Helicobakter Pylori Enfeksiyonu ve Arteriyel Sertlik Arasındaki İlişki

Öz

Öz Amaç: Çalışmalar, Helicobacter Pylori (Hp) seropozitifliğinin kardiyovasküler hastalıklar ile ilişkisini bulmuş ve Hp enfeksiyonu sırasında kronik inflamasyonun erken evre ateroskleroza neden olduğu gösterilmiştir. Bu çalışmanın amacı, endoskopik mide biyopsisi ile saptanan Hp pozitifliği ile ateroskleroz arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Bu kesitsel çalışmada, hastalar endoskopik mide biyopsi bulgularına göre Hp pozitif (n=48) ve Hp negatif (n=61) olmak üzere 2 gruba ayrılmıştır. Tüm hastalarda augmentasyon indeksi, arteriyel sertlik ve santral kan basıncı Nabız dalga hızı analizi/Ambulatuvar kan basıncı izlemi kullanılarak ölçüldü. Bulgular: Helicobacter Pylori pozitif grupta augmentasyon indeksi anlamlı olarak daha yüksekti (p=0.020). Santral kan basıncı ve augmentasyon indeksi ile Hp kolonizasyonunun yoğunluğu arasında hiçbir korelasyon yoktu (p=0.070, r=0.263). Ancak yapılan lojistik regresyon analizine göre yaş, BMI, sistolik ve diyastolik kan basıncı, merkezi kan basıncı, glikoz, kreatinin, toplam kolesterol, C-reaktif protein ve pozitif Hp faktörleri arasında pozitif Hp’nin 24.9 üzerinde augmentasyon indeksini tek ön gördürücü faktör olduğu belirlendi (OR: 3.593, 95%CI: 1.341-9,629, p=0.011). Sonuç: Helicobacter Pylori pozitif saptanan hastalarda ateroskleroz ve arteriyel sertlik riski artmıştır. Ek olarak Hp pozitifliğinin arteryel sertlik için ön gördürücü olduğu izlenmiştir. Hp ile ateroskleroz ilişkinin mekanizmasını detaylandırmak için daha büyük örneklem büyüklüğünde uzun vadeli takip çalışmalarına ihtiyaç vardır.

Anahtar Kelimeler

• Helicobacter Pylori
• Damar Sertliği
• Arterioskleroz
• Nabız Dalga Analizi

The Relationship Between Arterial Stiffness and Helicobacter Pylori Infection

Öz

Abstract Aim:Studies have found the association of Helicobacter Pylori (Hp) seropositivity with cardiovascular diseases and it has been shown that chronic inflammation with Hp may be related to early atherosclerosis. The aim of this study is to evaluate the relationship between Hp positivity detected by endoscopic gastric biopsy and arterial stiffness. Material and Method: In this cross-sectional study, patients were divided into 2 groups as Hp positive (n=48) and Hp negative (n=61) according to endoscopic gastric biopsy findings. Augmentation index, arterial stiffness and central blood pressure were measured using Pulse wave velocity analysis/Ambulatory blood pressure monitoring in all patients. Results: Augmentation index was significantly higher in the Hp positive group (p=0.020). There was no correlation between central blood pressure and augmentation index and the intensity of Hp colonization (p=0.070, r=0.263). However, logistic regression analysis revealed that positive Hp (OR: 3.593, 95%CI: 1.341-9,629, p=0.011) was the only variable predictive for an augmentation index > 24.9 among variables including, age, BMI, systolic and diastolic blood pressure, central blood pressure, glucose, creatinine, total cholesterol, C-reactive protein, and positive Hp. Conclusion: Helicobacter Pylori positive patients with confirmed biopsy have an increased arterial stiffness. Moreover, presence of Hp infection is predictive for an increased arterial stiffness. Regarding the diversity and frequency of Hp worldwide long term follow up studies with larger sample size are needed to elaborate the mechanism of this relationship.

