Son dönem böbrek yetmezliğindeki hastalarda r-HuEPO ve testosteron ester bileşiminin serum lipid ve lipoprotein profili üzerine olan etkilerinin karşılaştırılması
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Date
2001
Authors
Aslanhan, İsmail
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Amaç: Kronik hemodiyaliz tedavisi gören hastalarda, ateroskleroza bağlı kardiyovasküler hastalıklar önemli morbidite ve mortalite nedenidir. Ateroskleroz oluşmasında serum lipid profili önemli rol oynamaktadır. Biz bu çalışmamızda hemodiyaliz hastalarında renal anemi tedavisinde kullanılan rekombinant human eritropoietin (r-HuEPO) ile androjen tedavilerinin serum lipid ve lipoprotein parametreleri üzerine olan etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Kronik hemodiyaliz tedavisi uygulanan 19 erkek hasta çalışmaya alındı. Hastalara haftada iki veya üç kez 4 saat süre ile asetat hemodiyalizi yapıldı. Hastalar rastgele 2 gruba aynldılar. İlk gruptaki (Grup I) 9 hastaya her diyaliz sonrası hafta üç kez 50 Ü/kg dozunda subkutan r-HuEPO, ikinci gruptaki (Grup II) 10 hastaya 15 günde bir intramüsküler testosteron esterleri bileşimi (Sustanon ampul) üç ay süreyle uygulandılar. Hastaların tümünde hemen tedavi öncesi ve tedavinin üçüncü ayı sonunda 12 saat açlık sonrası haftanın ilk günü kan örnekleri alındı ve serum glikoz, total kolesterol, trigliserid, HDL-kolesterol, lipoprotein (a), apoprotein A1 ve apoprotein B düzeyleri çalışıldı. VLDL-kolesterol ve LDL-kolesterol düzeyleri Friedewald formüIüne göre hesaplandı. İstatiksel analiz grup içi karşılaştırmalarda nonparametrik Wilcoxon signed rank testi ve gruplar arası karşılaştirmalarda ise nonparametrik Mann Whitney U-testi ile yapıldı. Bulgular: Her iki gruptaki hastaların ortalama yaşları, diyaliz süreleri, sistolik ve diyastolik kan basınçları ile bazal hematolojik ve biyokimyasal parametreleri arasında fark yoktu (p>0.05). Grup l'deki hastalarda tedavi sonrası ortalama HDL-Kolesterol düzeyleri 28 ± 5.5 mg/dl'den 35.1 ± 7.6 mg/dl'ye anlamIı artarken (p<0.01 ), ortalama total kolesterol, trigliserid, LDL ve VLDL-kolesterol düzeylerinde farklılık saptanmadı. Grup ll'de ise bu paramatrelerde anlamlı değişiklik gözlenmedi. Grup l'deki hastalarda tedavi ile ortalama apoprotein A1 düzeyi 120 ± 12.4 mg/dl'den 104.6 ± 20.5 mg/dl'ye ve ortalama apoprotein B düzeyi ise 95.9 ± 25.8 mg/dl'den 82.3 ± 19.1 mg/dl'ye anlamlı azaldı (p<0.05). Grup ll'deki hastaların sadece ortalama lipoprotein (a) düzeyi 42.2 ± 44.2 mg/dl'den 32.9 ± 30.4 mg/dl'ye anlamlı azaldı (p<0.05). Tüm hastaların ortalama hemoglobin ve hematokrit düzeyleri anlamlı yükseldi (p<0.001). Ayrıca her iki gruptaki hastaların ideal kuru ağırlıklarında, serum albumin ve kreatinin düzeylerinde değişiklik saptanmadı. Sonuç: Sonuç olarak hemodiyaliz hastalarında r-HuEPO ve Sustanon tedavilerinin renal anemide düzelme sağladığını gözlemledik. Tek başına r-HuEPO alan hastalarda HDL-kolesterolün anlamlı arttığını, APO A1 ve B düzeyinin anlamlı azaldığını, sadece Sustanon alan hastalarımızda ise Lp(a) düzeyinin anlamlı azaldığını tespit ettik. Fakat serum lipid profili üzerine olan etkileri birbirleriyle karşılaştırıldığında HDL-kolesterol dışında bu parametrelerdeki yüzde değişiklikler arasında anlamlı bir fark olmadığı kanaatine vardık.
