Udruženost serumske koncentracije paratireoidnog hormona i ejekcione frakcije leve komore, markera srčane insuficijencije i inflamacije u akutnom infarktu miokarda sa ST elevacijom lečenim primarnom perkutanom koronarnom intervencijom
Sažetak
Uvod/Cilj. U prethodnim studijama pokazano je povećanje serumske koncentracije paratireoidnog hormona (PTH) u akutnom infarktu miokarda i srčanoj insuficijenciji. U ovom istraživanju ispitali smo odnos između paratireoidnog statusa i biohemijskih, elektrokardiografskih i ehokardiografskih pokazatelja veličine infarkta i srčane insuficijencije. Metode. Kod 390 bolesnika sa akutnim infarktom miokarda sa elevacijom ST segmenta (STEMI), prosečne dobi 62 ± 12 godine, učinjene su laboratorijske analize serumske koncentracije kreatin kinaza MB frakcije (CK-MB), C-reaktivnog proteina (CRP) i intaktnog PTH i koncentracija u plazmi moždanog natriuretskog peptide (BNP) tokom prva tri dana od prijema. Svi bolesnici su lečeni primarnom perkutanom koronarnom intervencijom (PKI). Bolesnici sa težom bubrežnom insuficijencijom isključeni su iz studije (klirens kreatinina ≤ 30 mL/min). Serumska koncentracija PTH određivana je prvog, drugog i, u nekim slučajevima, trećeg dana posle prijema i najveća dobijena koncentracija je uzeta za analizu. Kohorta bolesnika je podeljena u četiri grupe na osnovu kvartila maksimalne izmerene serumske koncentracije PTH (I ≤ 4.4 pmol/L; II > 4.4 pmol/L i < 6.3 pmol/L; III ≥ 6.3 pmol/L i < 9.2 pmol/L; IV ≥ 9.2 pmol/L). Selvesterov EKG skor, ejekciona frakcija leve komore (EFLK), i indeks pokretljivosti zidova leve komore (WMSI) su određivani na otpustu bolesnika, između 5–14 dana hospitalizacije. Rezultati. Ustanovljeno je da se na otpustu EFLK statistički značajno smanjuje (p < 0.001), WMSI i EKG Selvesterov skor statistički značajno povećavaju sa većim kvartilima PTH max. koncentracije (p < 0.001 za oba parametra). BNP, CRP i CK-MB nivoi značajno se povećavaju sa većim kvartilima max. koncentracije PTH (p < 0.001; p < 0.001 p = 0.004, retrospektivno). Zaključak. Bolesnici u četvrtom kvartilu PTH imaju manju EFLK i veći Selvesterov EKG skor i WMSI od ostalih bolesnika. Ovi bolesnici takođe imaju i značajno veču koncentraciju BNP, CRP i CK-MB u ranoj fazi akutnog infarkta miokarda sa ST elevacijom (STEMI).
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