Obsrükif uyku apne sendromlu hasalarda TNF-?, IL-6,NT pro-BNP düzeyleri ve sürekli poziif hava yolu basıbcı ile değişimleri
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Dosyalar
Tarih
2009
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
OUAS'lı hastalarda kardiyovasküler hastalıkların gelişiminde risk yaratabilecek IL-6, TNF-? ve NT pro-BNP serum seviyeleri OUAS'lı obez hastalar ile yine obez kontrol gubu arasında ek hastalık, ilaç kullanma ve sigara içme durumlarının etkisini dışlayarak araştırılması ve CPAP tedavisi ile bu parametrelerin seviyelerindeki değişim ve bunların ilişkili olduğu klinik parametreler araştırıldı. Materyal ve Metod: OUAS'lı hasta grubunda 33, kontrol grubunda 24, 3 aylık CPAP tedavisiyle 25 hastada PSG sonrası sabah 07 00-08 00 alınan kan örneklerinde TNF-?, IL-6 ve NT pro-BNP düzeyleri ELİSA sistemi ile ölçüldü. Bulgular: Vakalar OUAS'lı olmayan obezler (kontrol grubu, n=24) orta ve ağır dereceli OUAS'lı olan obezler (tedavi öncesi hasta grup n=33) ve bunlardan 3 ay süreyle düzenli CPAP kullananlar (tedavi sonrası grup n=25) olarak 3 gruba ayrıldı. Hasta ve kontrol grupları arasında AHI (p<0,001), min O2 sat (p<0,001), ort O2 sat (p<0,001), gece 90 ve üzeri satürasyonda geçen süre oranları (p<0,001) bel çevresi ölçümleri anlamlı derecede farklıydı (p<0,001) . Hasta grubun VKİ'leri kontrol grubundan yüksekti aradaki fark istatisti olarak anlamlıydı. (p=0,004). Hasta ve kontrol grup arasında yaş (p=0,11), boyun çevresi (p=0.090), uyku etkinliği (p=0.243), NREM3 uyku süresinin oranı (p=0.350), REM uyku süresinin oranı (p=0.324), EUÖ değerleri (p=0.075), ve Kolesterol (p=0.672), Trigliserit (p=0.958), LDL (p=0.649), HDL (p=0.817), NT pro-BNP (p=0.892), IL-6 (p=0.782), TNF-? (p=0.722) değerleri arasında istatistiki olarak anlamlı farklılık saptanmadı. OUAS'lı hastalarda tedavi ile AHI (p<0,001), EUÖ (p<0,001), REM (p<0,001) ve NREM 3 uyku süresi oranları (p<0.001) 90 ve üzeri O2 sat (p<0,001), ort O2 sat (p<0,001), min O2 sat (p<0,001) değerlerinde istatistiki olarak anlamlı düzelme tespit edildi. NT pro-BNP (p=0.350), IL-6 (p=0.137), TNF-? (p= 0.279) seviyeleri tedavi öncesine göre tedavi sonrası grupta daha düşüktü ancak istatistiki olarak anlamlı bir düşme tespit edilmedi. Tedavi öncesi OUAS'lı grupta IL-6 ve boyun çevresi arasında pearson korelasyon testi ile pozitif yönlü istatistiki olarak anlamlı bir ilişki bulundu (r=0.469 p=0.06). Düzenli olarak CPAP kullanan 25 hastada tedavi ile ortalama O2 satürasyonundaki düzelme ve TNF-? seviyesindeki azalma arasında regresyon analizi ile ters yönlü, istatistiki olarak anlamlı bir ilişki tespit edildi (t=-2,138 p=0.047) Sonuçlar: Sonuç olarak OUAS'lı hastalarda IL-6, TNF-? ve NT pro-BNP seviyelerinin kontrol grubundan anlamlı olarak yüksek olmaması ve 3 aylık CPAP tedavisi ile seviyelerinde anlamlı düşme tespit edilmemesi OUAS'da kardiyovasküler olayların gelişiminde başka faktörlerin rol oynayabileceğini ve OUAS'da enflamasyonun sistemik değil daha çok lokalize olabileceğini düşündürdü.
