Ankilozan spondilitli hastalarda diyastolik fonksiyon parametreleri ile serum adma düzeyi arasındaki ilişkinin değerlendirilmesi
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
Amaç: Bu çalışmadaki amacımız Ankilozan Spondilitli (AS) hastalarda diyastolik fonksiyon parametreleri ile serum Asimetrik Dimetil Arjinin (ADMA) düzeyleri arasındaki ilişkiyi değerlendirmekti. Ayrıca uygulanan farklı tedavi stratejilerinin ADMA ve diyastolik fonksiyon parametreleri üzerindeki etkilerini araştırdık. Metod: Bilinen klasik kardiyovasküler hastalık, risk faktörü ve semptomu olmayan 60 AS hastası (32.16±7.79 yaş, 53/7 E/K) ve 40 kontrol (29.92±7.29 yaş, 35/5 E/K) çalışmaya alındı. Glukoz, lipid düzeyleri, C Reaktif Protein (CRP), Eritrosit sedimentasyon hızı (ESH) ve ADMA düzeyleri çalışıldı. Hastalık aktivitesi Bath Ankylosing Spondylitis Disease Activity Index (BASDAİ), fonksiyonel durum Bath Ankylosing Spondylitis Functionel Index (BASFİ), spinal mobilite ise Bath Ankylosing Spondylitis Metrology Index (BASMİ) ölçümleri ile değerlendirildi. 2D (İki boyutlu), M-mod, standart ve doku Doppler ile ekokardiyografik ölçümler gerçekleştirildi. Bulgular: CRP, ESH ve ADMA düzeyleri AS grubunda kontrole göre belirgin olarak yüksek saptandı. Standart Doppler ekokardiyografi ile AS grubunda 6 (%10), kontrol grubunda ise 2 (%5) hastada Diyastolik Disfonksiyon (DD) saptandı, ancak fark istatiksel olarak anlamlı değildi (p=0.36). Doku Doppler (TDI) ile yapılan ekokardiyografik değerlendirmede ise AS grubunda 12 (%20), kontrol grubunda ise 3 (%8) hastada DD saptandı. Standart metoda göre doku Doppler ile AS grubunda DD saptanan hastalar 2 kat daha fazla olmasına rağmen istatiksel anlamlılık düzeyine ulaşmadı (p=0.08). 3 grubu (anti-TNF?, konvansiyonel tedavi ve kontrol grubu) serum ADMA, CRP, ESH düzeyleri ve ekokardiyografik parametreler açısından karşılaştırdık. ADMA, ESH ve CRP düzeyleri açısından gruplar arasında istatiksel olarak anlamlı fark saptadık. Serum ADMA düzeylerini Anti-TNF? tedavisi alanlarda konvansiyonel tedavi alanlara göre anlamlı olarak daha düşük saptadık (p<0.001). Kontrol grubunun serum ADMA düzeyi ise her iki tedavi grubundan anlamlı olarak daha düşüktü (p<0.001). Serum ADMA düzeyleri ile klinik, labaratuvar ve ekokardiyografik parametreler arasında korelasyon saptamadık. Sonuç: Bilinen klasik kardiyovasküler risk faktörü olmayan nispeten genç AS hastalarında ADMA düzeyinin artışı bozulmuş Nitrik Oksit (NO) metabolizmasını akla getirmektedir. Konvansiyonel tedavi alanlara göre ADMA düzeyinin anti-TNF? tedavisi alanlarda istatiksel olarak belirgin düşük olması, Anti-TNF? tedavisinin AS hastalarının vasküler fonksiyonlarına ve ADMA düzeylerinin düşürülmesine ek faydası olabilir. Özellikle TDI tekniği kullanılarak daha fazla DD saptanabileceğini gösterdik. Subklinik aşamada kardiyak tutulumun varlığının tespit edilmesi alınacak önlemlerle hastalığın uzun dönem prognozu üzerine olumlu etki sağlayabilir. AS hastalarında ADMA düzeyi ile diyastolik fonksiyon parametreleri arasında korelasyon saptamadık. Anahtar kelimeler: Ankilozan Spondilit, ADMA, diyastolik disfonksiyon, anti-TNF? tedavisi, doku Doppler
Objective: The aim of this study was to evaluate between parameters of diastolic function and serum ADMA levels in patients with ankylosing spondilitis. İn addition we investigated different treatment strategies effects of ADMA and diastolic function parameters. Methods : 60 AS patients (32,16±7,79 years, 53 M/ 7 F) and 40 control (29,92 ±7,29 years, 35 M/ 5F) subjects without classical cardiovascular (CV) risk factors, CV disease and symptoms were studied. Glucose, serum lipids, CRP, ESR, ADMA were studied. Spinal mobility, disease activity and functional status were assessed with Bath Ankylosing Spondylitis Metrology Index (BASMİ), Bath Ankylosing Spondylitis Disease Activity Index (BASDAİ) and Bath Ankylosing Spondylitis Functionel Index (BASFİ). Two- dimensional, M-Mod, SDE, PW-TDI echocardiography examinations were performed. Results: Acute phase reactants (CRP, ESR) and ADMA levels were significantly higher in AS group compared to the control. Two (5%) control subjects and 6 (10%) AS patients met the left ventricular diastolic dysfunction (DD) criteria by using conventional Doppler echocardiography, but the difference was not statistically significant (p=0,36). However, using PW-TDI method 12 (20%) patients in the AS group and 3 (8%) subjects in the control group were diagnosed to have LVDD. According to the standard method of tissue Doppler patient with AS group DD did not reach