genel tıp derg Genel Tıp Dergisi 2602-3741 Selcuk University Helikobakter pilori pozitif bireylerde endotel disfonksi serum CRP ve B12 vitamin düzeyleri arasındaki ilişki The relationship between endothelial dysfunction and serum levels of CRP and vitamin B12 in Helicobacter pylori-positive subjects Alpsoy Şeref Namık Kemal Üniversitesi Kardiyoloji Anabilim Dalı, Tekirdağ Oran Mustafa Mete Rafet Akyüz Aydın Namık Kemal Üniversitesi Kardiyoloji Anabilim Dalı, Tekirdağ Cayan Akkoyun Dursun Namık Kemal Üniversitesi Kardiyoloji Anabilim Dalı, Tekirdağ Topcu Birol Namık Kemal Üniversitesi Biyoistatistik Bilim Dalı, Tekirdağ Değirmenci Hasan Namık Kemal Üniversitesi Kardiyoloji Anabilim Dalı, Tekirdağ 01 01 2013 23 3 81 86 Copyright © 1990, Genel Tıp Dergisi 1990 Genel Tıp Dergisi

Amaç: Çalışmanın amacı Helicobacter pylori HP seropozitif ve negatif bireylerde, endotel fonksiyon parametrelerini, C- reaktif protein CRP ve vitamin B12 düzeylerini ölçmek ve endotel fonksiyon parametreleri ile CRP ve vitamin B12 arasında ilişki olup olmadığını ortaya koymaktı. Materyal ve metod: Dispeptik yakınmaları olan110 kişide HP immünglobulin G antikor düzeyleri, CRP ve B12 vitamini düzeyleri ölçüldü. Brakiyal arter endotel-bağımlı akım aracılı vazodilatasyon ve endotel bağımsız nitrogliserin bağlı vazodilatasyon yanıtı ölçümleri yüksek frekanslı ultrasonografik görüntüleme ile yapıldı. Bulgular: HP immünglobulin G antikoru 70 kişide pozitif, 40 kişide ise negatifti. HP negatif bireylere kıyasla HP pozitif bireylerde brakiyal arter akım aracılı dilatasyon yanıtı azalmış, CRP düzeyi yüksek, vitamin B12 düzeyi ise düşüktü. HP pozitif bireylerde akım aracılı vazodilatasyon yanıtı ile yaş ve CRP arasında ters yönlü ilişki varken vitamin B12 ile aynı yönde ilişki vardı. Endotel bağımsız vazodilatasyon her iki grupta da benzerdi. Sonuç: Kronik HP enfeksiyonunda, sistemik ve vasküler inflamasyon artışı ve vitamin B12 eksikliği endotel disfonksiyonu gelişmesinde etkili olabilir

Objectives: The aim of the study was to measure the endothelial function parameters and serum levels of C-reactive protein CRP and vitamin B12 in Helicobacter pylori HP -seropositive and negative individuals and to investigate the relationship between the endothelial function parameters and CRP and vitamin B12 levels. Materials and methods: The serum levels of immunoglobulin G antibodies to HP, CRP, and vitamin B12 were determined in 110 subjects who had dyspeptic complaints. High-frequency ultrasonog- raphic imaging of the brachial artery was used to determine endothelium-dependent flow-mediated vasodilation [FMD] and endo- thelium-independent nitroglycerin-induced vasodilation. Results: HP antibody was positive in 70 subjects and negative in 40 sub- jects. Compared to the HP negative subjects, HP-positive individuals had decreased brachial artery FMD, elevated levels of CRP and decreased level of vitamin B12. FMD was negatively correlated with age and CRP and positively correlated with vitamin B12 in HP positive subjects. Endothelium independent vasodilation was similar in both groups. Conclusion: Increasing in systemic and vascular inflammation, and vitamin B12 deficiency may be effective in the development of endothelial dysfunction in chronic HP infection

