Markeri rizika od kardiovaskularne inflamacije i „tiha” ishemija miokarda kod bolesnika sa dijabetesom melitusom tipa 2
Sažetak
Uvod/Cilj. Posebna osobina koronarne bolesti srca (KBS) kod bolesnika sa dijabetesom melitusom tipa 2 (T2DM) je ta da je često asimptomatska i javlja se kao posledica autonomne neuropatije kardiovaskularnog sistema. Disregulacija autonomnog nervnog sistema povezana je sa povišenim vrednostima markera inflamacije, kao što su visoko senzitivni C-reaktivni protein (hs-CRP) i interleukin-6 (IL-6), koji ubrzavaju aterosklerozu i pojavu kardiovaskularnih komplikacija kod bolesnika sa T2DM. Cilj studije bio je da se proceni značaj određivanja markera rizika od kardiovaskularne inflamacije IL-6 i hs-CRP u „skriningu” na prisustvo KBS kod asimptomatskih bolesnika sa T2DM. Metode. Studijom je bilo obuhvaćeno 169 bolesnika sa T2DM, bez simptoma i znakova KBS. Ergometrijskim testiranjem dokazano je ili isključeno prisustvo „tihe“ KBS. Nivoi hs-CRP i IL-6 određeni su ELISA metodom. Rezultati. Vrednosti IL-6 bile su statistički značajno više kod bolesnika sa pozitivnim ergometrijskim testom u odnosu na bolesnike sa negativnim ergometrijskim testom (6,83 ± 1,99 pg/mL prema 3,04 ± 1,39 pg/mL, redom; p < 0,001). Utvrđene su statistički značajno više vrednosti CRP kod bolesnika sa pozitivnim ergometrijskim testom u odnosu na bolesnike sa negativnim ergometrijskim testom (6,37 ± 2,25 prema 1,67 ± 1,41 mg/L, redom; p < 0,001). Kombinacije IL-6 i hs-CRP sa godinama starosti, vrednostima HbA1c i trajanjem T2D, predstavljene kroz tri binarna logistička regresiona modela, značajni su prediktori „tihe” KBS dokazane ergometrijskim testom, tj. sa njihovim povećanjem verovatnoća pozitivnog ergometrijskog testa takođe se povećava (p < 0,01). Senzitivnost udruženog nalaza povišenih vrednosti IL-6 i hs-CRP u detekciji „tihe” KBS ergometrijskim testiranjem bila je 90%, a specifičnost 86%. Zaključak. Hs-CRP i IL-6 su značajni prediktori „tihe” KBS i njihovo određivanje bilo bi značajno u poboljšanju stratifikacije kardiovaskularnog rizika kod asimptomatskih bolesnika sa T2DM.
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