The Role And Value Of Oxidatıve Stress In The Diagnosis And Pathogenesis Of Stemı Patients

Öz

Amaç: Akut ST elevasyonlu miyokard infarktüste (STEMİ) diğer tanısal belirteçlerin yanısıra oksidatif stress parametrelerinin nasıl etkilendiğini araştırarak, oksidatif stres parametrelerinin akut STEMİ hastalarında kullanılabilirliğini tartışmak istedik. Materyal ve Metod: EKG ve kardiyak enzim sonuçları ile STEMİ tanısı doğrulanan 31 hasta retrospektif olarak çalışmaya dahil edilmiştir. 35 sağlıklı gönüllü kontrol grubu olarak alınmıştır. Acil servise başvuru anında, oksidatif stres parametrelerini ölçmek için periferal venöz kan örneği alındı. Serum antioksidan durumu, STEMİ hastaları ve sağlıklı gönüllülerde total antioksidan durum (TAS) ve tiyol (T-SH) düzeyi ölçülerek, serum oksidatif durumu total oksidatif durum (TOS) ölçülerek değerlendirildi ve ardından oksidatif stres indeksi (OSI) hesaplandı. Bulgular: Hastaların 29’u (%93.5)erkek, 2’si (%6.5) kadındı. Yaş ortalaması 54.90 ± 12.23 yıldı. Kontrol grubu ile karşılaştırıldığında TOS, TAS ve OSI düzeyleri hasta grubunda yüksekti ve bu sonuçlar istatistiksel olarak anlamlı olup; sırasıyla, 15.02±10.82 μmol H2O2equivalent/l vs. 8.13±2.71 μmol H2O2 equivalent/l, p=0.001; 2310.95±549.80 μmol Trolox equivalent/l vs. 2065.71±280.98 μmol Trolox equivalent/l p=0.031; 0.65±0.40 arbitrary unit vs. 0.39±0.10 arbitrary unit, p=0.001). Ayrıca T-SH düzeyi hasta grubunda kontrol grubuna göre düşüktü (sırasıyla, 282.00±183.91 µmol/l . 472.11±307.15 µmol/l p=0.013). Sonuç: Bu çalışmada STEMİ hastalarında T-SH düzeyleri, TOS ve OSI düzeylerinde değişiklikler olması, patogenezde oksidatif stresin rol aldığını düşündürmektedir. Bu testlerin, tanıda, mevcut testlerin yanısıra yol gösterebileceği ileri sürülebilir. Ancak daha kapsamlı ve iyi dizayn edilmiş ileri çalışmalara ihtiyaç vardır. ABSRACT Objective: The objective of the study was to evaluate the usage of oxidative stress parameters in acute ST-elevation myocardial infarction (STEMI) beside other diagnostic markers, by determination of how oxidative stress parameters were affected. Materials and Methods: A total of 31 consecutive patients with STEMI were diagnosed by electrocardiography and cardiac enzyme results were included in the study. Thirty five volunteers were included as the control group. On admission to the emergency department, peripheral venous blood sample was taken for measuring oxidative stress parameters. Serum antioxidative status was evaluated by measuring Total Antioxidant Status (TAS) and Thiol (T-SH) levels in patients with ST-elevation myocardial infarction and in healthy individuals. Serum oxidative status was evaluated by measuring Total Oxidant Status (TOS), then Oxidative Stress Index (OSI) was calculated. Results: The male/female ratio of the patients was 29/2. Mean age was 54.90±12.23 years. TOS, TAS and OSI levels increased in the patient group compared to the control group (respectively, 15.02±10.82 μmol H2O2 equivalent/l vs. 8.13±2.71 μmol H2O2 equivalent/l, p=0.001; 2310.95±549.80 μmol Trolox equivalent/l vs. 2065.71±280.98 μmol Trolox equivalent/l p=0.031; 0.65±0.40 arbitrary unit vs. 0.39±0.10 arbitrary unit, p=0.001). On the other hand; T-SH level was decreased in the patient group compared to the control group (respectively, 282.00±183.91 µmol/l vs. 472.11±307.15 µmol/l p=0.013). Conclusion: Altered levels of T-SH as an antioxidant and also increased levels of TOS and OSI at STEMI patients may give an idea about the role of oxidative stress at the pathogenesis of STEMI , thus; usage of oxidative stress tests cooperative with the existing tests may be approved, but more comprehensive and well-designed studies are demanded.

