Kardiyopulmoner Baypass Sırasında Homosistein, Vitamin B12 ve Folik Asit Seviyelerinin Değişimi ve Birbirleri ile Olan İlişkilerinin İncelenmesi

Yıl 2019, Cilt: 46 Sayı: 2, 369 - 377, 11.06.2019

Hatice Bilge Açık Mustafa Göz Mehmet Salih Aydın Mahmut Padak , Reşat Dikme , Ömer Göç

https://doi.org/10.5798/dicletip.528618

Öz

Özet

Amaç: Yaptığımız bu çalışmada Kardiyopulmoner bypass (KPB)
sırasında homosistein, vitamin B12 ve folik asit parametrelerinin değişimlerine
bakılarak birbirleri ile olan ilişkilerinin araştırılması amaçlanmıştır.

Materyal ve Metod: Göğüs Kalp Damar Cerrahisi bölümünde
çeşitli sebeplerden dolayı KPB cerrahisi ile ameliyat olan hastalardan ameliyat
öncesi, pompaya (kalp akciğer makinesi) giriş, kross klemp sonrası ve protamin
verilmesi sonrası olmak üzere 4 jelsiz tüpe kan alınarak bir çalışma grubu
oluşturuldu. Alınan kanlarda serum Vitamin B12 düzeyi ve serum Folik asit
düzeyi Kemilüminesans yöntemi ile serum Homosistein düzeyi ise Kolorimetrik
yöntem ile ölçülmüştür.

Bulgular: Vitamin B12, pg/MI değeri; Ameliyat öncesi
206.30 ±64.76, Pompaya Giriş108.03 ± 35.75, Kross Klemp Sonrası 128.53 ± 38.43,
Protamin Sonrası 141.33 ± 39.21, p<0,001 olarak bulunmuştur. Folik Asit,
ng/MI değeri sırasıyla; 10.04 ± 2.89, 6.53 ± 1.84, 6.53 ± 1.95,  9.02 ± 2.83 ve p<0,001 olarak bulunmuştur.
Homosistein, μmol/L         değeri
sırasıyla;14.40 ± 4.48, 7.63 ± 2.30, 9.44 ± 2.62, 9.15 ± 2.55 ve p<0,001
olarak bulunmuştur.

Sonuç: Pompaya girişte
homosistein, vitamin B12 ve folik asit düzeyi prime solüsyondan dolayı sayısal
olarak düşerken; pompa girişinden kross klemp sonrasına kadar homosisteinde
anlamlı artış olmuş, folik asit düzeyinde artış olmamış, vitamin B12 oranındaki
artış ise homosistein kadar olmamıştır. Bu durum Vitamin B12 ve Folik asit
düzeyi ile serum homosistein konsantrasyonu arasında negatif bir korelasyon
göstermiştir. Kross klemp sonrasından protamin sonrasına kadarki dönemde homosistein
seviyesinde düşüş olmasına rağmen, Vitamin B12 ve folik asit seviyesinde
yükselmeler olmuştur. Bu yükseklik homositeinin Vitamin B12 ve folik asit ile
negatif ilişkisine destek olmaktadır. Perfüzyon süresi uzadıkça artan
inflamatuar yanıt ve kullanılan ilaçlar ile homosistein seviyesinde değişimlere
neden olmuş fakat bu etkileşimlerin homosistein, Vitamin B12 ve folik asit
düzeyi ile ilişkisi istatistiksel olarak gösterilememiştir.

 

INVESTIGATION OF THE RELATIONSHIP BETWEEN HOMOCYSTEINE, VITAMIN B12 AND
FOLIC ACID LEVELS AND THEIR RELATIONSHIP BETWEEN THE CARDIOPULMONARY BYPASS

ABSTRACT

Background: The aim of this study was to investigate the
association between homocysteine, vitamin B12 and folic acid parameters in
cardiopulmonary bypass (CPB).

Methods: In the thoracic cardiovascular surgery
department, a study group was formed by taking 4 gel-free scales from
pre-operative, pump (heart lung machine), after cross-clamp and protamine
administration from patients who underwent surgery with CPB surgery for various
reasons. Serum vitamin B12 level and serum Folic acid level were measured by
chemiluminescence method and serum homocysteine level by Colorimetric method.

Results: Vitamin B12, pg / mL value; Preoperatively
206.30 ± 64.76, Pump Entry 108.03 ± 35.75, Post Cross Clamp 128.53 ± 38.43,
Post Protamine 141.33 ± 39.21, p <0.001. Folic Acid, ng / ml value
respectively; 10.04 ± 2.89, 6.53 ± 1.84, 6.53 ± 1.95, 9.02 ± 2.83 and p
<0.001 respectively. Homocysteine, μmol / L values were found to be 14.40 ±
4.48, 7.63 ± 2.30, 9.44 ± 2.62, 9.15 ± 2.55 and p <0.001 respectively.

Conclusions: While homocysteine, vitamin B12 and folic
acid levels were decreased by prime solu- tion in the pump, there was a
significant increase in homocysteine from the pump inlet to the end of the
cross clamp, no increase in folic acid level, and no increase in vitamin B12 as
homocysteine. This showed a negative correlation between Vitamin B12 and Folic
acid level and serum homocysteine concentration. Although there was a decrease
in homocysteine levels after the crosstalk after protamine, there was a rise in
vitamin B12 and folic acid levels. This elevation supports the negative
association of homocyte with Vitamin B12 and folic acid. Increased duration of
perfusion resulted in increased inflammatory response and changes in
homocysteine levels with drugs used, but these interactions were not
statistically related to homocysteine, Vitamin B12 and folic acid levels.

Anahtar Kelimeler

Kardiyopulmoner baypas, Homosistein, Vitamin B 12, , Folik asid

Kaynakça

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