQH\DUGÕPHWPHNWHGLUSJPO,/-1 bulunan ortamda E. colinin üremesinin
\DNODúÕNNDWÕDUWWÕ÷ÕDQWDJRQLVWNLP\DVDOPDGGHOHULOHRUWDPGDPHYFXWRODQ,/-1 ortadan
NDOGÕUÕOGÕ÷ÕQGD EDNWHUL UHPHVLQLQ WHNUDU \DYDúODGÕ÷Õ J|VWHULOPLúWLU 3RUDW YH DUNDGDúODUÕ
71)
QLQGHEHQ]HUELUHWNLVLYDUGÕUIDNDW,/-4'ün böyle bir etkisi yoktur.
(*)
Q GRNX NRQVDQWUDV\RQX QJPO
QLQ DOWÕQD GúHUVH WEHUNOR] EDVLOLQLQ
UHPHVLQL DUWÕUPDNWDGÕU %HUPXGH] YH DUNDGDúODUÕ ,/-2, IL-6 ve GMCSF gibi
VLWRNLQOHU HQIHNVL\RQXQ ROGX÷X GRNXGD GúN NRQVDQWUDV\RQGD EXOXQGX÷XQGD EDNWHUL
UHPHVLQL DUWÕUDQ ELU HWNL J|VWHULU YH 16$,' EXQODUÕQ GRNX NRQVDQWUDV\RQODUÕQÕ GúUU
(Denis, 1992), (DenLVYHDUNDGDúODUÕ(QIHNVL\RQGDHQIODPDV\RQGDGH÷LO16$,'
NXOODQÕPÕWHNUDUJ|]GHQJHoLULOPHOLGLU
Periapikal enfeksiyonlu dokuda bulunan T lenfositlerinin profili gayet tipiktir,
&'&' RUDQÕ JHQHOOLNOH ! RODUDN EXOXQXU <DQL 7K KFUHOHULQLQ VD\ÕVÕ 7V YH 7F
KFUHOHULQLQ VD\ÕVÕQGDQ ID]ODGÕU %X RUDQ QRUPDO NDQGD “ HULúNLQ SHULRGRQWLWLVOL
KDVWDQÕQSHULDSLNDOGRNXVXQGD“HULúNLQSHULRGRQWLWLVOLKDVWDQÕQNDQÕQGD“
-1.7 ± 10.1, juvenil periodontitiste 1.1 ± 0.1, marginal gingivitiste 1.8 ± 0.2 olarak tespit
HGLOPLúWLU6H\PRXUYHDUNDGDúODUÕ
$NXW DSVHQLQ EDúODGÕ÷ÕQÕQ KDEHUFLVL RODQ GH÷LúLP GRNX\D KDNLP RODQ ,/-D
QÕQ
yerini IL-‰
\D EÕUDNPDVÕGÕU %X GH÷LúLP WLSLNWLU 3HULDSLNDO SHULRGRQWLWLVWHQ DNXW DSVH\H
geçiú G|QHPLQGH HNVXGD LoHULVLQGH ERO PLNWDUGD ,/-‰ WHVSLW HGLOPLúWLU %DUNKRUGDU YH
DUNDGDúODUÕ,/-‰
QÕQX\DUÕVÕLOHGRNXGDNLSURVWRJODQGLQNRQVDQWUDV\RQX\NVHOLU
SHULRGRQWDONHPLNGRNXGD\ÕNÕPYH\DSÕPIDDOL\HWOHULEDúODWÕOÕU,/-‰D\QÕ]DPDnda IL-6
ve IL-
LQ VDOÕQPDVÕQÕ VD÷ODU ,/-6, TGF-‰ VDOÕQÕPÕQÕ DUWÕUÕS 7K OHQIRVLWOHULQL
GX\DUVÕ]ODúWÕUDUDN ELU IHHG-EDFN ROXúWXUXUNHQ ,/-8 ise kuvvetli kemotaktik olan TNF
VDOÕQÕPÕQÕX\DUÕUKDWÕUOD\ÕQÕ]LNL]ÕWLPPQPHNDQL]PDQÕQELUOLNWHX\DUÕOPDVÕ Enflamatuar
ROD\ODUELULVLLQKLEHHGHQGL÷HULDPSOLIL\HHGHQLNLNXYYHWLQGHQJHVLKDOLQHG|QúU
øQKLEHHGLFLIDNW|UOHUEXG|QHPGH\DYDúoDEHOLUJLQKDOHJHOPH\HEDúODUIDNDWKDOHQROD\
GDKD oRN LPPQ DPSOLILNDV\RQXQ HWNLVL\OH LOHUL\H GR÷UX JLWPH\H PH÷LOOLGLU %X G|QHPGH
nötrofiller dokuya hakimdir. T lenfositleri ve makrofajlardan gelen IL- &6) DUDFÕOÕNOÕ
RODUDN\HQLLPPQKFUHOHULGRNX\DoHNHUYHDNWLYHHGHURVWHRNODVWODUÕYHRVWHREODVWODUÕ
ELUOLNWHX\DUÕU,/-ORNDOHWNLOHUL\DQÕQGDVLVWHPLNRODUDNGDHWNLJ|VWHULU.DUDFL÷HUGHQYH
NHPLN LOL÷LQGHQ $33
QLQ VDOÕQPDVÕQÕ VD÷ODU %X VÕUDGD GRNXGD 7*)-‰ YDUOÕ÷Õ J|]OHQLU
/HUQHU %X VLWRNLQLQ ND\QD÷ÕQÕ GRNXQXQ KHUKDQJL KFUHOHULQGHQ DODELOHFH÷L JLEL
GDKDoRNGHIDODUFDX\DUÕODQPDNURIDMODUGDQDOÕU%HQ]HUúHNLOGHGHIDODUFDX\DUÕODQ7
lenfositleri, trombositler ve fibroblastlar TGF-‰ VDODUODU $GHWD GRNX LQFLQPHVLQLQ DUWWÕ÷ÕQÕ
YH DUWÕN WDPLU ROD\ODUÕQÕQ EDúODWÕOPDVÕ JHUHNWL÷LQL WHPELK HGHUOHU (QIODPDV\RQXQ LQKLEH
edici faktörleri giderek kuvvHW ND]DQPD\D EDúODU %X G|QHPGH HNVGD PLNWDUÕQGD DUWÕú
olur.
3HULDSLNDO DSVHGH VÕNOÕNOD J|UOHQ |GHP ND\QD÷ÕQÕ DUWDQ GDPDU SHUPLDELOLWHVL
QHGHQL\OH VHUXPXQ GDPDU GÕúÕQD oÕNPDVÕQGDQ DOÕU gGHP VÕYÕVÕ PHNDQLN WUDYPDODUÕ
takiben 5- GDNLND VRQUD ROXúDQ NDSDOÕ \DUDODUGD VWHULO RODELOLU IDNDW SHULDSLNDO
HQIHNVL\RQODUGD|GHPVÕYÕVÕQGDHNVGDGDEXOXQXUYH|GHPVÕYÕVÕQÕQYROPQDUWPDVÕQD
sebep olur.
gGHPLQHQIHNVL\RQXQJLGLúLQHúXHWNLOHULROXU
1. Dokudaki toksinleri dilüe eder,
2. Toksinlerin nötralizasyRQXQXNROD\ODúÕU
3. 'DPDUGÕúÕQDoÕNDQYHDUWÕNEHVOHQHPH\HQLPPQKFUHOHUHEHVOHQPHND\QD÷Õ
ROXúWXUXU
4. $QWLNRUODULKWLYDHWWL÷LLoLQDVOÕQGDQRQVSHVLILNELUKXPDUDOVDYXQPDROXúWXUXU
5. 6HUXP ND\QDNOÕ ROGX÷X LoLQ NRPSOHPDQ SURWHLQOHUL LKWLYD HGHU YH LQFLQPLú
bölgede özgül olmayan antijen-DQWLNRUUHDNVL\RQODUÕQD\DUGÕPHGHU
6. )LEULQRMHQLKWLYDHWWL÷LLoLQLQFLQPLúE|OJHGHILEULQROXúWXUXUEXILEULQLVHLPPQ
KFUHOHULQKDUHNHWNDELOL\HWLQLDUWÕUÕU
7. 2UWDPÕQS+
VÕQÕWDPSRQODU
gGHP VÕYÕVÕQÕQ WRSODQPDVÕQGD prostoglandinlerin bilhassa PGE, PGD'nin rolü
YDUGÕU.RUWLNRVWHURLGYH\D16$,'NXOODQPDNVXUHWLLOH|GHPROXúXPXHQJHOOHQPHPHOLGLU
+DVWDQÕQ|GHPOLGRNX\DPHNDQLNEDVÕQoX\JXODPDVÕVDNÕQFDOÕGÕU*|UHYLWDPDPODQÕQFD
EXVÕYÕOHQIDWLNOHUWDUDIÕQGDQNHQGLOL÷LQGHQGUHQHROXU
3HULDSLNDO GRNXODUGD EDNWHULOHULQ WRNVLQOHUL YH \ÕNÕP UQOHUL QHGHQL\OH ,/-1 ve IL
LQ DNWLYDV\RQX YH /7%
Q YDUOÕ÷Õ QHGHQL\OH DNXW HQIODPDV\RQ ELU VUH GDKD GHYDP
eder. Lenfatik damarlardaki artan trafik birkaç gün sonra periapeNVWHNL HNVGDWLI EDVÕQFÕ
GúUHFHNWLUYHHQIHNVL\RQNURQLNOHúHFHNWLU
3HULDSLNDOHQIHNVL\RQQH]DPDQNURQLNOHúLU"
$NXW WHULPL DQL EDúOD\DQ KHPHQ RODQ KÕ]OÕ JHOLúHQ DQODPÕQD JHOLUNHQ NURQLN
WHULPLJHoG|QHPEHOLUJLQROPD\DQX]XQVUHQDQODPÕQÕWDúÕU%XWHULPOHUHQIHNVL\RQXQ
KLVWRSDWRORMLN NURQRORMLVLQL WDULI HGHU DPD NOLQLNWH EX LNL G|QHPL D\ÕUDFDN FLGGL ELU LSXFX
yoktur. O halde bir periapikal enfeksiyon için ne zaman "kronik" denilebilir?
.URQLN HQIODPDV\RQ LNL \ROGDQ JHOLúLU %LULQFL \ol, sürmekte akut reaksiyonun Ts
DNWLYLWHVLLOHEDVWÕUÕOPDVÕúHNOLQGHGLUøNLQFL\ROLVHROPD\DQDNXWFHYDEÕQ\HULQHPHFEXUHQ
ELU NURQLN FHYDS JHOLúPHVL úHNOLQGHGLU +DQJL \RO LOH ROXUVD ROVXQ DúD÷ÕGDNL KLVWRORMLN
LúDUHWOHUGHQELUNDoÕELUDUD\DJHOGL÷L]DPDQWDQÕPOÕELUNURQLNOH]\RQGDQEDKVHGLOLU
(NVGDWLISHULDSLNDOGRNXUHDNVL\RQODUÕGXUXU
3UROLIHUDWLISHULDSLNDOGRNXUHDNVL\RQODUÕEDúODU
3. Serumda APP'ler bulunmaz,
4. Nötrofiller ve PML'ler periapeksi terkeder,
5. Periapeks fibroblasttDQ]HQJLQOHúLU
6. Mononükleer hücreler periapekse gelir, (makrofaj, lenfosit ve plazma hücreleri
gibi).
+DVWDQÕQD÷UÕVÕYH|GHPL\RNWXUYH\DLKPDOHGLOHELOLUVHYL\HGHGLU
%XUD\DJ|oHGHQILEUREODVWODUN|NNDQDOÕQGDQVÕ]DQDQWLMHQLN\DSÕODUÕKDSVHGen ve
VD÷ODP GRNX\X D\ÕUDFDN ELU ILEURHSLWHO\DO VÕQÕU ROXúWXUXUODU 3HULDSLNDO GRNXODUGD
JUDQODPDW|]YHILEURHSLWHO\DOELUKDUHNHWOHQPHEDúODU
3HULDSLNDOHQIHNVL\RQQHGHQNURQLNOHúLU"
3HULDSLNDO HQIHNVL\RQXQ NURQLNOHúPHVL \DQL GRNXODUÕQ JUDQODPDW|z ve
ILEURHSLWHO\DO SUROLIHUDV\RQ \|QQGHNL WHúHEEV DVOÕQGD EDúDUÕODPD\DQ WDPLU
KDPOHVLQLQ ELU VRQXFXGXU (QIHNWH SXOSDQÕQ L\LOHúPHVL WDPDPODQPÕú ROVD\GÕ SHULDSLNDO
E|OJHGH ILEURHSLWHO\DODWDNODUJ|UOPH\HFHNWL2KDOGHSHULDSLNDONURQLNOHúPHL\LOHúmeye
DOWHUQDWLI RODUDN EDúODPDNWDGÕU <DQL SHULDSLNDO GRNXODU SXOSD WDPLULQL EDúDUDPDGÕNODUÕ
için proliferasyona gitmektedir.
3HULDSLNDO GRNXODUÕQ WDPLU KDPOHVLQL ERúD oÕNDUDQ KHU IDNW|U NURQLNOHúPHQLQ KHP
VHEHELKHPGHLúDUHWLGLU
*HQHOOLNOHúXQODUNURQLNOHúPHVHEHELGLU
(QIHNWH N|N NDQDOÕQGDQ SHULDSHNVH VÕ]DUDN GRNX LoHULVLQH LQILOWUH RODQ YH
IDJRVLWR]D GLUHQHQ EDNWHULOHU EXQODUÕQ KDQJL EDNWHULOHU ROGX÷X YH IDJRVLWR]D QDVÕO NDUúÕ
NR\GXNODUÕSXOSLWLVLQPLNUREL\RORMLVLEDúOÕ÷ÕDOWÕQGDDQODWÕOPÕúWÕU
6LQGLULOHPH\HQ EDNWHUL\HO DUWLIDNWODU ELOKDVVD VWUHSWRNRNODUÕQ KFUH GXYDUÕ
\DSÕODUÕDUWULWLVVHEHELRODFDNúHNLOGHGRNXGDNDOPDNWDGÕU
3HULDSHNVWH \DEDQFÕ FLVLP EXOXQPDVÕ .|N NDQDOODUÕQÕQ EL\RPHNDQLN
SUHSDUDV\RQODUÕ\DSÕOÕUNHQIRUDPHQDSLNDOHGHQGÕúDUÕoÕNDELOHFHNPDNURSDUWLNOOHUGHQWLQ
WDODúÕ VPHDU PDNURIDMODU WDUDIÕQGDQ NROD\FD VLQGLULOHPH] 0DNURIDMODUÕQ EXQODUÕ
HNVWUDVHOOHU OL]LV \ROX LOH RUWDGDQ NDOGÕUÕOPD JD\UHWOHUL SHULDSLNDO GRNX LQFLQPHVL LOH
VRQXoODQÕU 3HULDSHNVH WDúDQ PDWHU\DO VLOLNRQ HVDVOÕ\VD ROXúDQ UHDNVL\RQD VLOLNRVLV
denir. Silikosis genellikle fibrosis ile devam eder.
.LP\DVDO PDGGHOHU .|N NDQDOÕ LoHULVLQH X\JXODQDELOHFHN KHU NLP\DVDO PDGGH
SHULDSLNDO HQIHNVL\RQX NURQLNOHúWLUHELOLU %X NRQXGD RNX\XFX\D VWDQGart bir liste vermek
WDWPLQ HGLFL ROXUGX IDNDW KHU NRQDN LoLQ IDUNOÕ NLP\DVDOODU JHoHUOLGLU %|\OH NLP\DVDOODU
OLVWHVL YHULOHPH\HFHN NDGDU ID]ODGÕU *HQHOOLNOH RMHQRO YH RMHQROO ELOHúLNOHU NURQLNOHúPH\L
destekleyebilirler (Trowbridge ve Emling, 1989). TDúNÕQGROJXRODUDNLIDGHHGLOHQWHNQL÷LQ
JHUH÷L RODUDN SHULDSHNVH WDúÕUÕODQ NLP\DVDO PDGGHOHU GH NURQLNOHúPH\H VHEHS
olabilmektedir.
(QGRMHQPHWDEROLWOHU.DQDOLoHULVLQGHNDQDPDVRQXFXHULWURVLWOHUGHQDoÕ÷DoÕNDQ
demir, kolesterol ve ürik asit, enfeksL\RQXNURQLNOHúWLUHELOLU
øPPQ UHDNVL\RQODU VRQXFX JD\HW NDUPDúÕN PHNDQL]PDODUÕQ VRQXFXQGD DNXW
SHULDSLNDOHQIODPDV\RQNURQLNOHúHELOPHNWHGLU
$NXW SHULDSLNDO OH]\RQXQ \HWHUVL] OHQIDWLN GUHQDMÕ YHYH\D \HWHUVL] NDQODQPDVÕ
GXUXPXQGD OH]\RQ LoL EDVÕQo EHNOHQHQGHQ E\N ROXU YH PHUNH]GH QHNUR] EDúODU
1HNURWLNGRNXVWHULOELOHROVDEDNWHUL\HOUQOHUNDGDULULWDQGÕU
.URQLN YHYH\D DNXW WUDYPD 6RUXQOX GLúH X\JXQVX] \|Q YH E\NONWH NXYYHW
uygulayan protetik restorasyonlar (bruksizm gibi).
9.%LOLQPH\HQVHEHSOHU6LVWHPLNKDVWDOÕNODU\DúFLQVL\HWÕUNYHJHQHWLNIDNW|UOHULQ
HQIHNVL\RQXQNURQLNOHúPHVLQLQH\|QGHHWNLOHGL÷LELOLQPHPHNWHGLU
10. Tip-DúÕUÕGX\DUOÕOÕNUHDNVL\RQODUÕSUROLIHUDWLIJUDQODV\RQXGHVWHNOHU
Kronik Periapikal ApsHQLQøPPQRORMLVL(Lerner, 1994):
.DQDOGDQVÕ]DQOLWLNDUWÕNODUYHPDNURPROHNOOHUD]DOPD\DEDúOD\ÕQFDSHULDSLNDOGRNXGD
ELU WDPLU ROD\Õ EDúODU %X G|QHPGH DUWDQ OHQIDWLN GUHQDM SHULDSLNDO E|OJHGH WRSODQDQ
VHUXP YH HNVGDWLI VÕYÕODUÕQ EDVÕQFÕQÕ GHQJHOHQPH\H EDúODU 7V KFUHOHU GDKD DNWLI KDOH
JHOHUHN NRQDN FHYDEÕQÕ EDVNÕ DOWÕQD DOÕUODU %X G|QHPGH 7K7V RUDQÕ LQ DOWÕQD GúHU
.DQDOGDQSHULDSHNVHRODQVÕ]ÕQWÕQÕQNRPSR]LV\RQXJLGHUHNWHNG]HELUúHNLODOÕU6DGHFH
üçüncü faz bakterileri ve bu bakterilerH DLW DQWLMHQOHU VÕ]PDNWDGÕU 0RQRNORQDO % YH 7
KFUHOHUL ]DWHQ IRUDPHQ DSLNDOH\H \DNÕQ E|OJHGH KD]ÕUEXOXQPDNWDGÕUYHNDQDOGDQVÕ]DQ
DQWLMHQLN \DSÕODU GHUKDO WDQÕQDUDN \D IDJRVLWH HGLOPHNWH YH\D |]JO DQWLNRUODU LOH
ED÷ODQPDNWDGÕU VHQDU\R VDELWWLU %X dönemde, periapeksteki immün hücre
NRPSR]LV\RQXQGD EHOLUJLQ ELU GH÷LúLP EDúODU WDEOR\D KDNLP RODQ Q|WURILO YH PDNURIDMODU
\HULQL7VOHQIRVLWOHULPDNURIDMYHSOD]PDKFUHOHULQHEÕUDNÕUODU%XKFUHOHULQELUELUOHULQH
RUDQODUÕ HQIHNVL\RQGDQ HQIHNVL\RQD GH÷LúLU %DUNKRUGDU YH 'HVRX]D NURQLN
SHULDSLNDO OH]\RQGD 7 KFUHOHULQLQ \]H\ PDUNHU
ODUÕQÕ LQFHOHPLú WDQH 7 OHQIRVLWLQLQ
&'WDQHVLQLQ&'WDQHVLQLQ&'LúDUHWOLROGX÷XQXJ|VWHUPLúWLU
%X G|QHPGH ODPLQD GXUD JHQLúOH\HUHN RUDO Iloradan yeni bakterilerin apikal
E|OJH\H XODúPDVÕQÕ NROD\ODúWÕUÕU (ULúNLQGH PDUJLQDO SHULRGRQWLWLVLQLQ IORUDVÕQGD
Porphyromonas gingivalis (75.8%), Prevotella intermedia, Fusobacterium nucleatum,
Actinobacillus actinomycetemcomitans, Bacteroides forsythus, ve Capnocytophaga türleri
EXOXQXU %X NRPSR]LV\RQ DSLNDO SHULGRQWLWLVLQ IORUDVÕQD NÕVPHQ EHQ]HGL÷L LoLQ SHULDSLNDO
OH]\RQD SHULRGRQWDO EDNWHULOHULQ NDWÕOGÕ÷Õ GD GúQOPHNWHGLU $OL YH DUNDGDúODUÕ <XNDUÕGD VD\ÕODQODUÕQ GÕúÕQGD SHULDSLNDO GRNXODUGD D\UÕFD VSLURNHWOHU *UDP QHJDWLI
IDNOWDWLI oRPDNODU YH VWUHSWRNRNODU YDUGÕU 3HULDSHNVH SHULGRQWDO DUDOÕNWDQ LON VÕ]DQODU
KDUHNHWVWQO÷YHLQFHJ|YGHOHULQHGHQLLOHVSLURNHWOHUGLU7UHSRQHPDGHQWLFRODQÕQ
NE NLORED]
OÕN ELU SOD]PLWLQ EXOXQGX÷X YH EX SOD]PLWLQ 3VW, 3YX ,, 6PD , SDUoDODUÕQÕQ
SHULDSHNVWHLPPQFHYDEDVHEHSROGX÷XJ|VWHULOPLúWLU&KDQYHDUNDGDúODUÕ
.URQLNOHúPHQLQKHPHQEDúÕQGDOHQIG÷POHULQGHQLVSHWHQELUNoOPHROXU\HQL7
OHQIRVLWVHULOHULUHWLOPHGL÷LLoLQ,/-1 ve IL-VDOÕQPDVÕJLGHUHNND\EROXUEXQDED÷OÕRODUDN
DWHúGúHU$]DODQSHULDSLNDOEDVÕQoSHUNV\RQGX\DUOÕOÕ÷ÕQÕRUWDGDQNDOGÕUÕU
øúWHEXVDIKDGDNXYYHWOHUGHQJHKDOLQHJHOLU%LU\DQGDQNDQDOGDQSHULDSHNVHVDELW
ELUDQWLMHQVÕ]ÕQWÕVÕYDUGÕUGL÷HU\DQGDQEXVÕ]ÕQWÕQÕQNRQD÷DJLULúNDSÕVÕQGDSHULDSHNVWH
NRQXPODQPÕú |]JO 7 OHQIRVLW VHULOHUL SOD]PD KFUHOHUL YH PRQRVLWOHU EXOXQXU 6UHNOL
RODUDNYHPLQLPDOVHYL\HGHHNVGDROXúPDNWDYHKHSD\QÕKÕ]GDOHQIDWLNOHUWDUDIÕQGDQ
drene edilmekedir. EksüdatLI VÕYÕ YROPQGH ]DPDQ ]DPDQ RODELOHFHN NoN DUWÕúODU
OHQIDWLNOHU WDUDIÕQGDQ NROD\FD NRPSDQVH HGLOPHNWHGLU %X GLQDPLN ELU GHQJH KDOLGLU YH
PLQLPDO DOWHUQDV\RQODU LOH \ÕOODUFD GHYDP HGHELOLU .RQDN DOH\KLQH YH\D EDNWHUL OHKLQH
RODELOHFHNKHUKDQJLELUGH÷LúLPROD\ODUÕDNXWDSVHG|QHPLQHJHULG|QGUU
%XG|QúQVHEHELLNLWUORODELOLU
(QIHNWH N|N NDQDO IORUDVÕQÕQ SURILOLQLQ GH÷LúPHVL (QIHNWH N|N NDQDOÕ IORUDVÕQD
\HQL ELU EDNWHUL FLQVL HNOHQPLú RODELOLU %X GXUXPGD NRQD÷D \DEDQFÕ RODQ DQWLMHQOHU
NDQDOGDQSHULDSHNVHVÕ]PD\DEDúODUYHEXDQWLMHQOHULVXQPDN]HUH\HQLGHQ%OHQIRVLWOHUL
30/PDNURIDMODUSHULDSHNVWHWRSODQPD\DEDúODU0DNURIDMODUSURWRJODQGLQVDODUDN
KLVWL\RVLWOHUL 31/
OHUL 7 OHQIRVLWOHULQL DNWLYH HGHU D÷UÕHúL÷LQLGúUUNDSLler dilatasyona
VHEHS ROXU YH \HQLGHQ DUWDQ VHUXP VÕ]ÕQWÕVÕ OHQI G÷POHULQL \HQLGHQ JHQLúOHWLU YH
VHUWOHúWLULUVXEDNXWSHULDSLNDODSVH$\QÕVHQDU\RWHNUDUODQÕU
.|NNDQDOÕLoHULVLQH\HQLLODYHRODQEDNWHULOHUNDQDOÕQDoÕNEÕUDNÕOPDVÕLOHGHRODELOLU
)DNDW NDQDOÕQ NDSDOÕ ROGX÷X GXUXPODUGD ELOH EHOLUJLQ IORUD GH÷LúLPOHUL J|]OHQLU gUQH÷LQ
GHQWLQ NDQDOFÕNODUÕ LoHULVLQGH SURWHLQ DUWLIDNWODUÕQ WNHQPHVL HQIHNWH N|N NDQDOÕQÕQ
HNRORMLVLQLQ GH÷LúPHVL DQODPÕQD JHOLU YH EX GXUXPGD NDQDO LoHULVLQGHNL EDNWHUL Saterni
GH÷LúLU <HQL EDNWHULOHU JHOLUNHQ ED]ÕODUÕ |OHUHN X]DNODúÕU NORQDO GHOHV\RQ .|N NDQDOÕQD
NDUERQKLGUDW VÕ]ÕQWÕVÕ GXUXPXQGD GD NDQDOÕQ HNRORMLVL GH÷LúLU .DQDOGD NDUERQKLGUDW
EXOXQPDVÕGHPHNVDNNDUROLWLNEDNWHULOHULQEXUD\DJHOHUHNSURWHROLWLNOHULQVD\ÕVÕQÕ
D]DOWPDVÕ GHPHNWLU %WQ EX GH÷LúLPOHU LoLQ N|N NDQDOÕQÕQ D÷Õ]D DoÕN ROPDVÕQD JHUHN
\RNWXU )RUDPHQ DSLNDOHGHNL VHUXP VÕ]ÕQWÕVÕQÕQ YROXP YH\D NRPSR]LV\RQXQGD ELU
GH÷LúLNOLN ROPDVÕ HQIHNWH N|N NDQDOÕQGDNL EDNWHUL IORUDVÕQÕQ GH÷LúPHVL LoLQ ELr sebeptir.