 B12 vitamin eksikliği brakiyal arter C reaktif protein endotel Helicobacter pylori Vitamin B12 deficiency brachial artery C-reactive protein endothelium Helicobacter pylori Blaser MJ. Helicobacter pylori and the pathogenesis of gastroduo- denal inflammation. J Infect Dis 1990;161:626-33. Malaty HM. Epidemiology of Helicobacter pylori infection.Best Pract Res Clin Gastroenterol 2007;21:205-14. Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev 2006;19:449-90. Ruggiero P. Helicobacter pylori and inflammation. Curr Pharm Des 2010;16:4225-36. Mendall MA, Goggin PM, Molineaux N, et al. Relation of Heli- cobacter pylori infection and coronary heart disease. Br Heart J 1994;71:437-9. Patel P, Mendall MA, Carrington D, et al. Association of Helicoba- cter pylori and Chlamydia pneumoniae infections with coronary heart disease and cardiovascular risk factors. BMJ 1995;311:711-4. Jin SW, Her SH, Lee JM, et al. The association between current He- licobacter pylori infection and coronary artery disease. Korean J Intern Med 2007;22:152-6. Rogha M, Nikvarz M, Pourmoghaddas Z, et al. Is helicobacter py- lori infection a risk factor for coronary heart disease? ARYA Athe- roscler 2012;8:5-8. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999;340:115-26. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in ap- parently healthy men. N Engl J Med 1997;336:973–9. Fichtlscherer S, Rosenberger G, Walter DH, et al. Elevated C-re- active protein levels and impaired endothelial vasoreactivity in patients with coronary artery disease. Circulation 2000;102:1000-6 Stettin D, Waldmann A, Ströhle A, Hahn A. Association between Helicobacter pylori-infection, C-reactive protein and status of B vitamins. Adv Med Sci 2008;53:205-13. Jafarzadeh A, Hassanshahi GH, Nemati M. Serum levels of hi- gh-sensitivity C-reactive protein (hs-CRP) in Helicobacter pylo- ri-infected peptic ulcer patients and its association with bacterial CagA virulence factor. Dig Dis Sci 2009;54:2612-6. Ishida Y, Suzuki K, Taki K, et al.Significant association between Helicobacter pylori infection and serum C-reactive protein. Int J Med Sci. 2008;5: 224-9 Serin E, Gümürdülü Y, Ozer B, Kayaselçuk F, Yilmaz U, Koçak R. Impact of Helicobacter pylori on the development of vitamin B12 deficiency in the absence of gastric atrophy. Helicobacter 2002;7: 337-41. Kaptan K, Beyan C, Ural AU, et al. Helicobacter pylori-is it a no- vel causative agent in Vitamin B12 deficiency? Arch Intern Med 2000;160:1349-53. Selhub J, Jacques PF, Wilson PW, Rush D, Rosenberg IH. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993;270:2693-8. Woo KS, Chook P, Lolin YI, et al. Hyperhomocyst(e)inemia is a risk factor for arterial endothelial dysfunction in humans. Circu- lation 1997;968:2542-4. Lüscher TF, Barton M. Biology of the endothelium. Clin Cardiol 1997;20:II-3-10. Gemignani V, Bianchini E, Faita F, et al. Ultrasound measurement of the brachial artery flow-mediated dilation without ECG gating. Ultrasound Med Biol 2008;34:385-91. Oshima T, Ozono R, Yano Y, et al. Association of Helicobacter py- lori infection with systemic inflammation and endothelial dysfun- ction in healthy male subjects. J Am Coll Cardiol 2005;45:1219-22. Corretti MC, Anderson TJ, Benjamin EJ, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002;39: 257-65. Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician 2003;67:979-86. Jacobsen DW. Homocysteine and vitamins in cardiovascular disea- se. Clin Chem 1998;44:1833-43. Wolters M, Hermann S, Hahn A. B vitamin status and concentra- tions of homocysteine and methylmalonic acid in elderly German women. Am J Clin Nutr 2003;78:765-72. Schnyder G, Roffi M, Flammer Y, Pin R, Hess OM. Effect of homo- cysteine-lowering therapy with folic acid, vitamin B12, and vita- min B6 on clinical outcome after percutaneous coronary interven- tion: the Swiss Heart study: a randomized controlled trial. JAMA 2002;288:973-9. Zittan E, Preis M, Asmir I, et al. High frequency of vitamin B12 deficiency in asymptomatic individuals homozygous to MTHFR C677T mutation is associated with endothelial dysfunction and ho- mocysteinemia. Am J Physiol Heart Circ Physiol 2007;293:H860-5. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute pha- se response. Biochem J 1990;265:621–36. Vitale C, Cerquetani E, Wajngarten M, et al. In patients with coro- nary artery disease endothelial function is associated with plasma levels of C-reactive protein and is improved by optimal medical therapy. Ital Heart J 2003;4:627-32. Prasad A, Zhu J, Halcox JPJ, et al. Predisposition to atheroscle- rosis by infections: role of endothelial dysfunction. Circulation 2002;106:184 –90.