Kronik böbrek hastalığı olan ve olmayan hastalarda tiroid fonksiyon testleri ile santral kan basıncı ve arteriyal sertleşme parametreleri arasındaki ilişkinin değerlendirilmesi
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Dosyalar
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Nabız dalga hızının (NDH) ve augmentasyon indeksinin (AIx), farklı gruplarda erken dönem ateroskleroz ve kardiovasküler hastalıklar ile bir ilişkisi olduğu daha önceden gösterilmiştir. Kronik böbrek hastalığı (KBH) hastalarında artmış arteriyal sertlik ve endotel disfonksiyonu arterlerde erken ateroskleroz gelişimine neden olmaktadır. Bu çalışmanın amacı; kronik böbrek hastalığı olan ve kronik böbrek hastalığı olmayan hipertansif hastalarda nabız dalga hızını, augmentasyon indeksini bunların tiroid fonksiyon testleri ile olan ilişkisini ve bunları etkileyen faktörleri belirlemektir. 18 yaş üstünde KBH tanılı 69 ve KBH olmayan 106 hasta bu retrospektif çalışmaya dahil edildi. Hastaların demografik, laboratuar ve ambulatuar kan basıncı parametreleri kaydedildi. KBH olmayan grubun 34'ü (%32.1'i) erkek, 72'si (% 67.9'u) kadın; KBH olan grubun 37'si (%53.6'sı) erkek, 32'si (%46.4'ü) kadındı ve KBH grubunun yaş ortalaması daha yüksekti. Kilo ve BKİ daha düşüktü. KBH olan grupta GFH, albümin, ALT, AST, sodyum, kalsiyum, HDL-kolesterol, hemoglobin, hematokrit, trombosit ve sT3 anlamlı olarak daha düşüktü. Arteriograf ile nabız dalga hızı ve augmentasyon indeksi ölçüldü. KBH olan grupta, NDH anlamlı yüksekti, augmentasyon indeksi KBH olmayanlardan farklı değildi. KBH hastalarında nabız dalga hızı; yaş (p= 0.001 r=0.795), 24 saatlik sistolik kan basıncı (p=0.032; r=0.258), gündüz sistolik kan basıncı (p=0.034; r=0.256), 24 saatlik augmentasyon indeksi (p=0.001; r=0.384), gündüz augmentasyon indeksi (p=0.001; r=0.377) gece augmentasyon indeksi (p=0.007; r=0.320) gündüz asgari sistolik kan basıncı (p=0.039; r=0.249), azami sistolik kan basıncı (p=0.011; r=0.306) ile pozitif korele idi. 24 saatlik nabız sayısı (p=0.027; r=-0.266) ve gündüz nabız sayısı (p=0.024; r=-0.271) ile negatif korele idi. Tüm hastalarda TSH; 24 saatlik sistolik kan basıncı, ortalama arteriyal basınç, 24 saatlik santral sistolik kan basıncı, gündüz sistolik kan basıncı, gündüz santral sistolik kan basıncı, gündüz azami sistolik kan basıncı, gece santral sistolik kan basıncı, gece asgari sistolik kan basıncı, 24 saatlik, gündüz ve gece nabız basıncı, 24 saatlik periferik direnç ile pozitif korele idi. TSH sistolik kan basıncı azalması ile negatif korele idi. Tüm hastalarda sT4; HDL-kolesterol, 24 saatlik kardiyak atım ve gece kardiyak atım ile pozitif korele idi. Trigliserid, boy, MCV, gece asgari diyastolik kan basıncı, gündüz azami diyastolik kan basıncı, gündüz periferik direnç, gece periferik direnç ve 24 saatlik periferik direnç ile negatif korele idi. KBH olan hastalarda sT4 alt grupları arasında yapılan çalışmalar sonucunda ST4 normalin altında olan grupta sT4 normalin üstünde olan gruba göre HDL-kolesterol düşük saptanmıştır. sT4 normalin altında olan grupta sT4 normal olan gruba göre gündüz asgari sistolik kan basıncı, gündüz asgari diyastolik basıncı ve GFH daha düşük; kreatinin daha yüksek saptanmıştır. Tüm hastalarda sT3; yaş ile pozitif, 24 saatlik kardiyak atım, gündüz kardiyak atım, gece kardiyak atım ile negatif korele idi. KBH olan hastalarda sT3 normalin altında olan grupta gece augmentasyon indeksi sT3 normal aralıkta olanlara göre daha yüksek; gece kardiyak atım daha düşük bulunmuştur. KBH olmayanlarda bu gruplar arasında anlamlı fark bulunmamıştır. Sonuç olarak KBH hastalarında tiroid disfonksiyonlarına sıklıkla rastlanmaktadır. KBH hastalarında KBH olmayanlara oranla sT3 anlamlı şekilde daha düşük görülmüştür. Ancak arteriyal sertlik parametresi olan nabız dalga hızı ile sT3 arasında anlamlı ilişki görülmemiştir. KBH hastalarında tiroid fonksiyon testlerindeki değişikliklerin arteriyal sertlik üzerindeki etkilerinin değerlendirilmesi için iyi dizayn edilmiş büyük hasta sayılı prospektif çalışmalara ihtiyaç vardır.
