Akut miyokard enfarktüslü hastalarda dört haftalık karvedilol veya metoprolol tedavisinin okside LDL ve paraoksonaz 1 aktivitesi üzerine etkisi
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Date
2010
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Uludağ Üniversitesi
Abstract
Bu çalışmanın amacı akut MI geçiren hastalarda okside LDL ve PON1 aktivitesini sağlıklı gönüllülerle karşılaştırmaktır. Ayrıca akut MI'lı hastalarda bir aylık karvedilol ve metoprolol tedavisinin okside LDL düzeyi ve PON1 aktivitesi üzerine etkisini araştırmaktır.Çalışma Nisan 2008 ile Nisan 2009 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalında yürütüldü. Çalışmaya akut MI tanısı konulan 31 hasta alındı. 31 hastadan onbeşine karvedilol ve onaltısına metoprolol tedavisi verilerek iki guruba randomize edildi.Hastalardan tedavi öncesinde kuru tüpe 5 cc kan örnekleri alınıp 1500 devirde 5 dakika santrifüj yapılarak değerlendirilmek üzere -20 °C'de saklandı.Hastaların bazal fizik muayeneleri yapıldı. Çalışmanın sonunda başvuru ve kontrol vizitinde alınan ve saklanan kan örneklerinden ELISA yöntemi ile okside LDL çalışılarak başvuru ve tedavi sonrası 4. hafta sonuçları ng/ml cinsinden elde edildi. Başvuru ve 4. haftanın sonundaki PON aktivitesi ölçümleri sırasıyla tedavi öncesi PON1 ve tedavi sonrası PON1 aktiviteleri olarak kaydedildi.Kontrol gurubu polikliniğe başvuran akut koroner sendrom tanısı dışlanan 15 gönüllüden oluşturuldu. PON1 aktivitesi ve okside LDL düzeyleri venöz kandan yukarıda tarif edildiği gibi okside LDL1 düzeyleri ve PON1 çalışıldı.Hasta gurubu 20'si erkek, 11'i kadın toplam 31 hastadan, kontrol gurubu 8'i erkek ve 7'si kadın toplam 15 hastadan oluşturuldu. Hasta gurubunda kontrol gurubuna kıyasla başlangıç HDL düzeyi ve PON1 aktivitesi anlamlı olarak düşüktü. HDL düzeyleri hasta ve kontrol gurubunda sırası ile 36,03±9,13 mg/dl ve 44,13±8,32 mg/dl, p=0,002 saptandı. PON1 aktivitesi hasta ve kontrol gurubunda sırası ile 115±13 U/L, 220±32 U/L, p<0,001 saptandı. Okside LDL düzeyi hasta gurubunda kontrol gurubuna göre anlamlı olarak yüksekti. Hasta ve kontrol gurubunda sırası ile 275±23 ng/ml, 75±24 ng/ml saptandı (p<0,001). Hasta gurubunda bir aylık karvedilol ve metoprolol tedavisi sonunda okside LDL düzeylerinde istatistiksel olarak anlamlı düşme, PON1 aktivitelerinde de istatistiksel olarak anlamlı artış saptandı. Metoprolol alan hastalarda okside LDL düzeyi 272±26 ng/ml'den 264±22 ng/ml'ye geriledi (p<0,001). Karvedilol alan hastalarda da benzer şekilde bir ayın sonunda 278±20 ng/ml'den 270±21 ng/ml'ye geriledi (p=0,008). Fakat iki ilacın okside LDL üzerindeki etkileri anlamlı değildi. Okside LDL yüzde değişimi metoprolol ve karvedilol gruplarında sırası ile -0,3±0,02 ve -0,3±0,04 saptandı (p=0,34).Metoprolol gurubunda PON1 aktivitesi bir ayın sonunda 112±13 U/L 'den 120±11 U/L'ye yükseldi (p=0,01). Karvedilol gurubunda ise PON1 aktivitesi 117±15 U/L'den 132±34 U/L'ye yükseldi ( p=0,002). Fakat iki ilacın PON1 üzerindeki etkileri anlamlı değildi. PON1 yüzde değişimi metoprolol ve karvedilol gruplarında sırası 0,07±0,09 ve 0,12±0,23 saptandı (p=0,68).Sonuç olarak bu çalışmada akut MI geçiren hastalarda diğer çalışmalara paralel olarak okside LDL' nin arttığını ve HDL-K düzeyi ile PON1 aktivitesinin azaldığı gösterildi. Akut koroner sendromda sınıf I endikasyonla kullanılan beta blokerler olan karvedilol ve metoprolol tedavisinin okside LDL düzeylerini düşmesinde ve PON1 aktivitesinin artmasında faydalı olduğu fakat her iki ilaç arasında istatistiksel açıdan anlam fark saptanmamıştır.
