Akut koroner olaylarda endotelinin rolü
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Dosyalar
Tarih
1997
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu prospektif klinik çalışmada; AMI ve UAP'lı hastalarda, atheroskleroz ve akut koroner iskemik olayların fizyopatolojisinde önemli rol oynadığı düşünülen ETlerin, akut olay esnasındaki plazma düzeylerinin tesbiti ve farkh yöntemlerle tedavi edilen hastalarda plazma ET düzeylerinin zaman içindeki seyrinin takibi amaçlandı. Çalışmaya klinik, biyokimyasal ve elektrokardiyografik olarak AMI tanısı konmuş 20 hastanın, çeşidi nedenlerle trombolitik tedavi yapılamayan 10 tanesi iskemi grubu ve trombolitik tedavi yapılan 10 tanesi ise farmakolojik reperfüzyon grubu olarak alındı. Yeni başlayan angina progresif angina ve postmiyokard infarktüs angina nedeniyle selektif koroner anjiografileri yapılan ve PTCA karan alınan 11 hasta girişimsel reperfüzyon grubu olarak alındı. Çalışmaya alınan tüm olguların CPK, CK-MB, SGOT, LDH enzimlerinin günlük takibi yapıldı. Total kolesterol, LDL, HDL, trigliserid düzeyleri tesbit edildi. Ekokardiyografi ve/veya ventrikülografi ile EF'leri tesbit edildi, îskemi grubunda hastaneye kabulde, 1. saatte ve 7. saatte, farmakolojik reperfüzyon grubunda kabulde, trombolitik tedavi bitiminde 15 dakika sonra ve 7. saatte, plazma ETı düzeyleri için kan örneği alındı, Girişimsel reperfüzyon grubunda ise işlem öncesi, işlemden 15 dakika sonra ve 7. saatte plazma ETı düzeyleri için kan örneği alındı. İskemi grubundaki 10 olgudan 2'si (%20) kadın, 8'i (%80) erkek ve yaş ortalamaları 61.3±12.4 yıl idi. Farmakolojik reperfüzyon grubundaki 10 olgudan biri (%10) kadın, 9'u (%90) erkek ve yaş ortalamaları 51.4±8.7 yıldı. Girişimsel reperfüzyon grubundaki 11 olgudan biri (%9.1) kadın, 10'u (%90.9) erkek ve yaş ortalamaları 53.5±11.5 yıl idi. Olgular arasında yaş, cinsiyet, EF, T Kol, trigliserid açısından bir fark yoktu. Enzimlerin karşılaştırılmasında, sadece CK-MB düzeyleri karşılaştırıldı. İskemi ve farmakolojik reperfüzyon gruplarında, girişimsel reperfüzyon grubuna göre CK-MB düzeyleri istatistiksel açıdan anlamlı olarak (p<0.0001) yüksekti. İlk alınan ETı düzeyleri yönünden gruplar arasında bir fark yoktu. 2. ETı düzeylerinde ise iskemi grubu ile farmakolojik reperfüzyon grubu arasında fark yokken, iskemi ve 41 farmakolojik reperfüzyon grublannda girişimsel reperfüzyon grubuna göre anlamlı olarak (p<0.05) (p<0.01) yüksekti. 3. ETı değerleri yönünden farmakolojik ve girişimsel reperfüzyon grublan arasında fark yokken, iskemi grubunda hem farmakolojik (p<0.02) ve nemde girişimsel reperfüzyon (p<0.01) grubundan anlamlı yüksek bulundu. L, 2. ve 3. ETı değerleri iskemi grubunda anlamlı olarak artmış bulunurken (p<0.01) ve (p<0.01), farmakolojik reperfüzyon grubunda 2. ETı değeri 1. ve 3. ETı değerlerinden anlamlı olarak yüksekti (p<0.05) ve (p<0.05) ve 1. ve 3. ETı değerleri arasında anlamılı farklılık yoktu. Girişimsel reperfüzyon grubunda 1., 2. ve 3. ET] değerleri anlamlı olarak (p<0.01), (p<0.05) azalmıştı. Sonuç olarak; iskemi grubunda ETı değerleri düzenli şekilde artarken, girişimsel reperfüzyon grubunda azamaktadır. Farmakolojik reperfüzyon grubunda ise reperfüzyondan hemen sonra ETı düzeylerinde artış görülürken, 7. saatte anlamlı azalma gözlenmektedir. Literatürdeki normal değerlere, göre akut iskemik koroner olaylarda plazma ETı düzeyleri anlamlı olarak yüksek bulunmuştur. Reperfüzyon sağlanamayan olgularda, ET yükselişi devam ederken reperfüzyon sağlanan olgularda hızlı bir düşüş saptanmaktadır.