Pulse wave velocity (NDH) and augmentation index (AIx) have been previously shown to be associated with early atherosclerosis and cardiovascular disease in different groups. Increased arterial stiffness and endothelial dysfunction in patients with chronic kidney disease (CKD) cause early atherosclerosis in arteries. The purpose of this study is; Pulse wave velocity, augmentation index, their relation to thyroid function tests and the factors affecting them in hypertensive patients with chronic renal disease and without chronic renal disease. 69 patients with CKD and 106 patients without CKD over the age of 18 years were included in this retrospective study. Demographic, laboratory and ambulatory blood pressure parameters of the patients were recorded. 34 (32.1%) of the non-CKD group were male, 72 (67.9%) were female; 37 (53.6%) were male, 32 (46.4%) were female with CKD and the average age of the CKD group was higher. Weight and BMI are lower. GFH, albumin, ALT, AST, sodium, calcium, HDL-cholesterol, hemoglobin, hematocrit, platelets and sT3 were significantly lower in the CKD group. Pulse wave velocity and augmentation index were measured by arteriograph. In the CKD group, NDH was significantly higher and the augmentation index was not different from non-CKD. Pulse wave velocity in CKD patients was positively correlated with age (p=0.001; r=0.795), 24-hour systolic blood pressure (p=0.032; r=0.258), daytime systolic blood pressure (p=0.034; r=0.256), 24-h augmentation index (p=0.001; r=0.384), day augmentation index (p=0.001, r=0.377), night augmentation index (p=0.007; r=0.320), day-time minimum systolic blood pressure (p=0.039; r=0.249), maximum systolic blood pressure (p=0.011; r=0.306). There was a negative correlation with the 24-h pulse rate (p = 0.027; r = -0.266) and daytime pulse rate (p = 0.024; r = -0.271). In all patients TSH was a positive correlate with 24-hour systolic blood pressure, mean arterial pressure, 24-hour central systolic blood pressure, daytime systolic blood pressure, daytime central systolic blood pressure, daytime maximum systolic blood pressure, night central systolic blood pressure, night minimum systolic blood pressure, 24-hour pulse pressure, daytime pressure, night pulse pressure, 24-hour peripheric resistance. TSH was a negative correlate with systolic blood pressure decrease. In all patients sT4 was a positive correlate with 24-hour cardiac output, night cardiac output and HDL-cholesterol. sT4 was a positive correlate with triglyceride, height, MCV, night minimum diastolic blood pressure, daytime maximum diastolic blood pressure, 24-hour peripheral resistance, daytime peripheral resistance and night peripheral resistance. In patients with CKD, sT4 subgroups were found to have a low HDL-cholesterol level compared to the group above normal sT4 in the group below the sT4 normal. In the group with sT4 below normal, daytime minimum systolic blood pressure, daytime minimum diastolic pressure and GFH were lower than group with normal sT4; creatinine was higher. In all patients sT3 was a positive correlate with age; negative correlate with 24-h cardiac output, day and night cardiac output. In patients with CKD, the night augmentation index was found to be higher in patients with sT3 below normal than those with normal range of sT3 and in the group with sT3 below normal, cardiac output at night was higher than those with normal range of sT3. There was no significant difference between these groups in non-CKD. As a result, thyroid dysfunctions are frequently encountered in patients with CKD. sT3 was significantly lower in patients with CKD than in those without CKD. However, there was no significant relationship between pulse wave velocity, which is an arterial stiffness parameter, and sT3. There is a need for well-designed large patient-specific prospective studies to evaluate the effects of changes in thyroid function tests on arterial stiffness in patients with CKD.