)ORUDGD |QFHGHQ PHYFXWELUEDNWHULFLQVLVSRQWDQPXWDV\RQODUDX÷UD\DELOLU%XGXUXPGD
\]OHUFH \HQL DQWLMHQ NDQDO ERúOX÷XQD YH RUDGDQ SHULDSHNVH JHoHU <HQL DQWLMHQOHU GDKD
|QFHNRQDNWDUDIÕQGDQPXDPHOHJ|UPHGLNOHULLoLQROD\DNXWID]DWHUVLQLU+DVWDQÕQVLVWHPLN
DQWLEL\RWLN NXOODQPDVÕQÕQ NURQLN SHULDSLNDO HQIHNVL\RQX RODQ GLúOHULQ N|N NDQDOÕ IORUDVÕ
]HULQH EHOLUJLQ ELU HQJHOOH\LFL HWNLVL ROPD] oQN HQIHNWH N|N NDQDOÕ LoHULVLQGH NDQ
GRODúÕPÕ \RNWXU KLoELU VLVWHPLN LODo NURQLN HQIHNWH N|N NDQDOÕQD XODúDPD] -RKQ YH
DUNDGDúODUÕ%X|QHPOLGLUYHL\LFHELOLQPHOLGLU
.RQDN VDYXQPDVÕ D]DOPÕúWÕU %D]Õ GXUXPODUGD EX GLQDPLN GHQJHQLQ VDYXQPD
WDUDIÕ ]D\ÕI GúHELOLU gUQH÷LQ KHUKDQJL ELU VLVWHPLN HQIHNVL\RQ LOH PFDGHOH HWPHN
DPDFÕ\OD PDNURIDMODU OHQIRVLWOHU YH GL÷HU IDJRVLWLN KFUHOHU NRQD÷ÕQ EDúND GRNXODUÕQGDQ
JHOHQ DQWLMHQLN X\DUÕODU LoLQ \HQL DWLNRUODU VHQWH] HWPHN YH EXUDGDQ J|o HWPHN ]RUXQGD
NDODELOLUOHU %X E|OJHGH VDYXQPDQÕQ D]DOPDVÕ GXUXPXQGD NDQDOGDQ VÕ]DQ EDNWHULOHU
periapekste ço÷DOPD\D EDúODUODU <HQL ELU DQWLMHQLN X\DUÕ LOH LPPQ KFUHOHU UHDNWLYH
ROXUODUIDNDWROD\DNXWSHULDSLNDODSVHID]ÕQGDQEDúODU.RQDNVDYXQPDVÕQÕD]DOWDQEDúND
VHEHSOHU GHYDUGÕUgUQH÷LQKDVWDQÕQEXYH\DEDúNDELUDPDoODX\JXQVX]ELUDQWLEL\RWLN
kullDQÕOPDVÕPHNDQLNWHUPLNúLPLNWUDYPDODUNRUWLNRVWHURLGOHUYH16$,'NXOODQPDVÕ
NRQDNVDYXQPDVÕQÕD]DOWÕU
.URQLN DSLNDO DSVH G|QHPLQGH HQ EHOLUJLQ ROD\ODU GLQDPLN ELU GHQJHQLQ WHúHNNO
HWPHVL YH DSHNVL LoHULVLQH DODFDN ELU NHPLN NDYLWHVLQLQ ROXúPDVÕGÕr. Osteoklastlar, asidik
VDOJÕODUÕ RODQ oRN QNOHXVOX GHY KFUHOHUGLU 2VWHRQODUD \DNÕQ \HUOHúHQ ILEUREODVWODUÕQ
IDUNOÕODúPDVÕLOHROXúXUODU)LEUREODVWODUÕQRVWHRNODVWKDOLQHG|QúHELOPHVLLoLQ3*(YH
cAMP (Cyclic Adenosine Mono Phosphate) ile tetiklenPHOHUL JHUHNLU )LEUREODVWODUÕQ
\]H\LQGH DQWLNRUODUÕQ )F SDUoDVÕQÕ WXWDELOHFHN UHVHSW|UOHU YDUGÕU %X QHGHQOH DQWLMHQDQWLNRUNRPSOHNVOHULILEUREODVWODUÕELURVWHRNODVWKDOLQHG|QúWUHELOLU
Kronik döneminde periapekse hakim olan hücreler T ve B lenfositleri, makrofajlar,
Q|WURILOOHUGLU%XUDGDHJHPHQRODQ\DSÕODUDQWLMHQ-antikor kompleksleri, IL-1, IL-3, IL-4, IL6, IL-11, TNF-ß, M-&6)'0&6)/,)7*)71)
GLU)LEUREODVWODUEXNLP\DVDO\DSÕODUGDQ
HWNLOHQHUHN NDUPDúÕN ELU PHNDQL]PD LOH NHPLN \L\HQ GHY KFUHOHUH G|QúHELOLUOHU (÷HU
RVWHRNODVWODU DNWLYH ROXUODUVD D\QÕ DQGD D\QÕ X\DUÕ RVWHREODVWODUÕ GD DNWLYH HGHU
KDWÕUOD\ÕQÕ]]ÕWLNLPHNDQL]PDQÕQX\DUÕOPDVÕ
3HULDSLNDOGRNXODUGDQGRODúÕPDJHoHQ,/-NDUDFL÷HUGHQ$33
QLQVDOÕQÕPÕQÕDUWÕUÕU
bu SURWHLQOHUHQIODPDV\RQXQEXOXQGX÷XGRNX\DYDUGÕNODUÕQGDWURPELQILEULQSUHNDOOLNUHLQ
YH NLQLQRMHQ LVLPOL SURWHLQOHUH G|QúUOHU 3HULDSLNDO NHPLN UH]RUSVL\RQXQXQ
PHNDQL]PDVÕQD NDWNÕGD EXOXQDQ NDOOLNUHLQGLU 'RODúÕPGDQ JHOHQ $33 |QFH SUHNDOOLNUHLQ
isimli SUHNUV|U SROLSHSWLWH G|QúWUOU GDKD VRQUD NDOOLNUHLQ ROXúXU %X G|QúPGH
SOD]PLQ DUDFÕOÕNOÕ NDUPDúÕN ELU PHNDQL]PD YDUGÕU +DJHPDQ IDNW|UQQ DNWLYH ROPDVÕ
NDOOLNUHLQ
LQ ROXúPDVÕ LoLQ \HWHUOL ELU VHEHS WHúNLO HGHU .DOOLNUHLQ N'D D÷ÕUOÕ÷ÕQGD ELr
SURWHLQGLUVDO\DGLúHWLROX÷XOLNLWLYHGL÷HUYFXWVDOJÕODUÕQGDNDOOLNUHLQLQSUHNUV|U
olan pre-NDOOLNUHLQ ]DWHQ EXOXQPDNWDGÕU %XQODUÕQ ND\QD÷Õ VHUXPGDNL DNXW ID] SURWHLQOHUL
ROPD\DELOLUED]HQ7OHQIRVLWOHULGR÷UXGDQNDOOLNUHLQVDODELOLUOHU3HULDSekse hücum eden bu
proteinler, IL-6 ve IL- WDUDIÕQGDQ GDYHW HGLOPHNWHGLU YH RVWHRNODVW ROXúXPXQX
EDúODWPDNWDYDUVDDUWÕUPDNWDGÕU
.HPLN \ÕNÕPÕQÕQ HQ NXYYHWOL WHWLNOH\LFLVL EUDGLNLQLQGLU YH WDPDPHQ SURVWRJODQGLQ
VHQWH]LQH ED÷ÕPOÕ RODUDN VDOÕQÕU %UDGLNLQLQ NHPLN GRNX\D WHPDV HWWL÷LQGH 3*( YH 3,
3URVWRVLNOLQ,LVLPOLLNLHQ]LPLX\DUÕUÕUEXQODU-10 dakika içerisinde yeni prostoglandinleri
DoÕ÷DoÕNDUÕU'ROD\ÕVÕ\ODEUDGLNLQLQDNWLYLWHVLQGHELURWRDPSOLILNDV\RQYDUGÕU+HP
GL÷HU SURVWRJODQGLQOHU WDUDIÕQGDQ X\DUÕOÕU YH KHP GH SURVWRJODQGLQOHULQ VDOÕQÕPÕQÕ DUWÕUÕU
'ROD\ÕVÕ\ODEUDGLNLQLQGRNXGDLONWHVSLWHGLOGL÷LQGHQLWLEDUHQNRQVDQWUDV\RQXKÕ]ODDUWDU
Bradikininin kemik hücresine tutunabilmesi için, hücrenin yüzeyinde bradikinini
tutabilecek özel reVHSW|UOHULQ EXOXQPDVÕ JHUHNLU %X UHVHSW|UOHU ROPDGDQ EUDGLNLQLQOHU
kemikte rezorpsiyon yapamazlar. Kemik hücresinde bulunan bu reseptörlerin B1 ve B2
RODUDNLNLIDUNOÕWUYDUGÕU%UHVHSW|UOHULNHPLNKFUHOHULQLQ\]H\LQGH\D\JÕQRODUDN
bulunur. B2 reVHSW|UOHULVDGHFHEUDGLNLQLQLGH÷LOD\QÕ]DPDQGD3*(3,NDOOLGLQ.LQLQD]-I
ve Kininaz-II peptitlerini de tutabilirler. Bu maddelerden herhangi birisi B2 reseptörüne
WXWXQGX÷X ]DPDQ NHPLNWH UH]RUSVL\RQ EDúODU <DQL UH]RUSVL\RQXQ EDúODPDVÕ LoLQ %
reseptöUQHELUPHGL\DW|UQED÷ODQPDVÕ\HWHUOLGLU%XPHGL\DW|UOHULoHULVLQGHHQHWNLOL
RODQÕ EUDGLNLQLQGLU %UDGLNLQLQ LODYH HGLOPLú L]ROH NHPLN SUHSDUDWODUÕQGD NHPLNWHNL LON
UH]RUSVL\RQXQ J|]OHQPHVL VDGHFH GDNLNDODU DOPDNWDGÕU +DOEXNL EHQ]HU GHQH\ 3*( LOH
yaSÕOÕQFDNHPLNUH]RUSVL\RQXDQFDNVDDWVRQUDEDúODPDNWDGÕU
% UHVHSW|UOHUL NDOOLGLQ
L WXWDELOHFHN |]JOONWHGLU (÷HU ELU NHPLN KFUHVLQLQ
yüzeyinde hem B1 ve hem de B2 reseptörü varsa ve bunlardan B1 reseptörü kallidin
WDUDIÕQGDQ LúJDO HGLOPLúVH EX GXUXPGD D\QÕ KFUHQLQ % UHVHSW|U GX\DUVÕ]ODúÕU YH EX
KFUHEUDGLNLQLQ
HFHYDSYHUPH]YH\DoRN\DYDúYHJHoFHYDSYHULUKDOHJHOLU'ROD\ÕVÕ\OD
RUWDPGDNDOOLGLQEXXQGX÷XQGDEUDGLNLQLQ
LQNHPLNUH]RUSVL\RQXQDVHEHSROPDGÕ÷ÕJ|UOU
(Glukokortikoidler vH16$,'KHULNLUHVHSW|UGHGX\DUVÕ]ODúWÕUÕU2UWDPGDNDOOLGLQYDUNHQ
EUDGLNLQLQ NHPLN HULPHVLQH VHEHS ROPDPDVÕ YH SHULDSLNDO GRNXODUGD KHU LNLVL ELUOLNWH
EXOXQGX÷X KDOGH SHULDSLNDO NHPLN UH]RUSVL\RQXQXQ J|UOPHVL EDúND PHNDQL]PDODUÕQ
EXOXQGX÷XQX GúQGUU .HPLN UH]RUSVL\RQXQXQ EDúODPDVÕQD HWNL HGHQ YH\D HQ
D]ÕQGDQKÕ]ODQGÕUDQEDúNDPHNDQL]PDODUGDYDUGÕU
%XPHNDQL]PDODUGDQED]ÕODUÕú|\OH|]HWOHQHELOLU
Antijen-DQWLNRU NRPSOHNVOHULQLQ )F SDUoDVÕ ILEUREODVWODUÕQ \]H\LQGHNL UHVHSW|UOHUH
tutunarak RQODUÕDNWLYHHGHUYHRVWHRNODVWODUDG|QúPHVLQLVD÷ODU
%DúND ELU RVWHRNODVW DNWLYDV\RQX PDNURIDMODUÕQ VDOGÕ÷Õ NLQLQOHU LOH ROXU .LQLQOHU
GRNX\DVDOÕQÕQFDLNLNRPSRQHQWHGHJUDGHROXU%XQODUGDQELULQFLVL.LQLQD]-,DGÕQÕDODQELU
peptittir ve hücresel aNWLYLWH\H JHUHN NDOPDGDQ SHULDSLNDO NHPLN UH]RUSVL\RQXQX EDúODWÕU
'L÷HUSDUoD.LQLQD]-,,DGÕQÕDOÕUNHPLNWHQNDOVL\XPVHUEHVWOHúPHVLQLSRWDQVL\HOL]HHGHU
3DUDWLURLGKRUPRQEXROD\ODUDHúOLNHGHUIDNDWVLVWHPLNELURVWHROLWLNHWNLJ|VWHUPH]
ProstoglDQGLQ VHQWH]L YH NHPLN GRNX ND\EÕ LQGRPHWKDFLQ LOH GXUGXUXODELOLU
,QGRPHWKDFLQ KDVDU J|UHQ KFUH ]DUÕQGDQ DoÕ÷D oÕNDQ DUDúLGRQLN DVLWLQ VLNORRNVLMHQD]
PHWDEROLN\ROXLOHSURVWRJODQGLQOHUHG|QúPHVLQLHQJHOOHU1DLU
IL-‰GR]DYHVUH\HED÷OÕROarak PGE2 ve 6-keto-PGF1-DVDOÕQÕPÕQÕDUWÕUÕU%|\OH
RUWD\D oÕNDQ 3*( ,/-‰ PROHNOQ YH LQFL DPLQRDVLW KL]DVÕQGDQ NRSDUWÕU YH
\HQLPROHNONXYYHWOLELULPPQRMHQGLU\HQLELURWRLPPQUHDNVL\RQXEDúODWÕU%WQEXQODU
kemik rezorpsiyonuna öncülüNHGHU/HUQHUYHDUNDGDúODUÕ
%XUDGDQDoÕ÷DoÕNDQ3*(YHGRODúÕPGDNLSDUDWKRUPRQGRNXGDF$03VHQWH]LQL
DUWÕUDQ PHGL\DW|UOHUGLU %|\OHFH SHULDSLNDO GRNXODUGD F$03 VHYL\HVL \NVHOPH\H EDúODU
2OD\ODU ELUELUOHULQH VÕNÕFD ED÷OÕGÕU YH KDWWD LoLoH JHoPLú JLELGLU oQN F$03 NXYYHWOL ELU
IL-‰X\DUÕFÕVÕGÕU'DKDID]OD,/-1 demek, daha fazla PGE sentezlenmesi demektir, bu ise
GRNXGD GDKD ID]OD F$03 ELULNPHVL GHPHNWLU F$03 VHYL\HVLQGHNL EX DUWÕú NHPLN
UH]RUSVL\RQXQXKÕ]ODQGÕUÕU
'HZKLUVW YH DUNDGDúODUÕ L]ROH HGLOPLú JQON X]XQ NHPLNOHUL IRUVNROLQ YH
isobutyl-PHWK\O[DQWKLQH LOH PXDPHOH HWPLúOHUGLU EX PDGGHOHU F$03 VHQWH]LQL DUWÕUÕU
Daha sonra kemikteki rezorpsiyonun 2-NDWDUWWÕ÷ÕQÕJ|UPúOHUGLU
.HPLN \ÕNÕPÕQD NDWNÕGD EXOXQDQ ELU EDúND lenfokin OAF (Osteoclast Activating
)DFWRU
GÕU %X OHQIRNLQ 'D D÷ÕUOÕ÷ÕQGDGÕU PROHNOHU \DSÕVÕ ,/-1ß ile fevkalade
benzerlik gösterir. Sadece 0.66 ng/ml konsantrasyonda bile, OAF, kemikten kalsiyum
o|]QPHVLQL EDúODWÕU 'HZKLUVW YH DUNDGDúODUÕ %X PDGGH X\DUÕOPÕú OHQIRVLWOHU YH
GRODúÕPGDNL PRQRQNOHHU KFUHOHUGHQ VDOÕQÕU 0RQRVLWOHU 3* UHWHUHN VDGHFH |QFHGHQ
X\DUÕOPÕúRODQOHQIRVLWOHUL2$)VDOPD\DLWHU<RQHGDYH0XQG\)DNDWELUOHQIRVLWLQ
OAF salabilmesi için hücre içerisinde cAMP ELULNWLUPHVLúDUWWÕU<RQHGDYH0XQG\
Lenfositin cAMP biriktirmesi ancak IL- X\DUÕVÕ\OD ROXU 'HZKLUVW YH DUNDGDúODUÕ Periapikal dokularda en bol IL-VHYL\HVL7KDNWLYDV\RQXQROGX÷XG|QHPGHYDUGÕU2$)
ortamda IL-‰EXOXQPDGÕ÷ÕQGDWDPDPHQHWNLVL]GLU)OHVFKHUYHDUNGDúODUÕ
ùLPGL SHULDSLNDO GRNXODUGD 7K VD\ÕVÕ D]DOÕQFD QHGHQ NHPLN UH]RUSVL\RQXQXQ
D]DOGÕ÷ÕQÕDQODPDNGDKDNROD\GÕU
2$)
ÕQ NHPLNWHNL UH]RUSWLI HWNLVL NDOVLWRQLQ LOH YH\D RUWDPGDNL IRVIDW L\RQ
NRQVDQWUDV\RQXQ DUWÕUÕOPDVÕ LOH JHoLFL RODUDN HQJHOOHQHELOLU 2$)
ÕQ HWNLVL LQGRPHWKDVLQ
veya NASID ile engellenebilirse de, en etkili OAF inhibitörü kortizoldur.
*OXNRNRUWLNRLGOHU VHUXP NDOVL\XPXQX GúUUOHU QRUPDOGH -11 g/dl).
