TNF-α inhibitörleri ile tedavi edilen inflamatuar bağırsak hastalarının lipid profillerindeki etkilenmenin araştırılması – retrospektif çalışma
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Date
2017
Authors
Burgucu, Burcu Bozkurt
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Publisher
Uludağ Üniversitesi
Abstract
İnflamatuar bağırsak hastalıkları (İBH) klinik, endoskopik ve histopatolojik özelliklerine göre Crohn hastalığı (CH) ve ülseratif kolit (ÜK) olarak iki grupta sınıflandırılmış non-enfeksiyöz, sistemik inflamautar bir hastalık grubudur. Kronik inflamatuar hastalıklarda görülen sistemik inflamasyonun ateroskleroz gelişmesinde önemli rol oynadığını gösteren çok sayıda kanıt vardır ve ayrıca sistemik inflamatuvar hastalıklarda hastaların genel populasyona göre kardiyovasküler mortalite riskinde artış görülmektedir. IBH'si olan hastalarda, subklinik erken ateroskleroz gelişme riski daha yüksektir. Tümör nekroz faktör-alfa (TNF-α) İBH'de inflamasyonun patogenezinde merkezi bir role sahiptir. Ayrıca, anti-TNF-α inflamatuar koşullarda lipid profilinde bozulmaya neden olabilmektedir. Biz bu çalışmada Uludağ Üniversitesi Tıp Fakültesi Hastanesi Gastroenteroloji Bilim Dalı Polikliniği'ne 2009-2016 yılları arasında başvuran, 18-65 yaş arasında, klinik, radyolojik, endoskopik ve histolojik kriterlere uygun olarak inflamatuar bağırsak hastalığı tanısı almış ve anti-TNF tedavi (İnfliksimab veya Adalimumab) başlanması uygun görülmüş 52 (25 tanesi ülseratif kolit tanılı; 21 tanesi İnfliksimab tedavisi altında; 28'i kadın) hastanın tedavi öncesi ve tedavi sonrasındaki total kolesterol, düşük dansiteli lipoprotein (LDL-C), yüksek dansiteli lipoprotein (HDL-C) , trigliserid (TG) ve atherojenik indeks (Aİ) düzeylerini retrospektif olarak taradık. Hasta seçimi az üç doz İnfliksimab (0, 2 ve 6. haftalarda 5 mg/kg) veya üç doz Adalimumab (0. haftada 160 mg, 2. haftada 80 mg, 4. haftada 40 mg/2 hafta) almış hastalardan yapıldı. Çalışma sonucunda anti-TNF tedavinin (İnfliksimab veya Adalimumab) total kolesterol, trigliserid, HDL-C, LDL-C ve ateroskerotik indeksi etkilemediği görüldü. Yapılan pek çok çalışmada TNF inhibitörlerinin kan lipit seviyelerine ve erken bir atherosklerotik prediktif belirteç olan atherojenik indeks (total kolesterol/HDL oranına) etkileri arasında tutarlı sonuçlar bulunamamıştır. Tüm bu verilerin ışığında, uzun vadeli bir takip periyodunda anti-TNF ile iii tedavi edilen hastalardaki kardiyovasküler olayların prospektif büyük kohortlarda değerlendirilmesi uygun olacaktır.
Inflammatory bowel disease (IBD) is a non-infectious, systemic inflammatory disease group classified into two groups according to the clinical, endoscopic and histopathological features; Crohn's disease (CD) and ulcerative colitis (UC). There is a great deal of evidence that systemic inflammation in chronic inflammatory diseases plays an important role in the development of atherogenesis and systemic inflammatory disease has an increased risk of cardiovascular mortality compared to the general population. In patients with IBD, the risk of developing subclinical early atherosclerosis is higher. Tumor necrosis factor-alpha (TNF-α) has a central role in the pathogenesis of inflammation in IBD. In addition, anti-TNF-α may cause deterioration of lipid profile in inflammatory conditions. In this study, we diagnosed inflammatory bowel disease according to clinical, radiological, endoscopic and histological criteria between the ages of 18 and 65, who applied to Uludag University Medical Faculty Hospital Gastroenterology Science Department Policlinic between 2009-2016 and was treated with anti-TNF treatment (Infliximab or Adalimumab), we retrospectively analyzed total cholesterol, LDL-C, HDL-C, triglyceride and atherogenic index levels before and after treatment in 52 (25 of them were ulcerative colitis; 31 of them were treated with Adalimumab; 28 of them were women) eligible patients. Patient selection was made from patients who received at least three doses of Infliximab (5 mg/kg at 0, 2 and 6 weeks) or three doses of Adalimumab (160 mg/week followed by 80 mg/2 weeks and then 40 mg/2 weeks). As a result of this study, anti-TNF treatment (Infliximab or Adalimumab) did not affect total cholesterol, triglyceride, HDL-C, LDL-C and atherogenic index. v In many studies, there were no consistent results between the effects of TNF inhibitors on blood lipid levels and atherogenic index (the ratio of total cholesterol / HDL) which is an early atherosclerotic predictive marker. In the light of all these data, it may be appropriate to evaluate cardiovascular events in patients treated with anti-TNF in a long-term follow-up period in prospective large cohorts.
Inflammatory bowel disease (IBD) is a non-infectious, systemic inflammatory disease group classified into two groups according to the clinical, endoscopic and histopathological features; Crohn's disease (CD) and ulcerative colitis (UC). There is a great deal of evidence that systemic inflammation in chronic inflammatory diseases plays an important role in the development of atherogenesis and systemic inflammatory disease has an increased risk of cardiovascular mortality compared to the general population. In patients with IBD, the risk of developing subclinical early atherosclerosis is higher. Tumor necrosis factor-alpha (TNF-α) has a central role in the pathogenesis of inflammation in IBD. In addition, anti-TNF-α may cause deterioration of lipid profile in inflammatory conditions. In this study, we diagnosed inflammatory bowel disease according to clinical, radiological, endoscopic and histological criteria between the ages of 18 and 65, who applied to Uludag University Medical Faculty Hospital Gastroenterology Science Department Policlinic between 2009-2016 and was treated with anti-TNF treatment (Infliximab or Adalimumab), we retrospectively analyzed total cholesterol, LDL-C, HDL-C, triglyceride and atherogenic index levels before and after treatment in 52 (25 of them were ulcerative colitis; 31 of them were treated with Adalimumab; 28 of them were women) eligible patients. Patient selection was made from patients who received at least three doses of Infliximab (5 mg/kg at 0, 2 and 6 weeks) or three doses of Adalimumab (160 mg/week followed by 80 mg/2 weeks and then 40 mg/2 weeks). As a result of this study, anti-TNF treatment (Infliximab or Adalimumab) did not affect total cholesterol, triglyceride, HDL-C, LDL-C and atherogenic index. v In many studies, there were no consistent results between the effects of TNF inhibitors on blood lipid levels and atherogenic index (the ratio of total cholesterol / HDL) which is an early atherosclerotic predictive marker. In the light of all these data, it may be appropriate to evaluate cardiovascular events in patients treated with anti-TNF in a long-term follow-up period in prospective large cohorts.
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Keywords
Crohn hastalığı, Ülseratif kolit, İnfliksimab, Adalimumab, Kolesterol, Trigliserid
Citation
Burgucu, B. B. (2017). TNF-α inhibitörleri ile tedavi edilen inflamatuar bağırsak hastalarının lipid profillerindeki etkilenmenin araştırılması – retrospektif çalışma. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.