Serum Ürik Asit Düzeyinin Kardiyak Disfonksiyonda Prognostik bir Önemi Var mıdır?

Yıl 2018, , 369 - 374, 28.09.2018

Canan Topçuoğlu Sevilay Sezer Çiğdem Yücel Mustafa Yücel Fatih Dede Turan Turhan

https://doi.org/10.17098/amj.461376

Öz

Amaç: Ürik asit, pürin metabolizmasının son ürünü ve gut için iyi bilinen bir
risk faktörüdür. Bununla birlikte, yüksek serum ürik asit düzeyleri insülin
rezistansı, obezite,
hipertansiyon, renal disfonksiyon, hipotiroidi gibi birçok hastalıkla ilişkili
bulunmuştur. Öte yandan, ürik asidin kardiyovasküler
morbiditede nedensel bir rol oynayıp oynamadığı tartışılmaktadır. Çalışmamızda serum ürik asit
(ÜA) ve kalp yetmezliği prognostik belirteci olan N
terminal pro B-tipi Natriüretik Peptit (NT-proBNP) düzeyleri ile sol ventrikül fonksiyon
bozukluğu arasında ilişki olup olmadığını araştırmayı amaçladık.
Materyal ve Metot: Çalışma retrospektif
olarak planlandı. Mart 2016 ile Şubat 2017 tarihleri arasında Ankara Numune
Eğitim ve Araştırma Hastanesi Kardiyoloji Servisi ve Koroner Yoğun Bakımda yatan 326 hasta çalışmaya dahil edildi. Bu hastaların serum ÜA,
NT-proBNP düzeyleri ile ejeksiyon fraksiyonu (EF) bulguları hastane enformasyon
sisteminden alındı. Hastalar serum ÜA düzeylerine göre 4 gruba ayrıldı (1. grup
ÜA; 2,7-4,9 mg/dL, 2. grup ÜA; 5-6 mg/dL, 3. grup ÜA; 6,1-7,4
mg/dL, 4. grup ÜA; 7,5-15,6 mg/dL). Gruplar arasında parametreler ANOVA testi
kullanılarak karşılaştırıldı. Ayrıca, sol ventrikül disfonksiyon bulgularında
ürat düzeylerine göre değişimler incelenirken, cinsiyet, yaş ve eGFR ‘nin bu parametreler üzerindeki etkileri
değerlendirildi. Değişkenler arasında ilişki için Pearson korelasyon testi
kullanıldı.
Bulgular: 4. grup; yaş,
NT-proBNP, eGFR diğer gruplardan anlamlı düzeyde farklıydı (p<0.001). EF, 4.
grup ile 1. ve 3. gruplar arasında anlamlı farklı
bulundu (sırası ile p=0,006
and p=0,002). Ancak EF’nun
gruplar arasındaki farklılıkları üzerinde yaş ve eGFR etkisinin olmadığı
görüldü. Gruplardan bağımsız olarak serum ÜA düzeyi ile NT-proBNP arasında
istatistiksel olarak anlamlı ancak zayıf pozitif
korelasyon (r=0,310, p<0,001), % LVEF arasında ise düşük
düzeyde ancak anlamlı negatif korelasyon (r=-0,173, p=0,002) tespit edildi.

Sonuç: Çalışmamızdaki bulgulara göre serum ÜA düzeyinin kardiyak
disfonksiyonda prognostik öneme sahip olduğu ve
hastaların takibinde kullanılabileceği kanısına varılmıştır.

Anahtar Kelimeler

Kardiyak disfonksiyon, NT-proBNP, ürik asit

Is There a Prognostic Significance of Serum Uric Acid Levels in Cardiac Dysfunction?

Öz

Objectives: Uric acid (UA) is the end-product of purine metabolism and is a well-known risk factor for gout disease. In addition to that, elevated serum UA levels have been associated with many disorders including insulin resistance, obesity, hypertension, renal dysfunction and hypothyroidism. On the other hand, whether uric acid has any causal relationship with cardiovascular morbidity is a debated issue.

Materials and Methods: This retrospective study included totally 326 patients who were inpatients at the Cardiology Ward or Coronary Intensive Care Unit of Ankara Numune Training and Research Hospital between March 2016 and February 2017. Data regarding serum UA and N-terminal pro B-type Natriuretic Peptide (NT-proBNP) levels and left ventricular ejection fraction %) LVEF) were retrieved from the hospital information system. Patients were categorized into four groups based on their UA levels (Group 1 UA: 2.7-4.9 mg/dL, Group 2 UA: 5-6 mg/dL, Group 3 UA: 6.1-7.4 mg/dL, Group 4 UA: 7.5-15.6 mg/dL). Other parameters were compared between the groups using ANOVA test. Additionally, the effects of gender, age and eGFR were also examined when evaluating the changes in left ventricular function according to UA levels. Correlation between the variables was analyzed with Pearson’s correlation test.

Results: Group 4 was significantly different than the rest of the groups in terms of age, NT-proBNP and eGFR (p<0.001). In addition, group 4 showed significant difference from Group 1 and Group 3 regarding %LVEF (p=0.006 and p=0.002, respectively). However, the differences between the groups regarding %LVEF was not influenced by age or eGFR. Regardless of the groups, serum UA levels showed statistically significant but weak positive correlation with NT-proBNP (r=0.310, p<0.001), and low level of negative correlation with % LVEF, which was statistically significant (r=-0.173, p=0.002).

Conclusion: Based on our findings, we concluded that serum UA level has prognostic significance in cardiac dysfunction and can be used in the follow-up of such patients.

Anahtar Kelimeler

Cardiac dysfunction, NT-proBNP, uric acid

Kaynakça

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