ST elevasyonsuz akut koroner sendrom hastalarında serum netrin-1 düzeyinin değerlendirilmesi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kardiyovaskuler hastalıkların tanı ve tedavisindeki yeni ve büyük gelişmelere rağmen kardiyovaskuler hastalıkların dünya genelinde morbidite ve mortalitenin en sık sebebi olma yolunda giderek artan bir rolü mevcuttur ve erişkinlerde en sık görülen ölüm nedeni olduğu bilinmektedir. Yapılan çalışmalar kardiyovaskuler hastalıkların neden olduğu ölümlerin ilerleyen yıllarda daha da artacağını öngörmektedir. DSÖ tahminlerine göre 2030 yılında kardiyovaskuler hastalıklar sebebi ile 22 milyondan fazla insanın hayatını kaybedeceği belirtilmektedir. Ülkemizde yapılan TEKHARF çalışmasına göre 1990-2016 yılları arasında Türkiye'de meydana gelen kardiyovasküler hastaklı nedenli ölümler , tüm ölümlerin %42'sini oluşturmaktadır ve senede yaklaşık 420.000 koroner olay görülmektedir. Bu sebeple gelecekteki kardiyovaskuler olayları öngörme özelliğine sahip yeni biyobelirteç çalışmaları önem arz etmektedir. Çalışmamızda NSTEMI tanısı alan hastalar ile normal koroner anatomi saptanan hastalardan oluşan kontrol grubunun netrin-1 seviyelerinin kıyaslanmasını ve NSTEMI grubundaki hastaların Syntax I skorunu hesaplayarak koroner arter hastalığı yaygınlığı ile netrin-1 seviyesi arasındaki ilişkiyi göstermeyi amaçladık. Çalışmamızda NSTEMI grubunda 180 , kontrol grubunda ise 128 hasta olmak üzere 308 hasta analiz edildi. NSTEMI grubunun yaş ortalaması 62,96 ± 1,89 , kontrol grubunun ise 56,96 ± 2,1olarak tespit edildi ve anlamlı fark görüldü (p=0,006). Tüm hastalardan koroner anjiografi öncesi bakılan plazma netrin-1 düzeyi, NSTEMI grubunda kontrol grubuna göre daha düşük seviyede saptandı ancak istatistiksel açıdan anlamlı fark görülmedi (netrin-1 düzeyleri sırası ile 15,764±1,85 pg/ml , 18,21±3,04 pg/ml , p=0,791). Her 2 grupta HT, DM, SVO, HL, ailede KAH öyküsü, KOAH, hipotiroidi oranları benzer seviyedeydi ancak NSTEMI grubunda sigara içiciliği ve hipertiroidi kontrol grubuna kıyasla istatistiksel açıdan daha yüksek olarak görüldü (p değerleri sırası ile 0,035 ve 0,017). Bunun yanı sıra kontrol grubunun ejeksiyon fraksiyonu daha yüksek olarak belirlendi (56,55±1,03 ve 49,08±1,36 , p<0,001). Diğer laboratuar verileri açısından baktığımızda NSTEMI grubunda WBC, üre, kreatinin, glukoz seviyelerinin kontrol grubuna göre daha yüksek olduğu belirlendi ( p değerleri sırası ile <0,001 , =0,001 , <0,001 , <0,001). Kontrol grubunda ise HDL düzeyinin daha yüksek olduğu görüldü (p=0,002). Kontrol grubunda hastaların plazma netrin-1 düzeyleri yaş, komorbid hastalıklar, risk faktörleri, rutin laboratuar verileri ile kıyaslandı. NSTEMI grubunda da plazma netrin-1 seviyeleri bu parametrelere ek olarak ekokardiyografi verileri, perkutan girişim esnasında kullanılan balon ve stent sayıları, koroner anjiografi sonuçları , vücut kitle indeksi ve killip skorları ile kıyaslandı. Kontrol grubunda serum netrin-1 düzeyinin hemoglobin düzeyi ile negatif yönlü ( p=0,025 , r= -0,201) , trigliserid düzeyi ile pozitif yönlü ( p=0,049 , r= 0,175) anlamlı korele olduğu , NSTEMI grubunda ise serum netrin-1 düzeyinin total kolesterol seviyesi ile pozitif yönlü ( p=0,044 , r= 0,15) korele olduğu tespit edildi. NSTEMI grubundaki hastaların Syntax I skorları hesaplandı ve hastalar Syntax I skorlarına göre 2 gruba ayrıldı (Syntax I skoru <22 ve ≥22). Syntax I skoru ≥22 olan hastaların netrin-1 düzeylerinin, Syntax I skoru<22 olan hastalara göre daha yüksek olduğu belirlendi ancak istatistiksel açıdan anlamlı fark görülmedi (netrin-1 düzeyleri sırası ile 17,83±6,67 pg/ml , 15,45±1,95 , p=0,839) . Syntax I skoru ≥22 olan hastalarda total kolesterol ve LDL düzeyleri istatistiksel açıdan yüksek saptanırken , diğer parametrelerde anlamlı fark görülmedi (p değerleri sırası ile 0,004 ve 0,002). Sonuç olarak çalışmamızda netrin-1 seviyesinin NSTEMI tanısıyla takip edilen ve koroner arter hastalığı saptanan hastalarda , koroner arter hastalığı olmayan hastalara göre istatistiksel olarak anlamlı olmasa da daha düşük düzeyde olduğunu tespit ettik. Bu sonuçlara ilaveten tek merkezli bir çalışma olduğu için ve az sayıda hasta değerlendirildiği için, netrin-1'in koroner arter hastalığı ve akut koroner sendrom ile ilişkisi açısından kesin bir neticeye ulaşmamız mümkün gözükmemektedir. Bu neticeler ışığında netrin-1'in koroner arter hastalığı ve akut koroner sendromdaki rolünü belirlemek için çok merkezli ve daha fazla hastanın dahil edildiği geniş kapsamlı çalışmalara ihtiyaç vardır.