Glukokortikoidlerin serum seviyesi 105 M oldX÷XQGD 2$)
ÕQ HWNLVL HQ NXYYHWOL ELoLPGH
EDVNÕODQPD\DEDúODU6WUXPSIYHDUNDGDúODUÕ
%DúND RVWHRNODVWLN X\DUÕODU GD YDUGÕU EXQODU 7K KFUHOHULQLQ VDOGÕ÷Õ JDPPD
interferon, IL-1, IL-4, IL- 71)
GLU %XQXQ GR÷DO VRQXFX RODUDN H÷HU 7K KFUHOHUL \oksa
SHULDSLNDO NHPLN GRNXGD \ÕNÕP ROPDPDNWDGÕU YH\D oRN D] ROPDNWDGÕU 6WDVKHQNR YH
DUNDGDúODUÕVD÷OÕNOÕIDUHOHULQSHULDSLNDOGRNXODUÕQGD|QFHGHQKLo,/-EXOXQPDGÕ÷Õ
halde, IL- VHYL\HVLQLQ SXOSLWLVLQ LQFL JQQGHQ LWLEDUHQ DUWÕú J|VWHUGL÷LQL WHspit
HWPLúOHUGLU $UWDQ ,/-1 ile paralel olarak makrofaj, fibroblast, nötrofil granülosit ve nihayet
RVWHRNODVWODUÕQ DUWWÕ÷ÕQÕ J|VWHUPLúOHUGLU 2VWHRNODVWODU NHPLN GRNX\X HULWHQ KFUHOHUGLU
KHGHIOHULQHWDPELURU\DQWDV\RQODUÕ\RNWXUVDGHFHSHULDSLNDONHPL÷LQGH÷LOD\QÕ]DPDQGD
N|N GHQWLQL YH VHPHQWLQ \ÕNÕPÕQGDQ GD VRUXPOXGXU1DLU2VWHRNODVWODUÕQHQID]OD
ROGX÷XG|QHPHQIHNVL\RQXQ-20inci günleri olup, bu dönemde periapikal dokularda TNF
WRSODQGÕ÷ÕQÕ YH 7K KFUHOHULQLQ HQ ID]OD VD\ÕGD ROGX÷XQX J|VWHUPLúOHUGLU 2 KDOGH
NHPLNWHNLo|]OPHQLQWHWL÷LQLoHNHQVRUXPOXPDGGHEUDGLNLQLQ
LQVDOÕQPDVÕQÕVD÷OD\DQ,/ ROPDOÕGÕU %X VLWRNLQ ,/- 7K DNWLYLWHVLQLQ NDoÕQÕOPD] VRQXFXGXU 3HULDSLNDO NHPLN
NDYLWHVLQLQROXúPDVÕQGDEUDGLNLQ
LWHNEDúÕQDVRUXPOXWutmak yerine, bradikinin'in anahtar
UROR\QDGÕ÷Õ7KDNWLYLWHVLQLVRUXPOXWXWPDNEHONLGHGDKDGR÷UXRODFDNWÕU
*HUoHNWHQGH 7V DNWLYLWHVL EDúOD\ÕQFD \DQL SHULDSHNVWHNL JUOW ND\EROXS
HQIHNVL\RQ NURQLNOHúLQFH 7K KFUHOHUL WHVSLW HGLOHPHPHNWH NHPLNWHNL \ÕNÕP IDDOL\HWOHUL
D]DOPDNWDGXUPDNWDGÕU ,/- UHVHSW|UOHULQLQ EORNH HGLOGL÷L GHQH\VHO HQIHNVL\RQODUGD
SHULDSLNDO NHPLN HULPHVL HQ D] RUDQÕQGD HQJHOOHQPHNWHGLU 6WDVKHQNR YH
DUNDGDúODUÕ .OLQLN VH\LU EX ELOJLOHUL GHVWHNOHU úHNLOGH JHUoHNOHúLU Histolojik olarak
NHPLN UH]RUSVL\RQX DNXW DSVH G|QHPLQGH EDúODU IDNDW LON UDG\ROROXVHQV \DNODúÕN -3
hafta sonra sonra kolayca tespit edilebilir hale gelir.
3HULDSLNDOGRNXGDKLVWRORMLNNHPLNNDYLWHVLQLQROXúDELOPHVLLoLQVDGHFHNHPLN\ÕNÕPÕ
yeterli dH÷LOGLU .HPLN \ÕNÕPÕQÕQ VUG÷ G|QHPGH SHULDSLNDO GRNXQXQ LQWHUVHOOHU
NRPSRQHQWOHULQLQ GH \ÕNÕPÕ J|UOU 3HULDSLNDO E|OJHGH NROODJHQ OLIOHU ILEU|] \DSÕODU YH
LQWHUVHOOHUED÷GRNX\ÕNÕPÕQÕQPHNDQL]PDVÕYDUGÕU
1.
2VWHRNODVWLN \ÕNÕP \ROX 2VWHRNODVWODUÕQ RUWDPD VDOGÕNODUÕ DVLGLN HQ]LPOHU
NROODJHQLQ GHQDWUH ROPDVÕQÕ VD÷ODU <XNDUÕGD QDVÕO DNWLYH ROGXNODUÕ
DQODWÕODQRVWHRNODVWODUVDGHFHNHPLNN|NGHQWLQLYHVHPHQWLQGH÷LOD\QÕ
]DPDQGD ED÷ GRNXVXQXQ \ÕNÕPÕQD GD VHEHS ROXUODU øOJLQoWLUNL 2$)
ÕQ
kendisi kemikten kollagen çözülmesini engeller (Raisz, 1975).
2.
)DJRVLWLN \ÕNÕP \ROX %DNWHUL IDDOL\HWOHUL LOH RODELOHFH÷L JLEL DUWPÕú LPPQ
X\DUÕ QHGHQL\OH PDNURIDMODU ED÷ GRNXVX KFUHOHULQL IDJRVLWH HGHELOLUOHU
YH\D1.OHUGRNX\D]DUDUYHUHELOLUOHU$VOÕQGDEXGönem fagositik hücreleri
EXUD\D o|S WRSODPD\D JHOLUOHU (QIODPDV\RQ VÕUDVÕQGD LQFLQPLú NRQDN
KFUHOHUL FDQOÕ ELOH ROVDODU RQODU LoLQ \RN HGLOPHVL JHUHNHQ ELUHU o|SWU
(Bergenholtz, 1998).
3.
3OD]PLQRMHQHED÷ÕPOÕ\ÕNÕP+DJHPDQIDNW|UQQDNWLYHROPDVÕLOHRrtaya
oÕNDQ |]JO ROPD\DQ IDJRVLWR] LQFLQPLú NRQDN GRNX KFUHOHULQL KHGHI
DODUDN SHULDSLNDO ED÷ GRNXVXQXQ ND\EÕQD \DUGÕP HGHU %N] +DJHPDQ
Faktörü).
4.
0HWDORSURWHLQD] \ROX LOH \ÕNÕP 3&* 3URWHRJO\FDQ-core-proteins),
kollagen, jelatin, laminin, fibronektin gibi proteinlerin kimyasallardan
KHUKDQJL ELULVL LOH ROXúWXUGX÷X NRPSOHNVOHUH PHWDORSURWHLQOHU GHQLU %X
enzimler metaloproteinaz-I ve metaloproteinaz-,, ROPDN ]HUH LNL IDUNOÕ
\DSÕGDGÕU %XQODUGDQ ELOKDVVD PHWDORSURWHLQD]-,, ED÷GRNXVXQXQ
interselüler yDSÕODUÕQÕOL]LV\DSDUDNKHPED÷GRNXND\EÕQDVHEHSROXUKHP
GHSHULDSHNVLQWDKULúLLoLQELUEDúNDVHEHSROXúWXUXU+DQVHQ
%DNWHUL UQOHUOHULQGHQ /36 NHPLNWH NDOVL\XP o|]OPHVLQH \DUGÕP HGHUOHU
%XUDGDNL PHNDQL]PD /36
LQ GR÷UXGDQ RVWHROLWLN HWNLOL ROPDGÕ÷Õ IDNDW LPPQ KFUHOHUGHQ
EUDGLNLQLQ VDOÕQPDVÕQD VHEHS ROGX÷X úHNOLQGHGLU /36 % OHQIRVLWOHUL YH PDNURIDMODUÕ
GR÷UXGDQX\DUDUDNNHQGLVLQHNDUúÕ|]JO,J0DQWLNRUODUÕVDOÕQPDVÕQÕVD÷ODU6DGHFH/36
ED÷OD\DQEX|]JODQWLNRUODUD|]HOELULVLPYHULOPLúWLU/%3/LSRSROLVDNNDULW%LQGLQJ
3URWHLQ /36 /%3 LOH ELUOHúHUHN /36-/%3 NRPSOHNVLQL ROXúWXUXU %X PROHNO NRPSOHNVL
&'PDNURIDMODUWDUDIÕQGDQ\DNDODQÕUYHPDNURIDMODUGR÷UXGDQIDJRVLWLN|]HOOLNND]DQÕU
Aktive makrofajlar IL-1, IL-6, IL-8, TNF, nitrik oksit, interferon alfa ve prostoglandin salarak
D÷UÕYH|GHPROXúXPXQDYHNHPLNUH]RUSVL\RQXQDVHEHSROXU6HOW]HUYH)DUEHU
ILF-JDPD PHYFXGL\HWL JLQJLYDO GRNXODUGD J|VWHULOPLú IDNDW SHULDSLNDO GRNXODUGD
J|VWHULOHPHPLúWLU /36-LBP komplekVL GR÷UXGDQ ILEUREODVWODU WDUDIÕQGDQ \DNDODQDELOLU YH
RQODURVWHNODVWODUDG|QúHELOLUOHU%XEDúNDELUSHULDSLNDOUH]RUSVL\RQ\ROXGXU
%X WHWL÷L oHNHQ \HJDQH PLNURS DQWLMHQL HQGRWRNVLQ GH÷LOGLU (QGRWRNVLQ SHULDSLNDO
OH]\RQODUÕQ HQ HWNLOL VHEHEL ROVD\GÕ *UDP SR]LWLI EDNWHULOHUOH JHOLúHQ SHULDSLNDO OH]\RQODU
uysal karekterde olurdu (çünkü Gram pozitif bakterilerde endotoksin yoktur). Tam aksine
en sert ve tedaviye en dirençli periapikal lezyonlar Actinomyces, Propionibacterium
cinsi bakteriler ile meydana gelir (Sundqvist, 1994). Bu bakteriler birer Gram pozitif
oRPDNWÕUODU 7KXUQKHHU YH DUNDGDúODUÕ EX ELOJL\L GHVWHNOHPLúOHU YH $FWLQRP\FHV
WUOHULQLN|NNDQDOÕQGDGDKDKÕ]OÕWHVSLWHGHFHN\|QWHPOHUJHOLúWLUPLúOHUGLUE\NJUXED
D\UÕODQ \]OHUFe mikrokinlerin içerisinde lipopolisakkarit tabakaya böylesine zum
\DSÕOPDVÕ EHONLGH ODERUDWXYDUGD /36 LOH oDOÕúÕOPDQÕQ GL÷HUOHULQGHQ GDKD NROD\ ROPDVÕGÕU
:LOVRQ YH DUNDGDúODUÕ *UDP SR]LWLI EDNWHUL GÕú GXYDUÕQÕQ HWNLOHUL HQGRWRNVLQGHQ
GDKD D] GH÷LOGLU *UDPSR]LWLIEDNWHULOHULQKFUHGXYDUÕQÕQ\DSÕWDúÕRODQSHSWLGRJOLNDQGD
HQ D] HQGRWRNVLQ NDGDU ]HULQGH GXUXOPDVÕ JHUHNHQ NXYYHWOL ELU DQWLMHQGLU %LOKDVVD
X]D\DQSHULDSLNDOOH]\RQODUGD\NVHNNRQVDQWUDV\RQGDSHSWLGRJOLNDQWHVSLWHGLOL\RUROPDVÕ
önHPOLGLU3HSWLGRJOLNDQPDNURIDMODUÕJUDQORVLWOHULYHOHQIRVLWOHULGR÷UXGDQX\DUDUDN,/-1,
71)QLWULNRNVLWYHVLWRNLQOHULQVDOJÕODQPDVÕQÕVD÷ODU3HSWLGRJOLNDQWÕSNÕHQGRWRNVLQJLEL%
KFUHOHULQLGR÷UXGDQX\DUÕUPRQRNORQDO%KFUHOHULQLQVHQWH]LQHVebep olur, özgül ve IgM
WLSLQGH DQWLNRU ROXúPDVÕQÕ VD÷ODU NRPSOHPDQÕ NODVLN \ROGDQ DNWLYH HGHU 6HOW]HU YH
)DUEHU*UDPSR]LWLIOHULQSHSWLGRJOLNDQGXYDUODUÕQDED÷OÕRODQOLSRWHLNRLNDVLWOHU
|QHPOL DQWLMHQOHUGLU YH NHPLNWHNL UH]RUSVL\RQX EDúODWDELOGL÷L J|VWHULOPLúWLU %LOKDVVD
PDNURIDMODUDWXWXQDUDNSURVWRJODQGLQOHULQVDOJÕODQPDVÕVD÷ODUOHU6HOW]HUYH)DUEHU
6WUHSWRFRFFXV VDQJXLV YH GL÷HU *UDP SR]LWLI EDNWHULOHU WDUDIÕQGDQ RUWDPD \D\ÕODQ
OLSRWHLNRLNDVLWOHUGLúHWLGRNXVXQGDNLILEUREODVWODUÕDNWLYHHGHUHN+*)VDOÕQPDVÕQÕVD÷ODUODU
*UDP QHJDWLI EDNWHUL GXYDUÕQGDNL OLSRSROLVDNNDULWOHULQ E|\OH VHUW HWNLOHUL \RNWXU
Lipopolisakkaritler, epitel hücrelerinden IL- VDOJÕODWÕUNHQ OLSRWHLNRLN DVLWLQ E|\OH HUNHQ
X\DUÕ\D\RODoDQELU|]HOOL÷LWHVSLWHGLOHPHPLúWLU6XJL\DPDYHDUNDGDúODUÕ%DNWHUL
hücrelerinin porin proteinleri de endotoksin ve peptidoglikana benzer özelliklere sahiptir.
6RQ \ÕOODUGD 3UHYRWHOOD LQWHUPHGLDGDQ - NLORGDOWRQ D÷ÕUOÕ÷ÕQGD ELU JOLNRSURWHLQ
DQWLMHQL]ROHHGLOPLúYHEXQD3*33UHYRWHOOD*O\FR3URWHLQDGÕYHULOPLúWLU3*3/36
GHQ
GDKD GD\DQÕNOÕGÕU /36 EX PXDPHOHOHUH GD\DQDPDGÕ÷Õ KDOGH 3*3 & VÕFDNOÕ÷D VDDW GLUHQHELOPHNWHGLU SURWHD]ODU LOH PXDPHOH\H GH GLUHQoOLGLU $\QÕ EDNWHULGHQ L]ROH
edilen LPS'ler dalak KFUHOHULQL PDNURIDMODUÕ YH JLQJLYDO ILEUREODVWODUÕ VLWRNLQ VHQWH]L LoLQ
X\DUDPDGÕ÷Õ KDOGH 3*3 GDODN KFUHOHULQL PDNURIDMODUÕ YH JLQJLYDO ILEUREODVWODUÕ VLWRNLQ
sentezine sürüklemektedir. O halde Gram negatif bakterilerin LPS'lerinden daha önemli
toksiNUQOHULGHYDUGÕU+HP/36KHPGH3*3SRO\P\[LQ%LOHLQKLEHROPDNWDGÕU,NLYH
DUNDGDúODUÕ
Antijen-DQWLNRUNRPSOHNVOHULL]ROHRODUDNODERUDWXYDUNRúXOODUÕQGDPH\GDQDJHWLULOVH
YH GHQH\ KD\YDQÕQÕQ VD÷OÕNOÕ SXOSDVÕQD NRQXOVD DFDED SHULDSLNDO OH]\RQ ROXúDELOLU PL"
Yani antijen-DQWLNRUNRPSOHNVOHULSHULDSLNDOHQIODPDV\RQXQEDúODPDVÕLoLQ\HWHUOLPLGLU"
%XGHQH\7RUDELQHMDGYHDUNDGDúODUÕWDUDIÕQGDQ\DSÕOPÕúWÕU$QWLMHQOHU|]JO
DQWLNRUODUÕ WDUDIÕQGDQ ED÷ODQDUDN VDQNL SXOSD\D EDNWHUL LQRküle edilir gibi) deney
KD\YDQODUÕQÕVWHULOSXOSDODUÕLoHULVLQHNRQXOPXúWXU%HOLUOLELUG|QHPVRQUDSHULDSHNVH30/
YHRVWHRNODVWODUWRSODQPÕúYH\D\JÕQSHULDSLNDONHPLNUH]RUSVL\RQXEDúODPÕúWÕU
Periodontal ve periapikal dokulardaki enfeksiyon yeterince uzun bir süre devam
HGHUVH KDVWDQÕQ VLVWHPLN GRODúÕPÕQGD SDWRMHQ PLNURRUJDQL]PD\D NDUúÕ ,J0 YH ,J*
WLSLQGH |]JO DQWLNRUODU J|UOU %|\OH KDVWDODUÕQ VHUXPODUÕQGD $FWLQRP\FHV
)XVREDFWHULXP9HLOORQHOODWUOHULYH3PHODQLQRJHQLFDQÕQHSLWRSODUÕQDNDUúÕROXúDQ|]JO
DQWLNRUODUJ|VWHULOPLúWLU*UDQWYHDUNDGDúODUÕ
Mademki kronik enfeksiyonda serumda özgül antikorlar bulunabiliyor, acaba, bu
DQWLNRUODU NRQD÷D |QFHGHQ YHULOVH\GL SHULDSLNDO HQIHNVL\RQ NRQWURO DOWÕQD DOÕQDELOLU PL\GL"
Torabinejad YH .LJHU EX GHQH\L \DSPÕúODUGÕU .|N NDQDOÕ LoHULVLQH LQRNOH HWPH\L
GúQGNOHULEDNWHULQLQDQWLMHQOHULQLVDIODúWÕUDUDNGúNGR]ODUGDGHQH\KD\YDQÕQDGHULDOWÕ
\ROGDQ X\JXODPÕúODU GHQH\ KD\YDQÕQÕQ NDQÕQGD ERO PLNWDUGD |]JO DQWLNRU ROXúWX÷XQX
teVSLW HWWLNWHQ VRQUD VWHULO N|N NDQDOÕ LoHULVLQH EX EDNWHUL\L LQRNOH HWPLúOHUGLU 6RQXoWD
SHULDSLNDO E|OJHGH KÕ]OÕ EDúOD\DQ NHPLN UH]RUSVL\RQX J|]OHPLúOHUGLU %X ELU $UWKXV
reaksiyonudur (Bkz. Tip-DúÕUÕGX\DUOÕOÕN
%D]Õ EDNWHULOHU LOH ROXúDQ HQIHNVL\RQODU \D\ÕOPD\D PH÷LOOL LNHQ 3RUSK\URPRQDV
JUXEX JLEL GL÷HU ED]Õ EDNWHULOHU LVH NHQGL-NHQGLVLQL VÕQÕUOD\DQ SHULDSLNDO HQIHNVL\RQODU
\DSDUODU $FWLQRP\FHV JUXEX JLEL $\UÕFD NRQD÷D DLW IDNW|UOHU GH HQIHNVL\RQXQ DNLEHWLQL
EHOLUOHUgUQH÷LQLPPQ\HWPH]OLNRUWD\DoÕNDUDQLODoODUNXOODQDQúDKÕVODUGDUDG\RWHUDSL
DODQODUGD NRUWLNRVWHURLG NXOODQDQODUGD úHNHU KDVWDODUÕQGD HQIHNVL\RQ GDLPD \D\ÕOPD\D
PH÷LOOLGLU )DUHOHUGH 3 JLQJLYDOLV LOH ROXúWXUXODQ GHQH\VHO SHULRGRQWLWLVOHUGH 71)-a,
PDGF-ß, IL-1, TNF-a sHYL\HOHULQGHDUWÕúWHVSLWHGLOLUNHQGL\DEHWLNIDUHOHUGHEXDUWÕúWHVSLW
HGLOHPHPLúWLU'R[H\YHDUNDGDúODUÕ%XLVHGL\DEHWLNNRQD÷ÕQWDPLUSURFHVLQGHNL
EHOLUJLQ JHFLNPH\L J|VWHUPHNWHGLU 6LJDUD NXOODQDQODUGD GD HQIHNVL\RQ \D\ÕOPD
H÷LOLPLQGHGLU 6LJDUD LoHQOHULQ VHUXP ,J* VHYL\HOHUL QRUPDOGHQ GúN RODUDN WHVSLW
HGLOPLúWLU4XLQQYHDUNDGDúODUÕ
Periapikal enfeksiyonun akibeti:
1. GLNNDWOL\DSÕOPÕúELUN|NNDQDOÕWHGDYLVLLOHL\LOHúHELOLU
2. ILVWOROXúDELOLU
3. kemik içerisinde diffüz lezyonlDUKDOLQGH\D\ÕODELOLURVWHRP\HOLW
4. kronik olarak uzun süre böylece kalabilir,
5. enkapsülasyon görülebilir.
%L]EXUDGDWHGDYLHGLOPHGL÷LGXUXPXLQFHOH\HFH÷L]
Lezyonun Enkapsülasyonu ve Apikal Kist Formasyonu:
Kronik apikal apselerin erken döneminde HSLWHOL]DV\RQ KHQ] EDúODPDGÕ÷Õ LoLQ
DSLNDO HQIHNVL\RQ LQYD]LIWLU YH VD÷ODP GRNX VÕQÕUÕ PLNURVNRSLN RODUDN GDKL WHVSLW
HGLOHPH] %XQD UD÷PHQ SHULDSLNDO NHPLNWH UH]RUSVL\RQXQ \DYDúODGÕ÷Õ J|UOU 3HULDSLNDO
NHPLNUH]RUSVL\RQXQHGHQ\DYDúODPDNWDGÕU"%XVRUXQXQWDWPLQNDUFHYDEÕKHQ]DoÕNoD
verilememektedir. Ortamdaki TNF-a, Ts hücrelerini aktive ederek, osteoklastik aktivitenin
\DYDúODPDVÕQD UHKEHUOLN HGHU 7V WDUDIÕQGDQ 71)-‰ VDOÕQDUDN ILEUREODVWODU X\DUÕOÕU GRNX
WDPLUL YH YDVNODUL]DV\RQ WHúYLN HGLOLU Daha ileri dönemlerde fibroblastlar ve bunlardan
ND\QD÷ÕQÕDODQHSLWHOKFUHOHULOH]\RQXQSHULIHULQHKDNLPROXU.|NNDQDOÕQGDNLEDNWHULOHULQ
PHYFXGL\HWOHUL GHYDP HGHUVH IRUDPHQ DSLNDOHGHQ SHULDSHNVH GR÷UX DQWLMHQLN \DSÕODU
VÕ]PD\DGHYDPHGHUOHU%XQODUSHULDSHNVWHNLLPPQX\DUÕQÕQPDMRUVHEHELGLU
%X G|QHP VXENOLQLNWLU KDVWDQÕQGLúLLOHLOJLOLELU\DNÕQPDVÕ\RNWXUIDNDWSDHULDSLNDO
dokular hala makrofaj, lenfosit ve plazma hücrelerinden zengindir. Periapikal doku,
VUHNOLOLN ND]DQDQ DQWLMHQLN X\DUÕ\Õ GXUGXUDELOHFHN GH÷LúLPOHU JHoLULU $QWLMHQLN X\DUÕQÕQ
JHOGL÷L IRUDPHQ DSLNDOH\L LoHULVLQH DODFDN úHNLOGH ILEURHSLWHO\DO ELU NÕOÕI KD]ÕUODU ùHNLO
%|\OHFH ELU VDYXQPD EDUL\HUL NXUDU 3HULDSHNVWH HSLWHOL]DV\RQ X\DUÕVÕ úX ND\QDNODUGDQ
gelir:
1. Nörojenik HQIODPDV\RQ 3XOSLWLV EDKVL DQODWÕOÕUNHQ DoÕNODQGÕ÷Õ ]HUH PLNURELN
ROPDVÕQD JHUHN ROPDGDQ KHUKDQJL ELU X\DUÕ Q|URLPPQ VLVWHPL DNWLYH HGHU 6LQLU OLIOHUL
ER\XQFD &*53 YH 3 PDGGHVL VDOÕQÕU %X X\DUÕ VXERGRQWREODVWLN SOHNVXVWDQ JHOGL÷LQGH
odontoblastlDUÕ WDPLU GHQWLQL \DSPDN ]HUH X\DUÕUNHQ SHULDSLNDO E|OJHGH PH\GDQD
JHOGL÷LQGHHSLWHOL]DV\RQXWHúYLNHGHU
)LEUREODVW DNWLYDV\RQX 3HULDSNHVWH ROXúDQ LPPQ NRPSOHVOHULQ )F SDUoDODUÕ
ILEUREODVWODUÕQ \]H\ UHVHSW|UOHULQH GR÷UXGDQ WXWXQDUDN RQODUÕ HSLWHl hücre haline
G|QúPHN]HUHVZLWFKLQJ
H]RUOD\DELOLU+DWÕUODWPDKDOEXNLD\QÕX\DUÕ7KDNWLYLWHVLYH,/ YDUNHQ ILEUREODVWODUÕ RVWHNODVWODUD G|QúWU\RUGX $úÕUÕ X\DUÕODQ PDNURIDMODU ELOKDVVD
&' RODQODU YH 7 OHQIRVLWOHUL ILEUREODVWODUÕ HSLWHO KFUHOHULQH G|QúWUHELOHFHN
mediyatörler salabilirler (TGF-‰ JLEL (÷HU HSLWHO KFUHOHUL ND\QD÷ÕQÕ SHULDSLNDO GRNXGDNL
PDNURIDMODUGDQDOÕ\RUVDROXúDQHSLWHO|UWVVHNUHWXDUHSLWHOúHNOLQGHGLU
0DODVVH] DUWÕNODUÕQÕQ DNWLYDV\RQX $\QÕ LPPQ VLQ\DOOHU Malassez epitel
DUWÕNODUÕQÕSUROLIHUHHGHELOLU6RQXoWDVNXDP|]HSLWHOROXúXU
OH]\RQ UHWURPDNVLOOHU \HUOHúLPOL LVH LPPQ VLQ\DOOHU VLQV WDEDQÕQÕ G|úH\HQ
HSLWHOKFUHOHULQLSUROLIHUDV\RQD]RUOD\DELOLU%XVROXQXPHSLWHOLGLUWHNNDWOÕVLO\DOÕHSLtel).
