Koroner arter baypass cerrahisinde statinin antikardiyolipin antikor seviyelerine etkisi

Öz

Amaç: Bu araştırmanın amacı, koroner baypas cerrahisi hastalarında statinin lipit düşürme mekanizması ile diğer yararlı biyolojik etkileri arasındaki bağlantıyı preoperatif statin ile preoperatif, perioperatif ve postoperatif kardiyolipin IgG ve IgM antikor düzeyleri arasındaki ilişkiyi ortaya koyarak incelemektir. Açık kalp cerrahisinde durum sadece kalbin atmasını sağlamak değil, miyokardiyal hasarı önlemek veya en aza indirmektir. Bu nedenle kan elementlerinin ve miyokardın korunması için yeni bir yöntemin ortaya çıkarılması gerekmektedir. Gereç ve Yöntemler: Elektif koroner arter baypas greft cerrahisi planlanan ve araştırma kriterlerimize uyan koroner iskemik hastalığı olan 30 hasta, 40 mg/gün atorvastatin ile standart lipid düşürücü tedavi görenler olmak üzere iki gruba ayrıldı. ameliyattan en az 7 gün önce (grup A) ve ikinci grup ameliyat öncesi düzenli lipid düşürücü tedavi almayanlar (B). Demografik, hemodinamik, laboratuvar ve cerrahi teknik dahil olmak üzere tüm parametreler belgelendi ve kaydedildi. Bulgular: Kaydedilen parametreler ve değerler bilgisayar programında şu testler kullanılarak analiz edildi: Kolmogorov-Smirnov testi, student t testi, paired t testi ve Ki-kare testi. Tüm sonuçlar, basit ve daha iyi değerlendirme için 6 tabloda planlanmıştır. Sonuç: Bulgular, açık kalp cerrahisinde perioperatif ve postoperatif erken dönemde (ilk 24 saat) statinin yararlı etkilerini desteklemektedir.

Anahtar Kelimeler

• Açık kalp cerrahisi
• statin
• antikardiyolipin antikoru

Effect of statin on anticardiolipin antibody levels in coronary artery bypass surgery

Öz

Objectives: The aim of this research is to study the link between lipid lowering mechanism and other beneficial biological effects of statin in patients of coronary bypass surgery by revealing the relation of preoperative statin on pre- , peri- and postoperative cardiolipin IgG and IgM antibody levels. The case in open cardiac surgery was not keeping the heart beating only but preventing or minimizing the myocardial injury. For this reason, a new method for preservation of blood elements and myocardium must be uncovered. Material and Methods: Thirty patients with coronary ischemic disease whose scheduled to undergo elective coronary artery bypass graft surgery and fitting the criteria for our research were divided in to two groups, those on standard lipid lowering therapy using atorvastatin ( 40 mg/day ) for at least 7 days prior to surgery (group A) and second group those without regular lipid lowering therapy preoperatively (B). All the parameters were documented and recorded, including demographic, hemodynamic, laboratory and surgical technique with outcome. Results: The recorded parameters and values were analyzed using the following tests in computer program: Kolmogorov- Smirnov test, student t test, paired t test and Chi- square test. All results were scheduled in 6 tables for simple and better evaluation. Conclusion: The findings support the beneficial effects of statin in the perioperative and early postoperative (first 24 hours) in open cardiac surgery.

Anahtar Kelimeler

• Open cardiac surgery
• statin
• anticardiolipin antibody

Kaynakça

1. Cohn LH. Cardiac Surgery in The Adult 1 - History of Cardiac Surgery, The Development of Cardiopulmonary Bypass, 2008: 8-13.
2. Cohn LH. Cardiac Surgery in The Adult 1 - History of Cardiac Surgery, Myocardial Protection, 2008: 14.
3. Horbett TA. Principles underlying the role of adsorbed plasma proteins in blood interactions with foreign materials. Cardiovasc Pathol 1993; 2:137S.
4. Edmunds LH Jr. Blood activation in mechanical circulatory assist devices. J Congestive Heart Failure Circ 2000; 1(Suppl):141.
5. Ascione R, Lloyd CT, Underwood MJ: Inflammatory response after coronary revascularization with and without cardiopulmonary bypass. Ann Thorac Surg 2000; 69:1198.
6. Menasché PH. The systemic factor: The comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery. Ann Thorac Surg 2001; 72:S2260.
7. Krebs JJ, Hauser H, Carafoli E. Asymmetric distribution of phospholipids in the inner membrane of beef heart mitochondria. J Biol Chem. 1979;254(12):5308-16.
8. Hörkkö S, Miller E, Dudl E, Reaven P, Curtiss LK, Zvaifler NJ et al. Antiphospholipid ntibodies are directed against epitopes of oxidized phospholipids. Recognition of cardiolipin by monoclonal antibodies to epitopes of oxidized low-density lipoprotein. J Clin Invest 1996;3:815–25.

