Akut koroner sendromlu hastalarda serum trombosit kaynaklı büyüme faktörü beta düzeylerinin tanısal değerinin araştırılması
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Dosyalar
Tarih
2021
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Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Akut koroner sendrom koroner arterde meydana gelen plak rüptürünün koroner kan akımını engellemesi sonucu miyokardın oksijen ihtiyacının artması ile karakterizedir. ST yükselmesi olmayan miyokard infarktüsü, unstabil angina pektoris ve ST yükselmeli miyokard infarktüsü olarak üç alt tipi mevcuttur. Mortalitesi yüksek olan bu hastalığın tanısı ve tedavisinin hızlı olması gerekmektedir. Kreatin kinaz, yüksek duyarlı troponin T gibi laboratuvar testleri tanıyı desteklemek amacıyla kullanılmasına rağmen daha hızlı ve güvenilir tanı ve dışlama için kullanılacak yeni marker arayışları devam etmektedir. Çalışmamızda bu belirteçlerden biri olabileceği düşünülen trombosit kaynaklı büyüme faktörü-beta’nın akut koroner sendrom olgularında tanısal değerliliği araştırılmak amaçlanmıştır. Çalışmamız acil servise başvurmuş gönüllüler ile prospektif ve tek merkezli olarak yapılmıştır. Çalışmamıza, çalışmaya dahil edilme kriterlerini karşılayan ST yükselmesi olmayan miyokard infarktüsü tanısı alan 25 hasta, ST yükselmeli miyokard infarktüsü tanısı alan 25 hasta ve 25 kontrol grubu şeklinde 75 kişi dahil edilmiştir. Çalışmamızda anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Çalışmamızda hastaların yaş ortalaması kontrol grubunda 61,8±10,5, ST yükselmesi olmayan miyokard infarktüsü grubunda 63,8±12,8 ve ST yükselmeli miyokard infarktüsü grubunda 63,2±14,3 olarak saptandı. Kontrol grubunun %68’si, ST yükselmesi olmayan miyokard infarktüsü grubunun %76’sı ve ST yükselmeli miyokard infarktüsü grubunun %76’sı kadındı. Trombosit kaynaklı büyüme faktörü-beta düzeyi; ST yükselmesi olmayan miyokard infarktüsü grubunda 225,7±77,6 ve ST yükselmeli miyokard infarktüsü grubunda 118,8±20,1 olarak tespit edildi. Kontrol grubuna göre ST yükselmesi olmayan miyokard infarktüsü ve ST yükselmeli miyokard infarktüsü gruplarında trombosit kaynaklı büyüme faktörü-beta düzeyleri anlamlı derecede daha yüksek bulundu. ST yükselmesi olmayan miyokard infarktüsü grubunda ST yükselmeli miyokard infarktüsü grubuna göre trombosit kaynaklı büyüme faktörü-beta düzeyi anlamlı derecede daha yüksekti. Yüksek duyarlı troponin T ile trombosit kaynaklı büyüme faktörü-beta değerleri arasında pozitif yönlü anlamlı bir ilişki olduğu görüldü (p<0,001). Hipertansiyon varlığında trombosit kaynaklı büyüme faktörü-beta düzeyi anlamlı olarak daha yüksek bulundu. HEART skoru ile trombosit kaynaklı büyüme faktörü-beta düzeyinin arasında pozitif yönlü orta seviyede doğrusal ilişki, GRACE skoru ile de negatif yönlü zayıf doğrusal ilişki saptandı. Mortalite, cinsiyet, yaş ile trombosit kaynaklı büyüme faktörü-beta düzeyi arasında anlamlı ilişki saptanmadı. Çalışmamızda trombosit kaynaklı büyüme faktörü-beta’nın akut koroner sendrom için tanısal bir test olarak kullanılabileceği tespit edildi. Mortalite açısından yeterli bilgiyi vermemektedir. Literatürde öncü çalışma olan bu çalışma ışığında örneklem sayısının arttırılarak daha net sonuçlar elde edilebileceğini düşünmekteyiz.