%XQODUGDQ HQ DNWHO RODQ J|Uú HQIODPDV\RQ VRQXFX DoÕ÷D oÕNDQ VLWRNLQOHULQ
0DODVVHV HSLWHO DUWÕNODUÕQÕ SUROLIHUDV\RQD VUNOHGL÷L úHNOLQGHGLU 3HULDSLNDO NLVW
IRUPDV\RQXQXQ EX úHNLOGH JHUoHNOHúWL÷L GúQOPHNWHGLU %XQD UD÷PHQ ED]Õ DSLNDO
granülomaYHNLVWOHUGHNLVWGXYDUÕQÕoHYUHOH\HQHSLWHOLQVLO\DOÕROPDVÕGúQGUFGU
(÷HU EWQ NLVWOHU GDLPD 0DODVVH] HSLWHO DUWÕNODUÕQGDQ ND\QD÷ÕQÕ DOVDODUGÕ HSLWHO
GXYDUVLO\DOÕROPDPDOÕ\GÕ\DQLVNXDP|]HSLWHOROPDOÕ\GÕ6LO\DOÕHSLWHOELOKDVVDVWPRODU
GLúOHULQoHYUHVLQGHRUWD\DoÕNPDNWDGÕU%XGXUXPVROXQXPHSLWHOLQGHQEXUD\DKFUHJ|o
RODELOHFH÷LQLWHONLQHWPHNWHGLU1DLU
(SLWHOL]DV\RQXQEDúODPDVÕQGDEDNWHULOHULQYHEDNWHULDQWLMHQOHULQH|]JODQWLNRUODUÕQ
UROX VÕQÕUOÕGÕU dQN NOLQL÷H \DQVÕ\DQ ELU HQIHNVL\RQ KDWWD ELU HQIODPDV\RQ ELOH RUWD\D
oÕNPDGDQ VHVVL]FH JHOLúHQ SHULDSLNDO NLVWLN GHMHQHUDV\RQODU YDUGÕU 0HNDQLN WUDYPD\Õ
WDNLEHQ VRQUDGDQ HQIHNWH ROVD ELOH PLNURSVX] RODUDN EDúOD\DQ NLVWLN OH]\RQODU DVHSWLN
nörojenik enflamasyon ile vH\D LQFLQPLú NRQDN KFUHOHULQGHQ VDOÕQDQ DUDúLGRQLN DVLW
WUHYOHULLOHHSLWHOL]DV\RQXQSURYRNHRODELOHFH÷LQLJ|VWHULU
<XNDUÕGDNL VHEHSOHULQ ELU YH\D ELUNDoÕ ELUDUDGD EXOXQDELOLU 6RQXoWD SHULDSLNDO
OH]\RQ oHYUHVLQGH ELU HSLWHO NÕOÕI ROXúXPX EDúODU YH ILEURHSLWHO\DO ELU GXYDU JHOLúHUHN
VD÷ODP GRNX\X KDVDUOÕ GRNXGDQ D\ÕUÕU %X úHNLOGHNL OH]\RQD SHULDSLNDO JUDQXORPD DGÕ
verilir. Bu terimin sonundaki -RPDHNLQLQWP|UOHULWDQÕPODPDNWDNXOODQÕODQHNLOHELULOJLVL
yoktur. Periapikal granülomalar, doku incinmeVLJLGHULOGLNWHQVRQUDILEU|]WDPLULOHROXúDQ
bir granülasyon dokusudur.
$SLNDO JUDQORPDQÕQ KLVWRSDWRORMLN NHVLWOHULQGH JUDQORPDW|] GRNX LoHULVLQGH
PLNURDSVHOHU LQILOWUH ROPXú LPPQ KFUHOHU ILEUREODVWODU YH RQODUÕ oHYUHOH\HQ HSLWHO NÕOÕI
bunun da GÕúÕQGD L\L WDQÕPOÕ ELU ILEU|] ELU NDSVO WHVSLW HGLOLU %X NDSVO \R÷XQ NROODJHQ
OLIOHUGHQROXúPXúWXUYHELUXFXVHPHQWH\DSÕúÕNWÕU%|\OHGLúOHUoHNLOGLNOHULQGHN|NXFXQX
saran kollagen kapsül göz ile tespit edilebilir. Epitel doku kapsüle invajine oluU ED]Õ
\HUOHUGHGHULQRODUDNNDSVOQLoHULVLQHJLUHUHNJDOHULOHUYH\DKDONDODUúHNOLQGHDNDQWR]ODU
\DSDU YH ED÷ GRNXVXQGDQ JHOHQ GDPDUODU LOH EHVOHQLU (SLWHOL EHVOH\HQ NDQ GDPDUODUÕ
çevresinde B ve T lenfositleri, plazma hücreleri ve makrofajlar dizilirler. Buradaki T
KFUHOHULQLQSURILOLPXKWHPHOELUDQWLMHQVÕ]ÕQWÕVÕQÕDEDUWPD\DPH÷LOOLGLU&'PDUNHU
WDúÕ\DQ7OHQIRVLWOHUL&'RODQODUGDQID]ODGÕU7K7V!%XQODUÕQoR÷X*ID]ÕQGDGÕU
6WHUQYHDUNDGDúODUÕ0XKWHPHOELUDQWLMHQVÕ]ÕQWÕVÕQGDGHUKDODNWLYHROXUODUYH*
ID]ÕQDJHoHUOHU
3HULRGRQWDO YH SHULDSLNDO KDVWDOÕNODUÕQ SURJQR]XQX EHOLUOH\HQ JHQHWLN IDNW|UOHU GH
YDUGÕUYHKHUELUH\NHQGLEDNWHULDQWLMHQOHULQLNHQGLVOXEXLOHFHYDSODU1HZPDQ
Periapikal immün reaksiyonlDU EX EDVDPDNWD \ÕOODUFD GXUDELOLU 9H\D LOHUOH\HUHN
HWUDIÕ HSLWHO |UWV LOH oHYULOL RUWDVÕ GRNX \ÕNÕP UQOHUL LOH GROX RODQ OH]\RQODU JHOLúLU
EXQODUD SHULDSLNDO NLVW DGÕ YHULOLU +HU SHULDSLNDO JUDQORPD SHULDSLNDO NLVWH G|QúPH]
Periapikal granüloPDODUÕQ-
LRUWDODPDGHQGDKDD]ELUNÕVPÕNLVWLNGHMHQHUDQV
gösterir.
%XQGDQVRQUDNLROD\ODUID]GDJHOLúLU
1. Epitel proliferasyonu: 3HULDSLNDO JUDQORPD\Õ VDUDQ HSLWHO |UW IRUDPHQ DSLNDOH
FLYDUÕQGD NDOÕQODúPD\D EDúODU 3HULDSLNDO E|OJHGH HSLWHO NDOÕQODúPDVÕ ROXúPDGDQ |QFH
Q|WURILOOHULQ IRUDPHQ DSLNDOH FLYDUÕQGD GDKD oRN NDQDO D÷Õ]ODUÕQGD ELULNWLNOHUL J|UOU
1|WURILOOHULQEXUD\DJ|oHWPHVLYHNLVWLQHSLWHOGXYDUÕQGDNLJHOLúPHD\QÕDQGDEDúODU.|N
\]H\LQH\DSÕúDQHSLWHO|UWVHPHQW yüzeyine tutunarak foramen apikale'ye kadar ilerler.
%X HSLWHO SUROLIHUDV\RQX LOH Q|WURILOOHULQ EXUD\D JHOPHVL DUDVÕQGD ELU LOLúNL EXOXQGX÷X
]DQQHGLOPHNWHGLU 1|WURILOOHU JHOPHGHQ |QFH HSLWHOGH ELU KDUHNHW J|]OHQPHGL÷LQH J|UH
muhtemelen nötrofillerden saOÕQDQ7*)(*)YHDUWDQILEUREODVWLNDNWLYLWHQLQUROEOXQGX÷X
GúQOPHNWHGLU (SLWHO SUROLIHUDV\RQX IRUDPHQ DSLNDOH\H YDUGÕ÷ÕQGD GXUDELOLU YH\D
IRUDPHQ DSLNDOH HSLWHO LOH WDPDPHQ WÕNDQDELOLU %|\OH OH]\RQODUD SHULDSLNDO SDNHW NLVW
(periapical pocket cyst)leri denir.
$SHNVWHQ|WURILO\R÷XQODúPDVÕGHYDPHGHUNHQQ|WURILOOHUGHQED]ÕODUD|OUEXQODUÕQ
KFUH DUWÕNODUÕ NLVW ERúOX÷XQD NDUÕúÕU %X VDQNL SODQOÕ ELU WHPL]OLNKDUHNHWLJLELGLU(SLWHOLQ
LOHUOH\HFH÷LE|OJHGH|QFHGHQEXOXQDQEDNWHULOHUYHEDNWHUL\HOUQOHUQ|WURILOOHUWDUDIÕQGDQ
WHPL]OHQPHNWHGLU 'DKD VRQUD 7*) (*) VDOÕQDUDN HSLWHO KFUHOHUL WHPL]OHQHQ E|OJH\H
GR÷UX GDYHW HGLOPHNWHGLU .|N NDQDOÕ LoHULVLQH LOHUOH\HQ HSLWHO KHPLGHVPRVRPODU LOH
SXOSRGHQWLQDO PHPEUDQD \DSÕúÕU YH IRUDPHQ DSLNDOH\L WDPDPHQ WÕNDU $SLNDO IRUDPHQ
FLYDUÕQGDNL HSLWHOL EHVOH\HQ NDQ GDPDUODUÕQÕQ WXQLFD LQWHPD
VÕQGD EXOXQDQ HQGRWHO
KFUHOHULJHUHNWL÷LQGH$3&J|UHYLJ|UHFHNúHNLOGHIDUNOÕODúÕUODUYHE|\OHNDOÕUODU
(÷HU OH]\RQXQ PHUNH]L LOH N|N NDQDOÕQÕQ LOLúNLVL NHVLOPHPLú LVH \DQL N|N NDQDOÕ
ERúOX÷XLOHNLVWERúOX÷XELUELUOHULLOHLUWLEDWKDOLQGHLVHEXGXUXPGDJHUoHNSHULDSLNDONLVW
SHULDSLFDOWUXHF\VWYH\DUDGLNOHUNLVWUDGLFXODUF\VWOHUDGÕQÕDOÕUODU.RQDNVDYXQPDVÕ
N|NNDQDOÕLOHLOLúNL\LNHVHELOHFHNELUHSLWHOWÕNDoROXúWXUDELOGL÷LQGHSHULDSLNDOSDNHW
NLVWOHULROXúXU%XQODUGDKDNDUDUOÕOH]\RQODUGÕUYHE|\OHELUDSVHQLQDOHYOHQPHúDQVÕGDKD
D]GÕUDPDUDG\RORMLNRODUDNGDKDE\NWU
2. Kavitasyon:.LVWROXúXPXQXQLNLQFLKDPOHVLHSLWHOLQoHYUHOHGL÷LGRNX merkezinin,
VÕYÕODúWÕUÕODUDN X]DNODúWÕUÕOPDVÕGÕU %X LúOHPLQ QDVÕO \DSÕOGÕ÷Õ WDP RODUDN DoÕNODQDPDPÕú
ROPDVÕQD UD÷PHQ SHNoRN NLVW IRUPDV\RQ WHRULVLYDUGÕU%XQODUGDQLNLWDQHVLGDKDID]OD
WDUDIWDUEXOPXúWXU
ABeslenememe teorisi (Nutritional Deficiecy Theory): Periapikal
JUDQORPDQÕQPHUNH]LQGHLQFLQPLúNHPLNYHED÷GRNXVXKFUHOHUL
EXOXQXU%XE|OJH\LEHVOH\HQNDQGDPDUODUÕHSLWHONÕOÕIÕQLoHULVLQGHQ
JHoHUHN OH]\RQXQ PHUNH]LQH XODúÕUODU (SLWHOLQ NDOÕQODúPDVÕ LOH EX
NDQ GDPDUODUÕ ER÷XOXU YH OH]\RQXQ PHrkezinde "vasküler nekroz"
JHOLúLU (SLWHO |UWQQ EWQO÷ ER]XOPD] 'DKD VRQUD D\QHQ
SXOSDGD ROGX÷X JLEL QHNUR]H RODQ PHUNH] GRNX VÕYÕODúÕU
OLTXLILFDWLRQ QHFKURVLV 0HUNH]GHNL OLNLW DUWÕNODUÕQ X]DNODúWÕUÕOPDVÕ
için nötrofilik granülositler lezyonun merkezine girerler. Önce birçok
PLNURNDYLWH ROXúXU GDKD VRQUD EX NDYLWHOHU ELUOHúHUHN GDKD JHQLú
bir tek kemik kavitesi meydana getirirler. Bu kavitenin içerisi lökosit,
GHMHQHUHHSLWHOKFUHVLGRNX\ÕNÕPUQOHULLOHGROXGXU%DNWHULOHULQ
rolü yoktur, böyle lezyonlarda (bilhassa periapikal paket kistlerinde)
JHQHOOLNOHEDNWHULEXOXQPD]YH\DoRND]VD\ÕGDGÕU
BApse teorisi: Bu teoriye göre, merkez dokunun lizisi sekonder apse
LOHJHUoHNOHúLU0HUNH]GHKDSVHGLOHQ|OEDNWHULYHEDNWHULUQOHUL
SODQOÕ YH NRQWUROOX ELU úHNLOGH DEDUWÕOPÕú ELU LPPQ UHDNVL\RQOD
VÕYÕODúWÕUÕOÕU %LOKDVVD LPPQ VDYXQPD KFUHOHUL WDUDIÕQGDQ
HQIHNVL\RQXQ WDP RODUDN NRQWURO DOWÕQD DOÕQDPDGÕ÷Õ SHULDSLNDO
JUDQORPDODUÕQ EX \RO LOH NLVWLN OH]\RQODUD G|QúW÷
GúQOPHNWHGLU
3. Ekspansiyon: $UWÕNUDG\RORMLNRODUDNEHOLUJLQOLNND]DQDQELUNHPLNNDYLWHVLYDUGÕU
%XNDYLWHJHQLúOHPH\HEDúODU%XUDGDGDIDUNOÕWHRULOHURUWD\DDWÕOPÕúWÕU
A-2VPRWLN*HQLúOHPH7HRULVL%XJ|UúHJ|UHPHUNH]GHNLDUWDQVÕYÕEDVÕQFÕ
perifer kemikte osteoklasWODUÕ X\DUPDNWDGÕU EDVÕQo UH]RUSVL\RQX EDVÕQo DWURILVL
$SLNDOSDNHWNLVWOHULQGHSHULIHUNHPL÷HRODQEDVÕQoGDKDID]ODGÕUEXVHEHSOHNHPLN
NDYLWHVLGDKDJHQLúWLU5DGLNOHUNLVWOHUGHLVHNLVWNDYLWHVLLoHULVLQGHROXúDQVÕYÕN|N
NDQDOÕ ERúOX÷XQD YH SXOSD NDYLWHVL DoÕN LVH RUDGDQ GD D÷Õ] ERúOX÷XQD GUHQH
RODELOGL÷LLoLQSHULDSLNDOWDUDIWDJHQLúOHPHVLQLVSHWHQVÕQÕUOÕGÕU<DQLN|NNDQDO
ERúOX÷X DGHWD NLVW ERúOX÷XQXQ ELU GHYDPÕ JLELGLU YH NLVW VÕYÕVÕQGD RODELOHFHN YROPHWULN
DUWÕúODUÕNRPSDQVHHGHQELUWDPSRQOD\ÕFÕERúOXNJ|UHYLJ|UU
B- 0ROHNOHU 7HRUL .LVW GXYDUÕQGDNL PDNURIDMODU YH 7K OHQIRVLWOHUL DVHSWLN
ROVD ELOH NLVW VÕYÕVÕQÕ DQWLMHQLN X\DUÕ NDEXO HGHUHN ,/-1 ve prostoglandin üretirler.
3URVWRJODQGLQOHULQ GL÷HU ELU ND\QD÷Õ NLVWLQ NDYLWDV\RQ G|QHPLQGH RUWD\D oÕNDQ
LQFLQPLú KFUHOHULQ VLWRSOD]PLN PHPEUDQODUÕGÕU 3URVWRJODQGLQOHU NDOOLNUHLQ YH
NLQLQOHU RVWHRNODVWODUÕ DNWLYH HGHUHN SHULIHUGHNL SHULDSLNDO NHPL÷LQ UH]RUSVL\RQXQX
EDúODWÕUODU%XUDGDPHWDORSURWHLQD]-I ve metaloproteinaz-II enzimlerinin de rolü
EXOXQGX÷XGúQOPHNWHGLU
2OJXQUDGLNOHUNLVWOHULoWHQGÕúDGR÷UXNRPSRQHQWWHQROXúXU
1. Kist kavitesi: Kist kavitesinin içerisinde litik bir eksuda bulunur ve kompozisyonu
ú|\OHGLU QHNURWLN GRNX \ÕNÕP UQOHUL EXUD\D LQILOWUH ROGXNWDn sonra ölen nötrofil
JUDQORVLWOHU GL÷HU |O 30/ YH PDNURIDMODU OHQIRVLWOHU|OEDNWHULKFUHOHULWURPERVLWYH
eritrositler.
(ULWURVLWOHU EDúWD ROPDN ]HUH PHPHOL KFUH PHPEUDQÕ NROHVWHURO LKWLYD HGHU .LVW
NDYLWHVLQH XODúWÕNWDQ VRQUD EXUDGD |OHQ NRQDN KFUHOHULQLQ PHPEUDQODUÕQGDQ NROHVWHURO
DoÕ÷D oÕNDU +DWÕUODWPD EDNWHUL PHPEUDQODUÕQGD NROOHVWHURO \RNWXU PD\D YH PDQWDUODUGD
LVH HUJRVWHURO YDUGÕU EXUDGDNL NROOHVWHUROQ \HJDQH ND\QD÷Õ NRQD÷ÕQ NHQGLKFUHOHULGLU
Kolesterolun %29-NDGDUÕNLVWkavitesi içerisinde kristalize olur (kolestetom). Böyle kistik
OH]\RQODUGDQ DOÕQDQ |UQHNOHULQ PLNURVNRSLN LQFHOHPHVLQGH NROHVWHURO NULVWDOOHULQLQ WHVSLW
HGLOPHVLNLVWWHúKLVLNR\DELOPHNLoLQJHUHNYH\HWHUúDUWWÕU%XVÕYÕGDEROPLNWDUGD,J*
bulunur (TolOHUYH+ROERURZ,J*
GHQEDúND,J$YH,J0GHWHVSLWHGLOPLúWLU6NDXJ
YH+RIVWDGGDKDVRQUDNL\ÕOODUGDEXEXOJXODUGR÷UXODQPÕúWÕU1DLGRUI
2. Epitel duvar:%LUYH\DELUNDoWDEDNDOÕRODELOLU.LVWHSLWHOLND\QD÷ÕQÕDOGÕ÷ÕGRNX\DJöre
oHúLW RODELOLU 0DOHVVH] ND\QDNOÕ LVH VNXDP|] VROXQXP HSLWHOLQGHQ JHOL\RUVD WHN NDWOÕ
VLO\DOÕ YH\D ILEUREODVWODUÕQ VZLWFKLQJ
L LOH ROXúPXúVD VHNUHWXYDU HSLWHOGLU *HQHOOLNOH NLVW
GXYDUÕVNXDP|]HSLWHOWUQGHQGLU.LVWLQOPHQLQLG|úH\HQHSLWHOLQNLVWERúOX÷XQDEDNDQ
\]H\LQGH JOREOHU YH\D DNDQWRWLN oÕNÕQWÕODU YLOOXV EXOXQXU %XQODU NLVW NDYLWHVLQGH
EXOXQDQVÕYÕLOHJHQLúELU\]H\WHPDVÕWHPLQHGHUEDUVDNYLOOXVODUÕQGDROGX÷XJLEL.LVW
VÕYÕVÕQDWHPDVHGHQHSLWHOWDEDNDVÕQÕQLQWHUVHOOHUE|OJHOHULQGHQ|WURILOLQILOWUDV\RQXYDUGÕU
1|WURILOOHUNLVWPXKWHYL\DWÕQGDEXOXQDELOHFHNEDNWHULOHULRUWDGDQNDOGÕUÕUODU.DSVOHGR÷UX
\DQLGÕúDGR÷UXJLWWLNoHHSLWHOGRNXLoHULVLQGHNLQ|WURILOVD\ÕVÕDUWDUIDNDWHSLWHOGRNXQXQ
ELWWL÷L YH NDSVOQ EDúODGÕ÷Õ \HUGH Q|WURILOOHUH UDVWODQPD] %X GXUXP Q|WURILOOHULQ HSLWHO
GÕúÕGRNXODUGDQEXUD\DJHOGL÷LQLDPDNLVWOPHQLQHNXYYHWOHLQILOWUHROGXNODUÕQÕQLúDUHWLGLU
(SLWHOGÕúÕGRNXODU(SLWHO|UWLOHNDSVODUDVÕQGDLQFHELUED÷GRNXVXEXOXQXU%XUDGD
NDQ GDPDUODUÕ YDUGÕU (SLWHO |UWQQ KFUHOHUL DUDVÕQD VÕ]DQ Q|WURILOOHU EX NDQ GDPDUODUÕ
\ROXLOHJHOLUOHU1|WURILOOHULQGDPDUGÕúÕQDoÕNDUoÕNPD]HSLWHOLoHULVLQHLOHUOHGLNOHUL
]DQQHGLOPHNWHGLU EX VHEHSOH NLVWLQ ED÷ GRNXVXQGD Q|WURILOOHUH UDVWODQPD] veya çok
D]GÕU %X ED÷ GRNXVX LoHULVLQGH % YH 7 OHQIRVLWOHUL SOD]PD KFUHOHUL YH PDNURIDMODU
EXOXQXU*HQoSHULDSLNDONLVWOHULQJHQLúOHPHG|QHPLQGHNLVWGXYDUODUÕQGDPDNURIDMVD\ÕVÕ
\NVHN EXOXQPDVÕQD UD÷PHQ ROJXQ NLVW YH DSLNDO JUDQORPDODUÕQ GXYDUODUÕQGD PDNURIDM
VD\ÕVÕGHQD]GÕU%DUNKRUGDUYH'HVRX]D)DNDWHSLWHOKFUHOHUL]DPDQODRUDQÕQDXODúÕU2OJXQNLVWG|QHPLQGHED]RILOYHPDVWKFUHOHULQDGLUGLU'DKDoRN,J$
IgG ve daha az olarak IgM tipinde antikorlar bulunur. IgG seviyesLVD÷OÕNOÕGRNXGDNLQLQ
NDWÕQD oÕNDU .LVW VÕYÕVÕQGD YH GXYDUODUÕQGD ERO PLNWDUGD ,J* EXOXQXU 1DLU %X
GLNNDWoHNLFL,J*NPODV\RQXEL]HNLVWROXúXPXQGD7LS-DúÕUÕGX\DUOÕOÕNUHDNVL\RQODUÕQÕQ
URO EXOXQGX÷XQX DQODWÕU .RQDN EWQ\OH RUWDGDQ NDOGÕUDPDGÕ÷Õ DQWLMHQLN VÕ]ÕQWÕ
ND\QD÷ÕQÕSDNHWOH\LSGL÷HUGRNXODUGDQL]ROHHWPHNWHGLU
4. Kollajen kapsül: .ROODJHQGHQ\R÷XQELUNDSVONLVWLHQGÕúWDQVDUDUNDQGDPDUODUÕQÕQ
JHoLúLQH L]LQ YHULU IDNDW GÕúDUÕ\D RODELOHFHN VÕYÕ VÕ]ÕQWÕVÕQÕ HQJHOOHU .LVW hacminde
RODELOHFHNPLQRUGH÷LúLPOHULNRPSDQVHHGHELOHFHNNDGDUHODVWLNWLUøoHULVLQGHQJHoHQNDQ
GDPDUODUÕQGDQGDOODUDODUDNEHVOHQLU'Õú\]QGH7YH%KFUHOHULPDNURIDMODU\HUDOÕUODU
*UDQORPDYHNLVWVDIKDVÕQGDOH]\RQXQLPPQKFUHSURILOLQGHELUIDUNOÕOÕNEXOXQDPDPÕúWÕU
(Torabinejad, 1994)
3HULDSLNDOø\LOHúPH (Trowbridge ve Emling, 1989)
'LNNDWOL YH NXUDOODUD X\XODUDN \DSÕOPÕú ELU N|N NDQDOÕ WHGDYLVL \XNDUÕGD DQODWÕODQ
SHULDSLNDO KDVWDOÕNODUÕQ KHU VDIKDVÕQGD L\LOHúPH LoLQ JHQHOOLNOH \HWHUOLGLUJHUHNOLGLU ø\L ELU
N|N NDQDOÕ WHGDYLVLQGHQ VRQUD OH]\RQXQ D\ LOH VHQH JLEL GH÷LúNHQ VUHOHU LoHULVLQGH
ND\EROGX÷X J|UOU 3HULDSHNV GLQDPLN ELU GRNXGXU YHL\LOHúPH\HPH÷LOOLGLU3HULDSHNVLQ
HQL\LWHGDYLVLN|NNDQDOÕQGDQJHOHELOHFHNVÕ]ÕQWÕ\ÕGXUGXUPDNWÕU
3HULDSLNDOL\LOHúPHHQ]LPDWLNEDúODU%XVÕUDGDúXHQ]LPOHULQUROXYDUGÕU
1. Eosinofillerden gelen histaminaz enzimi histamini degrade eder; kininaz,
bradikinini, süperoksitdismutas ise dokuda biriken süperoksit radikallerini degrade eder.