Aim: Chronic hemodialysis patients are known to suffer from an increased mortality rate from atherosclerosis. There are many risk factors which predispose to atherosclerosis and among these, lipid abnormalities and hypertension are the most prominent. In this study, we aimed to investigate the effects of recombinant human erythropoietin (rHuEPO) and androgen treatments on serum lipid and lipoprotein parameters in hemodialysis patients. Material and Methods: 19 stable hemodialysis outpatients were included in the study. The cases were divided into two groups, randomly. While 9 cases in the first group (Group I) were receiving subcutaneous rHuEPO at a dose of 50 U/kg three times in a week after each dialysis session, 10 cases in the second group (Group II) received intramuscular testosterone ester compounds once every fifteen days (Sustanon) for 12 weeks. In all cases, after 12 hours fasting, serum glucose, total cholesterol, triglyceride, HDL-cholesterol, apoprotein A1 and Band lipoprotein (a) levels were performed before treatment and in third month of the treatment. VLDL- and LDL cholesterol levels were calculated with Friedewald formula. Statistical analysis was done with Wilcoxon signed rank test in intragroup comparisons, with Mann Whitney U-test in intergroup comparisons. Results: There was no difference between the mean ages, dialysis durations, systolic and diastolic blood pressures, baseline hematological and biochemical parameters of the patients in both groups (p>0.05). While the mean HDL-cholesterol levels of the patients in Group I increase from 28 ± 5.5 mg/di to 35.1 ± 7.6 mg/di after the treatment, (p<0.01), their mean total cholesterol, triglyceride, LDL- and VLDL-cholesterol levels did not change. The changes in these parameters in Group II were not significant. The mean apoprotein A1 and apoprotein B levels of the patients in Group I significantly decreased from 120 ± 12.4 mg/di and 95.9 ± 25.8 mg/di to 104.6 ± 20.5 mg/di and 82.3 = 19.1 mg/di, respectively (p<0.05). The mean lipoprotein (a) levels of patients in Group II decreased from 42.2 ± 44.2 mg/di to 32.9 ± 30.4 mg/di (p<0.05). In all cases, the mean hemoglobin and hematocrite values increased significantly (p<0.001). Additionaly, we did not determine the changes in the ideal dry weights, serum albumin and creatinine levels of the patients in both groups. Conclusion: As a result, we observed that the r-HuEPO and sustanon treatments in hemodialysis patients provided the improvement in renal anemia. We determined that HDL-cholesterol Jewels in the patients who received alone r-HuEPO significantly increased and APO A 1 and B lewels decreased, and that Lp (a) lewels in the patients who received alone sustanon significantly decreased. When the effects of both groups on serum lipid profile were compared each other, we came to the coclision that there was no significantly difference between the percentage changes in these parameters except HDL-cholesterol.
Aim: Chronic hemodialysis patients are known to suffer from an increased mortality rate from atherosclerosis. There are many risk factors which predispose to atherosclerosis and among these, lipid abnormalities and hypertension are the most prominent. In this study, we aimed to investigate the effects of recombinant human erythropoietin (rHuEPO) and androgen treatments on serum lipid and lipoprotein parameters in hemodialysis patients. Material and Methods: 19 stable hemodialysis outpatients were included in the study. The cases were divided into two groups, randomly. While 9 cases in the first group (Group I) were receiving subcutaneous rHuEPO at a dose of 50 U/kg three times in a week after each dialysis session, 10 cases in the second group (Group II) received intramuscular testosterone ester compounds once every fifteen days (Sustanon) for 12 weeks. In all cases, after 12 hours fasting, serum glucose, total cholesterol, triglyceride, HDL-cholesterol, apoprotein A1 and Band lipoprotein (a) levels were performed before treatment and in third month of the treatment. VLDL- and LDL cholesterol levels were calculated with Friedewald formula. Statistical analysis was done with Wilcoxon signed rank test in intragroup comparisons, with Mann Whitney U-test in intergroup comparisons. Results: There was no difference between the mean ages, dialysis durations, systolic and diastolic blood pressures, baseline hematological and biochemical parameters of the patients in both groups (p>0.05). While the mean HDL-cholesterol levels of the patients in Group I increase from 28 ± 5.5 mg/di to 35.1 ± 7.6 mg/di after the treatment, (p<0.01), their mean total cholesterol, triglyceride, LDL- and VLDL-cholesterol levels did not change. The changes in these parameters in Group II were not significant. The mean apoprotein A1 and apoprotein B levels of the patients in Group I significantly decreased from 120 ± 12.4 mg/di and 95.9 ± 25.8 mg/di to 104.6 ± 20.5 mg/di and 82.3 = 19.1 mg/di, respectively (p<0.05). The mean lipoprotein (a) levels of patients in Group II decreased from 42.2 ± 44.2 mg/di to 32.9 ± 30.4 mg/di (p<0.05). In all cases, the mean hemoglobin and hematocrite values increased significantly (p<0.001). Additionaly, we did not determine the changes in the ideal dry weights, serum albumin and creatinine levels of the patients in both groups. Conclusion: As a result, we observed that the r-HuEPO and sustanon treatments in hemodialysis patients provided the improvement in renal anemia. We determined that HDL-cholesterol Jewels in the patients who received alone r-HuEPO significantly increased and APO A 1 and B lewels decreased, and that Lp (a) lewels in the patients who received alone sustanon significantly decreased. When the effects of both groups on serum lipid profile were compared each other, we came to the coclision that there was no significantly difference between the percentage changes in these parameters except HDL-cholesterol.
Description
Keywords
Hemodiyaliz, Renal anemi, Eritropoietin, Dislipidemi, Androjen, Hemodialysis, Renal anemia, Erythropoietin, Androgen, Dyslipidemia
Citation
Aslanhan, İ. (2001). Son dönem böbrek yetmezliğindeki hastalarda r-HuEPO ve testosteron ester bileşiminin serum lipid ve lipoprotein profili üzerine olan etkilerinin karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.