Akut ST yükselmeli miyokard infarktüsü hastalarında plazma osteopontin ve serum fetüin-A düzeylerinin araştırılması
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Dosyalar
Tarih
2008
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Akut miyokard infarktüsü (AMI) koroner arterlerin trombotik oklüzyonu sonucu miyokardiyal kan akımının ani kesilmesi ile oluşur. Kararsız plaklarda inflamatuvar hücre infiltrasyonunun gözlenmesi AMİ patolojisinde önemli role sahiptir. Fetuin-A sistein proteaz inhibitörlerinin sistatin süperfamilyasına aittir. Vasküler biyoloji ve kemik metebolizmasında rol alır. Malignensi, inflamasyon, diyaliz ve son dönem böbrek hastalığı ve aterosklerozda düzeyi azalmaktadır. Osteopontin kronik kalp yetmezliğinde ve nekrotik yaralanmaya cevapta miyokardiyumda eksprese edilen ekstraselüler matriks proteindir Bu çalışmanın amacı; ST segment yükselmeli miyokard infarktüsü (STYMİ) sonrası primer perkütan girişime (PTKA) alınan hastalarda, bilinen risk faktörlerinin (lipit profili, diyabet, fibrin sigara vb.) yanı sıra matriks selüler protein olan osteopontin, kalsifikasyon inhibitörü olan fetuin-A gibi yeni kan paramtrelerinin AMI gelişimi, KAH yaygınlığını ve sol ventrikül fonksiyonları ile olan ilişkisini araşırmaktır. Methot: 110 STYMI'lı hasta çalışmaya alındı. Serum ve plazmada osteopontin ve fetuin-A düzeyleri sensitif ve spesifik Elisa yöntemi kullanılarak incelendi. Sonuçlar: AMI hastalarda serum fetuin-A düzeyi (48.38±26.68 ng/dl) sağlıklı kontrollerle karşılaştırıldığında (141.37±41.96 ng/dl) ( P= 0.0001) düşüktü. Fakat plazma osteopontin düzeyleri artmıştı (AMI:250.47±62.96 ng/dl, kontrol: 48.53±41.98 ng/dl). Hs-CRP düzeyi yüksekti (9.2±6.7mg/L). Fetuin-A hs-CRP, killips, hipertansiyon, VKİ, WBC, yaş, Gensini skoru ile ters koreleydi (sırasıyla ; r=-237, p<0.01, r=-239, p<0.01, r=302, p<0.00001, r=- 547, p<0.0001, r=-0.215 p<0.02, r=-235, p<0.05, r=-521, p<0.0001). Fakat plazma osteopotin düzeyi ile hs-CRP(r=0,004, p=0,968) arasında korelasyon yoktu. Osteopontin hipertansiyon (r=0,219, P=0,0001), sigara kullanımı, (r=0,350, p=0,0001), yaş (r= 0,177, p=0,036), ve Gensini skoru (r=192, p<0,04) ile pozitif koreleydi. Vücut kitle indeksi ile osteopontin arasında negatif korelasyon vardı (r=-0,470, p= 0,0001). Sonuç olarak bu çalışmadan elde ettiğimiz bulgulara göre AMI'lı hastalarda fetuin-A düzeyi daha düşüktür ve hastalığın şiddeti ile negatif koreledir. Ayrıca aynı hasta grubumuzda osteopontin düzeyi önemli derecede yüksektir ve KAH yaygınlığı ile pozitif ilişkilidir. Çalışmamız daha büyük çalışmalarla doğrulanması halinde düşük fetuin-A düzeyleri KAH şiddetinin, yüksek osteopontin düzeyleri ise KAH yaygınlığının bir göstergesi olarak kullanılabilir.