øQWUDVHOOHUF$03YHF*03RUDQÕHQIODPDV\RQXDUWÕUDELOHFH÷LJLELD]DOWDELOLUGH
F$03
QLQ GDKD ID]OD ROPDVÕ GXUXPXQGD HQIODPDV\RQ DUWDU +DOEXNL L\LOHúPHNWH ROHQ
SHULDSLNDOGRNXODUGDF*03GDKDEDVNÕQGÕU
+LVWDPLQ VDOÕQÕU )DNDW EX HQ]LP PDVW Kcrelerinin H2, reseptörlerine tutunur
+ GH÷LO E|\OHFH HQIODPDV\RQD NDUúÕ NR\DQ ELU UHDNVL\RQX EDúODWÕU %X HQ]LPDWLN
faaliyet, antikor sentezini, lökositlerin ekstraselüler lizisini, lenfosit kemotaksisini inhibe
eder. Bu arada, kompleman da inhibe olur.
3HULDSLNDO GRNXODUGD EWQ EX HQ]LPDWLN ROD\ODU EDúODGÕ÷ÕQGD LNL IDUNOÕ L\LOHúPH
prosedürü izlenir: Rejenerasyon ve Fibrosis.
.RQDN WDUDIÕQGDQ LON |QFH UHMHQHUDV\RQ GHQHQLU H÷HU EDúDUÕODPÕ\RUVD R ]DPDQ
ILEURVLV EDúODU 3HULDSLNDO GRNXODU ED÷ GRNXVX YH NHPLN GRNXVX DUDVÕQGD \HU DODQ VLQLU
OLIOHULYHGDPDUODUGDQROXúPXúWXU+HSVLQLQGHELUUHMHQHUDV\RQNDELOL\HWLYDUGÕU3HULDSLNDO
GRNXODUGD LON UHMHQHUDV\RQ EHOLUWLVL HSLWHOOHúPHGLU 'DKD VRQUD \D PHYFXW RVWHREODVWODU
X\DUÕOÕUYH\DILEUREODVWODURVWHREODVWKDOLQHG|QúHUHN\HQLNHPLN\DSÕPÕEDúODWÕU0HYFXW
GDPDUODUÕQ HQGRWHO YH NDV GRNXVX KFUHOHUL PLWR]D X÷UD\DUDN \HQL NDQ GDPDUODUÕQÕ
ROXúWXUXU*HQoNDQGDPDUODUÕGRNX\XEHVOH\HFHNNROODWHUDOOHULROXúWXUXU1|URVLWOHULKDVDU
J|UPHPLúVHDNVRQOLIOHULQLQGDKL1*)HWNLVLLOH]DPDQODX]DGÕNODUÕJ|UOU
6WURPDVÕQÕ ND\EHGHQ RUJDQODUGD UHMHQHUDV\RQ SURFHVL NDOLWHVL]GLU %X GXUXP
periapikal dokularda da böyledir. Rejenere olan doku her zaman orijinal doku gibi
ROPD\DELOLU .HPLN \DSÕPÕ |QH JHoHUVH SHULDSLNDO OH]\RQ WDPDPL\OH NDOVLIL\H RODELOHFH÷L
JLEL HSWHOL]DV\RQ YH NLVWOHúPH GH RUWD\D oÕNDELOLU 9H\D ROD\ NRQDN WDUDIÕQGDQ EDúDUÕVÕ]
görülerek, fibröz tamir yolu denenebilir.
5HMHQHUDV\RQWDPRODUDNEDúDUÕODPÕ\RUVDLQFLQPLúGRNXGDQDUWDNDODQILEURQHNtinILEULQ PDWULNVL VDQNL ELU RUJDQÕQ VWURPDVÕ JLEL NDEXO HGLOLUHN ]HULQH NROODJHQ \Õ÷ÕOÕU
Fibroblastlar dokuya hakim hale gelirler ve kollagen, proteoglikan ve daha fazla fibronektin
VDOJÕODUODU %XUDGDILEUREODVWODUWDUDIÕQGDQVHNUHWHHGLOHQNROODJHQ, protokollagen'dir. Bu
madde Tip-,,,NROODJHQRODUDNELOLQLU+DOEXNLGR÷DORODUDN|QFHGHQPHYFXWRODQNROODJHQ
Tip-,
GLU)LEUREODVWODUÕQVDOGÕNODUÕEXNROODJHQILEURQHNWLQ-ILEULQPDWULNVLQLQ]HULQH\DSÕúÕU
Yeni kollagenin mimarisi, o bölgeye gelen akWHO PHNDQLN NXYYHWOHUH J|UH úHNLOOHQLU
%LOKDVVD ILEULQOL HNVGD EXOXQGX÷XQGD NROODJHQ \Õ÷ÕOPDVÕ NROD\ODúÕU /H]\RQXQ EX úHNOL
ILEURVLVRODUDNLIDGHHGLOLU<HQLROXúDQDUWHUL\ROOHUEXOLIOHULQDUDODUÕQDGR÷UXLOHUOHUILEU|]
dokunun içerisinde zengin biU GDPDU D÷Õ ROXúWXUXUODU %X GDPDUODUGD KHP G] NDVODU YH
KHPGHRWRQRPVLQLUOLIOHULEXOXQXUùLPGLEX\HQLGRNX\DJUDQODV\RQGRNXVXGL\HELOLUL]
*UDQODV\RQ GRNXVX EX \RO GÕúÕQGD GLUHNW \RO LOH GH ROXúDELOLU *HQLúoH ELU NDQ SÕKWÕVÕ
bulunuyorsa, kan damDUODUÕSÕKWÕLoHULVLQHLOHUOH\HUHNGLUHNW\ROGDQJUDQODV\RQGRNXVXQX
ROXúWXUXUGDKDVRQUDLQWHUYDVNOHUE|JH\HNROODJHQ\Õ÷ÕOPDVÕROXUNHPLNNÕUÕNODUÕQGD
YH\DGLúoHNLPOHULQGHROGX÷XJLEL
.ROODJHQ IRUPDV\RQX VÕUDVÕQGD NRPSOHPDQ UHDNVL\RQODUÕQD UDVWODQPD] (÷HU EX
dönemde, periapikal dokularda kompleman aktivasyonu olursa kollagen sentezi durur
.UHDPYHDUNDGDúODUÕ
.RQDN NRPSOHNV VLVWHPOHUGHQ ROXúXU ILEU|] GRNX ELOLQPH\HQ ELU VHEHSOH
JUDQODV\RQ GRNXVXQD KLo ELU ]DPDQ G|QúPH\HELOLU %X GXUXPGD LoHULVLQGH EXOXQGX÷X
SHULDSLNDO NHPLN NDYLWHVLQLQ GXYDUODUÕQD VÕNÕFD \DSÕúÕU YH PHUNH]LQGH GDPDUODU LKWLYD
etmez. Buna skar GRNXVXGHQLUILEU|]DQNLOR]DGÕGDYHULOLU
3HULDSLNDOL\LOHúPHGHUROR\QD\DQKFUHOHU
Makrofajlar, fibroblastik aktiviWH\L NROD\ODúWÕUPDN LoLQ GRNXGDNL PDNUR DUWÕNODUÕ
IDJRVLWH HGHUOHU <HQL NDQ GDPDUODUÕQÕQ \HQL ILEUREODVWODUÕQ EXUD\D JHOPHVLQL VD÷OD\DFDN
HQ]LPOHU VDODUODU %XQODU WRSOXFD *) *URZWK )DFWRUV DGÕQÕ DOÕU )LEUREODVWODU L\LOHúPH
KDPOHVLQLLONEDúODWDQKFUHOHUGLUYHEXQXJROJLD\JÕWÕQGDQNROODJHQVHNUHWHHGHUHN
\DSDU%XSURWHLQEDúNDILEUREODVWODUÕDNWLYHHGHU\DQLEXUDGDGDELULPPQDPSOLILNDV\RQ
YDUGÕU 7*)-‰ &) *) OHQIRNLQOHU YH NRPSOHPDQ SURWHLQOHUL ILEUREODVWODUÕ EX \|QGH
uyarabilir.
Fibroblastlar oksijen gereksinirler. Bu sebeple, kollagen sentez etmeye lezyonun
SHULIHULQGHQ EDúODUODU <HQL NDQ GDPDUODUÕOH]\RQXQPHUNH]LQHRNVLMHQJHWLULQFH\HNDGDU
KDUHNHWOHUL \DYDúWÕU 'DKD VRQUD OH]\RQXQ PHUNH]LQH GR÷UX NROODJHQ ELULNWLUPH\H GHYDP
ederler. Fibroblastlar, bakteri, bakteriyel ürünler ve enflamasyon bakiyeleri ihtiva eden
GRNXGD LQDNWLIWLU %XUDGD Q|WURILOOHU GHYUH\H JLUHUOHU (÷HU SHULDSLNDO GRNXODUGD KDOD
RUWDGDQNDOGÕUÕOPDVÕJHUHNHQEDNL\HOHUYH\DGHEULVEXOXQX\RUVDQ|WURILOOHULQOLWLNHQzimleri
LOHVLQGLULOLUVRQUDPDNURIDMODUWDUDIÕQGDQ\XWXOXU.DQDOGDQVÕ]DQDQWLMHQLNPDGGHOHUYDUVD
periapeksteki granülasyon dokusunun fibroblastik aktivitesini azaltabilir.
Periapikal granülasyon dokusunun akibeti:
(÷HUSHULDSHNVWHJUDQODV\RQGRNXVXROXúXUVDELOLQPHOLGLUNLEXGRNXNLPOLNVL]ELU
dokudur. Her hasar gören dokuda, belirgin veya belirgin olmayan miktarlarda granülasyon
GRNXVX ROXúXU YH EX GRNX ]DPDQOD EXOXQGX÷X DGUHVWHNL GRNXQXQ NLPOL÷LQH EUQU
gUQH÷LQ NHPLN NÕUÕNODUÕQGD NÕUÕN IUDJPDQODUÕ DUDVÕQGDNL NDQ SÕKWÕVÕ |QFH ILEU|]H ROXU
VRQUDGDPDUODQDUDNJUDQODV\RQGRNXVXQDG|QúUVRQUDNRQGURLWYHVRQUDGDNDOVLIL\H
GH÷LúLPJHoLULU+DVDUJ|UHQGHULGHROXúDQJUDQODV\RQGRNXVXHSLGHUPLVHG|QúU
3HULDSLNDO L\LOHúPH VÕUDVÕQGD ROXúDn granülasyon dokusu, burada uzun süre
NLPOLNVL]RODUDNNDOPD]ùXQODURODELOLU
1.
Kalsifiye olabilir: Bu, periapikal granülasyon dokusunun en arzulanan
DNLEHWLGLU%XUDGDNL7OHQIRVLWDNWLYLWHVLQHGHQL\OHYH$33
QGHQDoÕ÷DoÕNDQ
kallikrein ve kininaz II'niQ KHP RVWHREODVWODUÕ YH KHP GH RVWHRNODVWODUÕ
X\DUGÕ÷Õ .URQLN $SLNDO $SVHQLQ øPPQRORMLVL EDúOÕ÷Õ DOWÕQGD DQODWÕOPÕúWÕ
%XPDGGHOHURUWDPGD30/F$03YH7KYDUNHQRVWHRNODVWODUÕGDKDID]OD
X\DUÕUODU+DOEXNLúLPGLSHULDSHNVWHEXHQ]LPYHKFUHOHU\RNWur, o halde
RVWHREODVWLN DNWLYLWH GL÷HULQLQ |QQH JHoPHOLGLU =DWHQ E|\OH GH ROXU
Kalsifikasyonun granülasyon dokusunun merkezinden bir kaç noktadan
EDúODUSHULIHULQHGR÷UX\D\ÕOÕU6RQUDEXRGDNODUELUOHúLU%D]HQEXROD\ODU
VÕUDVÕQGD VHPHQWLQ DOYHRO NHPL÷LQH DQNLOR]H ROGX÷X GD J|UOU EX
NRQXGDEDúNDWHRULOHUGHYDUGÕU
2.
)LEURHSLWHO\DO GHMHQHUDQV JHOLúWLUHELOLU ILEU|] VWURPD LoHULVLQH \HQLGHQ
HSLWHOKFUHOHULLOHUOH\HELOLU%XROD\EXUD\DJHOHQNDQGDPDUODUÕQÕQJHWLUGL÷L
WURPERVLWOHULQ ROD\D \DQOÕú PGDKDOHVL RODELOHFH÷L JLEL N|N NDQDOÕQGDQ
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salarak eosinofilleri tekrar dokuya davet ederler. Bunlar epitelizasyonu
provoke eden hücrelerdir (Bkz. periapikal granüloma). TGF-ß, TMF, GF ve
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1966).
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yükseNEXOXQXU1RUGK0RUVHYHDUNDGDúODUÕ7RUDELQHMDGYHDUNDGDúODUÕ
1983).
Akut apikal abseli bireylerde IgG, IgM, IgE ve kompleman komponentlerinin
NRQVDQWUDV\RQODUÕ QRUPDOGHQ \NVHNWLU 6YHWFRY YH DUNDGDúODUÕ .HWWHULQJ YH
TorabLQHMDG (QIHNVL\RQ NURQLNOHúVH ELOH WHGDYL HGLOPHGL÷L PGGHWoH E|OJHGH 7
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streptokoklara, 40 tanesinde sadece streptokoklara, 15 tanesinde sadece stafilokoklara
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1. Antijenler,
2. Antijen-antikor kompleksleri,
3. Heterofil antikorlar,
4. Otoantikorlar,
5. Allerji.
ùLPGLEXQODUDJ|]DWDOÕP
1. Antijenler:)RNDOHQIHNWLIRGDNWDQNRQD÷ÕQVLVWHPLNGRODúÕPÕQDVÕ]DQDQWLMHQOHU
ED]Õ NRQDN GRNXODUÕ LoHULVLQH oRN L\L SHQHWUH ROPXú RODELOLUOHU %X GXUXPGD IDJRVLWLN
KFUHOHU EX \DSÕODU LOH VÕFDN WHPDV WHPLQ HGHPH]OHU )DJRVLWLN KFUHOHU DQWLMHQLQ
WHVDGIHQ EXOXQGX÷X VRUXQVX] GRNX\D PPNQ ROGX÷X kadar infiltre olarak litik
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KHPHQ\DNÕQODUÕQGD]DWHQPH\GDQDJHOPHNWHGLUIDNDWVHVVL]GLU
%DNWHULOHULQVDGHFHDQWLMHQOHULGH÷LOSHNoRNHQ]LPLVLVWHPLNGRODúÕPDNDWÕODELOLUYH
EXQODUGDQED]ÕODUÕLPPQVLVWHPWDUDIÕQGDQIDUNHGLOPH\HELOLUYH\DWROHUHHGLOHELOLU(QIHNWD
N|N NDQDOÕ IORUDVÕQGDNL ED]Õ EDNWHULOHULQ ELOKDVVD 6WUHSWRFRFFXV FLQVOHUL HQ]LPOHULQLQ
WURPERVLWOHUL DJUHJH HGHQ ELU |]HOOLNOHUL YDUGÕU %X HQ]Lmler kalbi besleyen koroner
DUWHUOHUGHDWHURPSODNODUÕQÕQROXúPDVÕQÕVD÷ODU6H\PRXUYH6WHHOH6WUHSWRFRFFXV
FLQVL EDNWHULOHU YH RQODUÕQ VHOOHU HNVWUDNWODUÕ VDGHFH GLú GH÷LO D\QÕ ]PDQGD GLúHWL
HQIHNVL\RQODUÕQGDQGDNDQDJHoHELOPHNWHGLU3HULRGRQWDOKDVWDOÕNODUYHNDOSKDVWDOÕNODUÕ
DUDVÕQGD ELU LOLúNL EXOXQGX÷X |QH VUOPHNWHGLU VRQ \ÕOODUGD 0\FRSODVPD SQHXPRQLD
LVLPOL ELU EDNWHUL YH DWHURP SODNODUÕ DUDVÕQGD GD EHOLUJLQ ELU NRUHODV\RQ JLGHUHN GLNNDW
çekmektedir). O halde, odontojen bir fokal enIHNVL\RQ NDOS KDVWDOÕNODUÕQD VHEHS WHúNLO
edebilmektedir.