Anahtar Kelimeler

• Oksidatif stress
• ST yükseklikli myokard infarktüsü
• total oksidan durum
• total antioksidan durum
• tiyol (TS-H)

The Role And Value Of Oxidatıve Stress In The Diagnosis And Pathogenesis Of Stemı Patients

Öz

Kaynakça

1. 1. Post F, Münzel T. Acute coronary syndrome. A diffuse diagnosis. Internist (Berl) 2010; 51: 953-4, 956-8, 960-2.
2. 2. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc 2009; 84: 917-38.
3. 3. Moe KT, Wong P. Current trends in diagnostic biomarkers of acute coronary syndrome. Ann Acad Med Singapore 2010; 39: 210-5.
4. 4. Serdar Z, Serdar A, Altin A, Eryilmaz U, Albayrak S. The relation between oxidant and antioxidant parameters and severity of acute coronary syndromes. Acta Cardiol 2007; 62: 373-80.
5. 5. Soltaninejad K, Abdollahi M. Current opinion on the science of organophosphate pesticides and toxic stress: a systematic review. Med Sci Monit 2009; 15: 75-90.
6. 6. Takabatake S, Tsubokawa T, Yamagishi M. Electrocardiographic diagnosis of acute coronary syndrome. Nippon Rinsho 2010; 68: 642-7.
7. 7. Ortolani P, Reimers B, Tubaro M, Sesana G. How to reduce the time windows for primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2009; 10: 7-11.
8. 8. Kumar A, Cannon CP. Acute coronary syndromes: Diagnosis and management, part II. Mayo Clin Proc 2009; 84: 1021-36.

9. 9. Erel O. A new automated colorimetric method for measuringtotal oxidant status. Clin Biochem 2005; 38: 1103-11.
10. 10. Erel O. A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radicalcation. Clin Biochem 2004; 37: 277-85.
11. 11. Yumru M, Savas HA, Kalenderoglu A, Bulut M, Celik H, Erel O. Oxidative imbalance in bipolar disorder subtypes: a comparative study. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33: 1070-4.
12. 12. Kosecik M, Erel O, Sevinc E, Selek S. Increased oxidative stress in children exposed to passive smoking. Int J Cardiol 2005; 100: 61–4.
13. 13. Harma M, Harma M, Erel O. Increased oxidative stress in patients with hydatidiform mole. Swiss Med Wkly 2003; 133: 563-66.
14. 14. Aycicek A, Erel O. Total oxidant/antioxidant status in jaundiced newborns before and after phototherapy. J Pediatr (Rio J) 2007; 83: 319-22.
15. 15. Sethi R, Takeda N, Nagano M, Dhalla NS. Beneficial effects of vitamin E treatment in acute myocardial infarction. J Cardiovasc Pharmacol Ther 2000; 5: 51-8.
16. 16. Bolukbas C, Bolukbas FF, Horoz M, Aslan M, Celik H, Erel O. Increased oxidative stress associated with the severity of the liver disease in various forms of hepatitis B virus infection. BMC Infect Dis 2005; 5: 95.
17. 17. Mulder DJ, van Haelst PL, Graaff R, Gans RO, Zijlstra F, Smit AJ. Skin autofluorescence is elevated in acute myocardial infarction and is associated with the one-year incidence of major adverse cardiac events. Neth Heart J 2009; 17: 162-8.
18. 18. García-Pinilla JM, Gálvez J, CabreraBueno F, Jiménez-Navarro M, GómezDoblas JJ, Galisteo M, et al. Baseline glutathione peroxidase activity affects prognosis after acute coronary syndromes. Tex Heart Inst J 2008; 35: 262-7.
19. 19. Skvarilová M, Bulava A, Stejskal D, Adamovská S, Bartek J. Increased level of advanced oxidation products (AOPP) as a marker of oxidative stress in patients with acute coronary syndrome. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2005;149: 83-7.
20. 20. Serdar Z, Serdar A, Altin A, Eryilmaz U, Albayrak S. The relation between oxidant and antioxidant parameters and severity of acute coronary syndromes. Acta Cardiol 2007; 62: 373-80.
21. 21. Horoz M, Bolukbas C, Bolukbas FF, Sabuncu T, Aslan M, Sarifakiogullari S, et al. Measurement of the total antioxidant response using a novel automated method in subjects with nonalcoholic teatohepatitis. BMC Gastroenterol 2005; 5: 35.
22. 22. Bansal AK, Kaur AR. Cooperative functions of manganese and thiol redox system against oxidative stress in human spermatozoa. J Hum Reprod Sci 2009; 2: 76-80.
23. 23. Alturfan AA, Emekli-Alturfan E, Uslu E. Consumption of pistachio nuts beneficially affected blood lipids and total antioxidant activity in rats fed a high-cholesterol diet. Folia Biol (Praha) 2009; 55: 132-6.
24. 24. Bitiren M, Karakilcik AZ, Zerin M, Ozardali I, Selek S, Nazligül Y, et al. Protective effects of selenium and vitamin e combination on experimental colitis in blood plasma and colon of rats. Biol Trace Elem Res 2010; 136: 87-95.
25. 25. Zembron-Lacny A, Slowinska-Lisowska M, Szygula Z, Witkowski K, Stefaniak T, Dziubek W. Assessment of the antioxidant effectiveness of alphalipoic acid in healthy men exposed tomuscle-damaging exercise. J Physiol Pharmacol. 2009; 60: 139-43.
26. 26. Gupta A, Bhatt ML, Misra MK. Lipid peroxidation and antioxidant status in head and neck squamous cell carcinoma patients. Oxid Med Cell Longev 2009; 2: 68-72.
27. 27. De La Cruz JP, Quintero L, Villalobos MA, De La Cuesta FS. Lipid peroxidation and glutathione system in hyperlipemic rabbits: influence of olive oil administration. Biochem Biophys Acta. 2000; 1485: 36–44