Tip 2 Diabetes Mellituslu Hastalarda Kardiyak Otonomik Nöropati ve Plasma Homosistein Seviyesi Arasındaki İlişki

Yıl 2016, Cilt: 19 Sayı: 2, 108 - 113, 01.08.2016

Anıl Avcı , Mehmet Mustafa Tabakcı Cüneyt Toprak Elnur Alizade Göksel Açar Uğur Arslantaş Ramazan Kargın

Öz

Giriş: Kardiyak otonomik nöropati (KON) diyabetik hastalarda
artmış morbidite ve mortalitenin önemli bir sebebidir. Bu çalışmadaki amacımız
diyabetik hastalarda plasma homosistein seviyesi ve anormal kalp hızı
toparlanma indeksiyle belirlenen KON arasındaki ilişkiyi incelemektir.

Hastalar
ve Yöntem: Bu çalışmaya koroner arter
hastalığı şüphesiyle efor testi istenen 35 diabetes mellitus  (DB) hastası alındı. KON tanısı için kalp
hızı toparlanma indeksinin ≤ 21 olması kabul edildi.

Bulgular: Çalışmaya dahil edilen tip 2 diyabetik hastalar normal
kalp hızı toparlanma indeksi olanlar (> 21, n= 19) ve anormal kalp hızı
toparlanma indeksi olanlar (≤ 21, n= 16) olmak üzere 2 gruba ayrıldı. Gruplar
arasında klinik değişkenler, laboratuvar verileriyle yaş, hipertansiyon,
hiperlipidemi ve sigara gibi risk faktörleri açısından farklılık yoktu. Ancak
anormal kalp hızı toparlanma indeksi olan hasta grubunda homosistein seviyesi
ve diyabet süresi normal kalp hızı toparlanma indeksi olan gruba göre anlamlı
derecede yüksek bulundu (17.94 ± 5.91 umol/L’e karşı 13.27 ± 2.75 umol/L, p=
0.009 ve 10.06 ± 6.20’ye karşı 6.21 ± 4.87,    
p= 0.048, sırasıyla). Homosistein seviyesi ve anormal kalp hızı
toparlanma indeksi arasındaki ilişki diğer değişkenlerden bağımsızdı [Odds
oranı 1.319 (%95 CI: 1.011-1.721), p= 0.041]. Homosistein seviyesi ve kalp hızı
toparlanma indeksi arasında istatistiksel olarak anlamlı negatif korelasyon izlendi
(r= -0.382, p= 0.024).            ≥ 15.02
umol/L homosistein değerinin anormal 
kalp hızı toparlanma indeksini belirlemede sensitivitesi %75,
spesifitesi ise %63.2 olarak bulundu.

Sonuç: Tip 2 diyabetik hastalarda plasma
homosistein seviyesi ve kalp hızı toparlanma indeksi arasında negatif
korelasyon gösteren anlamlı bir ilişki mevcuttur. Diyabetik hastalarda KON’un
gelişimi ve takibinde homosistein seviyesinin değerlendirilmesi yardımcı
olabilir.

Anahtar Kelimeler

Tip 2 diabetes mellitus, kardiyak otonomik nöropati, kalp hızı toparlanma indeksi

Association between Cardiac Autonomic Neuropathy and Homocysteine Level in Patients with Type 2 Diabetes Mellitus

Öz

Introduction: Cardiac
autonomic neuropathy is an important cause of increased morbidity and mortality
in patients with diabetes mellitus. The aim of this study was to investigate
the association between plasma homocysteine level and cardiac autonomic
neuropathy assessed using the abnormal heart rate recovery index in patients
with type 2 diabetes mellitus.

Patients and Methods: Thirty-five
patients with type 2 diabetes mellitus who underwent an exercise stress test
were included in the study. Abnormal heart rate recovery index was defined as ≤
21 beat/min, which indicated cardiac autonomic neuropathy.