Pulse wave velocity (NDH) and augmentation index (AIx) have been previously shown to be associated with early atherosclerosis and cardiovascular disease in different groups. Increased arterial stiffness and endothelial dysfunction in patients with chronic kidney disease (CKD) cause early atherosclerosis in arteries. The purpose of this study is; Pulse wave velocity, augmentation index, their relation to thyroid function tests and the factors affecting them in hypertensive patients with chronic renal disease and without chronic renal disease. 69 patients with CKD and 106 patients without CKD over the age of 18 years were included in this retrospective study. Demographic, laboratory and ambulatory blood pressure parameters of the patients were recorded. 34 (32.1%) of the non-CKD group were male, 72 (67.9%) were female; 37 (53.6%) were male, 32 (46.4%) were female with CKD and the average age of the CKD group was higher. Weight and BMI are lower. GFH, albumin, ALT, AST, sodium, calcium, HDL-cholesterol, hemoglobin, hematocrit, platelets and sT3 were significantly lower in the CKD group. Pulse wave velocity and augmentation index were measured by arteriograph. In the CKD group, NDH was significantly higher and the augmentation index was not different from non-CKD. Pulse wave velocity in CKD patients was positively correlated with age (p=0.001; r=0.795), 24-hour systolic blood pressure (p=0.032; r=0.258), daytime systolic blood pressure (p=0.034; r=0.256), 24-h augmentation index (p=0.001; r=0.384), day augmentation index (p=0.001, r=0.377), night augmentation index (p=0.007; r=0.320), day-time minimum systolic blood pressure (p=0.039; r=0.249), maximum systolic blood pressure (p=0.011; r=0.306). There was a negative correlation with the 24-h pulse rate (p = 0.027; r = -0.266) and daytime pulse rate (p = 0.024; r = -0.271). In all patients TSH was a positive correlate with 24-hour systolic blood pressure, mean arterial pressure, 24-hour central systolic blood pressure, daytime systolic blood pressure, daytime central systolic blood pressure, daytime maximum systolic blood pressure, night central systolic blood pressure, night minimum systolic blood pressure, 24-hour pulse pressure, daytime pressure, night pulse pressure, 24-hour peripheric resistance. TSH was a negative correlate with systolic blood pressure decrease. In all patients sT4 was a positive correlate with 24-hour cardiac output, night cardiac output and HDL-cholesterol. sT4 was a positive correlate with triglyceride, height, MCV, night minimum diastolic blood pressure, daytime maximum diastolic blood pressure, 24-hour peripheral resistance, daytime peripheral resistance and night peripheral resistance. In patients with CKD, sT4 subgroups were found to have a low HDL-cholesterol level compared to the group above normal sT4 in the group below the sT4 normal. In the group with sT4 below normal, daytime minimum systolic blood pressure, daytime minimum diastolic pressure and GFH were lower than group with normal sT4; creatinine was higher. In all patients sT3 was a positive correlate with age; negative correlate with 24-h cardiac output, day and night cardiac output. In patients with CKD, the night augmentation index was found to be higher in patients with sT3 below normal than those with normal range of sT3 and in the group with sT3 below normal, cardiac output at night was higher than those with normal range of sT3. There was no significant difference between these groups in non-CKD. As a result, thyroid dysfunctions are frequently encountered in patients with CKD. sT3 was significantly lower in patients with CKD than in those without CKD. However, there was no significant relationship between pulse wave velocity, which is an arterial stiffness parameter, and sT3. There is a need for well-designed large patient-specific prospective studies to evaluate the effects of changes in thyroid function tests on arterial stiffness in patients with CKD.
Açıklama
Anahtar Kelimeler
Kronik böbrek hastalığı, Arteriyal sertlik, Tiroid fonksiyon testleri, Chronic renal disease, Arteriyal stiffness, Thyroid function tests
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Turgut, Z. İ. (2017). Kronik böbrek hastalığı olan ve olmayan hastalarda tiroid fonksiyon testleri ile santral kan basıncı ve arteriyal sertleşme parametreleri arasındaki ilişkinin değerlendirilmesi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
