Glomerülonefritli hastalarda karotis intima media kalınlığının prediktörü hangisidir; nötrofil-lenfosit oranı mı proteinüri mi?

Öz

Amaç:Glomerülonefrit glomerüllerin inflamasyondur ve proteinüri kendisi glomerüler inflamasyonun klinik bir yansımasıdır. Bu çalışmada, aterosklerozun en erken bulgularından biri olan karotis intima media kalınlığı (KIMK) ile glomerüler inflamasyon belirteçleri arasındaki ilişkiyi araştırmayı amaçladık.

Gereç ve yöntem: Biyopsi ile kanıtlanmış 40 glomerülonefrit hastası ve 46 sağlıklı kontrol çalışmaya dahil edildi. Serum örneklerinde Growth arrest spesific protein 6 (Gas6) düzeyleri ELISA ile çalışıldı. KIMK ölçümü aynı radyolog tarafından yapıldı. Nötrofil-lenfosit oranı (NLO) tam kan test sonucundan elde edilen nötrofil sayısının lenfosit sayısına bölünmesiyle hesaplandı.

Bulgular: Hasta grubunda ortalama yaş 42,88±15,41, kontrol grubunda 38,26±9,04 idi. Ortalama hastalık süresi 29.07±52.90 ay, proteinüri 4027.05±4030.22 mg/gün, MDRD-GFR 53.80±48.32 mL/dk/1.73m² idi. KIMK hasta grubunda 0.62±0.17 mm, kontrol grubunda 0.46±0.10 mm idi. NLO hasta grubunda 3.69±4.46, kontrol grubundan anlamlı derecede yüksekti (1.74±0.63). Kontrol grubunda Gas6 düzeyleri istatistiksel olarak daha yüksekti. KIMK yaş, fibrinojen, ferritin, proteinüri ve NLO ile pozitif korelasyon gösterdi ve glomerülonefrit grubunda HDL kolesterol ve Gas6 ile negatif korelasyon gösterdi. Lojistik regresyon modelinde yaş KIMK için belirleyiciydi. Tüm grupta KIMK yaş, kreatinin, ürik asit, fibrinojen, ferritin, CaxP çarpımı, proteinüri ve NLO ile pozitif ve hemoglobin düzeyi, Gas6 ile negatif korelasyon gösterdi. Lineer lojistik regresyon analizinde karotis IMK, yaş ve ferritin ve proteinüri ile anlamlı şekilde ilişkiliydi.

Sonuç: Çalışmamızda proteinürinin böbrek fonksiyonu göreceli olarak korunmuş glomerülonefritte GFR düzeylerinden bağımsız olarak artmış KIMK'nın temel belirleyicilerinden biri olduğunu gösterdik.

Anahtar Kelimeler

• Karotis intima media kalınlığı,glomerülonefrit,nötrofil-lenfosit oranı,Growth arrest specific protein 6

Which one is the predictor of carotid intima media thickness in patients with aglomerulonephritis; neutrophil-to-lymphocyte ratio or proteinuria?

Öz

Purpose:Glomerulonephritis is inflammation of the glomeruli and proteinuria itself is a reflection of the glomerular inflammation. In this study we aimed to investigate the relationship between carotid intima media thickness (CIMT) one of the earliest findings of atherosclerosis and markers of glomerular inflammation.

Materials and methods:40 patients with biopsy proven glomerulonephritis and 46 healthy controls were enrolled in the study.Human Growth arrest spesific protein 6 (Gas6) levels in serum samples were studied by ELISA.CIMT measurement was performed by the same radiologist.

Results: The mean age was 42,88±15,41in patient group and 38,26±9,04 in controls. The mean duration of illness was 29.07±52.90 mounts, proteinuria  was4027.05±4030.22 mg/day, MDRD-GFR  was 53.80±48.32 mL/min/1.73m². CIMT was 0.62±0.17 mm in patient group,0.46±0.10 mm in  controls.Neutrophil-to-Lymphocyte Ratio (NLR) was 3.69±4.46 in patient group and significantly higher than control group (1.74±0.63). Gas6 levels were statistically higher in control group. CIMT was positively correlated with age, fibrinogen, ferritin, proteinuria and NLR and negatively correlated with HDL cholesterol and Gas6  in glomerulonephritis group.  Age  was the predictor  for CIMT in the logistic regression model. In all group CIMT was positively correlated with age, creatinine, uric acid, fibrinogen, ferritin, CaxP product, proteinuria and NLR and negatively correlated with hemoglobin level, Gas6. In lineer logistic regression analysis carotid IMT was significantly associated with age and ferritin and proteinuria.

Conclusion: We have shown that proteinuria is one of the main determinants of increased CIMT independent from the GFR levels in glomerulonephritis with relatively preserved renal function. 

Anahtar Kelimeler

• Carotid Intima Media Thickness,Glomerulonephritis,Neutrophil-to-Lymphocyte Ratio,Growth Arrest Specific Protein 6

Kaynakça

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