Akromegali hastalarında IGF-1 ve büyüme hormonu ile santral aort basıncı ve augmentasyon indeksi arasındaki ilişkinin değerlendirilmesi
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Date
2016
Authors
Dereli, Seçkin
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Publisher
Uludağ Üniversitesi
Abstract
Akromegali aşırı miktarda büyüme hormonu (GH) ve insülin benzeri büyüme faktörü (IGF-1) salınımı ile karakterize bir sendromdur. Akromegalik hastalar arasında kardiyovasküler hastalıkların yüksek prevalansı bildirildikçe, GH ve IGF-1 ile kardiyovasküler sistem arasındaki ilişki daha fazla ilgi çekmeye başlamıştır. Bu hastalarda endotel disfonksiyonuna işaret eden güçlü kanıtlar vardır. Son zamanlarda arteriyel sertlik ve ilişkili endotelyal disfonksiyonu öngörmede augmentasyon indeksi (AIX) ve santral aort basıncı (SAB) gibi yeni parametreler kullanılmaktadır. Çalışmamızda tedavi ile kontrol altına alınan ve alınamayan akromegali hastalarında non-invaziv olarak ölçülen kardiyovasküler risk belirteçleri, büyüme hormonu ve IGF-1 parametreleri arasındaki ilişkiyi değerlendirmeyi amaçladık. Çalışmaya 53 akromegalili hasta ve 20 kontrol grubu dahil edildi. Hastalar 21'i aktif akromegali (AA), 32'si tedavi ile kontrol edilmiş akromegali (KA) olmak üzere iki gruba ayrıldı. İki grubun serumlarında açlık plazma glukozu, kan lipitleri, GH, IGF-1, HgbA1c değerleri ölçüldü ve hastalardan hemogram çalışıldı. Boy ve kiloya göre vücut kitle indeksi hesaplanıldı. Arteriyel sertlik invaziv olmayan CardioScope II Arteriograf cihazı ile değerlendirildi. Arteriyel sertlik parametreleri akromegali hastalarında kontrol grubuna göre daha yüksek saptandı. Augmentasyon indeksi; AA grubunda ortalama %98, KA grubunda %92 ve kontrol grubunda %79.5 bulunarak gruplar arasında istatiksel açıdan anlamlı olarak farklı saptandı (p<0.05). Santral aort basıncı ise en yüksek AA grubunda izlendi ve KA grubunda kontrol grubuna göre anlamlı derecede farklı saptandı (p<0.05). Akromegaliklerde kontrol grubuna göre GH, IGF-1, plazma glukozu, trombosit ölçümleri anlamlı derecede yüksek saptandı. Hem AA hem KA hastalarında regresyon analizi sonucunda HgbA1c ve trombosit sayısı ile arteryel sertlik parametreleri arasında güçlü korelasyon izlendi fakat bu ilişki IGF-1 ve GH düzelerinde izlenmedi. Kontrol grubunda ise açlık kan şekeri, HgbA1c ve trombosit seviyesi ile augmentasyon indeksi ilişkili saptandı. Tedavi alan ve almayan akromegali hastalarındaki arteriyel akromegali hastalarındaki değerlendirildiği çalışmamız sonucunda; hem AA grubunda hem de KA grubunda arteryel sertliğin göstergesi olan AIX ve santral kan basıncının kontrol grubuna göre anlamlı olarak daha yüksek olduğunu saptadık. Sonuçlar akromegalili hastalarda tedavi ile artmış arteryel sertliğin bazal değerlere gerilemediğine gösterilmiştir.