9. Atsumi T, Khamashta MA, Andujar C, Leandro MJ, Amengual O, Ames PR, et al. Elevated plasma lipoprotein(a) level and its association with impaired fibrinolysis in patients with antiphospholipid syndrome. J Rheumatol. 1998 ;25(1):69-73.
10. Koike T. Autoantibodies and thrombosis. Hokkaido Journal of Medical Science 1997;72:485–90. Triplett DA. Lupus antocoagulant. In: Peter JP, Shoenfeld Y, eds. Autoantibodies. NewYork: McGraw-Hill 1996: 474-7.
11. Arnout J. The pathogenesis of the anto phospholipid syndrome: a hypothesis based on parallelisms with heparin-induced thrombocytopenia. Thromb Haemostat 1996; 75: 536-41.
12. Hunninghake D.B. HMG-CoA reductase inhibitors. Curr.Opin.Lipidol.1992; 3: 22-8.
13. Blumenthal RS. Statins: Effective antiatherosclerotic therapy. Am.Heart.J. 2000; 139: 577-83.
14. Corsini A, Bellosta S, Baetta R, Fumagalli R, Bernini F. New insights into the pharmacodynamics and pharmacpkinetic properties of statins. Pharmacol.Ther. 1999; 84: 413-28.
15. Allou N, Augustin P, Dufour G, Tini L, Ibrahim H, Dilly MP, et al. Preoperative statin treatment is associated with reduced postoperative mortality after isolated cardiac valve surgery in high-risk patients. J Cardiothorac Vasc Anesth. 2010;24(6):921-6.
16. Dotani MI, Elnicki DM, Jain AC, Gibson CM. Effect of preoperative statin therapy and cardiac outcomes after coronary artery bypass grafting. Am J Cardiol. 2000;86:1128-30.
17. Poldermans D, Bax JJ, Kertai MD, Krenning B, Westerhout CM, Schinkel AF, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation. 2003;107(14):1848-51.
18. Salam AM. Expanding indications of statins; implications of the Heart Protection Study. Expert Opin Investig Drugs. 2003;12:509-13.
19. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333(20):1301-7.
20. Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebocontrolled trial. Lancet. 2002;360:7-22.
21. Wiesbauer F, Achlager O, Domanovits H, Wildner B, Maurer G, Muellner M, et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity: a systematic review and meta-analysis. Anesth Analg. 2007;104(1):27-41.
22. Werba JP, Tremoli E, Massironi P, Camera M, Cannata A, Alamanni F, et al. Statins in coronary bypass surgery: rationale and clinical use. Ann Thorac Surg. 2003;76(6):2132-40.
23. Lazar HL. Role of statin therapy in the coronary bypass patient. Ann Thorac Surg. 2004;78:730-40. Irat AM, Işık AS. Pleiotropic effects of HMG-CoA reductase inhibitors. J.Fac.Pharm. 2006; 35(3) 197-209.
24. Baetta R, Donetti E, Comparato C, Calore M, Rossi A, Teruzzi C. In vitro and in vivo apoptosis by atorvastatin in stimulated smooth muscle cells. Pharmacol.Res.1997; 36: 115-21.
25. Davignon J. Beneficial cardiovascular pleiotropic effects of statins. Circulation. 2004;109(suppl III):III39-43.
26. Alaupovic P, Fesmire JD, Hunnighake D, Domanski M, Forman S, Knatterud GL, et al. The effect of aggressive and moderate lowering of LDL-cholesterol and low dose anticoagulation on plasma lipids, apolipoproteins and lipoprotein families in post coronary artery bypass graft trial. Atherosclerosis. 1999;146(2):369-79.
27. Hojnik M, George J, Ziporen L, Shoenfeld Y. Heart valve involvement in the antiphospholipid syndrome. Circulation 1996;93:1579–87.