Üriner sistem taş hastalığı tedavisinde kullanılan extracorporeal shock wave lithotripsy (ESWL) yönteminin serum tgf-beta 1 ve idrar beta 2-mikroglobulin düzeylerine olan etkisi
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Date
2008
Authors
Edincik, Ender
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
ESWL tedavisinde uygulanan şok dalgalarının şiddeti ve sayısına bağlı olarak tübüler, intersitisyel, glomerüler değişiklikler meydana gelmekte ve bu değişikliklerin bir kısmı tübülointersitisyel fibrozise yol açmaktadır. Transforming growth faktör-Beta 1 (TGF-β1) gelişen fibrozisi uyaran en önemli faktördür. Çalışmamızda 8’i kadın 17’si erkek olan pelvis renaliste taşı mevcut 25 hastaya 2500 şok dalgası 20 kV şiddetinde ESWL uygulandı. ESWL öncesi hastalardan kan ve idrar örnekleri alındı. ESWL sonrası 7. gün hastalar kontrole çağrılarak yine kan ve idrar örnekleri alındı. Alınan kan örneklerden TGF-β1, üre, kreatinin, idrar örneklerinden Beta 2-Mikroglobulin (B2M) çalışıldı. Kontrol grubu 4’ü kadın 6’sı erkek olmak üzere 10 kişiden oluşturuldu. Bu hastalardan 7 gün ara ile iki kez kan ve idrar örnekleri alındı. Alınan kan örneklerden TGF-β1, üre, kreatinin, idrar örneklerinden B2M çalışıldı. Bu iki değerin ortalamaları alınarak elde edilen değerler kontrol grubunun bazal değerleri olarak kabul edildi. İstatistiksel analiz için Wilcoxon işaret testi ve Mann-Whitney testleri kullanıldı. Çalışma grubunda ESWL öncesi ölçülen serum TGF-β1, üre, kreatinin ve idrar B2M değerlerine göre ESWL sonrası 7. günde ölçülen değerler istatiksel olarak anlamlı yüksek saptandı. ESWL sonrası 7. günde ölçülen serum TGFβ1, ve idrar B2M değerleri, kontrol grubu bazal serum TGF-β1 ve idrar B2M değerleri ile karşılaştırıldığında istatiksel olarak daha yüksekken, üre, kreatinin değerleri karşılaştırıldığında istatiksel olarak anlamlı fark saptanmadı. Bu bulgular ESWL sonrası TGF-β1 düzeylerinde anlamlı artış olduğunu göstermektedir. Bu artışın böbreklerde tübülointersitisyel fibrozise ve böbrek tübüler fonksiyonlarında bozulmaya neden olabileceği serum üre, kreatinin ve idrar B2M seviyelerindeki artış ile gösterilmiştir. Ancak ESWL’e bağlı gelişen bu erken dönem değişikliklerin süresinin ve geç dönem sonuçlarının kesin olarak belirlenebilmesi için daha fazla hasta içeren daha uzun süreli çalışmalara ihtiyaç vardır.
Depending on the amplitude and frequency of shock waves in ESWL, changes occur in tubules, glomerules, interstitium and some of which results in tubulointestitial fibrosis. Transforming Growth Factor-Beta1(TGF-β1) is the most important factor in which inducing development of fibrosis. In our study, we performed ESWL that frequency of 2500, amplitude of 20 kV in 25 patients of 8 female and 17 male whose calculi in renal pelvis. Before ESWL, blood and urine samples were taken from patients. After ESWL, patients was told to come back for follow-up and blood and urine samples were taken at that visit. Levels of TGF-β1, urea, creatinin in blood samples and Beta2 microglobulin (B2M) in urine samples were determined. There was 10 patients of 4 female, 6 male in control group. Blood and urine samples were taken from these patientstwo times for seven days interval 7 days apart. Levels of TGF-β1, urea, creatinin in blood samples and B2M in urine samples was measured. Average of these two measurements were calculated as basal values of the control group. Statistical analysis was made using Wilcoxon sign ranked test and Mann Whitney test. In study group, measured pre-ESWL levels of TGF-β1, urea, creatinin and B2M, was statistically higher than those determined 7 days after ESWL. When compared to basal values of the control group, serum TGF-β1, and urine B2M levels on the seventh day of ESWL was statistically higher in the study group, while there was no statistically significant in values of urea and creatinin between two groups. These findings show that there is a statistically significant increase in TGF-β1 levels after ESWL. With the increase in levels of serum urea, creatinin and urine B2M, it has been shown that increased TGF-β1 levels can cause deterioration of renal tubuler function and tubulointerstitial fibrosis in the kidney. But, further researches with longer study period are needed to exactly define the time to progression to these early changes and late outcome.
Depending on the amplitude and frequency of shock waves in ESWL, changes occur in tubules, glomerules, interstitium and some of which results in tubulointestitial fibrosis. Transforming Growth Factor-Beta1(TGF-β1) is the most important factor in which inducing development of fibrosis. In our study, we performed ESWL that frequency of 2500, amplitude of 20 kV in 25 patients of 8 female and 17 male whose calculi in renal pelvis. Before ESWL, blood and urine samples were taken from patients. After ESWL, patients was told to come back for follow-up and blood and urine samples were taken at that visit. Levels of TGF-β1, urea, creatinin in blood samples and Beta2 microglobulin (B2M) in urine samples were determined. There was 10 patients of 4 female, 6 male in control group. Blood and urine samples were taken from these patientstwo times for seven days interval 7 days apart. Levels of TGF-β1, urea, creatinin in blood samples and B2M in urine samples was measured. Average of these two measurements were calculated as basal values of the control group. Statistical analysis was made using Wilcoxon sign ranked test and Mann Whitney test. In study group, measured pre-ESWL levels of TGF-β1, urea, creatinin and B2M, was statistically higher than those determined 7 days after ESWL. When compared to basal values of the control group, serum TGF-β1, and urine B2M levels on the seventh day of ESWL was statistically higher in the study group, while there was no statistically significant in values of urea and creatinin between two groups. These findings show that there is a statistically significant increase in TGF-β1 levels after ESWL. With the increase in levels of serum urea, creatinin and urine B2M, it has been shown that increased TGF-β1 levels can cause deterioration of renal tubuler function and tubulointerstitial fibrosis in the kidney. But, further researches with longer study period are needed to exactly define the time to progression to these early changes and late outcome.
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Keywords
Üriner sistem taş hastalığı, TGF-β1, β 2-mikroglobulin, ESWL, Urolithiasis, β 2-microglobulin
Citation
Edincik, E. (2008). Üriner sistem taş hastalığı tedavisinde kullanılan extracorporeal shock wave lithotripsy (ESWL) yönteminin serum tgf-beta 1 ve idrar beta 2-mikroglobulin düzeylerine olan etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.