Gastroözefageal reflü hastalarında ambulatuar kan basıncı takibi ve klinik anlamı
Küçük Resim Yok
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET Gastroözofageal reflü hastalığına sempatik disfonksiyon eşlik edebilse de esasen hastalıkta parasempatik disfonksiyon daha belirgindir. Kardiovasküler sistemde ise kan basıncı regülasyonunda sempatik/parasempatik denge önemli rol oynamaktadır. Her iki sistem de otonomik bozukluklardan etkilebilir. Sempatik etkinlikte artma periferik vazokonstriktör ve taşikardik etkileri ile hiperkinetik dolaşıma neden olmakta, ayrıca böbreklerde renin aktivasyonu ile kan basıncı paternlerini regüle etmektedir. Biz bu çalışmada, patofizyolojisinde otonomik disfonksiyon bulunan GÖRH varlığında kan basıncı paterninin etkilenebileceğini, kanda bulunan ve idrarda atılan bazı maddelerin atılım miktarlarının değişebileceğini (Na, ürik asit, protein ve albumin) düşünerek ambulatuvar kan basıncı ölçümü yanında idrar/kan değerlerini irdelemeyi amaçladık. Çalışmamıza 18 ile 65 yaş arası bireyler alındı. Ambulatuvar kan basıncı ölçümü tüm olgularda yapıldı. Reflü grubuna 50 olgu ve kontrol grubuna 50 olgu alındı. Olguların kan ve idrar örnekleri alındı. Her iki gruba da kardiovasküler hastalığı olan, hipertansiyonu olan, malignitesi olan, astım hastalığı bulunan, gastrik peptik ülseri olan, hepatit hastalığı olan, tüberkülozu olan, reflü dışında gastrointestinal hastalığı olan, serebrovasküler hastalığı olan, vaskülit hastalığı olan, kronik alkol içicisi olan, otonom sinir sistemini etkileyebilecek ilaç kullanan hastalar alınmadı. Reflü grubunda retrosternal ağrının şiddeti ile KH'nin arttığı saptandı. Reflü grubunda DKB değerleri anlamlı olarak azalmış bulundu. Bunun sonucu olarak NB değerleri yüksek bulundu. Reflü grubunda MCV anlamlı olarak düşük, lenfosit sayıları anlamlı olarak yüksek saptandı. Reflü grubunda K ve Cl değerleri anlamlı olarak düşük saptandı. Reflü grubunda istatistiksel anlama ulaşmasa da "Non-dipper" patern fazla bulundu. Sonuç olarak bu çalışmada reflü grubunda NB değerlerinin yüksekliği, LDL kolestrol ve TG yüksekliğinin varlığının saptanması bu hasta grubunda vasküler riskin artmış olabileceği hipotezini desteklemektedir. Bu nedenle GÖRH ile vasküler hastalık ve mortalite ilişkisini ortaya koyacak daha geniş ölçekli çalımaların planlanması uygun görünmektedir. Böylece belki de kardiyovasküler açıdan riskli yeni bir populasyon tanımlanacak ve erken tedavi ile mortalitede düşüş sağlanabilecektir.
SUMMARY Gastroesophageal reflux disease has distortion of sympathetic and parasympathetic components of the autonomic nervous system, but impaired parasympathetic function appears more significant than sympathetic dysfunction. Blood pressure regulation in cardiovascular system can be achieved with the balance of sympathetic/parasympathetic activity. Both gastrointestinal and cardiovascular systems can be affected by autonomic dysfunctions. Increase in sympathetic activity results in hyperkinetic circulation with peripheral vasoconstrictor and tachycardic influences and also regulates blood pressure patterns with increase of renin in kidneys. We planned to study both patterns of pulse pressure in the presence of gastroesophageal reflux disease with autonomic dysfunction in the pathophysiology, and also the alteration levels of some electrolytes (Na, uric acid, protein and albumin) which are present in blood and urine secretes. All individuals included the study were between 18 and 65 years old. Ambulatory blood pressure measuring was performed in all cases. Fifty patients in the reflux group and fifty individuals in the control group were included. Blood and urine specimens were examined. The individuals with cardiovascular disease, hypertension, malignancy, asthma disease, gastric peptic ulcer, hepatitis disease, tuberculosis, gastrointestinal disease excluding reflux, cerebrovascular disease, vasculitic disease, chronic alcohol usage, drugs with affect on autonomic system usage were excluded from study. The heart rate values increased statistically significantly in the same direction of the severity of retrosternal pain. We found statistically significant lower diastolic blood pressure values in reflux group. This resulted with the statistically significant increase in pulse pressure. Both the decrease in MCV values and also the increase in lymphocyte counts in reflux group considered as statistically significant. Both the decrease in potassium levels and also chloride levels in reflux group considered as statistically significant. Non-dipper pattern found more common in reflux group, but considered as statistically unsignificant. In conclusion, we found increased pulse pressure levels, increased LDL cholesterol and trigliserid levels in the reflux group, so this study supports the hypothesis that increased vascular risk may be present in patiens with gastroesophageal reflux disease. Thus, perhaps a new population at risk for cardiovascular disease will be identified and mortality rates will able to decrease with early treatment.
SUMMARY Gastroesophageal reflux disease has distortion of sympathetic and parasympathetic components of the autonomic nervous system, but impaired parasympathetic function appears more significant than sympathetic dysfunction. Blood pressure regulation in cardiovascular system can be achieved with the balance of sympathetic/parasympathetic activity. Both gastrointestinal and cardiovascular systems can be affected by autonomic dysfunctions. Increase in sympathetic activity results in hyperkinetic circulation with peripheral vasoconstrictor and tachycardic influences and also regulates blood pressure patterns with increase of renin in kidneys. We planned to study both patterns of pulse pressure in the presence of gastroesophageal reflux disease with autonomic dysfunction in the pathophysiology, and also the alteration levels of some electrolytes (Na, uric acid, protein and albumin) which are present in blood and urine secretes. All individuals included the study were between 18 and 65 years old. Ambulatory blood pressure measuring was performed in all cases. Fifty patients in the reflux group and fifty individuals in the control group were included. Blood and urine specimens were examined. The individuals with cardiovascular disease, hypertension, malignancy, asthma disease, gastric peptic ulcer, hepatitis disease, tuberculosis, gastrointestinal disease excluding reflux, cerebrovascular disease, vasculitic disease, chronic alcohol usage, drugs with affect on autonomic system usage were excluded from study. The heart rate values increased statistically significantly in the same direction of the severity of retrosternal pain. We found statistically significant lower diastolic blood pressure values in reflux group. This resulted with the statistically significant increase in pulse pressure. Both the decrease in MCV values and also the increase in lymphocyte counts in reflux group considered as statistically significant. Both the decrease in potassium levels and also chloride levels in reflux group considered as statistically significant. Non-dipper pattern found more common in reflux group, but considered as statistically unsignificant. In conclusion, we found increased pulse pressure levels, increased LDL cholesterol and trigliserid levels in the reflux group, so this study supports the hypothesis that increased vascular risk may be present in patiens with gastroesophageal reflux disease. Thus, perhaps a new population at risk for cardiovascular disease will be identified and mortality rates will able to decrease with early treatment.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Nefroloji, Nephrology
