KOAH'LI OLGULARDA ANEMİNİN, KLİNİK VE FONKSİYONEL PARAMETRELERLE İLİŞKİSİ

Yıl 2016, Cilt: 30 Sayı: 2, 67 - 73, 01.10.2016

Dicle Kaymaz Pınar Ergün Ezgi Utku Pervin Demir İpek Candemir Nilgün Mendil Filiz Taşdemir

Öz

Amaç: KOAH'ı olan olgularda daha çok polisitemi olduğu bilinmekle beraber son zamanlardaki yayınlarda anemi prevelansının da yüksek olduğu belirtilmektedir. Anemi ile dispne arasındaki ilişki biliniyor olmasına rağmen, diğer klinik durumlarla arasındaki ilişki net değildir. Bu çalışmada pulmoner rehabilitasyon merkezine başvuran KOAH'lı olgulardaki aneminin klinik ve fonksiyonel parametrelerle arasındaki ilişki değerlendirilmiştir. Yöntem ve Gereç: Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim Araştırma Hastanesi Pulmoner Rehabilitasyon merkezinde Ocak 2008- Aralık 2011 tarihleri arasında, pulmoner rehabilitasyon programına yönlendirilen 507 KOAH'ı olan olgu retrospektif olarak değerlendirildi. Anemiye neden olacak hastalığı olan olgular dışlandı. Kalan 176 olgu DSÖ kriterlerine göre anemik, polisitemik, normal hemoglobin düzeyi olanlar olmak üzere 3 gruba ayrıldı. Olguların; dispne algısı Medical Research Council (MRC) dispne skalası ile, sağlıkla ilişkili yaşam kaliteleri St. George's solunum anketi ile, vücut kompozisyonları biyoelektriksel impedans yöntemi ile, egzersiz kapasiteleri artan hızda mekik yürüme testi ve endurans mekik yürüme testi ile, psikososyal durumları ise Hastane Anksiyete Depresyon Skalası ile değerlendirildi. Bulgular: 14 (%8) olguda anemi, 24 (% 14) olguda ise polisitemi saptandı. Anemik olguların normal hemoglobin düzeyi olan olgulara göre MRC dispne skalası skorları istatistiksel olarak daha yüksek (p=0.011), vücut kitle indeksi, yağsız vücut kitlesi, yağsız vücut kitle indeksi, değerleri ise polisitemik ve normal hemoglobin düzeyi olan olgulara göre daha düşük saptandı. Ayrıca polisitemik olguların normal hemoglobin düzeyi olan olgulara göre endurans zamanı istatistiksel olarak daha kısaydı (p=0.036). Sonuç: Anemi oranı stabil KOAH'ı olan olgularda %8 olarak saptandı. Anemi artmış dispne ve kötü nutrüsyonel durum ile ilişkiliydi. Pulmoner rehabilitasyon programına başvuran KOAH'ı olan olgular anemi yönünden değerlendirilmelidir, Çünkü anemi pulmoner rehabilitasyon program sonuçlarını etkileyebilir.

Anahtar Kelimeler

Anemi, KOAH, Pulmoner Rehabilitasyon Programı, Hemoglobin anormallikleri, Klinik durum

THE ASSOSIATION OF ANEMIA WITH CLINICAL AND FUNCTIONAL PARAMETERS IN PATIENTS WITH COPD

Öz

Aim: Polycytemia is commonly associated with COPD but recent reports suggest that anemia is also prevalent. Though the associations between anemia and dyspnea, are generally well established the relation with the other clinical manifestations is unknown.The aim of this study was to determine the assosiation of anemia with clinical and functional parameters in patients with COPD who referred to pulmonary rehabilitation (PR) program Material and Methods: 507 COPD patients who referred to Atatürk Chest Disease and Chest Surgery Training Hospital PR Center between January 2008 December 2011 were evaluated retrospectively. Patients who had diseases likely to cause anemia were excluded and the remaining 176 patients were divided into three groups according to WHO criteria as anemia,normal,and polycythemia patients. Dyspnea was assessed with the Medical Research Council(MRC)scale;health related quality of life was assessed with St. George's respiratory questionnaire. Exercise capacity was measured using the incremental shuttle walk test,endurance shuttle walk test, body composition was assessed with bioelectirical impedance, anxiety and depression were assessed with the Hospital Anxiety Depression Scale. Results: Anemia was present in 14(8%)patients and polycythemia in 24 (14%).Anemia patients had significantly higher MRC scale scores than the normal patients(p=0.011),whereas had lower body mass index,fat-free mass index,and fat-free mass values as compared to polycythemia and normal patients.Endurance time was shorter in polycythemia patients than the normal patients (p=0.036). Conclusion: The rate of anemia was found approximately 8% in the patients with stable COPD and associated with increased dyspnea and poor nutritional status.COPD patients who referred to the PR programs should be assessed for anemia;because anemia could affect the PR program results.