.RURQHU \HWPH]OLN J|VWHUHQ KDVWDQÕQ GLú YH SHULRGRQWDO GRNXODUÕ LQFHOHQPLú
RGRQWRMHQ HQIHNVL\RQXQ úLGGHWL LOH DWHURP SODN ROXúXPX DUDVÕQGD OLQHHU ELU LOLúNL WHVSLW
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$\QÕ \D]DUODUD J|UH EDNWHULOHULQ HQ]LP YH HNVWUDNWODUÕ GÕúÕQGD DúÕUÕ PRQRVLW
X\DUÕOPDVÕ GD DWHURP SODN ROXúXPXQD \DUGÕP HWPHNWHGLU %X WLS DúÕUÕ X\DUÕPODU 30/
NHPRWDNVLVLQL VD÷OD\DQ IDNW|UOHUL LQKLEH HWPHNWHGLU 0DWVXL YH DUNDGDúODUÕ %X
sebeple, PML ve makrofaj gibi akut dönem immün hücreleri, kazayla incinen uzak dokuda
GH÷LOIRNDOHQIHNWLIRGDNWDWHVSLWHWPHNGDKDPPNQGU%X|]HOOLNIRNDOHQIHNWLIRGD÷ÕQ
VLQWLJUDILLOHWHVSLWLQLPPNQNÕODU%N])RNDOHQIHNVLVRQRGDNODUÕQÕQWHVSLWL
2GRQWRMHQ \RO LOH DQWLMHQOHU VUHNOL RODUDN GRODúÕPD NDWÕODELOLU IDNDW HQIHNWH N|N
NDQDOÕQGD NDQ GRODúÕPÕ EXOXQPDGÕ÷Õ LoLQ LPPQ PHNDQL]PD EXQODUÕ \DNDOD\DPD\DELOLU
%XQDUD÷PHQX\DUÕVLQ\DOOHULGHYDPHWWL÷LLoLQDQWLNRU\DSÕPÕGHYDPHWHUYHDQWLNRUID]ODVÕ
ROXúXU%XGXUXPGDPH\GDQDJHOHQDQWLMHQDQWLNRUNRPSOHNVOHULELUVRQUDNLPHNDQL]PDQÕQ
WHWL÷LQLoHNHU
2. Antijen-antikor kompleksleri:
(QIHNVL\RQ VÕUDVÕQGD YH\D VRQUD NDQGD YH GRNXODUGD EXOXQDQ DQWLMHQ-antikor
koPSOHNVOHULNRQDNGRNX\D]DUDUYHUHELOLUOHU%XNRPSOHNVOHULNLúHNLOGHRUWD\DoÕNDUODU
$QWLMHQOHU WHN EDúODUÕQD GRODúÕPD VÕ]DUODU YH GDKD VRQUD GRODúÕPGD LNHQ |]JO
DQWLNRUODUÕLOHELUOHúHUHNDQWLMHQ-antikor kompleksleri meydana getirebilirler. Streptococcus
PLWLVLQDQWLMHQOHULQLQ7FKFUHOHULX\DUDELOGL÷LJ|VWHULOPLúWLU0DWVXVKLWD
%DNWHUL DQWLMHQOHUL IRNDO HQIHNWLI RGD÷ÕQ SHULIHULQGH NHQGL |]JO DQWLNRUODUÕ LOH
ELUOHúHUHNDQWLMHQ-DQWLNRUNRPSOHNVOHULROXúWXUXUODUYHEXúHNLOGHGRODúÕPDVÕ]DELOLUOHU
.HQGL |]JO DQWLNRUX LOH ED÷ODQPÕú ELU DQWLMHQ QDVÕO ROXU GD NRQDN GRNX\D ]DUDU
YHUHELOLU" 0NHPPHO YH GHQJHOL VLVWHPOHU LOH GRQDWÕOPÕú LPPQ PHNDQL]PD EX \DQOÕú
UHDNVL\RQODUÕQHGHQIDUNHWPHPHNWHGLU"gQFHNLE|OPOHUGHQELOL\RUX]NLDQWLNRUODUDVOÕQGD
VHUXP ND\QDNOÕ LPPQJOREXOLQOHUGLU YH EXQODUÕQ DQWLMHQL ED÷OD\DQ )DE SDUoDODUÕQGDQ
EDúNDELUGHNRQDNGRNXQXQNHQGLLPPQKFUHOHULQLQWDQÕGÕ÷ÕELU)FSDUoDVÕYDUGÕU%N]
Antikorlar). Antijen-DQWLNRUELUOHúPHVLPH\GDQDJHOGLNWHQVRQUDEXNRPSOHNVLQ)FSDUoDVÕ
DoÕNWD NDOÕU .RQDN GHIDQV KFUHOHUL EX NRPSOHNVL \DNDODPDN LVWHGLNOHUL ]DPDQ )F
SDUoDVÕQGDQ\DNDOD\DELOLUOHU
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GRNXGD VHUEHVW KDOGH EXOXQPDVÕ ROD\Õ D]GÕUÕU oQN DQWLMHQ LOH ED÷ODQPÕú LPPQ
JOREXOLQ NRPSOHPDQ VLVWHPLQLQ DNWLYHROPDVÕQÕVD÷OD\DQ&SURWHLQLQHED÷ODQDUDNNODVLN
DNWLYDV\RQX EDúODWÕU %X GXUXP DQWLMHQ-antikor kompleksinin yeniden kompleman
DNWLYDV\RQXQD VHEHS RODPDVÕ YH GDKD ID]OD DQWLMHQ DQWLNRU NRPSOHNVL RUWD\D oÕNPDVÕ
GHPHNWLU(QL\LLKWLPDOLOHDQWLNRUID]ODOÕ÷ÕROXúPDVÕGHPHNWLU
.RQDN IDJRVLWLN KFUHOHUL GÕúÕQGD ED]Õ KFUHOHULQ GH EX )F SDUoDVÕQÕ
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NRPSOHNVLQL \DNDOD\DUDN LGUDUDLOHWLUOHU1HGHQVHUEHVWLPPQJOREXOLQOHUL)FSDUoDVÕndan
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HQGRWHOGH HNOHPOHULQ VLQRY\DO PHPEUDQODUÕQGD J|] NUHVLQLQ |Q YH DUND NDPHUDODUÕQÕ
ROXúWXUDQ YLWUL\|] VÕYÕGD HQGRNULQ VDOJÕ EH]OHULQLQ SDUDQNLP GRNXVXQGD SDnkreas,
VUUHQDO YH WULRLG GDKLO HSLWHO GRNXQXQ ED]DO ODPLQDVÕQGD YH KHPHQ SHN oRN IDJRVLWLN
NDELOL\HWOL KFUHQLQ \]H\LQGH )F SDUoDVÕQÕ WXWDELOHQ UHVHSW|UOHUGHQ EXOXQXU %X VHEHSOH
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\R÷XQODúPD\D PH÷LOOLGLU dR÷XQOXNOD J|] HNOHP E|EUHN ED]DO PHPEUDQODU LQWHUVWLV\HO
VÕYÕODU GDPDU HQGRWHOL JLEL GRNXODUÕQGD \R÷XQODúÕU $QWLMHQ-antikor komplekslerinin bu
GRNXODUGDROXúWXUGX÷XKDVDUÕQPHNDQL]PDVÕú|\OHGLU
1. Fibroblastlara ED÷ODQDUDNRQODUÕRVWHNODVWKDOLQHG|QúPH\HWHúYLNHGHUOHU$UWDQ
SURVWDJODQGLQOHU YH ELOKDVVD EUDGLNLQLQ HNOHP EDúÕQGD GHIRUPDV\RQODUD VLQRY\DO
materyalin denaturasyonuna sebep olabilmektedir. Lens ve Beertsen (1988), farelerin
GLúHWL PXNR]DVÕQD VDGHFH bakteri antijeni enjekte ederek, diz ekleminde kronik
HQIODPDV\RQ ROXúDELOHFH÷LQL J|VWHUPLúWLU 'HQH\ KD\YDQÕQD KLoELU EDNWHUL YHULOPHPLúWLU
Burada rol oynayan mekanizma nötrofillerin degranülasyonudur, anahtar sitokinler ise
IL-3 ve IL-
GÕU
FibroblasWODU UHWLNOHU YH LQWHUPHGLDWRU KFUH JUXSODUÕ JHUHNWL÷LQGH EDúND KFUH
JUXSODUÕQD G|QúHELOLUOHU .HQGLOHULQH JHOHQ DQWLMHQLN X\DUÕQÕQ QLWHOL÷L RQODUÕQ KDQJL KFUH
JUXEXQDIDUNOÕODúDFD÷ÕQÕEHOLUOHU(NOHPNDSVOoHYUHVLQGHNLILEUREODVWODURVWHRNODVWODra
IDUNOÕODúÕUNHQ D\QÕ X\DUÕ LOH EDúND GRNXODUGDNL ILEUREODVWODU HSLWHO GRNXVXQD
IDUNOÕODúDELOLUOHU$\QÕX\DUÕNRQDNWDNLELUHQGRNULQEH]LQVR\VX]ODúPDVÕQDVHEHSROXUNHQ
ELU EDúND GRNXGD PHPEUDQ KDVDUÕQD VHEHS RODELOPHNWHGLU %X NRQXGD WDWPLQ HGLFL
bilgimiz henüz yoktur. Romatoid artritisin patogenezinde IL-6 ve IL- DUDFÕOÕNOH NHPLN
HULPHVL EXOXQFX÷X GúQOPHNWHGLU %XUDGDNL RVWHRNODVWODUÕQ DNWLYDV\RQXQGD 2$) URO
DOPD]5RPDWRLGDUWULWLVOLKDVWDODUÕQHNOHPOHULQLQVLQRY\DOVÕYÕODUÕQGDQDOÕQDQPDNURIDMODUÕQ
2$)UHWHPHGLNOHULJ|UOPúWU)OHVFKHUYHDUNGDúODUÕ
*ORPHUORQHIULWLV YHLWLV JLEL KDVWDOÕNODUÕQ YH KDWWD JXDWU GLDEHWHV PHOOLWXV
$O]HKHLPHUYHNDWDUDNW
ÕQEXúHNLOGHJHOLúWL÷LKDNNÕQGDNXYYHWOLGHOLOOHUYDUGÕU)DXJHUHYH
DUNDGDúODUÕ, 1990).
2. Hageman faktörünü aktive ederler. Sonuçta özgül olmayan fagositozu provoke
ederler. Bu durumda IL-VDOÕQDUDNKHP1.KFUHOHULYH30/
OHUGRNX\DGDYHWHGLOLUKHP
GH DNWLYH HGLOLUOHU g]JO ROPD\DQ IDJRVLWLN IDDOL\HWOHU NRQDN GRNXQXQ ELU EDúND hasar
sebebidir.
3. $QWLMHQ DQWLNRU NRPSOHNVOHUL EXOXQGXNODUÕ GRNXGD &' LPPQ KFUHOHUL
X\DUÕUODU%XGXUXPGD|]JOROPD\DQIDJRVLWR]GDKDGDDOHYOHQLU
.ODVLN NLWDSODUGD OLSRSROLVDNNDULW DQWLMHQOHULQ GDPDU KDUDEL\HWLQH VHEHS ROX÷X
\D]ÕOÕGÕU %X GR÷UXGXU IDNDW X]XQ \ÕOODU ER\XQFD EX ROD\ÕQ PHNDQL]PDVÕQÕQ &'
KFUHOHULQLQ X\DUÕOPDVÕ LOH ROGX÷X WHVSLW HGLOHPHPLúWLU /36 ED÷OD\DQ |]JO ,J0
DQWLNRUODUÕQD /%3 JLEL |]HO ELU LVLP YHULOLU /36 /%3 LOH ELUOHúHUHN /36-LBP kompleksini
ROXúWXUXU%XPROHNO&'PDNURIDMODUWDUDIÕQGDQ\DNDODQÕUYHPDNURIDMODUGR÷UXGDQ
QRQVSHVLILN IDJRVLWLN |]HOOLN ND]DQÕU %XUDGDNL QRQVSHVLILN WHULPL |QHPOLGLU <DQL \NVHN
seviyede aktive olan CD14+ makrofajlar, belirgin bir hedef tayin etmeden fagositoz
\DSPD\DEDúODUAktive makrofajlar IL-1, IL-2, IL-6, IL-8, TNF, nitrik oksit, interferon alfa ve
SURVWRJODQGLQ VDODUDN D÷UÕ YH |GHP ROXúXPXQD LOHUOH\HQ G|QHPOHUGH NHPLN
UH]RUSVL\RQXQDVHEHSROXUODU6XJDZDUDYHDUNDGDúODUÕ$\UÕFDEXNRPSOHNVOHU
(LPS-LBP), Fc paUoDODUÕLOHGR÷UXGDQILEUREODVWODUÕX\DUDELOLUOHU6HOW]HUYH)DUEHU
%XUDGD EDKVL JHoHQ /36 VLVWHPLN GRODúÕPGD EXOXQX\RU LVH HQGRWRNVLN úRN WDEORVX
ROXúXUYH\D\JÕQHQGRWHOKDUDEL\HWLPH\GDQDJHOLU$UWÕN/36
QLQQHGHQGDPDUHQGRWHOLQL
harap ettL÷LQLELOL\RUX]
4. $QWLMHQ DQWLNRU NRPSOHNVOHUL WURPERVLW \]H\LQGHNL UHVHSW|UOHUH ED÷ODQDUDN
RQODUÕDJUHJDV\RQDVUNOHU0DVWKFUHOHULYHED]RILOOHUGHDQWLMHQ-antikor komplekslerini
yakalayabilirler ve PAF salarlar. Bu durumda damar çeperinde trombositler birikmeye
EDúODUODU %X VÕUDGD WURPERVLWOHUGH GHJUDQODV\RQ ROXU NDWHSVLQ -HT (5K\GUR[\WU\SWDPLQHGL÷HUDGÕVHUDWRQLQYH&3)&ORW3URPRWLQJ)DFWRUVDODUODU$\UÕFD
OL]R]RPDOHQ]LPOHUVDOGÕNODUÕGDWHVSLWHGLOPLúWLU3ÕKWÕROXúXPXGRNXGD|Qce vasküler staz
VRQUDGRODúÕPNROODSVÕQDVHEHSROXU
5. Antijen-antikor kompleksinin C-gamma- PROHNO NRPSOHPDQÕQ &T
PROHNOQH DIILQLWH J|VWHULU .RPSOHPDQ NODVLN \ROGDQ DNWLYH ROXU 6RQXoWD DoÕ÷D oÕNDQ
zara hücum kompleksi penetre olacak bir bakteri hücresi bulamaz, konak bazal
PHPEUDQODUÕQÕWDKULSHGHU
%X DúDPDGD VD\ÕODELOHFHN EDúND PHNDQL]PDODU GD YDUGÕU $QFDN HQ VÕN UDVWODQDQ
KDVDU PHNDQL]PDODUÕ EXQODUGÕU 1HGHQ KHU DQWLMHQ-DQWLNRU NRPSOHNVL NRQD÷D ]DUDU
YHUPHPHNWHGLU %X VRUXQXQ FHYDEÕ KHQ] QHWOLN ND]DQPDPÕúWÕU 0XKWHPHOHQ DQWLMHQLN
X\DUÕQÕQ VDELW YH VUHNOL ROPDVÕ DQDKWDU IDNW|U ROPDOÕGÕU 3DOLL YH DUNDGDúODUÕ ORNDOL]HELUHQIHNVL\RQXQIRNDOHQIHNVL\RQKDOLQHG|QúPHVLQGH7+)
QUROXEXOXQGX÷XQX
GúQPúOHUYHVLPD]LQH
QLQHWNLVLQLLQFHOHPLúOHUGLU
Hiç bir bakteri hücresine gerek olmadan, solunum yoluna girebilecek antijenler ve
EXQODUÕ ROXúWXUGX÷X DQWLMHQ-antikor kompleksleri glomerulonephritis sebebi olabilir
6WUXQVNL YH DUNDGDúODUÕ (QIHNWH VLQV NDYLWHVLQLQ LOWLKDEL HNVGDVÕQGDQ VROXQXP
\ROXQDYHYH\DVLVWHPLNGRODúÕPDVÕ]DQEDNWHULDQWLMHQOHULGHEXQDVHEHSRODELOLUOHU
Post-VWUHSWRNRNVLNKDVWDOÕNODU%LOJHKDQ
6WUHSWRNRNODUÕQ L\LOHúHQ L\LOHúPHVL JHFLNHQ YH\D NURQLNOHúHQ HQIHNVL\RQODUÕ EHOLUOL
bir süre sonra kRQDNWD \DQOÕú LPPQ WHSNLPHOHUH VHEHS RODELOLU %DNWHULOHULQ SULPHU URO
R\QDPDGÕ÷ÕEXKDVWDOÕNODUDSRVW-VWUHSWRNRNVLNKDVWDOÕNODUDGÕYHULOLU
$ YH % JUXEX VWUHSWRNRNODUÕQ ELOKDVVD $ JUXEX ‰ KHPROLWLN RODQODUÕQ KHPROL]
yapan ekstraselüler enzimleri varGÕU %XQODUGDQ ELULVL VWUHSWROL]LQ 2 GL÷HUL VWUHSWROL]LQ 6
DGÕQÕDOÕU%XQODUGDQVWUHSWROL]LQ2RNVLMHQLOHLQDNWLYHRODQDONROGHo|]QHQ-60 kDa
OXN ELU SURWHLQGLU 6WHUSWROL]LQ 2 L\L ELU LPPQRMHQGLU 6VDIODúWÕUÕODUDN GHULDOWÕ \RO LOH
WDYúDQODUD HQMHNWH HGLOGL÷LQGH NDUGL\DN VHEHSOL |OPOHU J|UOU $NDQ .RQDN
WDUDIÕQGDQVWUHSWROL]LQ2
\DNDUúÕKD]ÕUODQDQLON|]JODQWLNRUODU,J0WDELDWÕQGDROXS-14
JQLoHULVLQGHVHUXPGDEHOLULU%XDQWLNRUODUGDQJHoG|QHPGHROXúDQODUÕ,J*WLSLQGHROXS
ASO (Anti-Streptolizin-2 DGÕQÕ DOÕU 6D÷OÕNOÕ ELUH\OHULQ VHUXPXQGD ,J*-ASO
NRQVDQWUDV\RQX 8 QLWH FLYDUÕQGDGÕU 6WUHSWRNRN ND\QDNOÕ IRNDO HQIHNVL\RQODUGD
KDVWDQÕQ VHUXPXQGD $62 VHYL\HVL \NVHOLU %|\OHFH ELU KDVWDGD $62 WHWNLNL \DSÕOPDVÕ
(sadece VWUHSWRNRNDOIRNDOHQIHNVL\RQODULoLQELUWHúKLVYDVÕWDVÕGÕU
.DOS5RPDWL]PDVÕ6WUHSWRNRNODUÕQELOKDVVD$JUXEXRODQODUÕQÕQVLWRSOD]PLN]DUÕQGD
07YH5SURWHLQOHULDGÕYHULOHQVWUHSWRNRNODUD|]JODQWLMHQLN\DSÕODUYDUGÕU%XQODUGDQ0
SURWHLQLWDúÕ\DQVWHUSWRNRNODUIDJRVLWR]DGLUHQoOLGLUYHGDKDYLUODQGÕU%XSURWHLQÕVÕ\D
YH DVLWOHUH GLUHQoOLGLU IDNDW WULSVLQ
H GX\DUOÕGÕU $NDQ *HoLULOPLú YH\D NURQLNOHúPLú
bir streptokok enfeksiyonunu takiben 3- KDIWD VRQUD VWUHSWRNRNODUÕQ 0 SURWHLQLQH NDUúÕ
NRQDN WDUDIÕQGDQ KD]ÕUODQDQ |]JO DQWLNRUODU VHUXPGD WHVSLW HGLOLU øQVDQ NDOELQLQ
VDUNROHPPDVÕQGD0SURWHLQLQLQ\DSÕVÕQDEHQ]HUELUSURWHLQYDUGÕU%XSURWHLQHPHURP\FLQ
DGÕYHULOLU.DQGRODúÕPÕQGDNLDQWL-0SURWHLQDQWLNRUODUÕPHURP\FLQ
HED÷ODQDUDk kardiyak
afetlere sebep olur. Yani konak M proteinini hedef alarak immün cevap üretmekte fakat,
heterofil antikorlar ile kendi proteinini harap etmektedir. EKG ciddi problemler gösterirken,
NDQNOWUQHJDWLIWLU$62\NVHOPH\HELOLUDWHúEXOXQDELOLUYHya bulunmayabilir, eklemler
KHQ]ROD\DNDWÕOPDPÕúRODELOLU
$NXW5RPDWL]PDO$WHú%XDQWLNRUODUÕQELOKDVVD$62VHEHSROGX÷XRWRLPPQELU
WHSNLPHROGX÷XGúQOPHNWHGLU+HUKDQJLELUVWUHSWRNRNHQIHNVL\RQXQXQL\LOHúPHVLQGHQ
YH\D NURQLNOHúPHVLQGHQ -4 haIWD VRQUD RUWD\D oÕNDU +DVWDGD \NVHN DWHú GDKD oRN
E\N HNOHPOHUGH JH]LQHQ D÷UÕODU SROLDUWULWLV HQGRNDUW YH SHULNDUW
WD HQIODPDV\RQ
HQIHNVL\RQGH÷LOHULWHPDPDUJLQDWXPGúNQONKDOLGHULDOWÕQRGOOHULYDUGÕU$62
titresi bir kaç misli yükselLU .DQ NOWUOHUL QHJDWLIWLU %D]Õ GXUXPODUGD NDUGL\DN NDWÕOÕP
\RNWXUDPDH÷HUNDOSGRNXODUÕROD\DNDWÕOÕUVDVHNHONDODELOLU
$NXW (NOHP 5RPDWL]PDVÕ Meromycin'e benzer proteinler eklem sinovyal
PHPEUDQODUÕQGD GD EXOXQXU .DOS URPDWL]PDVÕQD VHEHS RODQ anti-0 SURWHLQ DQWLNRUODUÕ
HNOHP VLQRY\DO PHPEUDQODUÕQGD GD KDVDUD VHEHS ROX\RUVD EX KDVWDOÕ÷ÕQ DGÕ DNXW HNOHP
URPDWL]PDVÕ
GÕU.DQNOWUQHJDWLIWLUNDOSWHKHQ]SUREOHP\RNVDELOHWHKGLWYDUGÕU
Akut Glomerülonefritis: *HoLULOPLú YH\D NURQLNOHúPLú ELU streptokok enfeksiyonunu
takiben 1.5-KDIWDVRQUDVWUHSWRNODUÕQ0SURWHLQLYHYH\DVWUHSWROL]LQ2DQWLMHQOHULQHNDUúÕ
ROXDúDQ |]JO DQWLNRUODU EX DQWLMHQOHU LOH ELUOHúHUHN DQWLMHQ-antikor kompleksleri
ROXúWXUXUODU %X NRPSOHNVOHU E|EUHN JORPHUOOHULQLQ ED]DO ODPLQDVÕQGD KDUDEL\HWH VHEHS
olurlar. Bozulan glomerüler filtrasyon nedeniyle albüminüri, idrarda eritrosit, granüle
K\DOLQ VLOLQGLUOHU YDUGÕU +DVWDQÕQ \]QGH YH HNVWUHPLWHOHULQGH |GHP KLSHUWDQVL\RQ YH
D]RW UHWDQVL\RQX YDUGÕU 6WUHSWRNRNODUÕQ içerisinde bilhassa A grubu Tip 4, 12, 57 ve 49,
GL÷HUOHULQGHQELUD]GDKDID]ODQHIULWRMHQLNWLU
)XMLNDZDYHDUNDGDúODUÕDVHPSWRPDWLNNLúLQLQ$62WLWUHVLQLLQFHOHPLú
NLúLGH $62 WLWUHVLQL 8
LQ ]HULQGH EXOPXú QRUPDO GH÷HU 8 EXQODUÕQ
EDNWHUL\HPLVL] IRNDO HQIHNVL\RQODUÕ EXOXQGX÷XQX YH\D VWUHSWRNRN WDúÕ\ÕFÕVÕ ROGXNODUÕQÕ
J|VWHUPLúWLU$62WLWUHVLQLQ\NVHOGL÷LoRFXNODUGDWRQVLOOHNWRPLLoLQYDNLWND\EHGLOPHPHVLQL
WHNOLIHWPLúOHUGLU
3. Heterofil antikorlar: Antijenik moleküllerin üç boyutlu mimarisi bir tesadüf olarak
konaktaki herhangi bir dokunun moleküler mimarisine çok benziyorsa, bu antijen için
KD]ÕUODQDQ |]JO DQWLNRUODU \DQOÕúOÕNOD NRQDN GRNXQXQ NHQGL KFUHOHULQL KHGHI NDEXO
HGHELOLU .DOS URPDWL]PDVÕ YH DNXW HNOHP URPDWL]PDVÕ EDúOÕ÷Õ DOWÕQGD DQODWÕODQ SRVWVWUHSWRNRNVLN KDVWDOÕNODU ELUHU KHWHURILO DQWLNRU UHDNVL\RQXGXU +HWHURILO DQWLNRUODUD
)RUVVPDQ DQWLNRUODUÕ GHQLU .RQDN |]JO DQWLNRUODUÕQÕQ \DQOÕúOÕNOD ED÷ODQDELOGL÷L EDúND
PLNURRUJDQL]PDODU YH EDúND KHGHI GRNXODU GD YDUGÕU $úD÷ÕGD VD\ÕODQ
PLNURRUJDQL]PDODUÕQ \]H\ HSLWRSODUÕQD NDUúÕ ROXúDQ NRQDN FHYDEÕ NRQD÷ÕQ ELU GL÷HU
dokusuna hasar vermektedir.
