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Tip 2 diyabeti olan ve olmayan bireylerde qt mesafesiyle ayak bileği-kol indeksi arasındaki ilişkinin değerlendirilmesi

The evaluation of the association between qt interval and ankle brachial index in individuals with and without type 2 diabetes

  1. Tez No: 456062
  2. Yazar: ESRA CEYLAN
  3. Danışmanlar: PROF. DR. KAMİLE MARAKOĞLU
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Aile Hekimliği, Family Medicine
  6. Anahtar Kelimeler: Diabetes mellitus, QT interval, ankle brachial index
  7. Yıl: 2014
  8. Dil: Türkçe
  9. Üniversite: Selçuk Üniversitesi
  10. Enstitü: Tıp Fakültesi
  11. Ana Bilim Dalı: Aile Hekimliği Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 98

Özet

Amaç: Bu çalışmada tip 2 diyabeti olan ve olmayan bireylerde QT mesafesiyle ayak bileği-kol indeksi arasındaki ilişkinin değerlendirilmesi ve diyabetik bireylerde periferik arter hastalığı sıklığının belirlenmesi amaçlanmıştır. Gereç – yöntem: 01.04.2013 ile 31.05.2014 tarihleri arasında Selçuk Üniversitesi Aile Hekimliği Periyodik Muayene Polikliniğinde yürütülen bu çalışmaya Amerikan Diyabet Birliği'nin kılavuzunda (ADA 2014) belirtilen kriterlere göre daha önce DM teşhisi konulmuş olup takip ve tedavi altında olan erişkin tip 2 diabetes mellitus hastalığı olan 187 hasta vaka grubuna, Aile Hekimliği Periyodik Muayene Polikliniğine başvuran diabetes mellitus ve koroner arter hastalığı olmayan 187 birey ise kontrol grubuna alındı. Her iki gruptaki bireyler yaş, cinsiyet ve vücut kitle indeksi açısından benzer tutuldu. 31 soruluk sosyodemografik, kronik hastalıklar ve yaşam alışkanlıkları anket formu yüz yüze görüşme tekniği ile dolduruldu. Ayak bileği kol indeksi vasküler proplu 8 mHz'lik el dopleri ile her iki ayak bileğinden ve koldan elde edilen tansiyon ölçümleri kullanılarak hesaplandı. 12 derivasyonlu EKG'den elde edilmiş QT mesafeleri Bazett formülü ile hesaplandı. Tüm veriler SPSS 16.0 istatistik paket programına kaydedilerek değerlendirildi. Verilerin değerlendirilmesinde Student-t testi, Ki-kare ve Pearson korelasyon analizleri kullanıldı. Bulgular: Çalışmaya alınan vaka (n=187) ve kontrol (n=187) toplam 374 bireyin %56.7'si kadın, (n=212), %43.3'ü erkekti (n=162). Çalışmamıza alınan 374 bireyin yaş ortalaması 51.22 ± 7.67 (min:33, max:65 median:52) olarak bulundu. Vaka grubunun yaş ortalaması 51.97 ± 7.26, kontrol grubun yaş ortalaması 50.47 ± 8.02 idi ve istatiksel açıdan iki grup arasında anlamlı fark yoktu (p=0.058). Vaka grubunun VKİ ortalaması 31.59 ± 5.01 kg/m2, kontrol grubunun VKİ 30.62 ± 5.02 kg/m2 olup iki grup arasında istatiksel açıdan anlamlı fark yoktu (p=0.063). Vaka grubunun %47.6'sının (n=89) erkek, %52.4'ü (n=98) kadın; kontrol grubunun %39'u (n=73) erkek, %61'i (n=114) kadın olup iki grup arasında istatiksel açıdan anlamlı fark yoktu (p=0.095). Vaka grubundaki bireylerin bel çevresi ortalaması (104.09 ± 11.07 cm) kontrol grubundaki bireylerin bel çevresi ortalamasından (98.29 ± 13.10 cm) istatistiksel olarak anlamlı derecede yüksek saptandı (p

Özet (Çeviri)

