Homosisteinin aterosklerotik koroner arter hastalığındaki rolü; lezyon ağırlığı, B₁₂ vitamini ve folik asit ile ilişkisi

Abstract

Son yıllardaki çalışmalar, homosistein (Hst) seviyelerindeki yüksekliğin, aterosklerotik koroner arter hastalığı (KAH) gelişimini ve hastalığa yakalanma riskini artırdığını göstermiştir. Biz bu çalışmamızda, Hst'in KAH gelişimindeki rolünü; B₁₂ vitamini ve folik asit ve literatürde yeteri kadar incelenmemiş, lezyon ağırlığı ile olan ilişkisini araştırmayı amaçladık. Bu çalışma, Uludağ Üniversitesi Tıp Fakültesi (UÜTF) Kardiyoloji Kliniği'nde haziran 1998 ile ağustos 1999 tarihleri arasında, koroner anjiyografi (KAG) yapılan hastalarda planlandı. Yapılan KAG'ler, çalışmadan habersiz, deneyimli iki kardiyolog tarafından kantitatif olarak değerlendirildi. KAH lezyon ağırlığını göstermek için koroner arter lezyonları Gensini skor sistemine göre puanlandırıldı. Hastalardan Hst, B₁₂ vitamini ve folik asit için kan alındı. Hst'in; KAH'ndaki rolü; B₁₂ vitamini, folik asit ve lezyon ağırlığı ile olan ilişkisi istatistiki açıdan incelendi. Çalışmaya alınan 209 hastanın 45'inde KAG normal olarak bulundu. 164 hasta da ise lezyon tespit edildi. KAH olan grupta; ortalama yaş, erkek/kadın oranı, sigara içimi ve diyabet insidansı, B₁₂ vitamini, folik asit, Hst ve total kolesterol seviyeleri, KAH olmayan gruba göre daha yüksekti ve iki grup arasındaki fark istatistiki açıdan anlamlıydı (p<0.05). Çalışma grubunda, KAH risk faktörlerini tespit etmek için "Binary Logistik Regresyon testi'' uygulandığında artmış Hst seviyesinin, KAH'na yakalanma riskini 1.6 kat artırdığı tespit edildi (p<0.001). Yapılan grup analizlerinde artmış Hst seviyesi ve Gensini skoru arasında pozitif , B₁₂ vitamini ve folik asit seviyeleri ile arasında ise negatif, istatistiki açıdan anlamlı bir ilişki olduğu tespit edildi. (p<0.05), (p<0.05). Sonuç olarak çalışmamızda artmış homosistein seviyelerinin KAH için diğer klasik risk faktörlerinden bağımsız bir risk faktörü olduğunu bulduk. Ayrıca Hst seviyeleri yükseldikçe KAH yaygınlık ve şiddetinin arttığı sonucuna vardık.

Recent studies have shown that elevation in homocystein levels is an independent risk factor other than classical risk factors, for atherosclerotic coronary artery disease (CAD). In our study, we aimed to investigate the role of homocystein in CAD; and its association with vitamin B₁₂, folic acid and lesion burden which is not truly investigated. This study was made in Cardiology Department of Uludag University Medical Faculty between June 1998 and August 1999 among patients having indications for coronary angiography. 209 patients having chest pain who were given indication for coronary angiography were included in our study in that period. A questioner form in which classical risk factors and lipid profiles were included in addition to age, sex, height, and for woman, age at menopause was given to these patients. In all patients selective coronary angiography were performed with Judkins method with 6F diagnostic catheter. The coronary angiographies were evaluated by two experienced cardiologists quantitatively who were unaware of the study and blind to levels of homocystein levels. In order to show lesion burden of CAD, epicardial coronary artery lesions were given points according to Gensini scoring system. Patients were hospitalised after coronary angiography for one day. Blood samples were taken for homocystein, vitamin B₁₂ and folic acid the day after the angiography. Homocystein were evaluated by the ELISA method. Role of homocystein in atherosclerotic coronary artery disease; and its association with vitamin B₁₂, folic acid and lesion burden were examined statistically in groups separated according to Gensini score and homocystein levels. Coronary angiography was completely normal in 45 of 209 patients. In 164 patients there was CAD angiographycally. In the group with coronary artery disease mean age, male/female ratio, incidence of smoking and diabetes, levels of folic acid, vitamin B₁₂, homocystein and total cholesterol were higher than the group without CAD and the difference between the groups were statistically significant (p<0.05). In the study population when the Binary Logistic regression test was used for determination of coronary risk factors, elevated levels of homocystein were found as an independent risk factor other than classical risk factors and were found to increase risk of having CAD 1.6 (odds ratio) times (p<0.001,%95 Cl lower 1.32, upper 1.98). In group analysis it was found that elevated homocystein levels had a positive correlation with Gensini score and a negative correlation with levels of vitamin B₁₂ and folic acid which were both significant statistically (p<0.05). We also found that elevated levels of homocystein was an independent risk factor for CAD other than classical risk factors. In addition we concluded that homocystein levels are higher in patients with low vitamin B₁₂ and folic acid levels and with increases in levels of homocystein, extend and severity of CAD increases.