ST Yükselmeli Miyokard İnfarktüsünde Ürik Asit-Lenfosit Oranları ve Miyokard Hasarı Parametreleri

Öz

Amaç: Majör kardiyovasküler kötü sonuçlar ile ürik asit (UA), nötrofil/lenfosit oranı (NLO), lenfosit düzeyleri arasındaki ilişki güncel çalışmalar ile gösterilmiştir. Bu çalışmada, primer perkütan koroner girişim (PCI) yapılan STEMI ve anstabil angina pektoris (UAP) hastalarında UALO düzeylerini incelemek amaçlandı. Bu bağlamda, UALO 'nun miyokardiyal hasarlanma belirteçleri (troponin I, kreatin kinaz-MB), inflamatuar belirteçler (yüksek duyarlıklı C-reaktif protein(hsCRP) ve kan sayımı değişkenleri), serum lipidleri ve miyokardiyal kontraktilite ile ilişkileri incelendi.
Gereç ve Yöntem: Çalışmaya 176 STEMI ve 170 UAP olmak üzere toplam 346 hasta dâhil edildi. Parametreler arası anlamlı farkları görmek için T testi veya Mann-Witney U testi kullanıldı. STEMI ve UAP hastaları arasında anlamlı olarak farklı bulunan UA, NLO ve UALO için ROC analizleri yapıldı.
Bulgular: UA, NLR ve UALO düzeyleri STEMI’de ve UAP hastalarına göre anlamlı olarak farklı ve yüksek idi (sırasıyla p<0.001, p=0.014 ve p<0.001). Optimum kesme noktaları UA için 6.05 mg/dL (AUC 0.561, özgüllük % 50, duyarlılık % 72; UALO için 0.179 (AUC 0.980, özgüllük % 96, duyarlılık % 92); NLR için 2.3 (AUC 0.913, özgüllük% 82, duyarlılık,% 88 olarak bulundu.
Sonuç: STEMI hastalarında UALO ile NLO, hsCRP, LVEF1 ve hs-troponin I arasında anlamlı bir ilişki bulunmaktadır. STEMI hastalarının başvuru anında NLO, UA ve hsCRP’den daha dözgül ve duyarlı olarak bulduğumuz UALO düzeylerinin incelenmesini, miyokardın kasılma performansındaki bozulmanın bağımsız bir öngördürücüsü olarak kullanılabilecek, ucuz ve kolay erişilebilir bir rutin laboratuvar parametresi olarak öneriyoruz.   

Anahtar Kelimeler

• ürik asit,lenfosit,nötrofil/lenfosit oranı,miyokard enfarktüsü,koroner anjiyografi

Uric acid-lymphocyte ratios and myocardial damage parameters in ST elevated myocardial infarction

Öz

Abstract

Background/Aims:Studies recently have demonstrated the association between the major cardiovascular poor outcomes and uricacid (UA), the neutrophil/lymphocyteratio (NLR), lymphocyte counts. Barely, the relation between uricacid-to-lymphocyteratio (UALR) levels and inflammatory markers in ST elevated myocardial infarction (STEMI) hasn’t been investigated yet. In our current study, we tried to investigate whether alterations UALR levels between patients unstable angina pectoris (UAP) patients and STEMI patients who underwent primary percutaneous coronary intervention (PCI). In this context, were searched that altherelations of UALR with myocardial injury markers (troponin I, creatine kinase-MB), inflammatory markers (C-reactive protein, and covariaties of blood count), patients' lipid profiles and myocardial contractility.

Methods:A total of 346 STEMI and UAP patients were enrolled in this retrospectively study. T-test or Mann Witney U test was used to see the significant differences. We found independent predictive factors for UA, NLR, and UALR for STEMI and ROC analyses was performed for these parameters. 

Results:We showed significant differences between UA, NLR and UALR levels (P<0.005)between STEMI and UAP patients. We determined the optimal cut-off points as: 6.05mg/dL for UA (UAC 0.561, specifity%50, sensitivity%72); 0.179 for UALR (UAC 0.913, specifity%96,sensitivity %92) ;2.3 for NLR (UAC 0.395,  specifity %82, sensitivity %88). 

Conclusions: For the first time in the literature, it has been demonstrated that UALR is a distinct parameter associated with troponin I levels and myocardial contractility, and is more sensitive and specific than the NLR, UA and CRP parameters routinely used in STEMI.

Anahtar Kelimeler

• Uric acid,lymphocyte,neutrophyl-to-lymphocyteratio,myocardial infarction

Teşekkür

Ethics board approval was received for this study from institutional ethics committee of Healthy Sciency University, Kayseri Training and Research Hospital (Decision Number: 2016-52).

Kaynakça

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