Sistemik skleroz hastalarında damar sertliğinin kalp tipi yağ asidi bağlayıcı protein (H-FABP), homosistein ve asimetrik dimetilarjinin (ADMA) ile ilişkisi
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Dosyalar
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kardiyovasküler hastalık ve buna yol açan ateroskleroz bütün toplumlarda mortalite ve morbidite sebebi olan önemli bir sağlık sorunu haline gelmiştir. Aterosklerotik süreç endotelyal disfonksiyon ve damar sertliği ile ilişkilidir. Daha önce yapılan birçok çalışmada, Sistemik Skleroz (SSk) hastalarında damar sertliği olduğu gösterilmiştir. Nabız dalga hızı (PWV) ve augmentasyon indeksi (Alx) damar sertliğini en iyi gösteren non-invazif metodlardandır. Asimetrik dimetilarjinin (ADMA) ve homosistein ise damar sertliği ile ilişkisi iyi bilinen moleküler belirteçlerdir. Kalp tipi yağ asidi bağlayıcı protein (h-FABP) ise temel olarak miyokardiyal hasarlanmanın göstergesi olan bir moleküldür. h-FABP'nin arteriyel sertliğin de bir göstergesi olabileceği iddia edilmektedir. Bu çalışmanın amacı, SSk hastalarında holter ölçümü ile PWV ve Alx değerlerine bakarak damar sertliği olup olmadığını anlamak ve damar sertliğinin h-FABP, ADMA ve homosistein ile ilişkisini göstermektir. Yöntem: Çalışmaya 1980 ACR tanı kriterlerine göre SSk tanısı almış, kardiyovasküler risk faktörleri bulunmayan 38 kadın, 2 erkek hasta dahil edildi. Kontrol grubu olarak, yaş ve cinsiyeti benzer 30 sağlıklı birey alındı. Çalışmaya dahil edilen tüm bireyler 24 saatlik holter ve transtorasik ekokardiyografi ile kardiyovasküler tutulum açısından değerlendirildi. Hasta ve kontrol grubundan elde edilen kan örneklerinden h-FABP, ADMA ve homosistein çalışıldı. Elde edilen verilerin değerlendirilmesinde Student's T Testi, Mann-Whitney U Testi, Ki-Kare Testi, Fisher exact test, Spearman's ve Pearson Korelasyon testleri kullanıldı. Bulgular: Kardiyovasküler risk faktörü olmayan, 40 SSk hastasının ve 30 sağlıklı kontrol grubunun tansiyon holter cihazı ile PWV ve AIx değerleri hesaplandı. Hasta grubunda AIx 28,52±6,50 (%), kontrol grubunda 26,96±6,59 (%) olarak tespit edildi. Hasta grubunda PWV 6,75±1,26 (m/s), kontrol grubunda 6,37±1,00 (m/s) olarak tespit edildi. Hasta ile kontrol grubu arasında AIx (p=0,328) ve PWV (p=0,180) açısından farklılık gözlenmedi. Ayrıca diğer holter parametrelerinden SB (p=0,348), DB (p=0,159), OAB (p= 0,498) ve NB (p=0,201) kontrol grubuna göre farklılık göstermedi. PWV ve yaş arasında, hasta (r=0,905) ve kontrol (r=0,786) gruplarında pozitif yönlü ve güçlü bir ilişki saptandı. ADMA değeri her iki grup arasında farklılık göstermezken (p=0,340), ADMA ile ilişkili bir molekül olan SDMA değerleri hasta grubunda kontrol grubuna göre (sırasıyla 0,41±0,16 µmol/L ve 0,32±0,14 µmol/L) belirgin derecede yüksek saptandı (p=0,029). Homosistein, SSk hastalarında kontrol grubuna kıyasla (sırasıyla 12,43±8,94 umol/L ve 7,01±3,99 umol/L) belirgin derece yüksek bulundu (p=<0,001). h-FABP değerlerinde ise her iki grup arasında farklılık görülmedi (p=0,286). Sonuç: SSk hastalarının tedavilerinin kaçınılmaz bir parçası olarak kullandıkları KKB, pentoksifilin ve hidroksiklorokin gibi tedavi edici ajanlar aynı zamanda kan basıncı ve lipid profili üzerine olumlu etkilerinden dolayı muhtemelen arteriyel sertlik üzerine de olumlu etki göstermektedirler. SSk hastalarında arteriyel sertliğin gösterilmesi için daha farklı metodların kullanılmasına ihtiyaç vardır. Tedavi edici ajanların damar gerilebilirliğini artırıcı ve gerginliğini azaltıcı etkileri, SSk hastalarında gerçek damar sertliği değerlendirmesini zorlaştırmaktadır. Çalışmamızda SSk hastalarındaki holter bulguları damar sertliği varlığını desteklemese de, arteriyel sertlikle ilişkili bazı moleküler belirteçlerin yüksekliği damar sertliği varlığını düşündürmektedir. SSk tedavisinin kaçınılmaz bir parçası olan vazodilatatör tedavilerin, hastaları ciddi bir myokardiyal hasarlanmadan koruduğu düşünülebilir.
