Multiple sclerosis (MS) is a chronic autoimmune disease that primarily affects the the white matter of the brain. In MS, the immune system begins to attack the myelin, the protective layer around the axons of the nerve cells. Increased amounts of reactive oxygen species are formed in the central nervous system due to the inflammatory processes that accompany the disease. In our research, we studied the influence of MS and MS-related conditions on serum bilirubin levels. Bilirubin is a potent endogenous antioxidant with anti inflammatory and antithrombotic effects.
The purpose of this thesis is to examine the relationship between serum bilirubin concentrations and multiple sclerosis using a systematic review and meta analysis.
We conducted a systematic review in five different databases, namely PubMed (Medline), Web of Science, Clinical Trials, Cochrane Library and Google Scholar. The meta-analysis was performed in the R software enviroment (using meta package), and results were displayed using forest diagrams.
We performed 3 sets of analyses: comparison of serum BLR levels in MS patients compared to healthy controls, comparison of serum BLR levels in ON/NMO/CIS patients compared to healthy controls, and comparison of serum BLR levels between genders in MS patients compared to a healthy control. We compared total bilirubin (Tbil), direct bilirubin (Dbil) and indirect bilirubin (Ibil) in all three sets. The results show that MS patients have lower levels of BLR compared to healthy individuals. There is no statistically significant difference between patients with ON/NMO/CIS and healthy individuals. There are also no statistically significant differences between the sexes of MS patients. This allows us to confirm our hypothesis about reduced serum BLR values in MS patients. Based on these findings, we could consider serum bilirubin as a biomarker to follow the MS disease progression, and to assess the efficacy of pharmacotherapy.
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