Objective: In this study it was aimed to evaluate the relationship between ankle-brachial index with QT interval in individuals with and without type 2 diabetes, and to determine the prevalence of peripheral arterial disease in diabetic subjects. Material - Method: In the study conducted at the Selcuk University Family Medicine Periodic examination Clinic between 01.04.2013 and 31.05.2014, 187 adult patients with type 2 diabetes mellitus who were diagnosed with DM previously according to the criteria mentioned in the American Diabetes Association's guide (ADA 2014), were included in the patient group, and 187 individuals without diabetes mellitus and coronary artery disease, who were admitted to Periodic Inspection of Family Medicine Outpatient Clinic were enrolled in the control group. The age, gender and body mass index of the individuals in both groups were kept match. A 31-item demographic, chronic diseases and lifestyle habits questionnaire was filled with face to face interview technique. Ankle brachial index was calculated by measuring the blood pressure obtained from both hands and arms ankle with vascular probe 8 MHz hand doppler QT intervals obtained from 12-lead ECG were calculated using Bazett's formula. All data were analyzed loading onto the SPSS 16.0 statistical package program. Student's t-test, Chi-square and Pearson correlation analysis were used to evaluate the data. Results: Of the cases included in the study (n = 187) and control (n = 187) the total of 374 individuals, 56.7% were female (n = 212), 43.3% were male (n = 162). In our study, the mean age of 374 individuals was 51.22 ± 7.67 (min: 33, max: 65 median: 52), respectively. The average age of the patient group was 51.97 ± 7.26, the control group's mean age was 50.47 ± 8.02, and there was no statistically significant difference between the two groups (p = 0.058). The average BMI of the patient group was 31.59 ± 5.01 kg / m2, and BMI was 30.62 ± 5.02 kg / m2 in the control group, and the difference between the two groups was not statistically significant (p = 0.063). In the patient group, 47.6% (n = 89) of the cases were male, 52.4% (n = 98) were female; 39% of the control group (n = 73) were male, and 61% (n = 114) were female and there was no statistically significant difference between the two groups (p = 0.095). The average waist circumference of individuals in the patient group (104.09 ± 7.11 cm) was found significantly higher (p < 0.000) than the average waist circumference of the individuals in the control group (98.29 ± 13.10 cm). Right brachial arterial systolic blood pressure 127.50 ± 18.08 mmhg) of the cases in patient group was statistically significantly higher (p = 0.002) than the right brachial arterial systolic blood pressure (121.99 ± 15.47 mmHg) of the control group. The left brachial arterial systolic blood pressure of the cases in the patient group (127.08 ± 17.39 mmHg) was statistically significantly (p < 0.006) higher than the left brachial arterial systolic blood pressure (122.30 ± 15.97 mmHg) in the control group. There were current smokers with the same frequency in both the control and the patient group (21.9% - 21.9%). The frequency of smoking cessation in the patient group (26.2%) was statistically significantly higher than in the control group (9.6%) (p < 0.000). The risk of DM in smokers and quitted (infected) was [OR: 2.013 (1.321-3.067)] higher when compared to never-smokers (p = 0.001). The frequency of alcohol use in the patient group (8.6%) was statistically significantly higher than the prevalence of alcohol use in the control group (3.2%). The risk of DM in the cases who used and quit (infected) alcohol was [OR: 2.823 (1.079-7.381)) higher than never used alcohol (p = 0.028). Though the prevalace of increase in QT interval in patient group (6.4%) was not statistically significant from the increase in the control group (5.3%), it was higher (p = 0.660). The average ABI of the patient group (1.08 ± 0.14) was found statistically significantly higher (p = 0.042) than in the control group (1.11 ± 0.14). The prevalace of PAH in women in the patient group (10.2% (n = 10)) was significantly lower (p = 0.046) than the prevalence of PAH in women in the control group (3.5% (n = 4)). Conclusion: Peripheral arterial disease prevalace in individuals with DM is higher than in normal subjects. Ankle-brachial index (ABI) is a non-invasive, simple, cheap, fast method known as a screening method for the cardiovascular disease including especially peripheral arterial disease for the general population. In the routine examination of the diabetic subjects admitted to the Family medicine outpatient clinic, the presence of early atherosclerosis can be foreseen by measuring the ABI, and necessary measures and precautions can be taken. Those who are at high risk for peripheral artery disease can be referred to the cardiology clinic and thus, cardiac mortality and morbidity can be reduced.

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