Primer Perkütan Koroner Girişim Uygulanan St-segment Yükselmesi Miyokart İnfarktüsü Hastalarında Kontrast Nefropatisi Gelişimi İçin Monosit/Yüksek Yoğunluklu Lipoprotein Oranının Öngörülü Değeri

Yıl 2017, Cilt: 20 Sayı: 1, 13 - 18, 03.04.2017

Regayip Zehir Ahmet İlker Tekkeşin Nahide Haykır Yalçın Velibey Edibe Betül Börklü Ayça Gümüşdağ

Öz

Giriş: Kontrast madde nefropatisi (KMN) primer perkütan koroner girişim (p-PKG)
uygulanan ST yükselmeli miyokart infarktüsü (STEMİ) hastalarda ciddi bir
komplikasyondur. Monosit/yüksek dansiteli lipoprotein (HDL) oranı (MHR) son
zamanlarda inflamasyon ve oksidatif stres işaretleyici tanımlamıştır. Bu
çalışmanın amacı, p-PKG uygulanan hastalarda KMN riski için MHR öngörü değerini
araştırmaktır.

Hastalar ve
Yöntem: STEMİ tanısı ile hastaneye yatırılan ve p-PKG uygulanan
2120 hasta retrospektif olarak değerlendirildi. Kontrast maruziyeti sonrası 72
saat içinde başlangıç serum kreatininde ≥ %25 göreceli artış veya ≥ 0.5 mg/dL
mutlak artış olması KMN olarak tanımlandı. MHR acil servis başvurusunda
hesaplandı. KMN riski ile MHR arasındaki ilişki değerlendirildi.

Bulgular: KMN insidansı (n= 139) %6.6 idi. Yaş (p= 0.001), bazal kreatinin (p<
0.001), DM (p< 0.001), HT (p< 0.001), anemi (p= 0.001) KMN olan
hastalarda daha yüksekti. Hastalar CIN gelişimine göre iki gruba ayrıldı.
Periferik monosit sayısı, HDL ve MHR gruplar arasında farklılık yoktu. Tüm
temel karıştırıcı faktörler için düzeltme yapıldıktan sonra, periferik monosit
sayısı ve MHR bizim çok değişkenli lojistik regresyon analizi sonrasında KMN
gelişmesinin bağımsız belirleyicileri olarak saptanmadı.

Sonuç: MHR infarktüsün erken
safhasında stabil hastalardan çok farklı olmadığından, p-PKG uygulanan STEMİ
hastalarında KMN gelişimi için potansiyel belirleyicisi olarak
değerlendirilemez.

Anahtar Kelimeler

Kontrast nefropatisi, primer perkütan koroner girişim, ST-segment yükselmeli miyokart infarktüsü, monosit/yüksek dansiteli lipoprotein oranı

Predictive Value of Monocyte to High-Density Lipoprotein Cholesterol Ratio for Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention

Öz

Introduction: Contrast-induced
nephropathy (CIN) is a serious complication in patients with ST segment
elevation myocardial infarction (STEMI) undergoing primary percutaneous
coronary intervention (p-PCI). The monocyte to high-density lipoprotein (HDL)
cholesterol ratio (MHR) has recently been defined as an inflammation and
oxidative stress marker. The aim of this study was to evaluate the predictive
value of MHR for risk of CIN in patients with ST who underwent p-PCI.

Patients and Methods:
Data
of a 2120 patients who were hospitalised with the diagnosis of STEMI and
underwent p-PCI were retrospectively evaluated. A relative increase in serum
creatinine levels of ≥ 25% or an absolute increase of ≥ 0.5 mg/dL from the
baseline within 72 h of contrast exposure was defined as CIN. MHR was calculated
on emergency admission. The risk of CIN was evaluated across MHR values.

Results: The
incidence of CIN was 6.6% (n= 139). Age (p= 0.001), baseline creatinine levels
(p< 0.001), DM (p< 0.001), HT (p< 0.001) and anaemia (p= 0.001) were
higher in patients with CIN. The patients were divided into 2 groups based on
the development of CIN. Peripheral monocyte count, HDL levels and MHR did not
differ between the groups. After correction for all baseline confounders,
neither peripheral monocyte count nor MHR were found to be independent
predictors of CIN development in our multivariate logistic regression analyses.

Conclusion: Because MHR does not differ
much from that in stable patients at the early phase of infarction, it cannot
be a potential predictor of CIN development in patients with STEMI who
underwent p-PCI.

Anahtar Kelimeler

Contrast-induced nephropathy, primary percutaneous coronary intervention, ST segment elevation myocardial infarction, monocyte to high-density lipoprotein cholesterol ratio

Kaynakça

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