AKUT MYOKARD ENFARKTÜSÜNDE YÜKSELMİŞ SERUM CRP DÜZEYİ VE DİABETES MELLİTUS İLE İLİŞKİSİ

Abstract

Amaç: Günümüzde aterosklerozun enflamatuar bir hastalık olduğu ve serum CRP düzeyinin, aterosklerozun şiddeti ve genişliği ile korele şekilde yükseldiği kabul edilmektedir. Bu çalışmada, Ocak 2000 ile Temmuz 2000 tarihleri arasında, Adana Numune Eğitim ve Araştırma Hastanesi Koroner Yoğun Bakım Ünitesi’ne (KYBÜ) AMİ tanısıyla yatırılıp trombolitik tedavi uygulanan 55 hastada infarkt tipi ve genişliği ile serum CRP düzeyleri arasındaki ilişki incelendi.

Gereç ve Yöntem: Göğüs ağrısının başlangıcından itibaren 12. saatte serum CRP, kardiak troponin İ, CK-MB, LDH, AST, beyaz küre, sedimantasyon düzeyleri incelendi.

Bulgular: Serum CRP düzeyi ortalama 24.5 mg/L, beyaz küre sayısı ortalama 14.2 X10³/ml olup belirgin olarak yüksekti. Serum CRP düzeyi ile infarkt tipi ve genişliği arasında ilişki yoktu. Ayrıca CRP yüksekliği ile diabetes mellitus varlığı arasında pozitif yönde bir ilişki olduğu görüldü (r: 0.479, p<0.01).

Sonuç: AMİ’nde serum CRP düzeyinin yükselmesi, akut koroner sendromlarda enflamasyonun rolünü göstermesi açısından önemlidir.

Anahtar Kelimeler: Ateroskleroz, enflamasyon, CRP, akut myokard enfarktüsü

Keywords

• Ateroskleroz, enflamasyon, CRP, akut myokard enfarktüsü

References

1. 1. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999;340(2):115-126.
2. 2. Blake GJ, Ridker PM. Novel clinical markers of vascular wall inflammation. Circ Res 2001;89:763-771.
3. 3. Mulvihill NT, Foley JB. Inflammation in acute coronary syndromes. Heart 2002;87:201-204.
4. 4. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135-1143.
5. 5. Gabay C, Kushner I. Mechanism of disease: acute phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448-453.
6. 6. Berk BC, Weintraub WS, Alexander RW. Elevation of C-reactive protein in "active" coronary artery disease. Am J Cardiol 1990;65(3):168-172.
7. 7. Toss H, Lindahl B, Siegbahn A, Wallentin L. Prognostic influence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease. FRISC Study Group. Circulation 1997;96(12):4204-4210.
8. 8. Abdelmouttaleb I, Danchin N, Ilardo C, Aimone-Gastin I, Angioï M, Lozniewski A et al. C-Reactive protein and coronary artery disease: additional evidence of the implication of an inflammatory process in acute coronary syndromes. Am Heart J 1999;137(2):346-351.

9. 9. Lagrand WK, Visser CA, Hermens WT, Niessen HWM, Verheugt FWA, Wolbink GJ, Hack CE. C-reactive protein as a cardiovascular risk factor, more than an epiphenomenon? Circulation 1999;100:96- 102.
10. 10. de Beer FC, Hind CRK, Fox KM, Allan RM, Maseri A, Pepys MB. Measurement of serum C-reactive protein concentration in myocardial ischemia and infarction. Br Heart J 1982;47:239-243.
11. 11. Pietila KO, Harmoinen AP, Jokiniitty J, Pasternack AI. Serum C-reactive protein concentration in acute myocardial infarction and its relationship to mortality during 24 months of follow-up in patients under thrombolytic treatment. Eur Heart J 1996;17:1345–1349.
12. 12. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997;336(14): 973-979.
13. 13. Ridker PM, Glynn RJ, Hennekens CH. Creactive protein adds to the predictive value o
14. total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998;97:2007-2011.
15. 14. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of Creactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998;98:731-733.
16. 15. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002;347(20):1557-1565.
17. 16. Barron HV, Cannon CP, Murphy SA, Braunwald E, Gibson CM. Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction. Circulation 2000;102:2329-2334.
18. 17. Hillis GS, Keith AA. Cardiac troponins in chest pain can help in risk stratification. BMJ 1999;319:1451-1452.
19. 18. Falahatti A, Sharkey SW, Christensen D, McCoy M, Miller EA, Murakami MA, Apple FS. Implementation of serum cardiac troponin I as marker for detection of acute myocardial infarction. Am Heart J 1999;137(2):332-337.
20. 19. Haverkate F, Thomson SG, Pyke SD, Gallimore JR, Pepys MB. Production of Creactive protein and risk of coronary events in stable and unstable angina. Lancet 1997;349:462-466.
21. 20. Pietila K, Harmoinen A, Poyhonen L, Koskinen M, Heikkila J, Ruosteenoja R. Intravenous streptokinase treatment and serum C-reactive protein in patients with acute myocardial infarction. Br Heart J 1987;58:225-229.
22. 21. Lagrand WK, Niessen HWM, Wolbink GJ, Jaspars LH, Visser CA, Verheugt FWA et al. C-reactive protein colocalizes with complement in human hearts during acute myocardial infarction. Circulation 1997;95:97-103.
23. 22. Pietila K, Harmoinen A, Teppo AM. Acute phase reaction, infarct size and in hospital morbidity in myocardial infarction patients treated with streptokinase or recombinant tissue plasminogen activator. Ann Med 1991;23(5):529-535.
24. 23. Onat A ve ark. Batı bölgelerimiz erişkinlerinde kanda C-reaktif protein ile fibrinojen düzeyleri ve diğer risk faktörleriyle ilişkileri. Türk Kardiyoloji Derneği Arşivi 2001;29:72-79.
25. 24. Hoekstra T, Schouten E, Kluft C. C-reactive protein: associations with cardiovascular risk factors and all-cause mortality in elderly. Atherosclerosis 2000;151:29.
26. 25. Mendall MA, Patel P, Ballam L, Strachan D, Northfield TC. C-reactive protein and its relation to cardiovascular risk factors: a population-based cross sectional study. BMJ 1996;312:1061-1065.