Alt ekstremitede kronik venöz yetmezlik olgularında serum estrone düzeyinin önemi

Year 2023, , 302 - 305, 30.08.2023

Rukiye Ada Bender , Baran Şimşek

https://doi.org/10.47582/jompac.1322381

Abstract

Amaç: Kronik venöz yetmezlik (KVY), alt ekstremitelerde anormal venöz akış dinamikleri ile karakterize bir durumdur ve gebelik, yaş, obezite ve yüksek östrojen düzeyleri gibi çeşitli risk faktörleri ile ilişkilidir. Bu estrojenlerden biri olan estronun kardiyoprotektif etkileri olduğu bilinmektedir. BU çalışma ile KVY' li kadınlar ile sağlıklı kadınlardaki estron seviyeleri arasındaki ilişkiyi değerlendirmeyi amaçladık.
Yöntemler: KVY olan 39 kadın ve KVY olmayan 31 sağlıklı kadından klinik ve laboratuvar verileri toplandı. KVY' in ciddiyetini değerlendirmek için tüm katılımcılara spektral Doppler incelemeleri ve kombine B modu görüntüleme uygulandı.
Bulgular: Sonuçlar, KVY grubunda sağlıklı kontrol grubuna göre vena safen magna çapında istatistiksel olarak anlamlı bir artış gösterdi (p<0.05). Bununla birlikte, iki grup arasında estron seviyelerinde anlamlı bir fark yoktu. Ayrıca KVY grubunda estron düzeyi ile yaş (r: -0,351; p=0,028), VKİ ile yaş(r: 0,374; p=0,019), VKİ ile karın çevresi (r: 0,700; p<0,001) arasında anlamlı korelasyonlar gözlendi.
Sonuç: Çalışmamız, estron düzeylerinin KVY patogenezinde koruyucu bir etkiye sahip olabileceğini düşündürmektedir. Estronun KVY' li kadınlar üzerinde gözlemlenen etkisi, estradiol ile karşılaştırıldığında farklı reseptör seviyesi etkilerine bağlanabilir. Estronun KVY' e katkısını ve bunun altında yatan mekanizmaları tam olarak aydınlatmak için daha fazla araştırma gereklidir.

Keywords

Kronik venöz yetmezlik, estron, kardiyoprotektif etki, östrojen

The importance of serum estrone level in cases of chronic venous insufficiency in the lower extremity

Abstract

Aims: Chronic venous insufficiency (CVI) is a condition characterized by abnormal venous flow dynamics in the lower limbs and is associated with various risk factors such as pregnancy, age, obesity, and high estrogen states. One of these estrogens, estrone, is known to have cardioprotective effects. The study aimed to evaluate the relationship between estrone levels in women with CVI and healthy women.
Methods: Clinical and laboratory data from 39 women with CVI and 31 healthy women without CVI were collected. All participants underwent spectral Doppler examinations and combined B-mode imaging to assess the severity of CVI.
Results: The results showed a statistically significant increase in the diameter of the vena saphenous magna in the CVI group compared to the healthy control group (p<0.05). However, there were no significant differences in estrone levels between the two groups. Besides, significant correlations were observed between estrone levels and age (r: -0.351; p=0.028), BMI and age(r: 0.374; p=0.019), and BMI and abdominal circumference (r: 0.700; p<0.001) in the CVI group.
Conclusion: Our study suggests that estrone levels may have a protective effect on CVI pathogenesis. The observed effect of estrone on women with CVI may be attributed to its different receptor-level effects compared to estradiol. Further research is necessary to fully elucidate the contribution of estrone to CVI and its underlying mechanisms.

