Glomerülonefritli hastalarda karotis intima media kalınlığının prediktörü hangisidir; nötrofil-lenfosit oranı mı proteinüri mi?

Year 2019, , 269 - 279, 28.05.2019

Aysun Toraman , Berna Eren Fatih Duzgun Fatma Taneli , Seyhun Kursat

https://doi.org/10.31362/patd.500277

Abstract

Amaç:Glomerülonefrit glomerüllerin inflamasyondur ve proteinüri kendisi
glomerüler inflamasyonun klinik bir yansımasıdır. Bu çalışmada, aterosklerozun
en erken bulgularından biri olan karotis intima media kalınlığı (KIMK) ile
glomerüler inflamasyon belirteçleri arasındaki ilişkiyi araştırmayı amaçladık.

Gereç ve yöntem: Biyopsi ile kanıtlanmış 40 glomerülonefrit
hastası ve 46 sağlıklı kontrol çalışmaya dahil edildi. Serum örneklerinde Growth
arrest spesific protein 6 (Gas6) düzeyleri ELISA ile çalışıldı. KIMK ölçümü
aynı radyolog tarafından yapıldı. Nötrofil-lenfosit oranı (NLO) tam kan test sonucundan elde edilen
nötrofil sayısının lenfosit sayısına bölünmesiyle hesaplandı.

Bulgular: Hasta grubunda ortalama yaş 42,88±15,41, kontrol grubunda
38,26±9,04 idi. Ortalama hastalık süresi 29.07±52.90 ay, proteinüri
4027.05±4030.22 mg/gün, MDRD-GFR 53.80±48.32 mL/dk/1.73m² idi. KIMK
hasta grubunda 0.62±0.17 mm, kontrol grubunda 0.46±0.10 mm idi. NLO hasta
grubunda 3.69±4.46, kontrol grubundan anlamlı derecede yüksekti (1.74±0.63).
Kontrol grubunda Gas6 düzeyleri istatistiksel olarak daha yüksekti. KIMK yaş,
fibrinojen, ferritin, proteinüri ve NLO ile pozitif korelasyon gösterdi ve
glomerülonefrit grubunda HDL kolesterol ve Gas6 ile negatif korelasyon
gösterdi. Lojistik regresyon modelinde yaş KIMK için belirleyiciydi. Tüm grupta
KIMK yaş, kreatinin, ürik asit, fibrinojen, ferritin, CaxP çarpımı, proteinüri
ve NLO ile pozitif ve hemoglobin düzeyi, Gas6 ile negatif korelasyon gösterdi.
Lineer lojistik regresyon analizinde karotis IMK, yaş ve ferritin ve proteinüri
ile anlamlı şekilde ilişkiliydi.

Sonuç: Çalışmamızda proteinürinin böbrek fonksiyonu göreceli olarak korunmuş glomerülonefritte
GFR düzeylerinden bağımsız olarak artmış KIMK'nın temel belirleyicilerinden
biri olduğunu gösterdik.

Keywords

Karotis intima media kalınlığı, glomerülonefrit, nötrofil-lenfosit oranı, Growth arrest specific protein 6

Which one is the predictor of carotid intima media thickness in patients with aglomerulonephritis; neutrophil-to-lymphocyte ratio or proteinuria?

Abstract

Purpose:Glomerulonephritis is inflammation of the glomeruli and proteinuria
itself is a reflection of the glomerular inflammation. In this study we aimed
to investigate the relationship between carotid intima media thickness (CIMT)
one of the earliest findings of atherosclerosis and markers of glomerular
inflammation.

Materials and methods:40 patients with biopsy proven
glomerulonephritis and 46 healthy controls were enrolled in the study.Human
Growth arrest spesific protein 6 (Gas6) levels in serum samples were studied by
ELISA.CIMT measurement was performed by the same radiologist.

Results: The mean age was 42,88±15,41in patient group and 38,26±9,04 in
controls. The mean duration of illness was 29.07±52.90 mounts, proteinuria  was4027.05±4030.22 mg/day, MDRD-GFR  was 53.80±48.32 mL/min/1.73m².
CIMT was 0.62±0.17 mm in patient group,0.46±0.10 mm in  controls.Neutrophil-to-Lymphocyte
Ratio (NLR) was 3.69±4.46 in
patient group and significantly higher than control group (1.74±0.63). Gas6
levels were statistically higher in control group. CIMT was positively
correlated with age, fibrinogen, ferritin, proteinuria and NLR and negatively
correlated with HDL cholesterol and Gas6 
in glomerulonephritis group.  Age  was the predictor  for CIMT in the logistic regression model. In
all group CIMT was positively correlated with age, creatinine, uric acid,
fibrinogen, ferritin, CaxP product, proteinuria and NLR and negatively
correlated with hemoglobin level, Gas6. In lineer logistic regression analysis
carotid IMT was significantly associated with age and ferritin and proteinuria.

Conclusion: We have shown that proteinuria is one of the main
determinants of increased CIMT independent from the GFR levels in
glomerulonephritis with relatively preserved renal function. 

Keywords

Carotid Intima Media Thickness, Glomerulonephritis, Neutrophil-to-Lymphocyte Ratio, Growth Arrest Specific Protein 6

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