Cardiovascular diseases have an increasing role to be the most common cause of morbidity and mortality around the world, and they are known to be the most common cause of death among adults despite recent and major advances in the diagnosis and treatment of cardiovascular diseases. Studies predict that deaths caused by cardiovascular diseases will increase in the following years. WHO predicts that more than 22 million people will die in 2030 due to cardiovascular diseases. According to the TEKHARF study conducted in our country between the years of 1990-2016, induced deaths induced by cardiovascular diseases constitute 42% of all deaths and approximately 420,000 coronary events seen in each year. For this reason, new biomarker studies that have the ability to predict future cardiovascular events are important. In our study, we aimed to compare the netrin-1 levels of the patients diagnosed with NSTEMI and the control group consisting of patients with normal coronary anatomy, and to show the relationship between the prevalence of coronary artery disease and netrin-1 level by calculating the Syntax I score of the patients in the NSTEMI group. In our study, 308 patients, 180 in the NSTEMI group and 128 patients in the control group, were analyzed. The mean age of the NSTEMI group was 62.96 ± 1.89, while the mean age of the control group was 56.96 ± 2.1, and a significant difference was observed (p = 0.006). Plasma netrin-1 levels in all patients before coronary angiography were found to be lower in the NSTEMI group compared to the control group, but there was no statistically significant difference (netrin-1 levels were 15.764±1.85 pg/ml, 18.21± 3.04 pg/ml, respectively. p = 0.791). The rates of hypertension, diabetes mellitus, cerebrovascular disease, hyperlipidemia, family history of CAD, COPD, and hypothyroidism were similar in both groups, but smoking and hyperthyroidism were statistically higher in the NSTEMI group compared to the control group (p values 0.035 and 0.017, respectively). In addition, the ejection fraction of the control group was determined to be higher (56.55±1.03 and 49.08±1.36, p<0.001). Considering other laboratory data, WBC, urea, creatinine, and glucose levels were found to be higher in the NSTEMI group than the control group (p values <0.001, = 0.001, <0.001, <0.001, respectively). HDL level was found to be higher in the control group (p = 0.002). Plasma netrin-1 levels of the patients in the control group were compared with age, comorbid diseases, risk factors, and routine laboratory data. In the NSTEMI group, in addition to these parameters, plasma netrin-1 levels were compared with echocardiography data, number of balloons and stents used during percutaneous intervention, coronary angiography results, body mass index and Killip scores. In the control group, serum netrin-1 level was negatively correlated with hemoglobin level (p = 0.025, r = -0.201) and positively correlated with triglyceride level (p = 0.049, r = 0.175); in the NSTEMI group, serum netrin-1 level found to be positively correlated with the cholesterol level (p = 0.044, r = 0.15). The Syntax I scores of the patients in the NSTEMI group were calculated, and the patients were divided into two groups based on the Syntax I scores (Syntax I score <22 and ≥22). It was determined that patients with a Syntax I score of ≥22 had higher netrin-1 levels than patients with a Syntax I score <22, but there was no statistically significant difference (netrin-1 levels were 17.83 ± 6.67 pg / ml, 15.45 ± 1.95, respectively. p = 0.839). While total cholesterol and LDL levels were found to be statistically higher in patients with Syntax I score of ≥22 (p values 0.004 and 0.002, respectively), no significant difference was observed in other parameters. In conclusion, in our study, we found that the netrin-1 level was lower in patients with a diagnosis of NSTEMI and with coronary artery disease compared to patients without coronary artery disease, although it was not statistically significant. In addition to these results, since it is a single-center study and a small number of patients were evaluated, it does not seem possible for us to reach a definite conclusion in terms of the relationship of netrin-1 with coronary artery disease and with acute coronary syndrome. In the light of these results, multi-center studies with more patients are needed to determine the role of netrin-1 in coronary artery disease and in acute coronary syndrome.
