Diyabetik nefropatili (evre III,IV,V) hastalarda osteoprotegerin ve reseptör aktivatör nükleer kappa B ligand değişimi
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Dosyalar
Tarih
2010
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Son yıllarda kemik dokusu ile ilgili yapılan çalışmalarda osteosteoblastlar tarafından sekrete edilen osteoprotegerinin, reseptör aktivatör nükleer kappa B liganda bağlanarak osteoklastogenezi baskıladığı saptanmıştır. Kronik böbrek yetmezliği gelişen hastalarda osteoprotegerin ve reseptör aktivatör nükleer kappa B ligand değişimini inceleyen çalışmalarda farklı sonuçlar bildirilmektedir. Ancak diyabetik nefropatili hastalarda bu sistem hakkında sınırlı bilgi bulunmaktadır. Çalışmamızda evre III, evre IV ve evre V diyabetik nefropatili hastalarda osteoprotegerin ve reseptör aktivatör nükleer kappa B ligand düzeylerinin klinik ve laboratuvar verileri ile ilişkisinin incelenmesi amaçlanmıştır. Çalışmamıza diyabetik nefropatili 61 olgu ile yaş ve cinsiyet açısından eşleştirilmiş 20 sağlıklı olgu alındı. Olguların serum intakt paratiroid hormon, 25 hidroksi D vitamini, osteoprotegerin ve reseptör aktivatör nükleer kappa B ligand düzeyleri incelendi. Diyabetik nefropatili grupta intakt paratiroid hormon ve reseptör aktivatör nükleer kappa B ligand düzeylerinde anlamlı yükseklik, 25 hidroksi D vitamini düzeylerinde anlamlı düşüklük saptandı. Diyabetik nefropati evrelerine göre incelendiğinde serum intakt paratiroid hormon düzeyinin evre V'te diğer evrelere göre anlamlı yüksek olduğu, 25 hidroksi D vitamini düzeylerinin ise evre III'den evre 5'e gittikçe azaldığı görüldü. Grupların osteoprotegerin ve reseptör aktivatör nükleer kappa B ligand düzeyleri benzerdi. Diyabetik nefropatili olguları glomerüler filtrasyon hızı 60 ml/dk/1.73m2 ve altında olanlar ile üzerinde olanlar olarak ikiye ayırdığımızda ilk grupta reseptör aktivatör nükleer kappa B ligand düzeyleri istatistiksel olarak anlamlı yüksek bulundu. Bu grupta korelasyon analizinde reseptör aktivatör nükleer kappa B ligand düzeyi ve reseptör aktivatör nükleer kappa B ligand /osteoprotegerin oranı ile alkalen fosfataz arasında pozitif ilişki olduğu tespit edildi. Bu sonuçlar, literatürle uyumlu laboratuvar bulguları tespit ettiğimiz diyabetik nefropatili olguların ağırlıklı olarak düşük döngülü kemik hastalığı grubunda olduğunu ve bu grupta artan reseptör aktivatör nükleer kappa B ligand düzeyleri kemik yapımının daha ileri derecede bozulduğunu göstermektedir.