Keywords

Chronic venous insufficiency, estrone, cardioprotective effect, estrogen

References

• Baliyan V, Tajmir S, Hedgire SS, Ganguli S, Prabhakar AM. Lower extremity venous reflux. Cardiovasc Diagn Ther. Dec 2016;6(6):533-543. doi:10.21037/cdt.2016.11.14
• Kurz X, Kahn SR, Abenhaim L, et al. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. Int Angiol. Jun 1999;18(2):83-102.
• Sadick NS. Predisposing factors of varicose and telangiectatic leg veins. J Dermatol Surg Oncol. 1992; 18(10):883-6. doi:10.1111/j.1524-4725.1992.tb02921.x
• Fowkes FG, Lee AJ, Evans CJ, Allan PL, Bradbury AW, Ruckley CV. Lifestyle risk factors for lower limb venous reflux in the general population: Edinburgh Vein Study. Int J Epidemiol. 2001;30(4):846-852. doi:10.1093/ije/30.4.846
• Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S-48S. doi:10.1016/j.jvs.2011.01.079
• Bromen K, Pannier-Fischer F, Stang A, Rabe E, Bock E, Jockel KH. Should sex specific differences in venous diseases be explained by pregnancies and hormone intake? Gesundheitswesen. 2004;66(3):170-174. Lassen sich geschlechtsspezifische unterschiede bei venenerkrankungen durch schwangerschaften und hormoneinnahme erklaren? doi:10.1055/s-2004-813019
• Ciardullo AV, Panico S, Bellati C, et al. High endogenous estradiol is associated with increased venous distensibility and clinical evidence of varicose veins in menopausal women. J Vasc Surg. 2000;32(3): 544-9. doi:10.1067/mva.2000.107768
• Hetemaki N, Mikkola TS, Tikkanen MJ, et al. Adipose tissue estrogen production and metabolism in premenopausal women. J Steroid Biochem Mol Biol. 2021;209:105849. doi:10.1016/j.jsbmb.2021.105849
• Grow DR. Metabolism of endogenous and exogenous reproductive hormones. Obstet Gynecol Clin North Am. Sep 2002;29(3):425-436. doi:10.1016/s0889-8545(02)00009-8
• Seeger H, Mueck AO, Lippert TH. Effect of estradiol metabolites on prostacyclin synthesis in human endothelial cell cultures. Life Sci. 1999;65(13):PL167-170. doi:10.1016/s0024-3205(99)00383-5
• Selles J, Polini N, Alvarez C, Massheimer V. Novel action of estrone on vascular tissue: regulation of NOS and COX activity. Steroids. 2005;70(4):251-256. doi:10.1016/j.steroids.2004.10.012
• Massheimer V, Polini N, Alvarez C, Benozzi S, Rauschemberger MB, Selles J. Signal transduction pathways involved in non-genomic action of estrone on vascular tissue. Steroids. 2006;71(10):857-864. doi:10.1016/j.steroids.2006.05.015
• Chervenak J. Bioidentical hormones for maturing women. Maturitas. 2009;64(2):86-89. doi:10.1016/j. maturitas.2009.08.002
• Crescitelli MC, Rauschemberger MB, Cepeda S, Sandoval M, Massheimer VL. Role of estrone on the regulation of osteoblastogenesis. Mol Cell Endocrinol. 2019;498:110582. doi:10.1016/j.mce.2019. 110582
• Serra R, Gallelli L, Perri P, et al. Estrogen receptors and chronic venous disease. Eur J Vasc Endovasc Surg. 2016;52(1):114-118. doi:10.1016/j.ejvs.2016.04.020
• Asbeutah AM, Al-Enezi M, Al-Sharifi NM, et al. Changes in the diameter and valve closure time of leg veins across the menstrual cycle. J Ultrasound Med. 2014;33(5):803-809.
• Asbeutah AM, Al-Azemi M, Al-Sarhan S, Almajran A, Asfar SK. Changes in the diameter and valve closure time of leg veins in primigravida women during pregnancy. J Vasc Surg Venous Lymphat Disord. 2015;3(2):147-153. doi:10.1016/j.jvsv.2014.09.005
• Silva TC, Barrett-Connor E, Ramires JA, Mansur AP. Obesity, estrone, and coronary artery disease in postmenopausal women. Maturitas. 2008;59(3):242-8. doi:10.1016/j.maturitas.2008.01.008
• de Oliveira TS, de Oliveira LM, de Oliveira LP, et al. Activation of PI3K/Akt pathway mediated by estrogen receptors accounts for estrone-induced vascular activation of cGMP signaling. Vascul Pharmacol. 2018;110:42-48. doi:10.1016/j.vph.2018.07.003
• Gewaltig MT, Kojda G. Vasoprotection by nitric oxide: mechanisms and therapeutic potential. Cardiovasc Res. 2002;55(2):250-60. doi:10.1016/s0008-6363(02)00327-9
• Hollingsworth SJ, Tang CB, Dialynas M, Barker SG. Varicose veins: loss of release of vascular endothelial growth factor and reduced plasma nitric oxide. Eur J Vasc Endovasc Surg. 2001;22(6):551-556. doi:10.1053/ejvs.2001.1520