Heterofil reaksiyon veren mikroorganizmalar
Mikroorganizmalar
.RQDNWDUHDNVL\RQYHUGL÷LGRNX
6WUHSWRNRNODUÕQ0SURteini
Meromycin (kalp)
Klebsiella
HLA-B27 (eklem, ankilozan spondilit)
E. coli O14
.RORQPXNR]DVÕ
M. pneumonia
Eritrositlerin I endo antijeni
S. pneumonia Tip XIV
A Kan grubu eritrosit endo antijeni
Ebstein Bar Virus
Timus
M. tuberculosis
+63,VÕúRNSURWHLQL
N. meningitidis
Nöral dokular
Plasmodium malaria
Tymocin-a1
Trypanasoma cruzi
Kalp ve nöral dokular
Schistosomalar
Gluthathione transferase
Fokal enfeksiyonlarda hasar gören primer hedeflerden birisi, gözün devaskülerize
GRNXODUÕ RODELOPHNWHGLU 3DX )DXJHUH YH DUNDGDúODUÕ IRNDO
HQIHNVL\RQODUGDQ ND\QD÷ÕQÕ DODQ WDQH YHLW YDNDVÕ UDSRU HWPLúOHUGLU 9DNDODUÕQ
KLoELULVLQGHNDQGDEDNWHULEXOXQDPDPÕúIDNDWDQWLMHQDQWLNRUNRPSOHNVOHULDUWPÕúKXPRUDO
cevap, yüksek seviyede u\DUÕOPÕú 30/ YH % OHQIRVLWOHUL WHVSLW HGLOPLúWLU %XQODUÕQ VLQV
WRQVLO YH\D RGRQWRMHQ ND\QDNOÕ ROGXNODUÕ WHVSLW HGLOPLúWLU hYHLW LOH RGRQWRMHQ IRNDO
HQIHNHNVL\RQ DUDVÕQGD EHOLUJLQ ELU LOLúNL YDUGÕU YH EX LOLúNL DQDWRPLN NRPúXOXNWDQ GH÷LOGLU
(Sela ve Hharav, 1975).
4. Otoantikorlar:
(QIODPDV\RQXQELUSDUoDVÕRODUDNSHNoRNPHGL\DW|UVDOÕQÕUEXQODUÕQED]ÕODUÕoHúLWOL
UHDNVL\RQODUD JLUHUHN IDUNOÕ PHGL\DW|UOHUH YH IDUNOÕ NLP\DVDO PDGGHOHUH GH÷LúLUOHU (÷HU
DQWLMHQLN X\DUÕ X]XQ VUHUVH YH LPPQ VLVWHPL \HWHUL NDGDU X\DUÕUVD EX VÕUDGD RUWD\D
oÕNDQ PHGL\DW|UOHUGHQ ED]ÕODUÕ VDQNL ELU DQWLMHQPLú JLEL NDEXO HGLOHUHN \HQL ELU LPPQ
VDOGÕUÕ\D KHGHI WHúNLO HGHELOLU .RQDN LPPQ VLVWHPLQLQ NHQGL DQWLMHQLN \DSÕODUÕQD HQGR
DQWLMHQOHULQH NDUúÕ ROXúWXUGX÷X DQWLNRUODUD RWRDQWLNRU DGÕ YHULOLU 2WRDQWLNRUODU JHQHOOLNOH
,J0YHYH\D,J*WLSLQGHDQWLNRUODUGÕUYHKHUKDQJLELUHQGRDQWLMHQHNDUúÕROXúDELOLU6ÕNOÕNOD
+/$DQWLMHQOHULYH\D$33
QHNDUúÕROXúXU%HONLGHE|\OHLPPQFHYDSODULPPQVLVWHPLQ
firen etkisi yapan Ts DNWLYLWHVLQLQ DUWDQ X\DUÕVÕ VRQXFX JHOLúPHNWHGLU <DQL NRQDN LPPQ
VLVWHPLQL GXUGXUPD\Õ EDúDUDPDGÕ\VD NHQGLVLQH ]DUDU YHUHQ NHQGL VDOJÕVÕQÕ \RN HWPH\H
oDOÕúPDNWDGÕU
WDQH DNXW GHQWDO HQIHNVL\RQOX KDVWDQÕQ SOD]PD LPPQJOREXOLQ VHYL\HOHUL
|OoOPú HQIHNVL\RQXQ JLGLúLQH SDUHOHO RODUDN VHUXP JOREXOLQOHULQGH DUWÕú ROGX÷X WHVSLW
HGLOPLúWLU $WHúLQ GúPHVL YH HQIHNVL\RQXQ JHULOHPHVL LOH SOD]PD JOREXOLQ VHYL\HVLQGH
GúúWHVSLWHGLOPLúWLU6KDNHU
%LU J|UúH J|UH IRNDO HQIHNVL\RQ RGD÷ÕQÕQ oHYUHVLQH T lenfositleri infiltre olmakta,
bu bölgede HLA-'5DQWLMHQOHULUHWLOPHNWHGLU%XDQWLMHQOHUHKXPRUDOFHYDSROXúPDNWDYH
EX FHYDS JHQLúOH\HUHN YH DPSOLIL\H RODUDN IRNDO HQIHNVL\RQODUÕQ LPPQ KDVDU
PHNDQL]PDODUÕQGDQ ELULVLQL ROXúWXUPDNWDGÕU .LPXUD YH DUNDGDúODUÕ EX
PHNDQL]PD\ÕWRQVLOOHULQHSLWHOL]HULQGHJ|VWHUPLúOHUGLU
$33
OHULQGHQ ELU WDQHVL NLORGDOWRQ D÷ÕUOÕ÷ÕQGD ROXS +63 +HDW 6KRFN 3URWHLQ
NGRODUDNELOLQLU(QIODPDV\RQXQELUSDUoDVÕRODUDN,/-X\DUÕVÕ\ODNDUDFL÷HUGHQVDOÕQDQ
bu prRWHLQHQIODPDV\RQXQEXOXQGX÷XGRNX\DYDUGÕ÷ÕQGDNDOOLNUHLQSOD]PLQNLQLQD]JLEL
ED]Õ HQIODPDV\RQ PHGL\DW|UOHULQLQ VHQWH]LQGH URO DOÕU %X SURWHLQ NRQDN WDUDIÕQGDQ ELU
DQWLMHQ PXDPHOHVL J|UHELOLU %LOKDVVDWRQVLOOHUYHGHQWDOHQIHNVL\RQODUGD,J*\DSÕVÕQGDNL
anti-+63DQWLNRUODUÕQÕQVHUXPGDNLVHYL\HVLDUWDU%XELURWRDQWLNRUUHDNVL\RQXGXUNRQDN
NHQGL HQIODPDV\RQ PHGL\DW|UOHULQLQ VHQWH]LQL GXUGXUPD\D oDOÕúPDNWDGÕU ,]DNL YH
DUNDGDúODUÕGHQWDOHQIHNVL\RQODUGDVHUXPGDNL+63DUWÕúÕQՓ.065, n =
S WRQVLOOHU HQIHNVL\RQODUGDNL DUWÕúWDQ “ Q S GDKD
ID]ODEXOPXúODUGÕU%XVRQXoODURGRQWRMHQIRNDOHQIHNVL\RQODUGDGL÷HUOHULQGHQGDKDID]OD
RWRDQWLNRUROXúWX÷XQXJ|VWHUPHNWHGLU
:DNDED\DVKL YH DUNDGDúODUÕ VD÷OÕNOÕ GHQH\ KD\YDQODUÕQÕQ WHVWLVOHULQL VWHULO
NRúXOODUGD\HULQGHQDODUDNE|EUHNNDSVOQH\HUOHúWLUPLúOHUGLU-5 hafta sonra otoimmün
RUúLWLV PH\GDQD JHOPLúWLU øPPQ VLVWHP EXOXQPDPDVÕ JHUHNHQ ELU \HUGHNL EX GRNX\X
(kendisine ait bir doku olVDELOHKHGHIWD\LQHGHUHNRWRDQWLNRUODULOHRUWDGDQNDOGÕUPD\D
oDOÕúDELOPHNWHGLU
2WRDQWLNRUODU LOH ROXúDQ KDVWDOÕNODU ELU RUJDQ YH\D GRNXGD ORNDOL]H ROPD\DELOLUOHU
<D\JÕQ UHWLNOHU KDUDEL\HW GDPDU HQGRWHOLQLQ KDUDEL\HWLQH ED÷OÕ RODUDN OXSXV
eritemaWRVXVHULWURMHQLNSXUSXUDYH\DGDKDGH÷LúLNúHNLOOHUGHNOLQL÷H\DQVÕ\DELOLUOHU
)UHQJLVSKLOLV7UHSRQHPDSDOOLGXPLVLPOLVSLURNHWúHNOLQGHNLELUEDNWHULQLQVHEHS
ROGX÷X YHQHU\HQ ELU KDVWDOÕNWÕU %XODúPDGDQ - KDIWD VRQUD EDNWHULQLQ JLUGL÷L GHUL
yüzH\LQGHúDQNULVLPOLOH]\RQODUROXúXUED]HQROXúPD\DELOLUEXUDGDEROEDNWHULYDUGÕU%X
OH]\RQD÷UÕVÕ]GÕUNÕVD]DPDQGDNHQGLOL÷LQGHQL\LOHúLUELULQFLG|QHP%XQGDQ-10 hafta
sonra deride makülo-papüler döküntüler (roseol), genital bölgede masere lezyonlar
NRQGLORPD J|]GH NDU\RUHWLQLW RUWD\D oÕNDU YH NHQGLOL÷LQGHQ L\LOHúLU LNLQFL G|QHP
Bundan sonraki dönem (üçüncü dönem), 1-\ÕOVRQUDRUWD\DoÕNDUYHIHWDOVRQODQDELOLU
'HULGHPXNR]ODUGDNHPLNOHUGHGDPDNWDNDUDFL÷HUGHYHGL÷HURUJDQODUGDJranülamatöz,
WPRUDOOH]\RQODUJRPRUWD\DoÕNDU%XOH]\RQODUGDJHQHOOLNOHEDNWHUL\RNWXU$RUWLWLVYH
DRUW DQHYUL]PDODUÕ Q|URVILOL] IUHQJL GHOLOL÷L SDUDOL]LOHU WDEHV GRUVDOLV J|UOU NDQGD YH
hiçbir organda genellikle bakteri bulunmaz. Üçüncü dönHPGHNL KDVDUÕQ PHNDQL]PDVÕ
EDNWHUL DQWLMHQOHULQLQ NXYYHWOH X\DUGÕ÷Õ LPPQ VLVWHPLQ UHDJLQ DGÕYHULOHQRWRDQWLNRUODUÕQD
ED÷OÕGÕU5HDJLQKHPEDNWHULQLQHSLWRSODUÕQDKHPGHNRQDNNDUGL\ROLSLQOHULQHNDUúÕ
ROXúDQ |]JO ROPD\DQ ,J0 YH ,J$ WLSLQGHNL RWRDQWLNRUODUGÕU %LU EDNWHUL DQWLMHQLQLQ NRQDN
LPPQVLVWHPLQLX]XQVUHYHNXYYHWOHX\DUPDVÕGXUXPXQGDRUWD\DoÕNDELOHQRWRDQWLNRUODU
SHNoRNKDVWDOÕ÷ÕQHW\RORMLVLQLDoÕNOD\DELOLU
$33
QHNDUúÕNRQD÷ÕQ\DQOÕúUHDNVL\RQODUÕ%HKoHWKDVWDOÕ÷ÕQÕQSDWRJHQH]LQLDoÕNODr
QLWHOLNWHGLU+DVDQYHDUNDGDúODUÕ%HKoHWKDVWDVÕQÕQWDQHVLQLQVHUXPODUÕQGD
IgG tipinde anti-+63+HDW6KRFN3URWHLQNLORGDOWRQDQWLNRUODUÕWHVSLWHWPLúWLU%XQXQ
%HKoHW VHQGURPX LoLQ VSHVLILN ROGX÷XQX YH WHúKLV DPDFÕ\OD NXOODQÕOPDVÕQÕ WHNOLI
HWPLúOHUGLU%HKoHWKDVWDOÕ÷ÕQDoRNEHQ]H\HQ(O-Ayak-$÷Õ]KDVWDOÕ÷ÕGDE|\OHX]XQVUHQ
HQIHNVL\RQODUVRQXFXRUWD\DoÕNDQRWRDQWLNRUODULOHROXúXU
5. Allerji: %X WHULP ODWLQFHGHNL DOORV EDúND YH HUJRV Lú NHOLPHOHULQLQ
ND\QDúPDVÕLOHROXúXU Herhangi bir antijen (mesela yumurta albümini), herhangi bir deney
KD\YDQÕQD HQMHNWH HGLOGL÷LQGH NOLQLN EXOJX J|UOPH\HELOLU )DNDW D\QÕ DQWLMHQ -3 hafta
DUDOÕNODUOD WHNUDU YHULOGL÷LQGH LNLQFL oQF YH\D GDKD VRQUDNL HQMHNVL\RQODUÕQ KHUKDQJL
birisindH GHQH\ KD\YDQÕQGD FLGGL NOLQLN WDEORODU ROXúXU (QMHNVL\RQ E|OJHVLQGH EDVLW
KLSHUHPLGHQ\D\JÕQDQDILODNVL\HNDGDUGH÷LúHQD÷ÕUOÕNWDNLEXNOLQLNEHOLUWLOHUEDVLWoDDOOHUML
RODUDN WDQÕPODQÕU %XUDGD ELULQFL HQMHNVL\RQGDQ VRQUD NRQDN GRNXGD |]JO DQWLNRUODr
ROXúXU YH DQWLMHQLN X\DUÕQÕQ GXUPXúVD EX |]JO DQWLNRU UHWHQ SOD]PD KFUHOHUL NORQDO
GHOHV\RQ LOH ND\EROXU IDNDW SOD]PD KFUHOHULQGHQ IDUNOÕODúDQ 0&
OHUL EX DQWLMHQLN X\DUÕ\Õ
KDIÕ]DODUÕQGD PXKDID]D HGHUOHU $\QÕ DQWLMHQLQ VRQUDNL X\DUÕODUÕQD NRQDNWD daha ani ve
NXYYHWOL FHYDSODU UHWLOLU %X LúOHPH R NRQD÷ÕQ GX\DUOÕODúWÕUÕOPDVÕ GHQLU %XUDGD URO
R\QD\DQPHNDQL]PDKÕ]OՁUHWLOHQ,J(WLSLQGHNLDQWLNRUODUGÕU%XDQWLNRUODUED]RILOYHPDVW
hücrelerinin yüzeyine tutunarak degranülasyona ve histamin liberasyonuna sebep olurlar
(Tip- $úÕUÕ GX\DUOÕOÕN %X ROD\ODU DQWLMHQLQ JLULú NDSÕVÕQGD VDPDQ QH]OHVL DVWÕP DUÕ
VRNPDVÕ RODELOHFH÷L JLEL X]DN RUJDQ YH\D GRNXODUGD GD RODELOLU UWLNHU DQML\RQ|URWLN
ödem gibi).
Fokal enfektif odaktan çevre dokuya ve KDWWD VLVWHPLN GRODúÕPD oÕNDELOHFHN
antijenlere (veya antijen-DQWLNRU NRPSOHNVOHULQH NDUúÕ NRQDN GRNXGD ELU DOOHUML
JHOLúHELOHFH÷L LON GHID 7XUN WDUDIÕQGDQ \ÕOÕQGD WDUWÕúÕOPD\D EDúODQPÕúWÕU %XQGDQ LNL
sene sonra Schreiber (1975), fokal enfeksiyonda DOOHUMLQLQ VHEHS YH PHNDQL]PDVÕQÕ
J|VWHUPLúWLU )RNDO HQIHNVL\RQ RGD÷ÕQGDQ VÕ]DQ DWLMHQOHUH |]JO ,J( WLSLQGHNL DQWLNRUODU
KHPGRODúÕPGDKHPGHUHQDOWEOVOHUGHJ|VWHULOPLúWLU
.RQD÷ÕQ VUHNOL RODUDN IRNDO HQIHNVL\RQGDQ VÕ]DQ D\QÕ DQWLMHQOHU LOH X\DUÕOPDVÕ
NRQD÷ÕQEXDQWLMHQOHUHJLWWLNoHGX\DUOÕKDOHJHOPHVLQHVHEHSROXUYHDOOHUMLNFHYDSODUIRNDO
HQIHNVL\RQRGD÷ÕQÕQ\DNÕQODUÕQGDPH\GDQDJHOPHN]RUXQGDGH÷LOGLU'MHUDVVL
%|\OH IRNDO HQIHNVL\RQD ED÷OÕ DOOHUMLN UHDNVL\RQODUÕQ RGRQWRMHQ RODQODUÕ QDGLU
GH÷LOGLU)RNDOHQIHNVL\RQRGD÷ÕEXOXQXSRUWDGDQNDOGÕUÕODPÕ\RUVDWHGDYLDPDFÕLOHNRQDN
GRNXQXQGHVHQVHWLYL]HHGLOPHVLWHNOLIHGLOPLúWLU6HPHUG]LHYD
6UHNOL
DQWLMHQ
X\DUÕVÕ
OHQIRSUROLIHUDV\RQX
LQGNOH\HUHN
NURPR]RP
WUDQVODV\RQODUÕQD Kemopoetik patolojileri, lenfoma, lösemi gibi malign seyreden
UHWLNORHQGRWHO\DOVLVWHPKDVWDOÕNODUÕQDGDVHEHSRODELOPHNWHGLU5RLWW
)RNDOHQIHNVL\RQRGDNODUÕQÕQWHVSLWL
$ONRO VLJDUD YH GL÷HU ]DUDUOÕ PDGGHOHU IHQD EHVOHQPH X\NXVX]OXN oLQNR YH GL÷HU
HVHU PHWDOOHULQ HNVLNOL÷L NURQLN YH DNXW WRNVLNDV\RQODU LPPQ VLVWHPL ROXPVX] \|QGH
HWNLOHU +HUQDQGH] YH DUNDGDúODUÕ DONROLN IDUHOHU ]HULQGH LOJLQo ELU DUDúWÕUPD
\DSPÕúWÕU øoPH VX\XQD RUDQÕQGD HWDQRO NDUÕúWÕUÕODQ JHEH IDUHOHULQ RWRSVilerinde,
HPEUL\RQDORGRQWRJHQH]VÕUDVÕQGD(*)LQKLELV\RQXWHVSLWHGLOPLúWLU
6ÕN UDVWODQDQ IRNDO HQIHNVL\RQ RGDNODUÕ WRQVLOOHU VLQVOHU YH SHULDSLNDO GRNXODUGÕU
,]DNL YH DUNDGDúODUÕ RGRQWRMHQ ND\QDNOÕ IRNDO HQIHNVL\RQODUÕQ VLQV ND\QDNOÕ
olaQODUD NÕ\DVOD RUDQÕQGD ID]OD ROGX÷XQX ELOGLUPLúOHUGLU 7RQVLOOLW ND\QDNOÕ RODQODUD
GDVÕNUDVWODQPDNWDGÕU(QVÕNUDVWODQDQNRPSOLNDV\RQLVHDUWULWJORPHUORQHIULWYHNOLQLN
VHEHEL EHOLUOHQHPH\HQ VLVWHPLN OH]\RQODUGÕU %XUDGD VDGHFH RGRQWRMHQ ND\QDNOÕ IRNDO
HQIHNVL\RQRGDNODUÕQÕQQDVÕOWHVSLWHGLOHELOHFH÷LWDUWÕúÕODFDNWÕU
)RNDO HQIHNVL\RQ EXOXQGX÷XQGDQ úSKH HGLOHQ KDVWD ELU GLúKHNLPLQLQ NOLQL÷LQH
kendisi gelip durumunu ifade etmez, daha çok bir nefrolog veya bir dahiliye doktoru, bu
GXUXPGDQ úSKHOHQHUHN KDVWDVÕQÕ GLúKHNLPLQLQ J|UPHVLQL LVWHU <DQL E|\OH KDVWDODU
JHQHOOLNOH ELU NRQVOWDV\RQ KDVWDVÕGÕU 3UHQVLS RODUDN NRQWUROVX] |OPú QHNURWLN ELU GLú
NURQLN SHULDSLNDO DSVH LQWUDRVVH|] OH]\RQ YH GLú oHQH VLVWHPL oHULVLQGH \HU DODQ NURQLN
enfeksL\RQRGD÷ÕDUDQPDVÕGÕU%|\OHKDVWDODUÕQPXD\HQHVLúXEDVDPDNODUGD\DSÕOÕU
1. Anamnez:
+DVWDH÷HU\DúOÕLVHD÷Õ]ÕQGDELUIRNDOHQIHNVL\RQEXOXQPDVÕLKWLPDOLELUD]GDKDID]ODGÕU
)RNDOHQIHNVL\RQODUELOKDVVD\DúOÕELUH\OHUGHGDKDVHVVL]VH\UHGHU<DúRUWDODPDODUÕ
RODQ\DúOÕLQVDQGDKDVWDGH÷LO\DSÕODQELUD÷Õ]VD÷OÕ÷ÕWDUDPDVÕQGDRUDQÕQGD
IRNDO HQIHNVL\RQ RGD÷Õ WHVSLW HGLOPLúWLU %X EXOJXODU \NVHOPLú &53 YH GL÷HU DQDOL]OHU LOH
GR÷UXODQPÕúWÕU0HXUPDQYHDUNDGDúODUÕ
A- "Daha öQFH úLúLS DSVH \DSDQ GDKD VRQUD L\LOHúHQ ELU GLúLQLQ EXOXQXS
EXOXQPDGÕ÷ÕVRUXOPDOÕGÕU%|\OHELUGLúGDKDVRQUDN|NNDQDOÕWHGDYLVLJ|UPHPLúVHLGHDO
ELUIRNDOHQIHNVL\RQRGD÷ÕGÕU%XGLúVRQUDGDQN|NNDQDOÕWHGDYLVLJ|UPúVHWHGDYLGHQ
VRQUDúLúLSúLúPHGL÷LVRUXOPDOÕGÕU7HGDYLGHQVRQUDDNXWDSVH\DSPÕúVDEDúDUÕVÕ]ELUN|N
NDQDOÕ WHGDYLVL YDUGÕU YH IRNDO HQIHNVL\RQ RGD÷Õ RODUDN GH÷HUOHQGLULOPHOLGLU (÷HU EX GLú
WHGDYLGHQ VRQUD WHNUDU DNXW DSVH \DSPDPÕúVD ELOH IRNDO HQIHNVL\RQ RGD÷Õ RODELOHFH÷L
KDWÕUODQPDOÕGÕU
B- h]HULQH EDVWÕ÷Õ ]DPDQ GX\DUOÕOÕN J|VWHUHQ GLú EXOXQXS EXOXQPDGÕ÷Õ
VRUXOPDOÕGÕU .URQLN SHULRGRQWDO HQIHNVL\RQODU GD ELU IRNDO HQIHNVL\RQ VHEHEL
olabilmektedir.
C- (NVLN GLúOHULQL QHGHQ ND\EHWWL÷L VRUXOPDOÕGÕU 3HULRGRQWDO YH SHULDSLNDO
HQIHNVL\RQDED÷OÕGLúND\ÕSODUÕGH÷HUOHQGLULOPHOLGLU
D- (NVLN GLúOHULQGHQ KHUKDQJL ELULVLQLQ oHNLPL VÕUDVÕQGD NÕUÕOPD ROXS ROPDGÕ÷Õ
VRUXOPDOÕGÕU+DVWDE|\OHELUGLúWDULIHGL\RUVDVRQUD\DSÕODFDNRODQUDG\RORMLNNRQUROODUGD
bu bölge dikkatlice incelenmelidir.