Cardiovascular disease and atherosclerosis leading to it have become an important health problem causing mortality and morbidity in all of the societies. Atherosclerotic process is related to endothelial dysfunction and arteriosclerosis. It is shown in previous several studies that arteriosclerosis is present in systemic sclerosis (SSc) patients. Pulse wave velocity (PWV) and augmentation index (AIX) are among the non-invasive methods which best show atherosclerosis. Asymmetric dimethylarginine (ADMA) and homocysteine, on the other hand, are molecular markers which are well known to have an association with atherosclerosis. Heart type fatty acid binding protein (h-FABP) is basically a molecule which is the indicator of myocardial injury. It is suggested that h-FABP can also be an indicator of arterial stiffness. The objective of this study is to understand whether there is atherosclerosis in SSc patients by looking at PWV and AIX values with Holter measurement and to show the association of atherosclerosis with h-FABP, ADMA and homocysteine. Methods: The study included 38 women and 2 men who were diagnosed with SSc according to 1980 ACR diagnostic criteria and did not have cardiovascular risk factors. As control group, 30 healthy individuals with similar sex and age were included. All the individuals included in the study were evaluated in terms of cardiovascular involvement with 24-hour holter and transthoracic echocardiography. h-FABP, ADMA and homocysteine were studied from the blood samples obtained from the patient and control group. Student's T Test, Mann-Whitney U Test, Chi-square Test, Fisher's exact test, Spearman's and Pearson's Correlation tests were used for evaluation of the data obtained. Results: PWV and AIx values of 40 SSc patients and 30 healthy controls, who did not have cardiovascular risk factor were calculated with tension holter. AIx was 28.52±6.50 (%) in the patient group and 26.96±6.59 (%) in the control group. PWV was 6.75±1.26 (m/s) in the patient group and 6.37±1.00 (m/s) in the control group. There was not any difference between the patient and control groups in terms of AIx (p=0.328) and PWV (p=0.180). Moreover, of the other holter parameters, SP (systolic pressure) (p=0.348), DP (diastolic pressure) (p=0.159), MAP (mean arterial pressure) (p= 0.498) and PP (pulse pressure) (p=0.201) were not different compared to the control group. There was a positive and strong correlation between PWV and age in the patient (r=0.905) and control (r=0.786) groups. While ADMA value did not differ between both groups (p=0.340) SDMA (symmetric dimethylarginine) values, which is a molecule associated with ADMA, were significantly higher in the patient group than the control group (respectively 0.41±0.16 µmol/L and 0.32±0.14 µmol/L) (p=0.029). Homocysteine was significantly higher in SSc patients than the control group (respectively 12.43±8.94 umol/L and 7.01±3.99 umol/L) (p=<0.001). There was not any difference between the both groups in h-FABP values (p=0.286). Conclusions: Therapeutic agents such as CCB (calcium channel blockers), pentoxifylline and hydroxychloroquine which are used as an indispensable part of the treatment by SSc patients have also positive effects on blood pressure and lipid profile, and thus they probably show positive effect on arterial stiffness, as well. There is a need for using more different methods to diagnose the arterial stiffness in SSc patients. Vascular distensibility increasing and vascular tension decreasing effects of therapeutic agents make the evaluation of real atherosclerosis in SSc patients difficult. In our study, although holter findings do not support the presence of atherosclerosis in SSc patients, elevation of some molecular markers related to arterial stiffness suggests the presence of atherosclerosis. It can be thought that vasodilator treatments, an indispensable part of SSc treatment, protect the patients from a serious myocardial injury
