Böbrek nakli hastalarında kalsinörin inhibitörlerinin kardiyovasküler risk faktörleri ve kardiyovasküler olaylar üzerine etkilerinin değerlendirilmesi
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Date
2015
Authors
Sayılar, Emel Işıktaş
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada, böbrek nakli (Tx) hastalarında takrolimus (Tac) ve siklosporin-A (CsA) tedavilerinin nakil sonrası dönemde gelişen kardiyovasküler risk faktörleri ve hastalıklar üzerine etkisinin karşılaştırılması amaçlanmıştır. Çalışmaya 133 Tx hastası dahil edildi. 62 hasta CsA ve 71 hasta Tac kullanıyordu. Tüm hastalarda nakil öncesi ve sonrası 1. ay, 3. ay, 6. ay, 1. yıl, 2. yıl, 3. yıl ve 4. yılda kan basınçları (KB), vücut ağırlığı, vücut yağ yüzdesi, bel çevresi, kalça çevresi, el bileği çevresi ve ense çevresi ölçüldü. Böbrek fonksiyon testleri, glukoz ve lipid profili değerlendirildi. CsA ve Tac grubunda vücut ağırlığı, beden kitle indeksi (BKİ), vücut yağ yüzdesi, bel ve kalça çevresi değerleri 24. aya kadar anlamlı artış gösterdi. Ancak her iki grubun vücut ağırlığı, BKİ, yağ yüzdesi, bel çevresi ve bel-kalça oranı değerlerindeki değişiklikler arasında anlamlı fark saptanmadı. El bileği çevresi değerleri; CsA grubunda sadece 48. ayda preoperatif değerlere göre anlamlı olarak azalırken, Tac grubunda 3. ve 12. ayda istatistiksel olarak anlamlı arttı. Her iki gruptaki değişiklikler arasında sadece 48. ayda CsA grubunda Tac grubuna kıyasla anlamlı fark bulundu. CsA ve Tac grubunda ense çevresi değerleri sadece 24. aya kadar anlamlı artış gösterdi. Her iki gruptaki değişiklikler benzerdi. Her iki grubun sistolik ve diyastolik KB değişiklikleri arasında fark yoktu. Bacak sistolik KB ölçümleri, CsA grubunda 36. ayda ve Tac grubunda 6. ayda anlamlı arttı. Bacak diyastolik KB ölçümleri CsA grubunda anlamlı değişmedi. Tac grubunda 3., 6. ve 12. aylarda anlamlı arttı. Bilek brakiyal indeks (ABI: ankle/brachial index); bazale göre CsA grubunda 1. ayda anlamlı azalırken, Tac grubunda 6. ve 24. aylarda anlamlı arttı. Her iki grubun bacak sistolik ve diyastolik KB ölçümlerinde 36. ayda, ABI değerlerinde 3. ayda anlamlı fark vardı. CsA grubunda serum kreatinin 1. aya göre anlamlı değişmezken, Tac grubunda 6. ve 12. aylarda anlamlı arttı. Serum ürik asit değerleri 1. ay değerlerine göre; CsA grubunda 36. aya, Tac grubunda ise 12. aya kadar anlamlı arttı. Her iki gruptaki serum kreatinin ve ürik asit değerlerindeki değişiklikler benzerdi. Gruplararası karşılaştırmada serum glukoz değerlerinde 6. ve 12. aylarda anlamlı fark bulundu. Sonuç olarak, Tx hastalarında CsA daha fazla kilo, vücut yağ yüzdesi ve BKİ artışı, bel ve kalça çevresinde genişleme, aterojenik lipid profili, hiperürisemi, hipernatremi, hiperkalsemi ve daha düşük ABI değerlerine neden olurken, Tac daha fazla diyastolik KB yüksekliği, hiperglisemi ve kreatinin artışına neden oldu.