statistical significance although were than 2 times (p=0,08). Third group (Anti TNF, conventional treatment and the control group) were compared in terms of serum ADMA, CRP, ESR levels and echocardiographic parameters. We found plasma ADMA, ESR and CRP levels statistically significant difference between the groups. Anti TNF theraphy, according to conventional theraphy areas we found significantly lower serum ADMA levels (p<0,001). İn the control group, serum ADMA levels were significantly lower in both treatment groups (p<0,001). We did not find a correlation between serum levels of ADMA, clinical, laboratory and echocardiographic parameters. Conclusion: The increased ADMA levels obtained in a group relatively young AS patients who did not have classical CV risk factors suggest that Nitric Oxide (NO) metabolism is impaired in AS. According to conventional treatment areas who take anti TNF theraphy, to be statically significantly lower; Anti TNF treatments may have benefical effect on vascular function and reduce ADMA levels in AS. Especially be detected using the technique of TDI showed more DD. To detect the presence of subclinical cardiac involvement in stage measures to be taken, can provide a positive impact on long term prognosis of the disease. We did not find correlation between ADMA levels and diastolic function parameters in AS patients. Keywords: Ankylosing Spondylitis, Diastolic disfunctions, ADMA, Anti TNF? treatment, Tissue Doppler Imaging
Objective: The aim of this study was to evaluate between parameters of diastolic function and serum ADMA levels in patients with ankylosing spondilitis. İn addition we investigated different treatment strategies effects of ADMA and diastolic function parameters. Methods : 60 AS patients (32,16±7,79 years, 53 M/ 7 F) and 40 control (29,92 ±7,29 years, 35 M/ 5F) subjects without classical cardiovascular (CV) risk factors, CV disease and symptoms were studied. Glucose, serum lipids, CRP, ESR, ADMA were studied. Spinal mobility, disease activity and functional status were assessed with Bath Ankylosing Spondylitis Metrology Index (BASMİ), Bath Ankylosing Spondylitis Disease Activity Index (BASDAİ) and Bath Ankylosing Spondylitis Functionel Index (BASFİ). Two- dimensional, M-Mod, SDE, PW-TDI echocardiography examinations were performed. Results: Acute phase reactants (CRP, ESR) and ADMA levels were significantly higher in AS group compared to the control. Two (5%) control subjects and 6 (10%) AS patients met the left ventricular diastolic dysfunction (DD) criteria by using conventional Doppler echocardiography, but the difference was not statistically significant (p=0,36). However, using PW-TDI method 12 (20%) patients in the AS group and 3 (8%) subjects in the control group were diagnosed to have LVDD. According to the standard method of tissue Doppler patient with AS group DD did not reach statistical significance although were than 2 times (p=0,08). Third group (Anti TNF, conventional treatment and the control group) were compared in terms of serum ADMA, CRP, ESR levels and echocardiographic parameters. We found plasma ADMA, ESR and CRP levels statistically significant difference between the groups. Anti TNF theraphy, according to conventional theraphy areas we found significantly lower serum ADMA levels (p<0,001). İn the control group, serum ADMA levels were significantly lower in both treatment groups (p<0,001). We did not find a correlation between serum levels of ADMA, clinical, laboratory and echocardiographic parameters. Conclusion: The increased ADMA levels obtained in a group relatively young AS patients who did not have classical CV risk factors suggest that Nitric Oxide (NO) metabolism is impaired in AS. According to conventional treatment areas who take anti TNF theraphy, to be statically significantly lower; Anti TNF treatments may have benefical effect on vascular function and reduce ADMA levels in AS. Especially be detected using the technique of TDI showed more DD. To detect the presence of subclinical cardiac involvement in stage measures to be taken, can provide a positive impact on long term prognosis of the disease. We did not find correlation between ADMA levels and diastolic function parameters in AS patients. Keywords: Ankylosing Spondylitis, Diastolic disfunctions, ADMA, Anti TNF? treatment, Tissue Doppler Imaging
Açıklama
Anahtar Kelimeler
Ankilozan spondilit, Ankylosing spondylitis, ADMA, Diyastolik disfonksiyon, Diastolic disfunctions, Anti-TNFα tedavisi, Anti TNFα treatment, Doku Doppler, Tissue Doppler Imaging