Cardiovascular disease and atherosclerosis leading to it have become an important health problem causing mortality and morbidity in all of the societies. Atherosclerotic process is related to endothelial dysfunction and arteriosclerosis. It is shown in previous several studies that arteriosclerosis is present in systemic sclerosis (SSc) patients. Pulse wave velocity (PWV) and augmentation index (AIX) are among the non-invasive methods which best show atherosclerosis. Asymmetric dimethylarginine (ADMA) and homocysteine, on the other hand, are molecular markers which are well known to have an association with atherosclerosis. Heart type fatty acid binding protein (h-FABP) is basically a molecule which is the indicator of myocardial injury. It is suggested that h-FABP can also be an indicator of arterial stiffness. The objective of this study is to understand whether there is atherosclerosis in SSc patients by looking at PWV and AIX values with Holter measurement and to show the association of atherosclerosis with h-FABP, ADMA and homocysteine. Methods: The study included 38 women and 2 men who were diagnosed with SSc according to 1980 ACR diagnostic criteria and did not have cardiovascular risk factors. As control group, 30 healthy individuals with similar sex and age were included. All the individuals included in the study were evaluated in terms of cardiovascular involvement with 24-hour holter and transthoracic echocardiography. h-FABP, ADMA and homocysteine were studied from the blood samples obtained from the patient and control group. Student's T Test, Mann-Whitney U Test, Chi-square Test, Fisher's exact test, Spearman's and Pearson's Correlation tests were used for evaluation of the data obtained. Results: PWV and AIx values of 40 SSc patients and 30 healthy controls, who did not have cardiovascular risk factor were calculated with tension holter. AIx was 28.52±6.50 (%) in the patient group and 26.96±6.59 (%) in the control group. PWV was 6.75±1.26 (m/s) in the patient group and 6.37±1.00 (m/s) in the control group. There was not any difference between the patient and control groups in terms of AIx (p=0.328) and PWV (p=0.180). Moreover, of the other holter parameters, SP (systolic pressure) (p=0.348), DP (diastolic pressure) (p=0.159), MAP (mean arterial pressure) (p= 0.498) and PP (pulse pressure) (p=0.201) were not different compared to the control group. There was a positive and strong correlation between PWV and age in the patient (r=0.905) and control (r=0.786) groups. While ADMA value did not differ between both groups (p=0.340) SDMA (symmetric dimethylarginine) values, which is a molecule associated with ADMA, were significantly higher in the patient group than the control group (respectively 0.41±0.16 µmol/L and 0.32±0.14 µmol/L) (p=0.029). Homocysteine was significantly higher in SSc patients than the control group (respectively 12.43±8.94 umol/L and 7.01±3.99 umol/L) (p=<0.001). There was not any difference between the both groups in h-FABP values (p=0.286). Conclusions: Therapeutic agents such as CCB (calcium channel blockers), pentoxifylline and hydroxychloroquine which are used as an indispensable part of the treatment by SSc patients have also positive effects on blood pressure and lipid profile, and thus they probably show positive effect on arterial stiffness, as well. There is a need for using more different methods to diagnose the arterial stiffness in SSc patients. Vascular distensibility increasing and vascular tension decreasing effects of therapeutic agents make the evaluation of real atherosclerosis in SSc patients difficult. In our study, although holter findings do not support the presence of atherosclerosis in SSc patients, elevation of some molecular markers related to arterial stiffness suggests the presence of atherosclerosis. It can be thought that vasodilator treatments, an indispensable part of SSc treatment, protect the patients from a serious myocardial injury
Açıklama
Anahtar Kelimeler
ADMA, Ateroskleroz, Atherosclerosis, Homosistein, Homocysteine, Kalp, Heart, Skleroz, Sclerosis, Taşıyıcı proteinleri, Carrier proteins
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Öztürk, E. (2015). Sistemik skleroz hastalarında damar sertliğinin kalp tipi yağ asidi bağlayıcı protein (H-FABP), homosistein ve asimetrik dimetilarjinin (ADMA) ile ilişkisi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