Cardiovascular diseases have an increasing role to be the most common cause of morbidity and mortality around the world, and they are known to be the most common cause of death among adults despite recent and major advances in the diagnosis and treatment of cardiovascular diseases. Studies predict that deaths caused by cardiovascular diseases will increase in the following years. WHO predicts that more than 22 million people will die in 2030 due to cardiovascular diseases. According to the TEKHARF study conducted in our country between the years of 1990-2016, induced deaths induced by cardiovascular diseases constitute 42% of all deaths and approximately 420,000 coronary events seen in each year. For this reason, new biomarker studies that have the ability to predict future cardiovascular events are important. In our study, we aimed to compare the netrin-1 levels of the patients diagnosed with NSTEMI and the control group consisting of patients with normal coronary anatomy, and to show the relationship between the prevalence of coronary artery disease and netrin-1 level by calculating the Syntax I score of the patients in the NSTEMI group. In our study, 308 patients, 180 in the NSTEMI group and 128 patients in the control group, were analyzed. The mean age of the NSTEMI group was 62.96 ± 1.89, while the mean age of the control group was 56.96 ± 2.1, and a significant difference was observed (p = 0.006). Plasma netrin-1 levels in all patients before coronary angiography were found to be lower in the NSTEMI group compared to the control group, but there was no statistically significant difference (netrin-1 levels were 15.764±1.85 pg/ml, 18.21± 3.04 pg/ml, respectively. p = 0.791). The rates of hypertension, diabetes mellitus, cerebrovascular disease, hyperlipidemia, family history of CAD, COPD, and hypothyroidism were similar in both groups, but smoking and hyperthyroidism were statistically higher in the NSTEMI group compared to the control group (p values 0.035 and 0.017, respectively). In addition, the ejection fraction of the control group was determined to be higher (56.55±1.03 and 49.08±1.36, p<0.001). Considering other laboratory data, WBC, urea, creatinine, and glucose levels were found to be higher in the NSTEMI group than the control group (p values <0.001, = 0.001, <0.001, <0.001, respectively). HDL level was found to be higher in the control group (p = 0.002). Plasma netrin-1 levels of the patients in the control group were compared with age, comorbid diseases, risk factors, and routine laboratory data. In the NSTEMI group, in addition to these parameters, plasma netrin-1 levels were compared with echocardiography data, number of balloons and stents used during percutaneous intervention, coronary angiography results, body mass index and Killip scores. In the control group, serum netrin-1 level was negatively correlated with hemoglobin level (p = 0.025, r = -0.201) and positively correlated with triglyceride level (p = 0.049, r = 0.175); in the NSTEMI group, serum netrin-1 level found to be positively correlated with the cholesterol level (p = 0.044, r = 0.15). The Syntax I scores of the patients in the NSTEMI group were calculated, and the patients were divided into two groups based on the Syntax I scores (Syntax I score <22 and ≥22). It was determined that patients with a Syntax I score of ≥22 had higher netrin-1 levels than patients with a Syntax I score <22, but there was no statistically significant difference (netrin-1 levels were 17.83 ± 6.67 pg / ml, 15.45 ± 1.95, respectively. p = 0.839). While total cholesterol and LDL levels were found to be statistically higher in patients with Syntax I score of ≥22 (p values 0.004 and 0.002, respectively), no significant difference was observed in other parameters. In conclusion, in our study, we found that the netrin-1 level was lower in patients with a diagnosis of NSTEMI and with coronary artery disease compared to patients without coronary artery disease, although it was not statistically significant. In addition to these results, since it is a single-center study and a small number of patients were evaluated, it does not seem possible for us to reach a definite conclusion in terms of the relationship of netrin-1 with coronary artery disease and with acute coronary syndrome. In the light of these results, multi-center studies with more patients are needed to determine the role of netrin-1 in coronary artery disease and in acute coronary syndrome.
Açıklama
Anahtar Kelimeler
Koroner Arter Hastalığı, NSTEMI, Netrin-1, Syntax Skoru, Coronary Artery Disease, Syntax Score
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kırık, E. C. (2020). ST elevasyonsuz akut koroner sendrom hastalarında serum netrin-1 düzeyinin değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