Acute coronary syndrome is characterized by an increase in myocardial oxygen demand as a result of plaque rupture in the coronary artery preventing coronary blood flow. There are three subtypes of non-ST-elevation myocardial infarction; unstable angina pectoris and STelevation myocardial infarction. Diagnosis and treatment of this disease with high mortality is required. Although laboratory tests such as creatine kinase and high sensitive troponin are used to support the diagnosis, the search for new markers to be used for quicker and more reliable diagnosis and exclusion continues. In our study, we aimed to investigate the diagnostic value of serum platelet derived growth factor-beta, which is thought to be one of these biomarkers, in patients with acute coronary syndrome. Our study was conducted as a prospective and single-center study with volunteers who applied to the emergency service. Our study included 25 patients diagnosed with non-STelevation myocardial infarction, 25 patients diagnosed with ST-elevation myocardial infarction, and 25 control subjects, who met the criteria for inclusion in the study. In our study, the level of significance was accepted as p<0.05. In our study, the mean age of the patients was 61.8±10.5 in the control group, 63.8±12.8 in the non-ST-elevation myocardial infarction group and 63.2±14.3 in the ST-elevation myocardial infarction group. 68% of the control group, 76% of the non-ST-elevation myocardial infarction group, and 76% of the ST-elevation myocardial infarction group were female. Serum platelet derived growth factor-beta levels were determined as 225.7±77.6 in the non-ST-elevation myocardial infarction group and 118.8±20.1 in the ST-elevation myocardial infarction group. Serum platelet derived growth factor-beta levels were found to be significantly higher in the non-ST-elevation myocardial infarction and ST-elevation myocardial infarction groups when compared to the control group. Serum platelet derived growth factor-beta level was significantly higher in the non-ST-elevation myocardial infarction group than in the STelevation myocardial infarction group. It was observed that there was a significant positive correlation between high sensitive troponin and serum platelet derived growth factor-beta values (p<0.001). In the presence of hypertension, serum platelet derived growth factor-beta levels were found to be significantly higher. A moderately positive linear relationship was found between HEART scores and serum platelet derived growth factor-beta levels, and a weak negative linear relationship was found with Global Registry of Acute Cardiac Events scores. There was no significant relationship between mortality, gender, age and serum platelet derived growth factor-beta levels. In our study, it was determined that serum platelet derived growth factor-beta could be used as a diagnostic test for acute coronary syndrome. It does not provide sufficient information in terms of mortality. In the light of this study, which is a pioneering study in the literature, we think that clearer results can be obtained by increasing the number of samples.
Acute coronary syndrome is characterized by an increase in myocardial oxygen demand as a result of plaque rupture in the coronary artery preventing coronary blood flow. There are three subtypes of non-ST-elevation myocardial infarction; unstable angina pectoris and STelevation myocardial infarction. Diagnosis and treatment of this disease with high mortality is required. Although laboratory tests such as creatine kinase and high sensitive troponin are used to support the diagnosis, the search for new markers to be used for quicker and more reliable diagnosis and exclusion continues. In our study, we aimed to investigate the diagnostic value of serum platelet derived growth factor-beta, which is thought to be one of these biomarkers, in patients with acute coronary syndrome. Our study was conducted as a prospective and single-center study with volunteers who applied to the emergency service. Our study included 25 patients diagnosed with non-STelevation myocardial infarction, 25 patients diagnosed with ST-elevation myocardial infarction, and 25 control subjects, who met the criteria for inclusion in the study. In our study, the level of significance was accepted as p<0.05. In our study, the mean age of the patients was 61.8±10.5 in the control group, 63.8±12.8 in the non-ST-elevation myocardial infarction group and 63.2±14.3 in the ST-elevation myocardial infarction group. 68% of the control group, 76% of the non-ST-elevation myocardial infarction group, and 76% of the ST-elevation myocardial infarction group were female. Serum platelet derived growth factor-beta levels were determined as 225.7±77.6 in the non-ST-elevation myocardial infarction group and 118.8±20.1 in the ST-elevation myocardial infarction group. Serum platelet derived growth factor-beta levels were found to be significantly higher in the non-ST-elevation myocardial infarction and ST-elevation myocardial infarction groups when compared to the control group. Serum platelet derived growth factor-beta level was significantly higher in the non-ST-elevation myocardial infarction group than in the STelevation myocardial infarction group. It was observed that there was a significant positive correlation between high sensitive troponin and serum platelet derived growth factor-beta values (p<0.001). In the presence of hypertension, serum platelet derived growth factor-beta levels were found to be significantly higher. A moderately positive linear relationship was found between HEART scores and serum platelet derived growth factor-beta levels, and a weak negative linear relationship was found with Global Registry of Acute Cardiac Events scores. There was no significant relationship between mortality, gender, age and serum platelet derived growth factor-beta levels. In our study, it was determined that serum platelet derived growth factor-beta could be used as a diagnostic test for acute coronary syndrome. It does not provide sufficient information in terms of mortality. In the light of this study, which is a pioneering study in the literature, we think that clearer results can be obtained by increasing the number of samples.
Açıklama
Anahtar Kelimeler
Akut koroner sendrom, Trombosit kaynaklı büyüme faktörü, Biyobelirteç, Acil servis, Acute coronary syndrome, Platelet derived growth factor, Biomarker, Emergency service