The aim of this study is to compare oxidized LDL and PON1 activities in patients with acute myocardial infarction and healhty individuals. Furthermore, we wanted to search the effects of carvedilol and metoprolol treatment on oxidized LDL and PON1 activity.The study has been conducted between April 2008 and April 2009 in the Cardiology Department of Uludag University, Faculty of Medicine. 31 patients diagnosed as acute MI were enrolled in the study. Fifeteen of the patients were given carvedilol and remaining sixteen patients were given metoprolol. In this way, the patients were randomised into two groups.Before the beggining of the treatment blood sample of 5 cc was taken from the patients and was stored at ? 20°C after centrifuging for five minutes at 1500 cycle for every patients.The physical examinations of the patients were carried out, and the end of the study, oxidized LDL levels from the blood samples taken at admission and at the control visit at the 4th week of the treatment were studied with ELISA method. The results were estimated in ng/ml. PON activity at admission was accepted as PON1 activity before treatment and PON activity measured at end of the fourth week of treatment was recorded as PON1 activity after the treatment.The control group was composed of fiveteen patients who applied to cardiology policlinics and whose acute coronary syndrome was excluded. PON1 activity and oxidized LDL levels were studied from venous blood samples taken from these patients.There were twenty men and eleven women, totally thirtyone patients in the study group. There were eight men and seven women, totally fiveteen patients in the control group. HDL levels and PON1 activity at admission were significantly lower in the study group compared with the control group. The mean level of HDL was 36,03±9,13 mg/dl in the study group and 44,13±8,32 mg/dl in the control group (p=0,002). The mean PON1 activity was 115±13 U/L in the study group and 220±32 U/L in the control group (p<0,001). Oxidized LDL levels were significantly higher in the study group. The mean oxidized LDL level was 275±23 ng/ml in the study group and 75±24 ng/ml in the control grou ( p<0,001). Oxidized LDL levels were found to reduce significantly after four- week treatment of carvedilol and metoprolol in the study group, and PON1 activity was found to rise after treatment. Oxidized LDL level was reduced from 272±26 ng/ml to 264±22 ng/ml in the metoprolol group. Similarly, at end of the treatment oxidized LDL level was reduced from 278±20 ng/ml to 270±21 ng/ml in carvedilol group. But the effects of both treatments on oxidized LDL were not significant. The change in persents for oxidized LDL was -0,3±0,02 and -0,3±0,04, p=0,34 in metoprolol and carvedilol groups.PON1 activity increased from 112±13 U/L to 120±11 U/L (p= 0,01) in metoprolol group and from 117±15 U/L to 132±34 U/L in carvedilol group at end of the treatment (p=0,002). But effects of both treatmens and PON1 activity was not significant. The change in persent for PON1 was 0,07±0,09 and 0,12±0,23, p=0,68 for metoprolol and carvedilol groups, respectively.As a result, the study has shown that oxidized LDL increase and HDL-C and PON1 activity is reduced in patients with acute miyocardial infarction in paralel with the other studies. Carvedilol and metoprolol are two beta blocking agents that are used in patients with acute coronary syndromes asclass I indication. Both agents are usefull in reducing oxidized LDL levels and increasing PON1 activity, but there is no significant difference statistically between them.