Background: Acute myocardial infarction (AMI) results from cessation of myocardial blood flow caused by thrombotic occlusion of a coronary artery. Observations of inflammatory cell infiltration in unstable coronary plaques suggest that inflammation may play an important role in the pathogenesis of AMI. Fetuin-A, a member of the cystatin superfamily of cysteine protease inhibitors involved in vascular pathology and bone metabolism, has been reported to be reduced in patients with atherosclerosis and medial calcification related to end stage renal disease or dialysis, inflammation and malignancy. Osteopontin is an extracellular matrix protein also expressed in myocardium in response to necrotic injury and in experimental models of chronic heart failure. The aim of this study is investigating the association of new blood parameters like osteopontin (matrix celuler protein), fetuin-A (inhibitor of calcification) besides traditional risk factors (lipid profil,diabetes, cigarette) with the left ventricul function, development of acute miyocardial infarction, extent of coronary artery disease in patient who undergone percutaneous coronary intervention after ST-elevation acute miyocardial infarction (STEMI). Methods: 110 patients diagnosed with STEMI were recruited for the study. A sensitive and specific Elisa was developed to assay fetuin-A and osteopontin concentrations in plasma. Results: In AMI patients, serum fetuin-A concentrations were decreased (48.38±26.68 ng/dl, on admission) compared to healthy individuals (141.37±41.96 ng/dl) ( P= 0.0001) but plasma osteopontin levels was increased ( acut MI:250.47±62.96 ng/dl, control: 48.53±41.98 ng/dl). Hs-CRP was increased (9.2±6.7mg/L). Fetuin-A was inversely correlated with hs-CRP, killips, hypertension, body mass index, WBC, age, Gensini score (respectively ; r=-237, p<0.01, r=-239, p<0.01, r=302, p<0.00001, r=- 547, p<0.0001, r=-0.215 , p<0.02, r=-235, p<0.05, r=-521, p<0.0001). But there was no corellation between the levels of osteopotin and hs-CRP(r=0,004, p=0,968). Osteopontin was positively correleted with hypertension (r=0,219, P=0,0001), smoker (r=0,350, p=0,0001), age (r= 0,177, p=0,036), and Gensini score (r=192, p<0,04). There was a negative correlation between the body mass index and osteopontin levels. (r=-0,470, p= 0,0001). Conclusions: According to the results of this study; fetuin-A level is decreased in the patient with AMI and negatively correlated with the extent of coronary atherosclerosis. Also osteopontin level is significantly increased and positively associated with the extent of coronary atherosclerosis in the same patient group. In case our study cofirms with larger studies, low-fetuin-A levels may be used as a marker of coronary arter disease severity and high osteopontin levels may be used as a marker of coronary arter disease extensivity.
Background: Acute myocardial infarction (AMI) results from cessation of myocardial blood flow caused by thrombotic occlusion of a coronary artery. Observations of inflammatory cell infiltration in unstable coronary plaques suggest that inflammation may play an important role in the pathogenesis of AMI. Fetuin-A, a member of the cystatin superfamily of cysteine protease inhibitors involved in vascular pathology and bone metabolism, has been reported to be reduced in patients with atherosclerosis and medial calcification related to end stage renal disease or dialysis, inflammation and malignancy. Osteopontin is an extracellular matrix protein also expressed in myocardium in response to necrotic injury and in experimental models of chronic heart failure. The aim of this study is investigating the association of new blood parameters like osteopontin (matrix celuler protein), fetuin-A (inhibitor of calcification) besides traditional risk factors (lipid profil,diabetes, cigarette) with the left ventricul function, development of acute miyocardial infarction, extent of coronary artery disease in patient who undergone percutaneous coronary intervention after ST-elevation acute miyocardial infarction (STEMI). Methods: 110 patients diagnosed with STEMI were recruited for the study. A sensitive and specific Elisa was developed to assay fetuin-A and osteopontin concentrations in plasma. Results: In AMI patients, serum fetuin-A concentrations were decreased (48.38±26.68 ng/dl, on admission) compared to healthy individuals (141.37±41.96 ng/dl) ( P= 0.0001) but plasma osteopontin levels was increased ( acut MI:250.47±62.96 ng/dl, control: 48.53±41.98 ng/dl). Hs-CRP was increased (9.2±6.7mg/L). Fetuin-A was inversely correlated with hs-CRP, killips, hypertension, body mass index, WBC, age, Gensini score (respectively ; r=-237, p<0.01, r=-239, p<0.01, r=302, p<0.00001, r=- 547, p<0.0001, r=-0.215 , p<0.02, r=-235, p<0.05, r=-521, p<0.0001). But there was no corellation between the levels of osteopotin and hs-CRP(r=0,004, p=0,968). Osteopontin was positively correleted with hypertension (r=0,219, P=0,0001), smoker (r=0,350, p=0,0001), age (r= 0,177, p=0,036), and Gensini score (r=192, p<0,04). There was a negative correlation between the body mass index and osteopontin levels. (r=-0,470, p= 0,0001). Conclusions: According to the results of this study; fetuin-A level is decreased in the patient with AMI and negatively correlated with the extent of coronary atherosclerosis. Also osteopontin level is significantly increased and positively associated with the extent of coronary atherosclerosis in the same patient group. In case our study cofirms with larger studies, low-fetuin-A levels may be used as a marker of coronary arter disease severity and high osteopontin levels may be used as a marker of coronary arter disease extensivity.
Açıklama
Anahtar Kelimeler
Miyokard infarktüs, Myocardial infarction, Plazma osteopontin, Plasma osteopontin
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Zengin, K. (2008). Akut ST yükselmeli miyokard infarktüsü hastalarında plazma osteopontin ve serum fetüin-A düzeylerinin araştırılması. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
