Romatizmal Kapak Hastalığında Serum Eser Elementlerinin Değerlendirilmesi

Öz

Amaç Bu çalışmanın amacı romatizmal kapak hastalığı (RKH) olan bireylerde serum eser elementleri düzeyinin değerlendirilmesidir. Materyal ve Metod Bu çalışmaya, kardiyoloji polikliniğine başvuran hastalar arasından RKH mevcut olup fonksiyonel kapasitesi sınıf 1 olan ardışık 30 (15 Erkek ve ort yaş: 34,0±9,3 yıl) hasta dâhil edildi. Yapılan kardiyak değerlendirme sonucunda patoloji saptanmayan, benzer demografik özelliklere sahip ardışık 30 (9 Erkek ve ortalama yaş:37,4±5,9 yıl ) sağlıklı birey kontrol grubu olarak alındı. Serum Çinko (Zn) düzeyi alev fotometresinde, Selenyum (Se) düzeyi atomik absorbsiyon spektrofotometresinde ve Demir (Fe) düzeyi ise spektrofotometrik olarak ölçüldü. Sonuçlar Yaş ve cinsiyet, gruplar arasında benzerdi (p>0,05). Boy, vücut ağırlığı, serum Fe, Se ve Zn düzeyleri hasta grubunda kontrol grubuna göre daha düşüktü (tüm p değerleri <0,05). Yapılan korelasyon analizinde, serum Fe düzeyi ile, yaş, vücut ağırlığı, serum Se ve Zn düzeyi arasında pozitif ilişki saptandı (p<0,05). Serum Se düzeyi, boy, serum Fe ve Zn düzeyi ile; serum Zn düzeyi ise boy, vücut ağırlığı, serum Fe ve Se düzeyleri ile pozitif korele idi. (tüm p değerleri <0,05). Çok değişkenli logistik regresyon analizi bu değişkenlerden sadece serum demir seviyesinin RKH varlığının bağımsız belirleyicisi olduğunu gösterdi (beta değeri=0,500, p<0,05). Tartışma Çalışmamızda, RKH olanlarda, serum eser elementlerinin kontrol grubuna göre daha düşük olduğu bulunmuştur. Serum eser elementlerindeki bu düşüklük, RKH olanlardaki uygunsuz immün yanıt ile ilişkili olabilir. Ancak eser element seviyelerinin RKH'larında düşük olmasının sebep mi sonuç mu olduğu kesin olarak bilinmektedir. Ayrıca, eser elementleri yerine koymanın hastalık ilerleyişine etkisini inceleyen çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Romatizmal kapak hastalığı,Eser elementler,Selenyum,Demir,Çinko

The Evaluation Of Trace Elements In Rheumatic Valvular Disease

Öz

Aim The aim of this study was to investigate trace elements in patients with rheumatic valvular disease Material and Method A total of 30 consequently (15 male and age: 34.0 ±9.3 years) patients with rheumatic valvular disease and functional capacity class 1 according to NYHA (RVD) who admitted to our cardiology department were enrolled in this sturdy. 30 randomly age/sex matched subjects with no cardiovascular or systemic disease were recruited as control group. Serum levels of trace elements including selenium (Se) zinc (Zn) and iron (Fe) were measured. Results The age and sex were comparable between two groups (p>0.05). Height, weight, serum levels of Fe, Se and Zn were lower in patients with RVD compared to control group (all p values <0.05). In correlation analysis, serum Fe levels were positively correlated with age, weight, and serum Se and Zn levels (all p values <0.05). Serum Se levels were positively correlated with height, serum Fe and Zn levels, while serum Zn levels were positively correlated with height, weight, and serum Fe and Se levels (all p values <0.05). Multivariable regression analyses showed that serum Fe levels were the only independent predictor of RVD (beta value=0,500, p<0.05). Conclusion In this study, we yield that serum levels of Fe, Se and Zn were significantly lower in patients with RVD. These results may be associated with inappropriate immune response in this population. However, it is not clear whether this is a cause or a result of rheumatic heart disease. Additionally, further studies which investigating the effect of replacement of trace elements in rheumatic valvular disease are needed.

