Endotelin-1 i azot-monoksid u trogodišnjoj prognozi nakon akutnog infarkta miokarda

  • Svetlana Apostolović Clinical Center Nis, Clinic for cardiovascular diseases; Medical Faculty, University of Nis
  • Sonja Salinger-Martinović Clinical Center Nis, Clinic for cardiovascular diseases
  • Ruzica Janković-Tomašević Clinical Center Nis, Clinic for cardiovascular diseases
  • Danijela Djordjević-Radojković Clinical Center Nis, Clinic for cardiovascular diseases
  • Milan Pavlović Clinical Center Nis, Clinic for cardiovascular diseases; Medical Faculty, University of Nis
  • Tomislav Kostić Clinical Center Nis, Clinic for cardiovascular diseases
  • Vladan Cosić Clinical Center Nis, Central biochemical laboratory; Medical Faculty, University of Nis
  • Tatjana Ristić Clinical Center Nis, Central biochemical laboratory
  • Ivana Stojanović Medical Faculty, University of Nis
DOI: https://doi.org/10.2298/VSP151029278S
Ključne reči: myocardial infarction||, ||infarkt miokarda, biological markers||, ||biološki pokazatelji, ultrasonography||, ||ultrasonografija, endothelins||, ||endotelini, nitric oxide||, ||azot, oksidi, prognosis||, ||prognoza, sensitivity and specificity||, ||osetljivost i specifičnost,

Sažetak


Uvod/Cilj. Akutni infarkt miokarda (AIM) je značajan uzrok obolevanja i umiranja u svetu. Biomarkeri imaju značaj u postavljanju dijagnoze i u prognozi kod bolesnika sa AIM. Cilj studije bio je utvrđivanje porasta markera endotelne disfunkcije kod bolesnika sa AIM, merenih trećeg dana, poređuju sa vrednostima u kontrolnoj grupi zdravih ispitanika i značaja pomenutih markera u kratkoročnoj i dugoročnoj (trogodišnjoj) prognozi (ishodu). Metode. U prospektivnu studiju bilo je uključeno 108 bolesnika sa AIM koji su činili eksperimentalnu grupu i 50 zdravih dobrovoljaca kontrolne grupe. Kod svih ispitanika određivani su endotelin-1 (ET-1) i degradacioni produkti azot-monoksida (NOx). Rezultati. Prosečna starost ispitanika u eksperimentalnoj grupi bila je 62 ± 10 godina, a 59 ± 9 godina ispitanika u kontrolnoj grupi. U eksperi-mentalnoj grupi 74.1% ispitanika bilo je muškog pola a 68.8% u kontrolnoj grupi. Kod 74.1% bolesnika iz eksperimentalne grupe postavljena je dijagnoza infarkta miokarda sa elevacijom ST segmenta (STEMI), dok je 25.9% imalo infarkt miokarda bez delovanja ST segmenta (NSTEMI). Tokom 3 godine praćenja umrlo je 13 (5.6%) bolesnika. Oni su imali više koncentracije ET-1 u poređenju sa preživelim bolesnicima [4,02 (2,72–5,93) vs 3,06 (2,23–3,58) pg/mL; p = 0,015]. Zajedno, mortalitet i rehospitalizacija bili su prisutni kod 46 (42,6%) bolesnika, koji su takođe imali više koncentracije ET-1 [3,14 (2,54–4,41) vs 3,05 (2,18–3,56) pg/mL; p = 0,035]. Intrahospitalne komplikacije bile su prisutne kod 41 (48%) bolesnika, a oni sa ehokardiografski uočenim komplikacijama (ventrikularna diskinezija, tromb u levoj komori i ruptura papilarnog mišića) imali su značajno viši ET-1 [4,02 (2,78–5,57) vs 3,06 (2,29–3,66) pg/mL; p = 0,012]. Vrednosti ET- 1 iznad 75-og percentila (> 3,77 pg/mL) bile su udružene sa povećanim rizikom od lošeg ishoda [Log Rank (χ2=13,44; p < 0,001)]. Bolesnici koji su rehospitalizovani imali su niže vrednosti NOx [125,5 (111,4–143,6) vs 139,3 (116,79–165,2) µmol/L; p = 0,04]. Vrednosti endotelina-1 bile su u pozitivnoj korelaciji sa visoko-senzitivnim troponinom I (hsTnI), moždanim natriuretskim peptidom (BNP) i brojem leukocita. Zaključak. Endotelin-1 i NOx su bili povišeni trećeg dana od AIM i bili su pokazatelji loše kratkotrajne (intrahospitalne) i trogodišnje prognoze ishoda. Vrednosti endotelina-1 bile su u korelaciji sa tradicionalnim prognostičkim markerima u AIM.

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Objavljeno
2017/09/19
Broj časopisa
Vol. 74 Br. 9 (2017)
Rubrika
Originalni članak