Anahtar Kelimeler

• Helicobacter Pylori
• Vascular Stiffness
• Arteriosclerosis
• Pulse Wave Analysis

Kaynakça

1. Suerbaum S, Michetti P. Helicobacter pylori infection.N Engl J Med. 2002;347:1175-86. DOI: 10.1056/NEJMra020542.
2. Konturek SJ, Konturek PC, Konturek JW, M Plonka, M Czesnikiewicz-Guzik, T Brzozowski et al. Helicobacter pylori and its involvement in gastritis and peptic ulcer formation. J Physiol Pharmacol. 2006;57 Suppl3:29–50.
3. Torisu T, Takata Y, Ansai T,Matsumoto T, Sonoki K, Soh Iet al. Possible association of atrophic gastritis and arterial stiffness in healthy middle-aged Japanese. J Atheroscler Thromb. 2009;16 (5):691-7. DOI: 10.5551/jat.943.
4. Yang YF, Li Y, Liu JH, Wang XM, Wu BH, He CS et al. Relation of Helicobacter pylori infection to peripheral arterial stiffness and 10-year cardiovascular risk in subjects with diabetes mellitus. Diab Vasc Dis Res. 2020 May-Jun;17(5):1479164120953626. DOI: 10.1177/1479164120953626.
5. Xu Z, Li J, Wang H, Xu G Helicobacter pylori infection and atherosclerosis: is there a causal relationship?.Eur J Clin Microbiol Infect Dis. 2017 Dec;36(12):2293-2301. DOI: 10.1007/s10096-017-3054-0.
6. Jafarzadeh A, Nemati M, Tahmasbi M, Ahmadi P, Rezayati MT, Sayadi AR. The association between infection burden in Iranian patients with acute myocardial infarction and unstable angina. Acta Med Indones. 2011;43(2):105–11.
7. Schottker B, Adamu MA, Weck MN, Müller H, Brenner H. Helicobacter pylori infection, chronic atrophic gastritis and major cardiovascular events: a population-based cohort study. Atherosclerosis. 2012;220(2):569–74. DOI:10.1016/j.atherosclerosis.2011.11.029.
8. Franceschi F, Gasbarrini A. Helicobacter pylori and extragastric diseases. Best Pract Res Clin Gastroenterol. 2007;21(2):325-34. DOI:10.1016/j.bpg.2006.10.003.