Anahtar Kelimeler

• rheumatic valvular disease,trace elements,Selenium,iron,zinc

Kaynakça

1. 1 . h t t p : / / w w w . t k d - o n l i n e . o r g / UKSP/UKSP_Bolum02.pdf
2. 2. Cakır N, Pamuk ÖN, Derviş E, Imeryüz N, Uslu H, Benian Ö, Elelçi E, Erdem G, Sarvan FO, Senocak M. The prevalences of some rheumatic diseases in western Turkey: Havsa study. Rheumatol Int. 2012 Apr;32(4):895-908.
3. 3. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132
4. 4. Namboodiri N, Remash K, Tharakan JA, Shajeem O, Nair K, Titus T, Ajitkumar VK, Sivasankaran S, Krishnamoorthy KM, Harikrishnan SP, Harikrishnan MS, Bijulal S. Natural history of aortic valve disease following intervention for rheumatic mitral valve disease. J Heart Valve Dis. 2009 Jan;18(1):61-7.
5. 5. Fairweather-Tait SJ, Bao Y, Broadley MR, Collings R, Ford D, Hesketh JE, Hurst R. Selenium in human health and disease. Antioxid Redox Signal. 2011 Apr 1;14(7):1337-83.
6. 6. Handelman GJ, Levin NW. Iron and anemia in human biology: a review of mechanisms. Heart Fail Rev. 2008 Dec;13(4):393-404.
7. 7. Prasad AS. Zinc in human health: effect of zinc on immune cells. Mol Med. 2008 May-Jun;14(5-6):353-7.
8. 8. Ganz T, Nemeth E. Iron homeostasis in host defence and inflammation. Nat Rev Immunol. 2015 Aug;15(8):500-10.

9. 9. Bonaventura P, Benedetti G, Albarède F, Miossec P. Zinc and its role in immunity and inflammation. Autoimmun Rev. 2015 Apr;14(4):277-85.
10. 10. Wong CP, Ho E. Zinc and its role in age-related inflammation and immune dysfunction. Mol Nutr Food Res. 2012 Jan;56(1):77-87.
11. 11. Huang Z, Rose AH, Hoffmann PR. The role of selenium in inflammation and immunity: from molecular mechanisms to therapeutic opportunities. Antioxid Redox Signal. 2012 Apr 1;16(7):705-43.
12. 12. Cunningham MW. Rheumatic fever, autoimmunity, and molecular mimicry: the streptococcal connection. Int Rev Immunol. 2014 Jul-Aug;33(4):314-29.
13. 13. Ramakrishnan U. Prevalence of micronutrient malnutrition worldwide. Nutr Rev. 2002 May;60(5 Pt 2):S46-52..
14. 14. Kosar F, Sahin I, Acikgöz N, Aksoy Y, Kucukbay Z, Cehreli S. Significance of serum trace element status in patients with rheumatic heart disease: a prospective study. Biol Trace Elem Res. 2005 Oct;107(1):1-10.
15. 15. Steinbrenner H, Al-Quraishy S, Dkhil MA, Wunderlich F, Sies H. Dietary selenium in adjuvant therapy of viral and bacterial infections. Adv Nutr. 2015 Jan 15;6(1):73-82.
16. 16. Bonaventura P, Benedetti G, Albarède F, Miossec P. Zinc and its role in immunity and inflammation. Autoimmun Rev. 2015 Apr;14(4):277-85.
17. 17. Formigari A, Irato P, Santon A. Zinc, antioxidant systems and metallothionein in metal mediated-apoptosis: biochemical and cytochemical aspects. Comp Biochem Physiol C Toxicol Pharmacol. 2007 Nov;146(4):443-59.
18. 18. Ganz T, Nemeth E. Iron homeostasis in host defence and inflammation. Nat Rev Immunol. 2015 Aug;15(8):500-10.
19. 19. Govindaraju V, Prabhudev N, Gurappa M, Jawali VS, Chandrasekhara PM, Manjunath CN. Zinc in rheumatic heart valves. J Assoc Physicians India. 1993 Oct;41(10):653-4.
20. 20. Durak I, Akyol O, Es MU, Canbolat O, Akpoyraz M. Element structure in stenotic mitral valves. Am J Cardiol. 1993 Feb 1;71(4):355.