The serum levels of IL-6, TNF-? and NT pro-BNP that might cause the risk of the development of cardiovascular disease in obstructive sleep apnea syndrome patients, the research of obese obstructive sleep apnea patients and obese control group excluding the effect of the cases such as additional disease, drug use and smoking, and the cure of CPAP and the changes in the level of these parameters and the clinic parameters with which those are related were searched. Materials and method: The levels of TNF-?, IL-6 and NT pro-BNP in the blood samples taken at 07 00-08 00 in the morning after PSG from 33 in obstructive sleep apnea patients, 24 control group, 25 patients after 3 months CPAP treatment were measured by ELISA system. Findings: The cases were separated into three groups by obese with non-obstructive sleep apnea syndrome (control group, n=24), obese with middle and high level obstructive sleep apnea syndrome (patient group before curing n=33) and the patients that used CPAP for 3 months regularly. AHI (p<0,001), minimum oxygen saturation (p<0,001), average oxygen saturation (p<0,001), the rate of the time passing 90 and above saturation at night (p<0,001), the measurements of waist circumference (p<0,001) between the patients and the control groups were significantly different. BMI of the patient group was higher than the control group, the difference was significant statistically (p=0,004). A significant difference was not determined statistically between the patient and the control group in the values of neck circumference (p=0.090), age (p=0.11), sleep activity (p=0.243), NREM 3 rate of the sleeping time (p=0.350), REM rate of the sleeping time (p=0.324), ESS values (p=0.075), and Cholesterol (p=0.672), Triglyceride (p=0.958), LDL (p=0.649), HDL (p=0.817), NT pro-BNP (p=0.892), IL-6 (p=0.782), TNF-? (p=0.722). Statistically significant improvement was determined in the values of AHI (p<0,001), ESS (p<0,001), REM (p<0,001) and NREM 3 rate of the sleeping time (p<0.001), the rate of the time passing 90 and above saturation, average oxygen saturation (p<0,001), minimum oxygen saturation (p<0,001) by the treatment of the OSAS patients. The levels of NT pro-BNP (p=0.350), IL-6 (p=0.137), TNF-? (p= 0.279) were lower in the group after the treatment but statistically a significant increase could not be determined. Statistically a significant relation in positive way was found between IL-6 and neck circumference by Pearson correlation test before the treatment of the OSAS patients, (r=0.469 p=0.06). Statistically a significant relation (t=-2,138 p=0.047) between improvement in average oxygen saturation by the treatment in 25 patients that used CPAP regularly and the decrease at the level of TNF-? oppositely with the regression analysis was determined. Conclusion: Consequently, the levels of IL-6, TNF-? and NT pro-BNP being not higher significantly in OSAS patients than the control group and not detecting a significant decrease in the levels by three monthly CPAP treatment consider that other factors might play role in the improvement of cardiovascular cases in OSAS and inflammation is not systematic but rather localized in OSAS.
The serum levels of IL-6, TNF-? and NT pro-BNP that might cause the risk of the development of cardiovascular disease in obstructive sleep apnea syndrome patients, the research of obese obstructive sleep apnea patients and obese control group excluding the effect of the cases such as additional disease, drug use and smoking, and the cure of CPAP and the changes in the level of these parameters and the clinic parameters with which those are related were searched. Materials and method: The levels of TNF-?, IL-6 and NT pro-BNP in the blood samples taken at 07 00-08 00 in the morning after PSG from 33 in obstructive sleep apnea patients, 24 control group, 25 patients after 3 months CPAP treatment were measured by ELISA system. Findings: The cases were separated into three groups by obese with non-obstructive sleep apnea syndrome (control group, n=24), obese with middle and high level obstructive sleep apnea syndrome (patient group before curing n=33) and the patients that used CPAP for 3 months regularly. AHI (p<0,001), minimum oxygen saturation (p<0,001), average oxygen saturation (p<0,001), the rate of the time passing 90 and above saturation at night (p<0,001), the measurements of waist circumference (p<0,001) between the patients and the control groups were significantly different. BMI of the patient group was higher than the control group, the difference was significant statistically (p=0,004). A significant difference was not determined statistically between the patient and the control group in the values of neck circumference (p=0.090), age (p=0.11), sleep activity (p=0.243), NREM 3 rate of the sleeping time (p=0.350), REM rate of the sleeping time (p=0.324), ESS values (p=0.075), and Cholesterol (p=0.672), Triglyceride (p=0.958), LDL (p=0.649), HDL (p=0.817), NT pro-BNP (p=0.892), IL-6 (p=0.782), TNF-? (p=0.722). Statistically significant improvement was determined in the values of AHI (p<0,001), ESS (p<0,001), REM (p<0,001) and NREM 3 rate of the sleeping time (p<0.001), the rate of the time passing 90 and above saturation, average oxygen saturation (p<0,001), minimum oxygen saturation (p<0,001) by the treatment of the OSAS patients. The levels of NT pro-BNP (p=0.350), IL-6 (p=0.137), TNF-? (p= 0.279) were lower in the group after the treatment but statistically a significant increase could not be determined. Statistically a significant relation in positive way was found between IL-6 and neck circumference by Pearson correlation test before the treatment of the OSAS patients, (r=0.469 p=0.06). Statistically a significant relation (t=-2,138 p=0.047) between improvement in average oxygen saturation by the treatment in 25 patients that used CPAP regularly and the decrease at the level of TNF-? oppositely with the regression analysis was determined. Conclusion: Consequently, the levels of IL-6, TNF-? and NT pro-BNP being not higher significantly in OSAS patients than the control group and not detecting a significant decrease in the levels by three monthly CPAP treatment consider that other factors might play role in the improvement of cardiovascular cases in OSAS and inflammation is not systematic but rather localized in OSAS.
Açıklama
Anahtar Kelimeler
Obstrüktif uyku apne sendromu, Sürekli pozitif hava yolu basıncı, İnflamasyon, Obstructive sleep apnea syndrome, Continue positive airway pressure, Inflammation
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Doğan, F. Ü. (2009). Obsrükif uyku apne sendromlu hasalarda TNF-?, IL-6,NT pro-BNP düzeyleri ve sürekli poziif hava yolu basıncı ile değişimleri. Selçuk Üniversitesi, Yayımlanmış tıpta uzmanlık tezi, Konya.