Abstract
It has been determined by the studies carried out in the recent years that osteoclastogenosis is suppressed by combining the receptor activator of nuclear factor kappa B ligand with that of an osteoprotegerin secreted by an osteosteoblast. The studies, being performed concerning the changes of osteoprotegerin and the receptor activator of nuclear factor kappa B ligand in the patients who are exposed to chronic kidney failure, have resulted in different findings. But, there is limited information about this system in the patients with diabetic nephropathy. The aim of this study is to investigate the relationship between the clinical and labotatory findings regarding the levels of osteoprotegerin and the receptor activator of nuclear factor kappa B ligand in the patients with diabetic nephropathy at the third, at the fourtrh and at the fifth phases. This study includes 61 patients with diabetic nephropathy and 20 healthy people matched to each other in terms of their age and gender. The levels of serum intact parathyroid hormone, 25 hydroxy-vitamin D, osteoprotegerin and the receptor activator of nuclear factor kappa B ligand in the patients were examined. Meaningful differences were found high related to intact parathyroid hormone and the levels of the receptor activator of nuclear factor kappa B ligand in the patients in the group of diabetic nephropathy whereas meaningful differences were found low at the levels of 25 hydroxy-vitamin D in that group. When the phases of diabetic nephropathy compared, it was determined that the levels of serum intact parathyroid hormone at the fifth phase were found high meaningfully than the others whereas those of 25 hydroxy-vitamin D gradually fell down from the third phase to that of the fifth one. The levels of osteoprotegerin and the receptor activator of nuclear factor kappa B ligand of both groups were the same. When the patients with diabetic nephropathy were divided into two groups as those having a glomerular filtration speed over 60 ml/min./1.73sqm and those having a glomerular filtration speed under 60 ml/min./1.73sqm, the levels of the receptor activator of nuclear factor kappa B ligand were found statically high in the first group on which the correlation analysis was performed and it was proved that there is a positive relationship between alkaline phosphatase and those of the level of the receptor activator of nuclear factor kappa B ligand and the rate of receptor activator of nuclear factor kappa B ligand /osteoprotegerin. In conclusion, these results show that the laboratory findings determined in this study are consistent with the literature about the patients with diabetic nephropathy and the levels of the increased receptor activator of nuclear factor kappa B ligand show the existence of more advanced degrees of deformation in osteoblastogenesis.
Abstract
It has been determined by the studies carried out in the recent years that osteoclastogenosis is suppressed by combining the receptor activator of nuclear factor kappa B ligand with that of an osteoprotegerin secreted by an osteosteoblast. The studies, being performed concerning the changes of osteoprotegerin and the receptor activator of nuclear factor kappa B ligand in the patients who are exposed to chronic kidney failure, have resulted in different findings. But, there is limited information about this system in the patients with diabetic nephropathy. The aim of this study is to investigate the relationship between the clinical and labotatory findings regarding the levels of osteoprotegerin and the receptor activator of nuclear factor kappa B ligand in the patients with diabetic nephropathy at the third, at the fourtrh and at the fifth phases. This study includes 61 patients with diabetic nephropathy and 20 healthy people matched to each other in terms of their age and gender. The levels of serum intact parathyroid hormone, 25 hydroxy-vitamin D, osteoprotegerin and the receptor activator of nuclear factor kappa B ligand in the patients were examined. Meaningful differences were found high related to intact parathyroid hormone and the levels of the receptor activator of nuclear factor kappa B ligand in the patients in the group of diabetic nephropathy whereas meaningful differences were found low at the levels of 25 hydroxy-vitamin D in that group. When the phases of diabetic nephropathy compared, it was determined that the levels of serum intact parathyroid hormone at the fifth phase were found high meaningfully than the others whereas those of 25 hydroxy-vitamin D gradually fell down from the third phase to that of the fifth one. The levels of osteoprotegerin and the receptor activator of nuclear factor kappa B ligand of both groups were the same. When the patients with diabetic nephropathy were divided into two groups as those having a glomerular filtration speed over 60 ml/min./1.73sqm and those having a glomerular filtration speed under 60 ml/min./1.73sqm, the levels of the receptor activator of nuclear factor kappa B ligand were found statically high in the first group on which the correlation analysis was performed and it was proved that there is a positive relationship between alkaline phosphatase and those of the level of the receptor activator of nuclear factor kappa B ligand and the rate of receptor activator of nuclear factor kappa B ligand /osteoprotegerin. In conclusion, these results show that the laboratory findings determined in this study are consistent with the literature about the patients with diabetic nephropathy and the levels of the increased receptor activator of nuclear factor kappa B ligand show the existence of more advanced degrees of deformation in osteoblastogenesis.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Diyabetik Nefropati, Osteoprotegerin, Reseptör Aktivatör Nükleer Kappa B Ligand, Diabetic Nephropathy, Osteoprotegerin, Receptor Activator of Nuclear Factor Kappa B Ligand
