İskemik strok'lu hastalarda bağımsız risk faktörü olarak hiperhomosisteinemi
Hyperhomocysteinemy as an independent risk factor in patients with ischemic stroke
- Tez No: 163911
- Danışmanlar: PROF.DR. YALÇIN YILIKOĞLU
- Tez Türü: Tıpta Uzmanlık
- Konular: Nöroloji, Neurology
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2005
- Dil: Türkçe
- Üniversite: Atatürk Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Nöroloji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 90
Özet
HI ÖZET İskemik strok'Iu hastalarda bağımsız risk faktörü olarak hiperhomosisteinemi Bu çalışmada, akut serebral iskemili hastalarda homosisteinin serum seviyeleri ölçüldü. Aynı zamanda serum vitamin B12, folik asit düzeyleri ve bunların plazma homosistein seviyeleri ile ilişkisi araştırıldı. Çalışmaya alınan olguların tümünde HT, DM, hiperkolestrolemi, sigara ve alkol kullanımı, iskemik kalp hastalığı öyküsü ile vitamin B12, folik asit ve homosistein düzeyleri arasındaki ilişki araştırıldı. Çalışmaya 60 hasta ve kontrol grubu olarak da 30 sağlıklı birey alındı. Hasta grubunda ortalama Hey düzeyi 26.16±10.50umol/L iken kontrol grubunda 1 1.70±5.28umol/L idi ve aradaki fark istatistiksel olarak anlamlı idi (p0.005).IV Hasta ve kontrol grupları ortalama yaş, vitamin B12, folik ast ve Hey düzeyleri açısından karşılaştırıldıklarında ; hasta grubunda ortalama yaş 61.25+7.59, kontrol grubunda 59.93+9.37 bulundu ve aradaki fark istatistiksel olarak anlamlı değildi (p>0.05). Hasta ve kontrol grupları arasında cinsiyet, sigara ve alkol kullanımları açısından herhangi bir fark tespit edilememiştir (p>0.05). Elde edilen sonuçlar, akut serebral iskemili hastalarda homosistein seviyesinin yüksek olduğunu göstermiştir. Homosistein ile vitamin B12 arasında da negatif korelasyon tespit edilmiştir. Akut serebral iskeminin patogenezinde plazma homosistein seviyesinin yüksekliğinin önemli olduğu sonucuna varıldı. Bu nedenle iskemik İnmede primer ve sekonder korunmada bilinen diğer risk faktörlerinin yanında hiperhomosisteinemi de göz önünde bulundurulmalı hiperhomosisteinemisi bulunan vakalara folik asit, vitamin B6, vitamin B12 verilmesiyle Hey düzeylerinin azaltılabileceğinden, iskemik inmeli hastalarda bu parametrelerin de araştınlması ve düşük bulunanlarda tedaviye eklenmesi gerektiği düşünülmektedir.
Özet (Çeviri)
SUMMARY Hyperhomocysteinemy as an independent risk factor in patients with ischemic stroke In this study, homocysteine plasma levels were measured in patients with acute cerebral ischemia. Serum vitamin B12, folic acid levels and their correlation with homocysteine levels also were investigated. In all the cases in this study, the correlation between vitamin B12, folic acid and homocysteine levels with HT, DM, hypercholesterolemia, smoking, alcohol intake and history of ischemic heart disease was investigated. 60 patients and 30 healthy individuals as control group were included in the study. While average Hey levels in the patient group was 26.16 ± 10.50, it was 11.70 ± 5.28 in the control group and there was statistically significant distinction between them ( p < 0.001). While average vitamin B12 level in the patient group was 227.53 ± 59.12, it was 267.03 ± 162.50 in the control group and the distinction between them was statistically significant ( p < 0.005). While average folic acid in patient group was 4.45 ±1.61, it was 6.58 ± 2.93 in the control group, and the distinction between them was statistically significant ( p < 0.001). When correlation between folic acid levels and vitamin B12 levels with Hey levels was examined in the patient group, it was detected that there was negative correlation between them ( r =- 0.358 and p = 0.029). In the control group, when correlation between vitamin B12 and folic acid levels with Hey levels was examined, there was negative correlation only in between Hey levels and folic acid levels, and this was statistically significant ( r = -0.217 and p = 0.04). There was no statistically significant correlation between the other parameters. While Hey levels were over normal limits in 49 of 60 patients in the patient group, they were in normal limits in 5 of 30 patients in the control group. The distinction between them was statistically significant ( p < 0.01). When ischemic stroke subgroups were compared with regard to vitamin B12, folic acid and Hey levels, there was no significant distinction between the groups with regard to 3 parameters ( for all : p > 0.005). When patient and control groups were compared with regard to mean age, vitamin B12, folic acid and Hey levels, the age in the patient group was 61.25 ±VI 7.59, and it was 59.93 ± 9.37 in the control group, and the distinction between them was not statistically significant ( p > 0.05). There wasn't any distinction between the patient and the control group as regards gender, smoking and alcohol intake ( p > 0.05). The obtained results indicated that homocysteine level was high in patients with acute cerebral ischemia. Negative correlation was also detected between homocysteine and vitamin B12. It was concluded that high plasma homocysteine level was important in the pathogenesis of cerebral ischemia. For this reason, hiperhomocysteinemy should be considered in ischemic stroke besides the other known risk factors in the secondary and primary protection; it is considered that because of homocysteine levels would be able to reduced by giving folic acid.vitamin B6 and vitamin B12 in patients with hiperhomocysteinemy, this parameters should be investigated in patients with ischemic stroke and should be added to the treatment in those with lower levels.
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