Anahtar Kelimeler

Anemia, COPD, Pulmonary Rehabilitation Program, Hemoglobin abnormalities, Clinical Condition

Kaynakça

• 1. Means RT,Krantz SB. Progress in understanding the pathogenesis of the anemia of chronic disease. Blood 1992; 80(7): 1639–47.
• 2. World Health Organization. Nutrional anemias:report of a WHO scientific group WHO Technical Report Series 405,Geneva,World Health Organization, 1968; pp.1-37.
• 3. Kasper DL,Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, et al,eds.Harrison’s Principles of Internal Medicine 16 th Edn. McGraw-Hill’s Access Medicine.www.accessmedicine.com /content.aspx Aıd=58150.Date last accessed: December 11,2006.
• 4. Mahler DA. Measurement of dyspnea Clinical ratings. In: Mahler DA, O'Donnell DE (eds). Dyspnea. 2nd Ed. Lung Biology in Health and Disease. Taylor and Francis, Boca Raton 2005; 208: 147-65.
• 5. Singh SJ, Morgan MDL, Scott S,Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airway obstruction. Thorax 1992; 47: 1019-24.
• 6. Revill SM, Morgan MDL, Singh SJ, Williams J, Hardman AE. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive diseases. Thorax 1999; 54: 213-22.
• 7. Meguro M, Barley EA, Spencer S, Jones PW. Development and Validation of an Improved, COPDSpecific Version of the St. George Respiratory Questionnaire. Chest 2007; 132: 456-63.
• 8. Polatlı M, Yorgancıoğlu A, Aydemir Ö, Demirci NY, Kırkıl G, Naycı SA, Köktürk N, Uysal A, Akdemir SE, Özgür ES, Günakan G. St George Solunum Anketinin geçerlilik ve güvenilirliği. Tüberküloz Toraks 2013; 61(2): 81-87. Doi: 10.5578/tt.5404
• 9. Walter-Kroker A, Kroker A, Mattiucci-Guehlke M, Glaab T. A practical guide to bioelectrical impedance analysis using the example of chronic obstructive pulmonary disease. Nutr J 2011; 21; 10- 35.
• 10. Aydemir Ö. Validity and reliability of Turkish version of hospital anxiety and depression scale. Türk Psikiyatri Dergisi 1997; 8(4): 280-7.
• 11. Groopman JE, Itri LM. Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst 1999; 91: 1616-34.
• 12. Krishnan G, Grant BJ, Muti PC, Mishra A,OchsBalcom HM, Freudenheim JL, et al.Association between anemia and quality of life in a population sample of individuals with chronic obstructive pulmonary disease. BMC Pulm Med 2006; 6: 23.
• 13. Halpern MT, Zilberberg MD, Schmier JK, Lau EC, Shorr AF. Anemia, costs and mortality in chronic obstructive pulmonary disease. Cost Eff Resour Alloc 2006; 4: 17.
• 14. Cote C, Zilberberg MD, Mody SH, Dordelly LJ, Celli B. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007; 29: 923–29.
• 15. Smith DL. Anemia in the elderly. Am Fam Physician 2000; 62: 1565-72.
• 16. Kollert F,Müller C, Tippelt A, Jörres R.A, Heidinger D, Probst C, et al.Anaemia in Chronic Respiratory Failure. Int J Clin Pract 2011; 65 (4): 479–86.
• 17. Dourado VZ, Tanni SE, Vale SA,Systemic manifestations in chronic obstructive pulmonary disease. J Bras Pneumol 2006; 32: 161-71.