The aim of this study is to compare the effects of tacrolimus (Tac) and cyclosporine-A (CsA) treatments on cardiovascular risk factors and diseases developed during post-translation period in patients with renal transplantation (Tx). In this study, 133 Tx patients were included. 62 patients were receiving CsA and 71 were receiving Tac. In all patients, blood pressure (BP), body weight, body lipid percentage, waist circumference, hip circumference, wrist circumference and neck circumference were measured before transplantation and on month 1, month 3, month 6, year 1, year 2, year 3 and year 4 after transplantation. Renal function tests, glucose and lipid profile were evaluated. Body weight, body mass index (BMI), body lipid percentage, waist and hip circumference were significantly increased up to month 24 in groups of CsA and Tac. However there were no significant differences in changes of body weight, BMI, lipid percentage, waist circumference and waist-hip ratio between both groups. Measurement of wrist circumference was significantly reduced at only month 48 compared to pre-operative values in CsA group, while it was statistically increased on months 3 and 12 in Tac group. There was significant difference in CsA group compared to Tac group only on month 48 in respect of alterations in both groups. In CsA and Tac groups, neck circumference was significantly increased only up to month 24. Alterations in both groups were similar. There was no difference in alterations of systolic and diastolic BP in both groups. Leg systolic BP was significantly increased on month 36 in CsA group and month 6 in Tac group. Leg diastolic BP was not significantly changed in CsA group. In Tac group, it was significantly increased on months 3, 6 and 12. Ankle brachial index (ABI) was significantly reduced compared to baseline on month 1 in CsA group, while it was significantly increased on months 6 and 24 in Tac group. There was significant difference in leg systolic and diastolic BP on month 36 in both groups and ABI measurements on month 3. In CsA group, serum creatinine was not significantly changed compared to month 1, whereas it was significantly increased on months 6 and 12 in Tac group. Serum uric acid level was significantly increased up to month 36 compared to month 1 in CsA group and up to month 12 in Tac group. Alterations in serum creatinine and uric acid were similar in both groups. Serum glucose was significantly different on month 6 and 12 between groups. Consequently, CsA led to more increase in body weight, body lipid percentage and BMI, widening in waist and hip circumference, atherogenic lipid profile, hyperuricemia, hypernatremia, hypocalcemia and lower ABI in Tx patients; Tac increased more diastolic BP increase, hyperglycemia and increased creatinine.
The aim of this study is to compare the effects of tacrolimus (Tac) and cyclosporine-A (CsA) treatments on cardiovascular risk factors and diseases developed during post-translation period in patients with renal transplantation (Tx). In this study, 133 Tx patients were included. 62 patients were receiving CsA and 71 were receiving Tac. In all patients, blood pressure (BP), body weight, body lipid percentage, waist circumference, hip circumference, wrist circumference and neck circumference were measured before transplantation and on month 1, month 3, month 6, year 1, year 2, year 3 and year 4 after transplantation. Renal function tests, glucose and lipid profile were evaluated. Body weight, body mass index (BMI), body lipid percentage, waist and hip circumference were significantly increased up to month 24 in groups of CsA and Tac. However there were no significant differences in changes of body weight, BMI, lipid percentage, waist circumference and waist-hip ratio between both groups. Measurement of wrist circumference was significantly reduced at only month 48 compared to pre-operative values in CsA group, while it was statistically increased on months 3 and 12 in Tac group. There was significant difference in CsA group compared to Tac group only on month 48 in respect of alterations in both groups. In CsA and Tac groups, neck circumference was significantly increased only up to month 24. Alterations in both groups were similar. There was no difference in alterations of systolic and diastolic BP in both groups. Leg systolic BP was significantly increased on month 36 in CsA group and month 6 in Tac group. Leg diastolic BP was not significantly changed in CsA group. In Tac group, it was significantly increased on months 3, 6 and 12. Ankle brachial index (ABI) was significantly reduced compared to baseline on month 1 in CsA group, while it was significantly increased on months 6 and 24 in Tac group. There was significant difference in leg systolic and diastolic BP on month 36 in both groups and ABI measurements on month 3. In CsA group, serum creatinine was not significantly changed compared to month 1, whereas it was significantly increased on months 6 and 12 in Tac group. Serum uric acid level was significantly increased up to month 36 compared to month 1 in CsA group and up to month 12 in Tac group. Alterations in serum creatinine and uric acid were similar in both groups. Serum glucose was significantly different on month 6 and 12 between groups. Consequently, CsA led to more increase in body weight, body lipid percentage and BMI, widening in waist and hip circumference, atherogenic lipid profile, hyperuricemia, hypernatremia, hypocalcemia and lower ABI in Tx patients; Tac increased more diastolic BP increase, hyperglycemia and increased creatinine.
Description
Keywords
Böbrek nakli, Kalsinörin inhibitörleri, Kardiyovasküler risk, Antropometrik ölçümler, Renal transplantation, Calcineurin inhibitors, Cardiovascular risk, Anthropometric measurements
Citation
Sayılar, E. I. (2015). Böbrek nakli hastalarında kalsinörin inhibitörlerinin kardiyovasküler risk faktörleri ve kardiyovasküler olaylar üzerine etkilerinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.