PDF

ÖZET Amaç: Endotel fonksiyon bozukluğu koroner arter hastalığı gelişiminde ve prognozunda önemli rol oynar. Koroner arter hastalığında, uzun süreli ortalama glisemik indeksi gösteren bir parametre olan glikolize hemoglobinin (HbA1c) endotel fonksiyonları üzerine etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Koroner anjiyografi ile belgelenmiş koroner arter hastalığı olan 56 hasta çalışmaya dahil edildi. Akım aracılı vazodilatasyon (AAD) testi ile endotel fonksiyonları değerlendirildi. İstatistiksel analiz için IBM SPSS Statistics 25.0 programı kullanıldı. Nümerik değişkenlerin normal dağılıma uygunluğu Kolmogorov-Smirnov (n≥50) testiyle incelendi. HbA1c ve AAD yüzdelik değişim arasındaki korelasyonu değerlendirmek için Spearman korelasyon analizi kullanıldı. Bulgular: Çalışmaya dahil edilen 56 hastanın ortalama yaşı 61,5±10,3 yıldır. Hastaların %71’ i erkek, %29’ u kadın ve ortalama vücut kitle indeksi 27,5±5,5 kg/m2’dir. AAD testinde ortalama radial arter bazal çapı 0,25 (±0,028) cm, AAD sonrası ortalama radial arter çapı 0,28 (±0,033) cm olarak saptandı. HbA1c düzeyleri ile endotel fonksiyonlarını gösteren arter çapındaki yüzdelik değişim arasında negatif yönde zayıf bir ilişki olduğu görüldü (r=-0,306, p=0,022). Sonuç: Koroner arter hastalığında, uzun süreli ortalama glisemik indeksi gösteren HbA1c düzeyleri endotel fonksiyon bozukluğunda bağımsız bir faktör olarak düşünülebilir. Anahtar Kelimeler: Koroner Arter Hastalığı; Endotel Fonksiyonu; Hba1c ABSTRACT Objective: Endothelial dysfunction plays an important role in the development and prognosis of coronary artery disease. We aimed to evaluate the effects of glycolyzed hemoglobin (HbA1c), which is a parameter that shows the long-term mean glycemic index, on endothelial functions in coronary artery disease. Material and Methods: Fifty-six patients who has coronary artery disease documented by coronary angiography were included in this study. Endothelial functions were evaluated by flow-mediated vasodilation (FMD) test. IBM SPSS Statistics 25.0 program was used for statistical analysis. The suitability of numerical variables to normal distribution was examined with Kolmogorov Smirnov (n≥50) test. Spearman correlation analysis was used to evaluate the correlation between HbA1c and FMD percent change. Results: The average age of 56 patients included in this study was 61.5 ± 10.3 years. 71% of the patients are male, 29% of patients are female and mean body mass index is 27.52 ± 5.54 kg / m2. In the FMD test, the mean radial artery basal diameter was 0.25 (±0.028) cm, and the mean radial artery diameter after FMD was 0.28 (± 0.033) cm. A negative correlation was observed between HbA1c levels and the percentage change in artery diameter that was showed endothelial functions (r = -0.306, p = 0.022). Conclusion: In coronary artery disease, HbA1c levels that showing long-term mean glycemic index can be considered as an independent factor in endothelial dysfunction. Keywords: Coronary Artery Disease; Endothelial Function; Hba1c

KORONER ARTER HASTALIĞINDA HbA1c DÜZEY, ENDOTEL FONKSİYONLAR, ARASINDAKİ İLİŞKİ

• 1. Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, MS, Murphy A. Growing epidemic of coronary heart disease in low- and middleincome countries. Curr Probl Cardiol. 2010; 35(2): 72–115. DOI: 10.1016/j.cpcardiol.2009.10.002
• 2. Vita JA, Keaney JF. Endothelial function: a barometer for cardiovascular risk? Circulation. 2002;106:640–2. DOI: 10.1161/01. cir.0000028581.07992.56.
• 3. Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473(7347):317-25. DOI: 10.1038/nature10146.
• 4. Godo S, Shimokawa H. Endothelial functions. Arterioscler Thromb Vasc Biol. 2017;37(9):e108–14. DOI: 10.1161/ATVBAHA.117.309813.
• 5. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature. 1993;362:801–9. DOI: 10.1038/362801a0
• 6. Halcox JP, Schenke WH, Zalos G, Mincemoyer R, Prasad A, Waclawiw MA, et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation. 2002;106:653–8.
• 7. Schächinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation. 2000;101:1899–906.
• 8. Yeboah J, Folsom AR, Burke GL, Johnson C, Polak JF, Post W, et al. Predictive value of brachial flow-mediated dilation for incident cardiovascular events in a population-based study: the multi-ethnic study of atherosclerosis. Circulation 2009; 120:502–9.
• 9. Weykam C. HbA1c: A review of analytical and clinical aspects. Ann Lab Med. 2013;33(6):393-400. DOI: 10.3343/alm.2013.33.6.393.
• 10. Yugar-Toledo JC, Tanus-Santos JE, Sabha M, Sousa MG, Cittadino M, Tácito LH, et al. Uncontrolled hypertension, uncompensated type II diabetes, and smoking have different patterns of vascular dysfunction. Chest. 2004;125(3):823-30. DOI: 10.1378/ chest.125.3.823.