9. Mendall MA, Patel P, Asante M, L Ballam, J Morris, D P Strachan et al. Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Heart. 1997;78(3):273–7. DOI: 10.1136/hrt.78.3.273.
10. Laurent S, Boutouyrie P, Asmar R,Gautier I, Benetos A, Lacolley Pet al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236−41. DOI: 10.1161/01.hyp.37.5.1236.
11. Shirai K, Hiruta N, Song M, Kurosu T, Suzuki J, Tomaru Tet al. Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives. J Atheroscler Thromb. 2011;18(11):924–38. DOI: 10.5551/jat.7716.
12. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;30;55(13):1318-27. DOI: 10.1016/j.jacc.2009.10.061.
13. Glasser SP, Arnett DK, McVeigh GE, Finkelstein SM, Bank AJ, Morgan DJet al. Vascular compliance and cardiovascular disease: a risk factor or a marker? Am J Hypertens. 1997;10(10 Pt 1):1175-89. DOI: 10.1016/s0895-7061(97)00311-7.
14. Shirai K, Utino J, Otsuka K, Takata M. A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb. 2006; 13(2):101-7. DOI: 10.5551/jat.13.101.
15. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJet al. Aortic pulse wave velocity improves cardiovascular event prediction: An individual participant metaanalysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63(7):636–46. DOI: 10.1016/j.jacc.2013.09.063.
16. Kadayifci A, Buyukhatipoglu H, Cemil Savas M, Simsek I et al. Eradication of Helicobacter pylori with triple therapy: an epidemiologic analysis of trends in Turkey over 10 years. Clin Ther. 2006;28(11):1960-6. DOI: 10.1016/j.clinthera.2006.11.011.
17. Realdi G, Dore MP, Fastame L. Extradigestive manifestations of Helicobacter pylori infection: fact and fiction. Dig Dis Sci. 1999;44(2):229-36. DOI: 10.1023/a:1026677728175.
18. Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose Ket al. Validityreproducibilityand clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002;25(3):359−64. DOI: 10.1291/hypres.25.359.
19. Markus HS, Mendall MA. Helicobacter pylori infection: a risk factor for ischaemic cerebrovascular disease and carotid atheroma. J Neurol Neurosurg Psychiatry. 1998;64(1):104−7. DOI: 10.1136/jnnp.64.1.104.
20. Osawa H, Kawakami M, Fujii M, Kubo N, Iwanaka H, Yamamoto W et al. Helicobacter pylori infection and coronary heart disease in Japanese patients. Cardiology. 2001;95(1):14−9. DOI: 10.1159/000047337.
21. Adachi K, Arima N, Takashima T, Miyaoka Y, Yuki M, Ono M et al. Pulse-wave velocity and cardiovascular risk factors in subjects with Helicobacter pylori infection. J Gastroenterol Hepatol. 2003;18(7): 771−7. DOI: 10.1046/j.1440-1746.2003.03059.x.
22. Saijo Y, Utsugi M, Yoshioka E, Horikawa N, Sato T, Gong Y et al. Relationship of Helicobacter Pylori Infection to Arterial Stiffness in Japanese Subjects. Hypertens Res. 2005;28(4):283-92. DOI: 10.1291/hypres.28.283.
23. Moss SF, Legon S, Davies J, Calam J. Cytokine gene expression in Helicobacter pylori associated antral gastritis. Gut. 1994;35(11): 1567−70. DOI: 10.1136/gut.35.11.1567.
24. Crabtree JE, Shallcross TM, Heatley RV, Wyatt JI. Mucosal tumour necrosis factor alpha and interleukin-6 inpatients with Helicobacter pyloriassociated gastritis.Gut.1991;32(12):1473-7. DOI: 10.1136/gut.32.12.1473.
25. Zhang ZW, Patchett SE, Perrett D, Domizio P, Farthing MJ.Gastric alpha-tocopherol and beta-carotene concentrationsin association with Helicobacter pylori infection. Eur JGastroenterol Hepatol.2000;12(5):497-503. DOI: 10.1097/00042737-200012050-00004
26. Shirwany NA, Zou MH. Arterial stiffness: a brief review. Acta Pharmacol Sin. 2010;31(10):1267-76. DOI: 10.1038/aps.2010.123.
27. Muiesan ML, Salvetti M, Rizzoni D, Paini A, Agabiti-Rosei C, Aggiusti Cet al. Pulsatile hemodynamics and microcirculation: Evidence for a close relationship in hypertensive patients.Hypertension.2013;61(1):130-6. DOI:10.1161/HYPERTENSIONAHA.111.00006.
28. Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke. 2003;34(5):1203–6. DOI: 10.1161/01.STR.0000065428.03209.64.
29. Scuteri A, Tesauro M, Appolloni S, Preziosi F, Brancati AM, Volpe M. Arterial stiffness as an independent predictor of longitudinal changes in cognitive function in the older individual. J Hypertens. 2007;25(5):1035–40. DOI: 10.1097/HJH.0b013e3280895b55.
30. Hashimoto J, Ito S. Central pulse pressure and aortic stiffness determine renal hemodynamics: Pathophysiological implication for microalbuminuria in hypertension. Hypertension. 2011;58(5):839–46. DOI: 10.1161/HYPERTENSIONAHA.111.177469.
31. Omboni S, Posokhov IN, Kotovskaya YV, Protogerou AD, Blacher J. Twenty-Four-Hour Ambulatory Pulse Wave Analysis in Hypertension Management: Current Evidence and Perspectives. Curr Hypertens Rep. 2016;18(10):72. DOI: 10.1007/s11906-016-0681-2.
32. Sung HR, Cho HC, Sang JH, Park KC, Kim MJ, Park KS et al. The relationship between Helicobacter pylori infection and arterial stiffness in adults with abnormal gastroduodenoscopic findings. Korean J Fam Pract. 2015;5(Suppl 3):43-48.
33. Choi JM, Lim SH, Han YM, Lee H, Seo JY, Park HE et al. Association between Helicobacter pylori infection and arterial stiffness: Results from a large cross-sectional study. PLoS One 2019 Aug 29;14(8):e0221643. DOI: 10.1371/journal.pone.0221643.