E- +DVWD\D SULPHU úLND\HWOHUL VRUXOPDOÕGÕU ùLND\HWOHULQLQ E|EUHN WEOVOHUOHUL
VLQRY\DO PHPEUDQODU GDPDU HQGRWHOL HQGRNULQ EH]OHU LOH ELU LOLúNLVL ROXS ROPDGÕ÷Õ WHVSLW
HGLOPHOLGLU )RNDO HQIHNVL\RQODUÕQ KDQJL GRNXODUGD KDUDEL\HWH VHEHS RODbilecekleri
\XNDUÕGDVD\ÕOPÕúWÕU
2. Klinik muayene:
A-$÷Õ]GDNLPHYFXWGLúOHULQDSHNVOHULKL]DVÕQDYHVWLEOGHQYHOLQJXDOSDODWLQDO
GHQ
J|] LOH GLNNDWOLFH EDNÕODUDN DNWLI YH\D SDVLI ELU ILVWO D÷]Õ DUDQPDOÕGÕU *HUHNLUVH YHVWLEO
sulkus, parmak ile sÕYD]ODQDUDNYDUVDILVWOD÷]ÕQÕQJ|UOPHVLQLNROD\ODúWÕUPDNJHUHNOL
olabilir.
B- Kuron-N|SUUHVWRUDV\RQODUÕLoHULVLQGHNLGLúOHULQYLWDOLWHVLQLDQODPD\DHQJHOWHúNLO
ederler, bunlar daha sonra tekrar simante edilmek üzere dikkatlice sökülmelidir. Bunda
tereddüt edilmemelidir.
C-0RELOGLúOHULQSHULRGRQWDOKDVWDOÕNODUÕEXOXQDELOHFH÷LPXWODNDGúQOPHOLGLU%X
DPDoODGLúOHULQPRELOLWHVLQHEDNÕOPDOÕGÕU
D- 3HULRGRQWDO VRQGD LOH FHS GHULQOLNOHUL |OoOPHOLGLU 3HULRGRQWDO NHPLN ND\EÕQÕQ
EXOXQGX÷XE|OJHOer not edilmelidir.
E- hVW NHVLFLOHULQ SDODWLQDO \]QGH GHQV LQ GHQWH EXOXQXS EXOXQPDGÕ÷Õ
LQFHOHQPHOLGLU%XQODUELUHUIRNDOHQIHNVL\RQRGDJÕRODELOPHNWHGLU%XVHEHSOHRUWD\DoÕNDQ
ELUVWUHSWRNRNDOHQGRNDUGLWELOGLULOPLúWLU:K\PDQYH0DF)DG\HQ
3. Radyolojik muayene:
A- %WQ GLúOHULQ PXWODND U|QWJHQL LQFHOHQPHOLGLU $SLNDO E|OJHGH UDG\ROXVHQV
DUDQPDOÕGÕU%XDPDoOD|QFHRUWRSDQWRPRJUDILLVWHQLUYHGDKDVRQUDúSKHOLE|OJHOHUGHQ
periapikal röntgenler çekilir.
B- 2OPD\DQ GLúOHU E|OJHVLQGH NÕUÕODUDN LoHULGH NDOPÕú N|N SDUoDODUÕ DUDQPDOÕGÕU
IRUDPHQPHQWDOHLOHELUDSLNDOOH]\RQXD\ÕUWHWPHNJHUHNLU
C- 'L÷HU GLúOHUGHQ IDUNOÕ RODUDN GHULQOHúPLú NHPLN FHEL DUDQPDOÕGÕU <D\JÕQ YH
KRPRMHQNHPLNHULPHVLIRNDOHQIHNVL\RQRGD÷ÕROPD\DELOHFH÷LKDOGHbilhassa ve sadece
ELUE|OJHGHGHULQOHúHQNHPLNLoLFHSOHUIRNDOHQIHNVL\RQND\QD÷ÕRODELOPHNWHGLU
4. Laboratuvar tetkikleri:
A- +DVWDGDQ ER÷D] NOWU LVWHQPHOL IORUD\D KDNLP EDNWHULQLQ ELU VWUHSWRNRN ROXS
ROPDGÕ÷ÕWHVSLWHGLOPHOLGLU6RQLNLD\|QFHVLQHNDGDU\DSWÕUGÕ÷ÕEDúNDER÷D]NOWUYDUVD
LVWHQPHOL \HQLVL LOH NDUúÕODúWÕUÕOPDOÕ VWUHSWRNRNODU OHKLQH ELU GH÷LúLP ROXS ROPDGÕ÷Õ
L]OHQPHOLGLU ùSKHOL YH \R÷XQ VWUHSWRNRN NRORQL]DV\RQX YDUVD KDVWDQÕQ GRNWRUXQD EX
úSKH DNWDUÕOPDOÕGÕU *HUHNLUVH PLNUREL\RORML ODERUDWXYDUÕQGDQ SDWRMHQ ROVXQ ROPDVÕQ
ER÷D] IORUDVÕQGDNL WP PLNURRUJDQL]PDODUÕQ NDQWLWDWLI OLVWHVL LVWHQPHOLGLU %LOKDVVD VD\ÕFD
DUWDQWHNELUEDNWHULYDUVDSDWRMHQROVXQROPDVÕQEXNRQXGDKDVWDQÕQGRNWRUX
X\DUÕOPDOÕGÕU
B- Kanda APP arWÕúÕWHVSLWHGLOPHOLGLU&53$62YH5)
Q|QHPLYDUGÕU%XQODUGDQ
ELULVLQLQQRUPDOLQ]HULQGHEXOXQPDVÕIRNDOHQIHNVL\RQúSKHVLQLGHVWHNOH\LFLGLU6PROLDU
)RNDO HQIHNVL\RQOX KDVWDODUGD 5) DUWÕúÕ WHúKLV LoLQ \HWHUL NDGDU LGHQWLNWLU 7KHH
1996).
Bu testlerde rastlanabilecek CRP, ASO ve /veya RF yükselmesi, fokal enfeksiyon
EXOXQGX÷XGúQFHVLQLKDNOÕoÕNDUÕUIDNDWRGRQWRMHQROGX÷XQDLúDUHWHWPH]
C- Lökosit formülü istenmelidir. Lenfositlerin, plazma hücrelerinin, nötrofillerin
VD\ÕFDDUWPÕúROPDODUÕNURQLNHQIHNVL\RQXWHONLQHGHU
D- )RNDO HQIHNVL\RQ RGD÷ÕQÕQ YH\D RGDNODUÕQÕQ HQ EDúDUÕOÕ WHVSLWL WHFKQHWLXP-99m
LOH LúDUHWOL VLQWLJUDIL P-Tc Labeled Scintigraphy) ile mümkün olur. Bu tetkik, tam
WHúHNNOO ODERUDWXYDUODUGD KDOHQ X\JXODQPDNWD RODQ ELU \|QWHPGLU +HU GLúKHNLPL IRNDO
HQIHNVL\RQ EXOXQGX÷XQGDQ úSKHOHQGL÷L KDVWDVÕQGDQ EX WHWNLNL LVWH\HELOLU %X WHWNLNWH
damar yolundan technetium-99m kontrast maddesi verilmekte, ve tüm vücudun sintigrafisi
DOÕQPDNWD O|NRVLWOHULQ WRSODQGÕ÷Õ GRNXODU J|rünür hale gelmektedir. Lökositlerin bir organ
YH\D GRNXGD WRSODQÕ\RU ROPDODUÕ RUDGD ELU HQIHNVL\RQXQ GHYDP HWWL÷L DQODPÕQGDGÕU YH R
GRNXELUIRNDOHQIHNVL\RQRGD÷ÕGÕU:DKOIRNDOHQIHNVL\RQOXKDVWDGD\DSÕODQELU
oDOÕúPDGDEX\|QWHPLQXOWUDVRnografi ve CT (Computerized tomografi) yöntemlerine göre
KDVVDVL\HWL GDKD ID]OD |]JOO÷ GR÷UXOX÷X ID]OD RODUDN WHVSLW HGLOPLúWLU
0LQRMDYHDUNDGDúODUÕ
%RHUPDQYHDUNDGDúODUÕIDUHOHUL6WDSK\ORFRFFXVDXHUHXVLOHHQIHNWHHGHrek
FLOW DOWÕQGD ORNDOL]H OH]\RQODU JHOLúWLUPLúOHU YH EX OH]\RQODUÕ VLQWLJUDIL \|QWHPL LOH WHVSLW
HWPLúOHUGLU%XVLVWHPLoLQLOHULWHNQLNOHUWDQÕPODPÕúWÕU
E-%LUGLúLQYH\DGRNXQXQIRNDOHQIHNVL\RQRGD÷ÕROGX÷XQGDQúSKHOHQLOL\RUIDNDW
EXQXQ LVSDWÕ JHUHNL\RUVD KDVWDQÕQ NHQGL LPPQ VLVWHPLQL IRNDO HQIHNVL\RQ RGD÷ÕQD
VDOGÕUWDUDN VHVVL] RGD÷Õ DNXW HQIHNVL\RQD oHYLUPHN YH EX úHNLOGH WHúKLV HWPHN
PPNQGU%XILNLU\HQLGH÷LOGLU'LHW]IRNDOHQIHNVL\RQRGD÷ÕQÕWHVSLWHGHELOPHN
DPDFÕ\ODNRQD÷ÕQNHQGLSDWRORMLNSXOSDILOWUDWODUÕQÕGHULDOWÕQDHQMHNWHHWPLúWLU
ùSKHOL GLúLQ N|N NDQDOÕQÕQÕQ YH\D KHUKDQJL ELU GRNXQXQ \ÕNDPD VX\X ÕVÕ LOH
denatüre (veya formalin ile fikse) edildikten sonra, serum fizyolojik ile dilüe edilerek
KDVWD\D FLOW DOWÕQGDQ PO YHULOLU (÷HU úSKHOL PDWHU\DO JHUoHNWHQ IRNDO HQIHNVL\RQ
VHEHEL RODQ DQWLMHQLN \DSÕODUÕ WDúÕ\RUVD KDVWD VHUXPXQGDNL KD]ÕU DQWLNRUODU LOH GHUKDO
UHDNVL\RQD JLUHU YH úSKHOL GRNXGD HQMHNVL\RQ E|OJHVLQGH GH÷LO DNXW HQIODPDV\RQ
EDúODU %XQD %RWW\DQ DQWLMHQ WHVWL DGÕ YHULOLU DQFDN KDVWDKDQHGH \DWDQ KDVWD\D
X\JXODQDELOLUYHGLúKHNLPLNOLQL÷LQGH\DSÕOPDPDOÕGÕU%HONLGHKLo\DSÕOPDPDVÕJHUHNHQELU
WHVWWLU1RWEXWHVWNÕ]ÕOWDQÕVÕQGDGDNXOODQÕOÕUR]DPDQ6KLFNWHVWLRODUDNLVLPOHQGLULOLU
5. DevLWDO GLúOHULQ WHVSLWL %WQ GLúOHULQ YLWDOLWHOHULQH PXWODND EDNÕOPDOÕGÕU 6DGHFH
GHYLWDO GLúOHU IRNDO HQIHNVL\RQ RGD÷Õ RODELOPHNWHGLUOHU &DQOÕ ROGX÷X WHVSLW HGLOHQ GLúOHU
]HULQGH GDKD ID]OD oDOÕúPD \DSPD\D JHUHN \RNWXU &DQOÕ GLúOHU HPQL\HWOH OLVWHGHQ
oÕNDUÕODELOLU (VNLGHQ N|N NDQDOÕ WHGDYLVL \DSÕOPÕú GLúOHULQ ELU IRNDO HQIHNVL\RQ RGD÷Õ
RODELOPHVL PPNQ ROGX÷X KDOGH EXQODUÕ WHVSLW HGHELOPHN LoLQ PDNXO YH SUDWLN ELU PHWRW
yoktur (Freidin ve Nikolaev, 1988).
A- (OHNWULN DNÕPÕ LOH oDOÕúDQ YLWDORPHWUHOHU ED]HQ \DQOÕú SR]LWLI VRQXoODU
YHUHELOPHNWHGLU (OHNWULNOL YLWDORPHWUHOHU LOH FDQOÕ ROGX÷X WHVSLW HGLOHQ GLúOHULQ JHUoHNWHQ
FDQOÕROGXNODUÕUDG\RORMLNYHNOLQLNRODUDNGR÷UXODQPDOÕGÕU
B- 9LWDORPHWUH VRQXoODUÕQD JYHQLOPHPHOL NOLQLN YH UDG\RORMLN RODUDk destekler
úHNLOGHEDúNDEXOJXODU\RNLVHoRNVR÷XNYH\DoRNVÕFDNVX\DEDWÕUÕOPÕúNoNWDPSRQODU
GLú ]HULQH GRNXQGXUXODUDN KDVVDVL\HW \DSÕS \DSPDGÕ÷Õ VRUXOPDOÕGÕU +DVVDVL\HW
\DSÕ\RUVD GLúLQ YLWDO ROGX÷X YH EX GLúLQ IRNDO HQIHNVL\RQD VHEHS RODPD\DFD÷Õ
GúQOPHOLGLU
C- (Q WDWPLQNDU PHWRW 'RQQHX IUH] WHVWLGLU $QHVWH]L \DSPDGDQ IUH] LOH \DYDúoD
SXOSD\DGR÷UXLOHUOHQLUD÷UÕROXSROPDGÕ÷ÕQDEDNÕOÕU+DVWDQÕQLOND÷UÕGX\GX÷X\HUGHWHVW
EÕUDNÕOÕU NDYLWH X\JXQ GROJX PDGGHVL LOH NDSDWÕOÕU +DVWD D÷UÕ GX\PX\RUVD SXOSD RGDVÕQD
JLULOLUYHEXGLúLQIRNDOHQIHNVL\RQúSKHVLYDUGHPHNWLU%XWHVWYLWDOLWHKDNNÕQGDHQNHVLQ
sonucu verir, fakat travmatik olabilir.
D-'HYLWDOGLúOHUEXOXQXUVDYHGDKD|QFHGHQN|NNDQDOÕWHGDYLVLJ|UPHPLúVHEX
GLúOHUGHQELUHUIRNDOHQIHNVL\RQRGD÷ÕRODUDNúSKHOHQLOPHOLGLU
'H÷HUOHQGLUPH<DSÕODQPXD\HQHGHKHUGLúLoLQEXWDEORGDX\JXQELUVHoHQHNDUDQÕU
(F, farketmez; + evet; -KD\ÕU“EHONL
Vital
Radyolusens
CRP, RF veya ASO
Fokal enfeksiyRQúSKHVL
F
F
+
+
+
F
±
+
F
-
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WDEORVX GD IRNDO HQIHNVL\RQ úSKHVLQH GHVWHN YHULU QLWHOLNWH LVH EX GXUXPGD GLúLQ
antibiyotik profilaksisini takiben hemen çekilmesi radikal ama belkidH HQ GR÷UX ELU
o|]PGU%XDúDPDGDWDUWÕúPDODUYDUGÕUøGHDOELUN|NNDQDOWHGDYLVLEXUDGDQDQWLMHQ
VÕ]ÕQWÕVÕQÕ GXUGXUDELOPHNWHGLU %X GLúOHULQ N|N NDQDO WHGDYLOHULQLQ GHQHQPHVLQL |QHUHQ
J|UúOHU YDUGÕU %X J|Uú LGGLDOÕ ELU \DNODúÕPGÕU <DSÕODELOHFHN \HWHUVL] NDQDO GROJXODUÕ
IRNDO HQIHNVL\RQ RGD÷ÕQÕ RUWDGDQ NDOGÕUDPD\DELOLU 7HUD]LQLQ GL÷HU NHIHVLQGH E|EUHNOHU
J|]OHU YH\D NDOS EXOXQGX÷XQGD GLúOHU NÕ\PHWVL] RUJDQODUGÕU (÷HU WHVSLW HGLOHQ IRNDO
HQIHNVL\RQRGD÷Õ|QFHGHQN|NNDQDOÕWHGDYLVLJ|UPúELUGLú ise, tekrarlayan tedavilerden
NDoÕQÕOPDOÕGÕU)UHLGLQYH1LNRODHY
(VDVHQ IRNDO HQIHNVL\RQODU LOH PH\GDQD JHOHQ KDVWDOÕNODUÕQ WHGDYLVL LNL NROGDQ
\UWOU %LULQFLVL IRNDO HQIHNVL\RQ RGD÷ÕQÕQ RUWDGDQ NDOGÕUÕOPDVÕGÕU LNLQFLVL
kortikosteroidler iOH KDVWDQÕQ LPPQ VLVWHPLQLQ EDVNÕODQDUDN NHQGLVLQH KDVDU YHUPHVLQLQ
GXUGXUXOPDVÕGÕU'LúKHNLPLQLQJ|UHYLYDUVDRGRQWRMHQIRNDOHQIHNWLIRGD÷ÕQWHVSLWHGLOHUHN
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EDNWHUL VD\ÕVÕ VÕQÕUOÕGÕU .URQLN HQIHNWH N|N NDQDOÕ YDUVD SHULSDLNDO GRNXODUGD GDLPDKHU
VDIKDGDLPPQUHDNVL\RQODUPH\GDQDJHOPHNWHGLU(÷HUEXEDNWHULOHULoLQRUWDNELUDQWLMHQ
saptanabilirse ve konakta yeterli Ig$ YH ,J* |]JO FHYDEÕ |QFHGHQ ROXúWXUXODELOLUVH DúÕ
KD]ÕUODPDQÕQLPNDQVÕ]ROPDGÕ÷ÕJ|VWHULOPLúWLU
$NXW SHULDSLNDO DEVHOHULQ WHGDYLVL LoLQ SROLYDOHQW DúÕ KD]ÕUOD\DQ /HRQDUGR ROXPOXVRQXoODUDOÕQPÕúWÕU
Smith ve Taubman (1996), iki grup fareden birinci gruba GBP59 (Glucan Binding
Protein- NLORGDOWRQ LQMHNWH HWPLúOHU YH KDIWD VRQUD VHUXPGD |]JO ,J* DQWLNRUODUÕQÕ
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SHULDSLNDO KDVWDOÕNODU YH SHULRGRQWDO NHPLN GHIHNWOHULQGH HIHNWLI RODQ DQWLNRUlar ise IgG
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G|QHPGH WDPDPODQDELOGL÷L J|UOPúWU %LEHUPDQ YH 0RUGYLQRYD 71). Burada hedef
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zordur.
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5-HT
APC
APP
ASO
B lenfositleri
BAF
cAMP
cGMP
CD
CF
CGRP
CPF
CRP
CSF
CTMC
ECF
EGF
Fab
5-hydroxytryptamine
Antigen Presenting Cells
$FXWH3KDVHSURWHLQV ÕVÕúRNSURWHLQL
Anti-Streptolizin-O antikoru
%XUVDIDEULFXVNDUDFL÷HUYHNHPLNLOL÷LOHQIRVLWL
B Activating Factor
Cyclic Adenosine Mono Phosphate
Cyclic Guanidine Mono Phosphate
Cluster of Differantiation
Chemotactic Factors
Calcitonin Gene Related Peptide
Clot Promoting Factor
C Reaktif Protein
Colony Stimulation Factor
Connective Tissue Mast Cell
Eusinophill Chemotactic Factor
Epithel Growth Factor
Fragment AntiBody
Fc
G-CSF
GBP
GF
GMCSF
HEV
HGF
HLA
HSP
ICE
IFN
Ig
IL
ILF-a
ILF-ß
ILF-G
Konak
LAF
LBP
LFA
LIF
LPS
LT
LTA
LTB
LTC
LTD
LTE
M-CSF
MALT
MC
MHC
MIF
MMIF
MMC
MMCSF
MPA
NCP
NGF
NK
NSAID
OAF
P substance
PAF
PALS
PCG
PG
PGE2
PGI2
PGP
Fragment Cristalizable
Granulocytes-Colony Stimulating Factor
Glucan Binding Protein
Growth Factors
Granulocyte Macrophage Colony Stimulating Factor
High Endotelial Venules
Hepatocyt Growth Factor, scatter factor
Human Leucocyte Antijen
Heat Shock Protein = APP
Interleukine-1 Activating Enzym
Interferon
Immün globulin
Interlökin
Alfa interferon
Beta interferon
Gamma interferon
&DQOÕRUJDQL]PD
Leucocyte Activating Factor
Lipopolisakkarit Binding Protein
Leucocyte Factor Associate
Leucocyte Migration Inhibiting Factor
Lipopolisakkarit
Lökotrien
Lökotrien A
Lökotrien B
Lökotrien C
Lökotrien D
Lökotrien E
Macrophage-Colony Stimulating Factor
Mucosa Associated Lymphoid Tissue
Memeory Cell
Major Histocompatibility Complex
Migration Inhibition Faktor
Monocyte Migration Inhibiting Factor
Mucosa-associated Mast Cell
Monocyte Macrophage Colony Stimulating Factor
Macrphage Plasminogen activator
Nötrofil Cationic Proteins
Nerve Growth Factor
Naturel Killer
NonSteroid Anti Inflamatuar Drugs
Osteoclast Activating Factor
P maddesi
Platellet Activating Factor
PeriArteiolar Lymphoid Sheat
Proteoglycan-core-proteins
Prostoglandin
Prostoglandin E2
Prostoglandin I2
Prevotella glycoprotein
PI
PNL
RF
Seratonin
SPEB
SRS
Stress protein
T lenfositleri
Tc
TCGF
TCR
TGF-ß
Th
THF
TMF
TNF
Ts
UMC
VIP
Prostosiklin I
Polimorf Nükleer Lökosit
Romatoid faktör
Bkz. 5HT
Streptococcal Pyrogenic Exotoxin B
Slow reacting Substance
Bkz. APP
Timusta üretilen lenfositler
T sitotoksik
T Cell Growth Factor
T Cell Receptor
Transforming Growth Factor
T helper lenfositi
Tymic humoral Factor
Thymocite Mitogenic Factor
Tumor Necrosing Factor
T supresor lenfositi
Undifferantied Mesencimal Cells
Vasoactive Intestinal Polypeptides
KAYNAKLAR:
$NDQ(*HQHO0LNUREL\RORMLYHøPPQRORML*QH\0DWEDDVÕ$GDQD
$NDQ(7ÕEELPLNUREL\RORML6DUD\NLWDEHYL$GDQD
$QÕO $ *HQo HUJLQ YH \DúOÕ LQVDQ GLúL SXOSDODUÕQÕQ DQDWRPLVL YH
\DSÕVDO|]HOOLNOHULQLQÕúÕNYHHOHNWURQPLNURVNRSXGX]H\OHULQGHNDUúÕODúWÕUPDOÕ
olarak incelenmesi. Doktora tezi, Ankara, 1986.
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periapical lesions. Oral Surg. Oral Med. Oral Pathol., 65: 763, 1988.
Barkhordar, R.A., Hussain, m.z., Hayashi, C. : Detection of in
interleukin-1 beta in human periapical lesions. Oral Sur. Oral Med. Oral
Pathol., 73: 334, 1992.
Barnes, G.W., Langeland, K. : Antibody formation in primates following
introduction of antigens into the root canal. J. Dent. Res., 45:1111-1114, 1966.
%HUJHQKROW]*.LúLVHOKDEHUOHúPH
Bergenholtz, G., Ahistedt, S., Lindhe, J. : Experimental pulpitis in
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EnfeksL\RQODUÕ%DUÕú<D\ÕQODUÕø]PLU
%LOJHKDQ + 7HPHO 0LNUREL\RORML YH %D÷ÕúÕNOÕN%LOLPLEDVNÕùDIDN
0DWEDDFÕOÕN$QNDUD
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Diabetes
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*OKDQ$3HGRGRQWLøVWDQEXOhQLYHUVLWHVLEDVÕPHYLøVWDQEXO
*OPH]R÷OX((UJYHQ6øPPQRORML)HU\DO0DWEDDVÕ$QNDUD
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