The aim of this study is to compare oxidized LDL and PON1 activities in patients with acute myocardial infarction and healhty individuals. Furthermore, we wanted to search the effects of carvedilol and metoprolol treatment on oxidized LDL and PON1 activity.The study has been conducted between April 2008 and April 2009 in the Cardiology Department of Uludag University, Faculty of Medicine. 31 patients diagnosed as acute MI were enrolled in the study. Fifeteen of the patients were given carvedilol and remaining sixteen patients were given metoprolol. In this way, the patients were randomised into two groups.Before the beggining of the treatment blood sample of 5 cc was taken from the patients and was stored at ? 20°C after centrifuging for five minutes at 1500 cycle for every patients.The physical examinations of the patients were carried out, and the end of the study, oxidized LDL levels from the blood samples taken at admission and at the control visit at the 4th week of the treatment were studied with ELISA method. The results were estimated in ng/ml. PON activity at admission was accepted as PON1 activity before treatment and PON activity measured at end of the fourth week of treatment was recorded as PON1 activity after the treatment.The control group was composed of fiveteen patients who applied to cardiology policlinics and whose acute coronary syndrome was excluded. PON1 activity and oxidized LDL levels were studied from venous blood samples taken from these patients.There were twenty men and eleven women, totally thirtyone patients in the study group. There were eight men and seven women, totally fiveteen patients in the control group. HDL levels and PON1 activity at admission were significantly lower in the study group compared with the control group. The mean level of HDL was 36,03±9,13 mg/dl in the study group and 44,13±8,32 mg/dl in the control group (p=0,002). The mean PON1 activity was 115±13 U/L in the study group and 220±32 U/L in the control group (p<0,001). Oxidized LDL levels were significantly higher in the study group. The mean oxidized LDL level was 275±23 ng/ml in the study group and 75±24 ng/ml in the control grou ( p<0,001). Oxidized LDL levels were found to reduce significantly after four- week treatment of carvedilol and metoprolol in the study group, and PON1 activity was found to rise after treatment. Oxidized LDL level was reduced from 272±26 ng/ml to 264±22 ng/ml in the metoprolol group. Similarly, at end of the treatment oxidized LDL level was reduced from 278±20 ng/ml to 270±21 ng/ml in carvedilol group. But the effects of both treatments on oxidized LDL were not significant. The change in persents for oxidized LDL was -0,3±0,02 and -0,3±0,04, p=0,34 in metoprolol and carvedilol groups.PON1 activity increased from 112±13 U/L to 120±11 U/L (p= 0,01) in metoprolol group and from 117±15 U/L to 132±34 U/L in carvedilol group at end of the treatment (p=0,002). But effects of both treatmens and PON1 activity was not significant. The change in persent for PON1 was 0,07±0,09 and 0,12±0,23, p=0,68 for metoprolol and carvedilol groups, respectively.As a result, the study has shown that oxidized LDL increase and HDL-C and PON1 activity is reduced in patients with acute miyocardial infarction in paralel with the other studies. Carvedilol and metoprolol are two beta blocking agents that are used in patients with acute coronary syndromes asclass I indication. Both agents are usefull in reducing oxidized LDL levels and increasing PON1 activity, but there is no significant difference statistically between them.
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Keywords
Koroner arter hastalığı, Miyokard enfarktüsü, Metoprolol, Karvedilol, Okside LDL, Paraoksanaz 1, Coronary artery disease, Myocardial infarction, Carvedilol, Oxidized LDL, Paraoxanase 1
Citation
Albayrak, S. (2010). Akut miyokard enfarktüslü hastalarda dört haftalık karvedilol veya metoprolol tedavisinin okside LDL ve paraoksonaz 1 aktivitesi üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.