Acromegaly is a syndrome characterized by (GH) and (IGF-1) oversecretion. The relation between GH, IGF-1 and the cardiovascular system has raised great interest as a prevalence of cardiovascular disease has been described in acromegalic patients. There is strong evidence on endothelial dysfunction in hypertensive patients. Recently augmentation index (AIX) and central aortic pressure are used as the new parameters, as predictors of endothelial dysfunction associated with arterial stiffness. In this study, we aimed to investigate the role of GH, IGF-1 and cardiovascular risk predictors in the pathogenesis of arterial stiffness in both active and controlled acromegaly patients. 53 patients and 20 healthy controls were included in the study. We divided patients in two groups: active acromegaly (AA) and controlled acromegaly (KA). Blood glucose, lipids, GH, IGF-1, HgbA1c levels were assayed in sera of the subjects of both groups. White blood cell and platelet were analyzed from full blood count in acromegaly patients and control cases. BMI was calculated according to height and weight values. Arterial stiffness was assessed non-invasively by using CardioScope II Arteriograph Arterial stiffness parameters were found to be higher in acromegaly patients. Augmentation index (AIX) value was found to be 98% in AA group, 92% KA group and 79.5% in the control group and the difference was statistically significant (p<0.05). Central systolic pressure in AA group was significantly higher than both KA group and the control group (p<0.05). Also GH, IGF-1, Plasma glucose, platelet levels were significantly higher in both AA and KA group (p<0.05). Age, white blood cell, hemoglobin and lipid levels were similar comparing patients and controls. Regression analysis revealed HgbA1c, platelet level inversely, as significantly and independently associated with AIX in acromegaly patients. In control cases plasma glucose, HgbA1c and BMI were correlated with AIX. In a result of our study that evaluate arterial stiffness in acromegaly patients whom either receive treatment or not; it's found that both group AA and group KA have higher AIX and central blood pressure which shows arterial stiffness than control group. Results show that in acromegaly patients arterial stiffness hasn't regressed with treatment.
Acromegaly is a syndrome characterized by (GH) and (IGF-1) oversecretion. The relation between GH, IGF-1 and the cardiovascular system has raised great interest as a prevalence of cardiovascular disease has been described in acromegalic patients. There is strong evidence on endothelial dysfunction in hypertensive patients. Recently augmentation index (AIX) and central aortic pressure are used as the new parameters, as predictors of endothelial dysfunction associated with arterial stiffness. In this study, we aimed to investigate the role of GH, IGF-1 and cardiovascular risk predictors in the pathogenesis of arterial stiffness in both active and controlled acromegaly patients. 53 patients and 20 healthy controls were included in the study. We divided patients in two groups: active acromegaly (AA) and controlled acromegaly (KA). Blood glucose, lipids, GH, IGF-1, HgbA1c levels were assayed in sera of the subjects of both groups. White blood cell and platelet were analyzed from full blood count in acromegaly patients and control cases. BMI was calculated according to height and weight values. Arterial stiffness was assessed non-invasively by using CardioScope II Arteriograph Arterial stiffness parameters were found to be higher in acromegaly patients. Augmentation index (AIX) value was found to be 98% in AA group, 92% KA group and 79.5% in the control group and the difference was statistically significant (p<0.05). Central systolic pressure in AA group was significantly higher than both KA group and the control group (p<0.05). Also GH, IGF-1, Plasma glucose, platelet levels were significantly higher in both AA and KA group (p<0.05). Age, white blood cell, hemoglobin and lipid levels were similar comparing patients and controls. Regression analysis revealed HgbA1c, platelet level inversely, as significantly and independently associated with AIX in acromegaly patients. In control cases plasma glucose, HgbA1c and BMI were correlated with AIX. In a result of our study that evaluate arterial stiffness in acromegaly patients whom either receive treatment or not; it's found that both group AA and group KA have higher AIX and central blood pressure which shows arterial stiffness than control group. Results show that in acromegaly patients arterial stiffness hasn't regressed with treatment.
Description
Keywords
Akromegali, Büyüme hormonu, İnsülin benzeri büyüme faktörü-1, Arteryel sertlik, Acromegaly, Growth hormone, Insuline like growth hormone-1, Arterial stiffness
Citation
Dereli, S. (2016). Akromegali hastalarında IGF-1 ve büyüme hormonu ile santral aort basıncı ve augmentasyon indeksi arasındaki ilişkinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.