Astımlı hastalarda rosuvastatin tedavisinin havayolu inflamatuvar belirteçleri ve yaşam kalitesi göstergeleri üzerine etkisi

Yıl 2017, Cilt: 30 Sayı: 2, 73 - 81, 14.05.2017

Sehnaz Olgun Yıldızelı Derya Kocakaya Baran Balcan Aygun Ikıncı Rengin Ahıskalı Berrin Ceyhan

https://doi.org/10.5472/marumj.344816

Cited By: 2

Öz

Amaç: Statinler kan lipid düzeylerinde azalma sağlamakla beraber

aynı zamanda pleiotropik ve anti-inflamatuvar etkileri olan ilaçlardır.

Statinlerin bir çok inflamatuvar hastalıkta yararlı etkileri gösterilmiş

olmasına karşın sonuçlar halen tartışmalıdır. Bu çalışmanın amacı

astım hastalarında rosuvastatin tedavisinin klinik ve anti-inflamatuvar

etkilerini incelemektir.

Hastalar ve Yöntem: Astım hastalarında vaka-control çalışması

planlanmıştır. Toplam 136 astım hastası incelenmiş ve 74 hasta

çalışmaya uygun bulunarak dahil edilmiştir. Elli bir hasta çalışmayı

tamamlayabilmiştir. Hastalar başlangıçta yapılan kan tahlilinde serum

düşük dansiteli lipoprotein (LDL) seviyesine göre iki gruba ayrılmıştır,

LDL düzeyi 130mg/dL üzerinde olan 25 hasta mevcut tedavilerine ek

olarak 8 hafta boyunca 40mg rosuvastatin tedavisi alırken, 26 hasta

kontrol grubu olarak almakta oldukları tedaviye devam etmişlerdir.

Her iki gruptaki hastalar, başlangıçta ve 8. haftanın sonunda solunum

fonksiyon testi (SFT), bronş provokasyon testi (PD20), indükte

balgamda serum inflamatuvar belirteçleri, astım kontrol testi (AKT) ve

yaşam kalitesi skorları (QoL) ile değerlendirilmişlerdir.

Bulgular: Statin kullanan grupta 8. hafta sonunda SFT’de FEV1/

FVC (pp) (%85,8±11,1 vs .%90,2±8,8 P<0,043), FEF % 25-75 (%

63,6±7,8 vs %74,6±8,4, P<0.0001) ve FEF25-75(L/sc) (3,51±0,4 vs

4,1±0,4 P<0,05) düzelme saptanırken statin kullanmayan grupta anlamlı

fark saptanmamıştır (P>0,05). Rosuvastatin tedavisi ile indükte balgam

eosinofilisinde (P<0,05); IL-6 ve TNF-alfa seviyelerinde azalma

(P<0,05) saptanırken, AKT ve QoL skorları ve bronş provakasyon

testinde anlamlı değişiklik saptanmamıştır.

Sonuç: Bu çalışmada, astım hastalarında rosuvastatin 40mg ile

8 haftalık tedavi sonrasında periferik eosinofili, total IgE seviyesi,

indükte balgamda inflamatuvar belirteçlerde anlamlı düzeyde azalma

saptanmıştır. Yine SFT parametrelerinde düzelme izlenmiştir ancak

buna karşın AKT ve QoL skorlarında değişim saptanmamıştır.Bu

sonuçlara göre rosuvastatin tedavisinin astım hastaları üzerinde bir

takım potensiyel anti-inflamatuar etkileri bulunmaktadır. Rosuvastatinin

klinik etkilerinin saptanması için daha fazla sayıda randomize çalışmaya

ihtiyaç vardır.

Anahtar Kelimeler

Astım, Havayolu inflamasyonu, Remodeling, Rosuvastatin, Statin

Influence of rosuvastatin treatment on airway inflammatory markers and health related quality of life domains in asthmatic patients

Öz

Objectives: Statins are lipid lowering agents which have pleiotropic and

anti-inflammatory effects. Beneficial effects of statins have been shown

in many inflammatory and asthmatic diseases. However, the results are

still not consistent. The aim of this study is to determine the clinical and

anti-inflammatory effects of rosuvastatin in asthmatic patients.

Patients and Metods: A case control study among asthmatic

patients was conducted. One hundred and thirty-six participants were

screened. Seventy-four patients were eligible. Fifty-one patients

have completed the trial. Twenty-five patients with blood levels of

low-density-lipoprotein (LDL) above 130mg/dL, were treated with

rosuvastatin 40mg for 8 weeks in addition to their standard treatment

for asthma; 26 asthmatic patients were followed as control group. In

both groups baseline and 8th week evaluation were recorded including

pulmonary function test (PFT), bronchial provocation test (PD20),

induced sputum and serum inflammatory markers, asthma control test

(ACT) and quality of life scores (QoL).

Results: Statin group showed improvement in FEV1/FVC (pp)

(85.8±11.1% vs 90.2±8.8% P<0.043), FEF 25-75 % (63.6±7.8 %

vs 74.6±8.4 %, P<0.0001) and FEF25-75(L/sc) (3.51±0.4 vs 4.1±0.4

P<0.05) and no change was seen in non-statin group (P>0.05) at the

end of the 8-week treatment. Treatment with rosuvastatin resulted in

decreased sputum eosinophilia percentage (P<0.05); IL-6 and TNFalpha

levels (P<0.05) however, bronchial challenge test, ACT and QoL

domains did not change in both groups (P>0.05).

Conclusion: An 8-week treatment with 40mg rosuvastatin in asthma

decreased the peripheral eosinophilia, total IgE levels and inflammatory

markers in the induced sputum samples. Beneficial effects in PFT have

also been observed. However, ACT and QoL domains were not affected.

The implication of this study is that rosuvastatin could potentially have

anti-inflammatory effects on asthmatic airways. Prospective randomised

trials to evalute the clinical effects of rosuvastatin are warranted.

Anahtar Kelimeler

Asthma, Airway inflammation, Remodelling, Rosuvastatin, Statin

Kaynakça

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