Hiperhomocisteinemija i biomarkeri inflamacije povezani su sa višim kliničkim SINTAKS skorom kod bolesnika sa stabilnom koronarnom arterijskom bolešću
Sažetak
Uvod/Cilj. Prethodne studije potvrdile su pozitivnu korelaciju između nivoa homocisteina i većeg rizika od nastanka akutnog koronarnog sindroma i moždanog udara, ali nije bilo istraživanja koja su ispitivala povezanost između vrednosti homocisteina i inflamacijskih markera i težine koronarne arterijske bolesti prema kliničkom SINTAKS skoru kod bolesnika sa stabilnom anginom pektoris. Cilj ovog istraživanja bio je da se utvrdi povezanost između koncentracije homocisteina i inflamacijskih biomarkera: interleukina (IL)-6, visoko senzitivnog C-reaktivnog proteina (hs-RCP), fibrinogena i sedimentacije eritrocita (SE) i stepena težine koronarne arterijske bolesti prema kliničkom SINTAKS skoru. Metod.
Kod 82 bolesnika sa stabilnom anginom pektoris (prosečne starosti 65 ± 8 godina, 28,9% žena) urađena je koronarografija, nakon čega su podeljeni u tri grupe prema kliničkom SINTAKS skoru: I grupa < 22 (39 bolesnika), II grupa 23–32 (16 bolesnika), III grupa > 33 (27 bolesnika). Stepen težine koronarne arterijske bolesti određen je prema kliničkom SINTAKS skoru, množenjem SINTAKS I skora i modifikovanog ACEF skora, koji uzima u obzir ejekcionu frakciju leve komore, starost bolesnika i klirens kreatinina (izvedenog pomoću Cockcroft-Gault-ove jednačine). Rezultati. Vrednosti homocisteina bile su značajno više kod bolesnika sa visokim kliničkim SINTAKS skorom [I grupa: medijana (interkvartilini raspon ‒ IQR): 10,20 (3,97), II grupa: 10,45 (5,77), III grupa: 14,70 (7,50), p = 0,005]. Bolesnici III grupe imali su značajno više vrednosti homocisteina u poređenju sa I grupom (p = 0,001). Takođe smo detektovali pozitivnu korelaciju između inflamacijskih markera (IL-6, hs-CRP, fibrinogena i SE) i težine koronarne arterijske bolesti prema kliničkom SINTAKS skoru (p = 0.017, 0.001, 0.032, 0.049 redom). Detektovali smo značajno niže vrednosti vitamina B12 u grupama III i II u odnosu na grupu I (I grupa: medijana (IQR): 238 (160), II grupa: 171 (160), III grupa: 172 (102), p = 0,022) što ukazuje na njegovu važnu ulogu u metabolizmu homocisteina. Zaključak. Povišene koncentracije homocisteina, IL-6, hsCRP, fibrinogena i SE u plazmi detektovane su kod pacijenata sa visokim kliničkim SINTAKS skorom (> 33). Naši rezultati pokazali su da hiperhomocisteinemija i pojedini inflamacijski biomarkeri mogu ukazati na prisustvo ozbiljnije i ekstenzivnije koronarne arterijske bolesti kod bolesnika sa stabilnom anginom pektoris.
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