KOAH olgularında nokturnal hipoksinin sistemik inflamasyon üzerine etkilerinin değerlendirilmesi
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Date
2013
Authors
Cengiz, Arzu Ertem
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Kronik Obstrüktif Akciğer Hastalığı (KOAH) sistemik inflamasyon ile seyreden bir hastalıktır ve sistemik infalamasyon KOAH'ta morbidite ve mortalitenin ana nedenidir. Hipoksi ise sistemik inflamasyonun oluşumunda çok önemli bir rol oynamaktadır. Nokturnal hipoksi KOAH'lı hastalarda tek başına görülebildiği gibi Obstrüktif Uyku Apne Sendromu (OSAS)'un eşlik etmesi nedeniyle de görülebilir. OSAS ve KOAH birlikteliği yani Overlap Sendromu (OS) toplumda % 1 sıklığında görülmektedir. Bu iki hastalığın birlikteliğinde sistemik inflamasyon şiddeti daha da artmaktadır. Bu nedenle de OS'lı hastalarda morbidite ve mortalite daha fazla oranda görülmektedir.Bu çalışmanın amacı orta ve ağır KOAH' lı hastalarda nokturnal hipoksinin inflamasyon ile ilişkisini, nokturnal hipoksi sebebi OSAS saptanan grupta inflamasyon şiddetindeki artışı değerlendirmek ve inflamasyonla ilişkili faktörleri araştırmaktı.Çalışmamıza 29 KOAH'lı hasta dahil edilmiştir. Karşılaştırma 19 KOAH'lı ve 10 OS'lı 2 hasta grubu arasında yapılmıştır. İnflamasyon belirteci olarak kullanılan highsensitif CRP (hsCRP) OS'lı grupta 0,72 mg/l , KOAH'lı grupta ise 0,39 mg/dl olarak saptanmıştır. Bu fark istatistiksel olarak anlamlı bulunmuştur. Bir diğer belirteç olan TNF ise iki grup arasında anlamlı düzeyde farklı bulunmamıştır. Korelasyon analizinde hsCRP ile sigara kullanımı (paket /yıl) ve PSG'de tespit edilen saturasyonun % 90 `ın altında kalma süresi ile pozitif korelasyon, yine PSG'de tespit edilen ortalama saturasyon düzeyi ile negatif korelasyon saptanmıştır. 18 kişiye uygulanan KPET ve Body Pletismografsi ile MIP,,MEP ölçümlerinde 6 OS'lı ve 12 KOAH' lı grup karşılaştırmasında anlamlı fark saptanmamıştır.Sonuç olarak bu çalışma OS'lı grup ile KOAH'lı grubu inflamasyon düzeyi açısından karşılaştırıldığında OS'lı grupta artmış hsCRP düzeyleri ile bu grupta inflamasyon şiddetinin daha yüksek olduğunu kanıtlar niteliktedir.
COPD is associated with systemic inflammation and the main cause of morbidity and mortality in COPD is systemic inflammation. Hypoxia plays a very important role in the formation of systemic inflammation Nocturnal hypoxia can be seen as an alone component in COPD or as a component of overlap syndrome. Overlap syndrome, which is the association of COPD and obstructive sleep apnea syndrome, has in incidence of %1 in population. Comorbidity of these two disorders is increasing the severity of systemic inflammation and therefore increasing mortality and morbidity.The aim of this study was to analyze the relationship between systemic inflammation and nocturnal hypoxia in patients with moderate and severe COPD. An other aim of the study was to determine the severity of inflammation and the factors assosiated with systemic inflammation in the group of patients who had OSAS as the cause of nocturnal hypoxia.From 29 patients with COPD examined in our study, 19 of them presented overlap syndrome. Highsensivtive CRP (hsCRP) and TNF were used as systemic inflammation markers. Patients with OS had an average of 0,72 mg/l hsCRP meanwhile patients with COPD had an average of 0,39 mg/dl. The differance between this average values was statistically revelant. On the other hand the difference of TNF levels between two groups was not statistically revelant. hsCRP levels were in corelation with cigarette usage and lower saturation at PSG studies. Results of KPET and Pletismografy studies were not statistically revelant.To conclude, COPD patients presenting a lower level of hsCRP have a less severity of inflammation than OS patients. This study is one of the rare studies on this field and can be concidered as a pilot a study.
COPD is associated with systemic inflammation and the main cause of morbidity and mortality in COPD is systemic inflammation. Hypoxia plays a very important role in the formation of systemic inflammation Nocturnal hypoxia can be seen as an alone component in COPD or as a component of overlap syndrome. Overlap syndrome, which is the association of COPD and obstructive sleep apnea syndrome, has in incidence of %1 in population. Comorbidity of these two disorders is increasing the severity of systemic inflammation and therefore increasing mortality and morbidity.The aim of this study was to analyze the relationship between systemic inflammation and nocturnal hypoxia in patients with moderate and severe COPD. An other aim of the study was to determine the severity of inflammation and the factors assosiated with systemic inflammation in the group of patients who had OSAS as the cause of nocturnal hypoxia.From 29 patients with COPD examined in our study, 19 of them presented overlap syndrome. Highsensivtive CRP (hsCRP) and TNF were used as systemic inflammation markers. Patients with OS had an average of 0,72 mg/l hsCRP meanwhile patients with COPD had an average of 0,39 mg/dl. The differance between this average values was statistically revelant. On the other hand the difference of TNF levels between two groups was not statistically revelant. hsCRP levels were in corelation with cigarette usage and lower saturation at PSG studies. Results of KPET and Pletismografy studies were not statistically revelant.To conclude, COPD patients presenting a lower level of hsCRP have a less severity of inflammation than OS patients. This study is one of the rare studies on this field and can be concidered as a pilot a study.
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Keywords
KOAH, Hipoksi, Inflamasyon, Overlap sendromu, Highsensitif CRP, COPD, Hypoxia, Inflammation, Overlap syndrome, Highsensitive CRP
Citation
Cengiz, A. E. (2013). KOAH olgularında nokturnal hipoksinin sistemik inflamasyon üzerine etkilerinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.