Endothelins are thought to play an important role in pathophysiology of atherosclerosis and acute coronary ischemic events in patients with acute myocardial infarction (AMI) and unstable angina (UAP). In this prospective clinical study; we aimed to determine plasma levels of endothelins during acute ischemic event and we followed the course of plasma endothelin levels in patients treated with different methodes. 20 patients diagnosed as AMI by clinical, biochemical and electrocardiographical findings are included in the study. 10 of them couldn't take thrombolytic thraphy and was accepted ischemia group. The other group talcing thrombolytic thraphy was accepted as pharmacological reperfusion group. Cases with new onset angina, progressive angina and post MI angina for which PTCA are planned as result of coronary aniography were taken as interventional reperfusion group. Daily follow up of CPK, CK-MB, SGOT and LDH enzymes was made in all patients. Total cholesterol, LDL, HDL and TG level were determined. Ejection fraction was calculated by echocardiography and/or ventriculography. Blood samples were taken for ET plasma levels on admission, at 1st and 7th hours in ischemic group; on admission, 15 minutes after thrombolytic thraphy and at 7th hour in pharmacological reperfusion group. In interventional reperfusion group, blood samples were taken before and 15 minutes after procedure and at 7th hour. 2 of 10 cases in ischemia group were female, and 8 of them (80%) were male with a mean age of 61.3 ± 12.4 years. 1 of 10 cases in pharmacological reperfusion group was female (10%), 9 of them were males with a mean age of 51.4 ± 8.7 years. One female (9.1%) and 10 male (90.9%) 11 cases as total with a mean age of 53.5 ± 11.5 years were included interventional reperfusion group. There was no different between cases from the point of age, sex, EF, T. chol. and tryglycelides. As enzymes only CK-MB levels were compared. It was significantly higher (p<0.0001) in ischemic and pharmacologic reperfusion groups as compared to 43 interventional reperfusion group there was no difference between groups in the first ET levels. In second ET levels while there was no difference between ischemia and pharmacological reperfusion group, it was significantly higher (p<0.05) (p<0.01) in these groups as compared to interventional reperfusion group. Third ET levels were found significantly higher (p<0.02) (p<0.01) in ischemia group than the other groups although there was no signicant difference between pharmacological and interventional reperfusion groups. Although 1st, 2nd and 3rd ET levels (p<0.01) (p<0.01) increased significantly in ischemia group 2nd ET level was significantly higher (p<0.05) (p<0.05) than 1st and 3rd ones and also there was no significant difference between 1st and 3rd levels in pharmacological reperfusion group. In interventional reperfusion group, all ET levels decreased significantly (p<0.0l) (p<0.05). As a conclusion; ET levels increased progressively in ischemia group while decreasing in interventiol reperfusion group. In pharmacological reperfusion group, ET level increased soon after reperfusion and significant decreased was observed at 7th hour plasma ET levels were found significanly higher in acute ischemic coronary events as compared to normal values in literature. A rapid decrease was observed in cases with succesfull reperfusion while it continues to increase in others.
Endothelins are thought to play an important role in pathophysiology of atherosclerosis and acute coronary ischemic events in patients with acute myocardial infarction (AMI) and unstable angina (UAP). In this prospective clinical study; we aimed to determine plasma levels of endothelins during acute ischemic event and we followed the course of plasma endothelin levels in patients treated with different methodes. 20 patients diagnosed as AMI by clinical, biochemical and electrocardiographical findings are included in the study. 10 of them couldn't take thrombolytic thraphy and was accepted ischemia group. The other group talcing thrombolytic thraphy was accepted as pharmacological reperfusion group. Cases with new onset angina, progressive angina and post MI angina for which PTCA are planned as result of coronary aniography were taken as interventional reperfusion group. Daily follow up of CPK, CK-MB, SGOT and LDH enzymes was made in all patients. Total cholesterol, LDL, HDL and TG level were determined. Ejection fraction was calculated by echocardiography and/or ventriculography. Blood samples were taken for ET plasma levels on admission, at 1st and 7th hours in ischemic group; on admission, 15 minutes after thrombolytic thraphy and at 7th hour in pharmacological reperfusion group. In interventional reperfusion group, blood samples were taken before and 15 minutes after procedure and at 7th hour. 2 of 10 cases in ischemia group were female, and 8 of them (80%) were male with a mean age of 61.3 ± 12.4 years. 1 of 10 cases in pharmacological reperfusion group was female (10%), 9 of them were males with a mean age of 51.4 ± 8.7 years. One female (9.1%) and 10 male (90.9%) 11 cases as total with a mean age of 53.5 ± 11.5 years were included interventional reperfusion group. There was no different between cases from the point of age, sex, EF, T. chol. and tryglycelides. As enzymes only CK-MB levels were compared. It was significantly higher (p<0.0001) in ischemic and pharmacologic reperfusion groups as compared to 43 interventional reperfusion group there was no difference between groups in the first ET levels. In second ET levels while there was no difference between ischemia and pharmacological reperfusion group, it was significantly higher (p<0.05) (p<0.01) in these groups as compared to interventional reperfusion group. Third ET levels were found significantly higher (p<0.02) (p<0.01) in ischemia group than the other groups although there was no signicant difference between pharmacological and interventional reperfusion groups. Although 1st, 2nd and 3rd ET levels (p<0.01) (p<0.01) increased significantly in ischemia group 2nd ET level was significantly higher (p<0.05) (p<0.05) than 1st and 3rd ones and also there was no significant difference between 1st and 3rd levels in pharmacological reperfusion group. In interventional reperfusion group, all ET levels decreased significantly (p<0.0l) (p<0.05). As a conclusion; ET levels increased progressively in ischemia group while decreasing in interventiol reperfusion group. In pharmacological reperfusion group, ET level increased soon after reperfusion and significant decreased was observed at 7th hour plasma ET levels were found significanly higher in acute ischemic coronary events as compared to normal values in literature. A rapid decrease was observed in cases with succesfull reperfusion while it continues to increase in others.
Açıklama
Anahtar Kelimeler
Coronary disease, Koroner hastalık, Endothelins, Endotelinler, Atherosclerosis, Ateroskleroz
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Tokaç, M. (1997). Akut koroner olaylarda endotelinin rolü. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
