Böbrek nakli yapılmış hastalarda atherosklerotik kalp-damar hastalıkları ile ilişikili çeşitli belirteçlerin incelenmesi
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Date
2011
Authors
Kırhan, Emine
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Böbrek nakli (BN) olan hastalarda en önemli morbidite ve mortalite nedeni hızlnamış atheroskleroz oluşumuna bağlı gelişen kardiyovasküler hastalık (KVH)' lardır. BN yapılan hastalarda klasik risk faktörleri (yaş, cinsiyet, obezite, sigara, diabet, sedanter yaşam, hipertansiyon) ile artmış KVH riski tam olarak açıklanamamaktadır. İnflamasyon, oksidatif stres, antioksidan mekanizmalarda azalma gibi çeşitli mekanizmaların bu hasta grubundaki hızlanmış atheroskleroz ile ilişkili olduğu düşünülmektedir.Bu çalışmaya, BN süresi en az 6 ay olan 62 hasta ve 50 sağlıklı kontrol alındı. Deneklerden hiçbirinde bilinen KVH'lığı yoktu. Tüm olguların serum lipid profili, glukoz, üre ve kreatinin seviyeleri ve kan basınçları ölçüldü. Bunun yanı sıra atherosklerotik süreçte çeşitli etki mekanizmaları ile rol oynadığı düşünülen yüksek duyarlılıklı-C reaktif protein (hs-CRP), homosistein, ileri glikasyon son ürünleri (AGEs), protein S100B, insülin benzeri büyüme faktörü-1 (IGF-1), insülin benzeri büyüme faktörü bağlayıcı protein-3 (IGFBP-3), paraoksonaz 1 (PON1), A vitamini ve E vitamini gibi çeşitli parametreler de incelendi.Böbrek nakli yapılan hastaların serum lipid profilleri, yüksek trigliserid düzeyleri hariç kontrol grubu ile benzerdi. BN grubunda kan basıncı, serum hs-CRP, AGEs, protein S100B, IGF-1, IGFBP-3 ve A vitamini düzeyleri anlamlı olarak daha yüksek; serum paraoksonaz/arilesteraz aktiviteleri ise daha düşük olarak bulundu. BN hastalarında kreatinin düzeyleri hem protein S100B hem de homosistein ile, PON1 aktivitesi ise hem hs-CRP hem de E vitamini düzeyleri ile anlamlı pozitif ilişki gösteriyordu. IGF-1 ile total kolesterol ve LDL-K arasında da anlamlı negatif ilişki gözlendi.Bu çalışmada BN hastalarında atheroskleroz ile ilişkilendirilen çeşitli parametrelerde anlamlı değişiklikler saptanmıştır. BN hastalarında bu parametrelerin KVH gelişiminin saptanması, önlenmesi veya tedavinin izlenmesi gibi çeşitli aşamalarda faydalı olabileceği görüşüne varılmıştır.
The most important cause of morbidity and mortality in kidney transplantation patients is cardiovascular diseases related to accelerated atherosclerosis formation. Increased risk of cardiovascular diseases in kidney transplantation patients can not merely be explained by traditional risk factors (age, gender, obesity, diabetes, sedantary living, hypertension). Inflammation, oxidative stress and decreased antioxidant defence are suggested mechanisms, related with increased atherosclerosis formation, in this patient group.Sixty two patients with at least 6 months of kidney transplantation period and 50 healthy control cases were recruited to the study. Subjects with known cardiovascular diseases were not included in this study, Serum lipid profile, glucose, urea and creatinine levels and blood pressure of all cases were determined. In addition to this, several other parameters related to atherosclerosis, such as high sensitivity C-reactive protein (hs-CRP), homocysteine, advanced glycation end-products (AGEs), protein S100B, insulin-like growth factor 1 (IGF-1), Insulin-like growth factor-binding protein-3 (IGFBP-3), paraoxonase 1 (PON1), vitamin A and vitamin E were evaluated.Except the increased triglyceride levels, lipid profile of the patient group was similiar to the control group. Blood pressure, serum hs-CRP, AGEs, protein S100B, IGF-1, IGFBP-3 and vitamin A levels were significantly higher and serum paraoxonase/arylesterase activities were lower in kidney transplantation patients than those of the controls. In kidney transplantation patients, creatinin levels were positively correlated with both protein S100B and homocysteine levels and PON1 activity was positively correlated with both hs-CRP and vitamin E levels. IGF-1 was negatively correlated with both total cholesterol and LDL-C levels.In the present study, we observed several significant changes in the atherosclerosis related parameters of the BN group. These findings encouraged us to suggest that these parametrs could be used in the diagnosis, prevention, follow up of the tratment of cardiovascular events in the BN patients.
The most important cause of morbidity and mortality in kidney transplantation patients is cardiovascular diseases related to accelerated atherosclerosis formation. Increased risk of cardiovascular diseases in kidney transplantation patients can not merely be explained by traditional risk factors (age, gender, obesity, diabetes, sedantary living, hypertension). Inflammation, oxidative stress and decreased antioxidant defence are suggested mechanisms, related with increased atherosclerosis formation, in this patient group.Sixty two patients with at least 6 months of kidney transplantation period and 50 healthy control cases were recruited to the study. Subjects with known cardiovascular diseases were not included in this study, Serum lipid profile, glucose, urea and creatinine levels and blood pressure of all cases were determined. In addition to this, several other parameters related to atherosclerosis, such as high sensitivity C-reactive protein (hs-CRP), homocysteine, advanced glycation end-products (AGEs), protein S100B, insulin-like growth factor 1 (IGF-1), Insulin-like growth factor-binding protein-3 (IGFBP-3), paraoxonase 1 (PON1), vitamin A and vitamin E were evaluated.Except the increased triglyceride levels, lipid profile of the patient group was similiar to the control group. Blood pressure, serum hs-CRP, AGEs, protein S100B, IGF-1, IGFBP-3 and vitamin A levels were significantly higher and serum paraoxonase/arylesterase activities were lower in kidney transplantation patients than those of the controls. In kidney transplantation patients, creatinin levels were positively correlated with both protein S100B and homocysteine levels and PON1 activity was positively correlated with both hs-CRP and vitamin E levels. IGF-1 was negatively correlated with both total cholesterol and LDL-C levels.In the present study, we observed several significant changes in the atherosclerosis related parameters of the BN group. These findings encouraged us to suggest that these parametrs could be used in the diagnosis, prevention, follow up of the tratment of cardiovascular events in the BN patients.
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Keywords
Böbrek nakli, Kardiyovasküler hastalıklar, hs-CRP, AGEs, Protein S100B, IGF-1, Paraoksonaz, Kidney transplantation, Cardiovascular diseases, hs-CRP, AGEs, Protein S100B, IGF-1, Paraoxonase
Citation
Kırhan, E. (2011). Böbrek nakli yapılmış hastalarda atherosklerotik kalp-damar hastalıkları ile ilişikili çeşitli belirteçlerin incelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.