Importance of apopitosis markers and oxidized low density lipoprotein for diagnosis and prognosis determination of acute myocardial infarction

Öz

Akut miyokard infarktüsü teşhisi ve prognozunu belirlemede CK-18, HSP70, H-FABP ve Ox-LDL gibi biyokimyasal belirteçlerin önemini, aralarındaki korelasyonu ve CK-MB, TROPONİN I gibi bilinen kardiyak parametrelere karşı üstünlükleri olup olmadığını belirlemek amaçlanmıştır.Çalışma; semptomlar başladıktan 6 saat içinde acile başvuran ve giriş troponin değerleri yüksek, ilk defa Mİ geçiren 45-65 yaş arası 40 erkek bireyden alınan kanlar üzerinde gerçekleştirilmiştir. Bu hastaların ilk başvuruda, 24. saat ve 30.gün sonrasında venöz kan örnekleri toplanmıştır. Bu parametrelerin sağlıklı bireylerdeki referans aralığının belirlenebilmesi amacıyla, hasta grubumuzla benzer yaş ve cinsiyet dağılımı gösteren 30 sağlıklı gönüllü erkek bireyden de bir defaya mahsus kan örnekleri alınmıştır. Gruplar; grup I (Girişteki kan değerleri), grup II (24. saat kan değerleri), grup III (30. gün kan değerleri) ve grup IV (Kontrol grubu kan değerleri) şeklinde düzenlenmiştir. HSP70, CK-18, H-FABP ve Ox-LDL düzeyleri ELİSA tekniği ile çalışan ticari kitlerle, CK-MB ve TroponinI parametreleri ise kemilüminesan esaslara göre ölçülmüştür.Hastaların girişteki kan değerlerine bakıldığında:  HSP70, H-FABP ve Ox-LDL' nin; 24. saatteki değerler için HSP70 ve H-FABP' nin ve 30. gün kan değerleri için ise CK-18, Ox-LDL ve HSP70' in kontrol grubundaki değerlere oranla önemli düzeyde yüksek ve istatistiksel olarak anlamlı olduğu görülmüştür. HSP70 ve cTnI arasında pozitif korelasyon olduğu saptanmıştır.Bulgularımız; H-FABP' nin AMI'nün erken teşhisi için tanısal doğruluğa sahip olduğunu, Ox-LDL' nin AMI için önemli bir risk faktörü olduğunu, MI erken teşhisinde periferal kanda tepitiyle tanıyı kuvvetlendirebileceğini, MI sonrası antioksidan tedavinin de gerekli olabileceğini, HSP70' in MI teşhisinde cTnI ile beraber tanısal doğruluğu artırmakta olduğunu ve prognostik değer taşıdığını, CK-18' in iskemi reperfüzyon sonucu mikrovasküler endotelial dokudan salgılanarak kan serum seviyelerinin tespit edilebilir olduğunu fakat AMI erken teşhisinde tanısal doğruluğu göstermede yeterli olamayacağını göstermiştir.

Anahtar Kelimeler

• FABP3 proteini,akut koroner sendrom,HSP70,kreatin kinaz,troponin I,okside düşük dansiteli lipoprotein,m30 sitokeratin-18 peptit

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