Results: Patients
with type 2 diabetes mellitus were divided into two groups, that is, patients
with a heart rate recovery index of > 21 beat/min and those with a heart rate
recovery index of ≤ 21 beat/min. Clinical variables, laboratory variables and
risk factors, such as age, hypertension, hyperlipidemia and smoking, were not
different between the groups. However, the homocysteine level and duration of
type 2 diabetes mellitus were significantly higher in patients with ≤ 21
beat/min than in those with > 21 beat/min (17.94 ± 5.91 umol/L vs 13.27 ±
2.75 umol/L, p= 0.009 and 10.06 ± 6.20 umol/L vs 6.21 ± 4.87 umol/L, p= 0.048,
respectively). The homocysteine level was independently associated with the
abnormal heart rate recovery index [odds ratio, 1.319 (95% CI, 1.011-1.721); p=
0.041] The homocysteine level was negatively correlated with the heart rate
recovery index (r= -0.382, p= 0.024). The homocysteine cut-off value, indicating
an abnormal heart rate recovery, was ≥ 15.02 umol/L, with 75% sensitivity and
63.2% specificity.

Conclusion: There was an
independent association with a negative correlation between the plasma
homocysteine level and abnormal heart rate recovery index in patients with type
2 diabetes mellitus. 

Anahtar Kelimeler

Type 2 diabetes mellitus, cardiac autonomic neuropathy, heart rate recovery index

Kaynakça

• 1. Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment. World J Diabetes 2015;6:80-91.
• 2. Chyun DA, Wackers FJ, Inzucchi SE, Jose P, Weiss C, Davey JA, et al. Autonomic dysfunction independently predicts poor cardiovascular outcomes in asymptomatic individuals with type 2 diabetes in the DIAD study. SAGE Open Med 2015;3:2050312114568476.
• 3. Jung CH, Jung SH, Kim BY, Kim CH, Kang SK, Mok JO. Association of serum omentin levels with cardiac autonomic neuropathy in patients with type 2 diabetes mellitus: a hospital-based study. Cardiovasc Diabetol 2015;14:140.
• 4. Lauer MS. Autonomicfunction and prognosis. Cleve Clin J Med 2009;76 (Suppl 2):S18-S22.
• 5. Georgoulias P, Demakopoulos N, Valotassiou V, Orfanakis A, Zaganides A, Tsougos I, et al. Long-term prognostic value of heart-rate recovery after treadmill testing in patients with diabetes mellitus. Int J Cardiol 2009;134:67-74.
• 6. Sydó N, Sydó T, Merkely B, Carta KG, Murphy JG, Lopez-Jimenez F, et al. Impaired heart rate response to exercise in diabetes and its long-term significance. Mayo Clin Proc 2016; doi: 10.1016/j.mayocp.2015.10.028.
• 7. Ndrepepa G, Kastrati A, Braun S, Koch W, Kölling K, Mehilli J, et al. Circulating homocysteine levels in patients with type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2008;18:66-73.
• 8. Goldstein M, Leibovitch I, Yeffimov I, Gavendo S, Sela BA, Loewenstein A. Hyperhomocysteinemia in patients with diabetes mellitus with and without diabetic retinopathy. Eye (Lond) 2004;18:460-5.
• 9. Cohen JA, Jeffers BW, Stabler S, Schrier RW, Estascio R. Increasing homocysteine levels and diabetic autonomic neuropathy. Auton Neurosci 2001;87:268-73.
• 10. Akyüz A, Alpsoy S, Akkoyun DC, Değirmenci H, Güler N. Heart rate recovery may predict the presence of coronary artery disease. Anadolu Kardiyol Derg 2014;14:351-6.
• 11. Kaya C, Akgül E, Pabuccu R. C-reactive protein and homocysteine levels are associated with abnormal heart rate recovery in women with polycystic ovary syndrome. Fertil Steril 2010;94:230-5.
• 12. Leoncini G, Bruzzese D, Signorello MG. Activation of p38 MAPKinase/cPLA2 pathway in homocysteine-treated platelets. J Thromb Haemost 2006;4:209-16.
• 13. Leoncini G, Pascale R, Signorello MG. Modulation of L-arginine transport and nitric oxide production by gabexate mesylate. Biochem Pharmacol 2002;64:277-83.
• 14. Signorello MG, Viviani GL, Armani U, Cerone R, Minniti G, Piana A, et al. Homocysteine, reactive oxygen species and nitric oxide in type 2 diabetes mellitus.Thromb Res 2007;120:607-13.