South Clin Ist Euras. 2000; 11(3): 865-869

AKUT MYOKARD ÝNFARKTÜSÜNDE AKUT FAZ REAKTANLARINDAKÝ DEÐÝÞÝM VE TROMBOLÝTÝK TEDAVÝNÝN BU DEÐÝÞÝME ETKÝSÝ

Serdar Fenercioðlu¹, Mahmut Gümüþ¹, Ýbrahim Erbay¹, Haluk Sargýn¹, Mehmet Sargýn¹, Mehmet Aliustaoðlu¹, Taflan Salepçi¹, Ali Yayla¹
Dr.Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi Dahiliye Kliniði

Myokard infarktüsü, myokardýn mutlak veya relatif aðýr perfüzyon yetersizliði sonucu geliþen bölgesel nekrozudur. Yaptýðýmýz çalýþmada akut myokard infarktüsü seyrinde görülen, akut koroner olaylardan sorumlu faktörler olduðuna dair bulgularýn sürekli arttýðý, inflamasyonun akut faz reaktanlarýndan olan C-reaktif protein (CRP), eritrosit sedimentasyon hýzý (ESH) ve lökosit düzeylerinin trombolitik tedavi ile deðiþkenliði araþtýrýlmýþtýr. Hastanemiz Koroner Yoðun Bakým Ünitesi'nde Ocak 2000-Aralýk 2000 tarihleri arasýnda myokard infarktüsü nedeni ile trombolitik tedavi uygulanan 40 hasta ve AMÝ tanýsý alan fakat endikasyonu olmamasý nedeni ile trombolitik tedavi uygulanmayan diðer 40 hasta çalýþmaya alýndý. Hastalarýn yatýþlarýnýn ilk saatinde kan þekeri, üre, kreatinin, ürik asit, kolesterol, trigliserid, yüksek dansiteli lipoprotein, karaciðer fonksiyon testleri, total protein, albumin, globulin, sodyum, potasyum, eritrosit sedimentasyon hýzý, Anti-Streptolizin O (ASO), CRP, hemogram ölçümleri için kan örnekleri alýndý. Ayrýca hastalarýn periferik yaymalarý hazýrlanýp boyanarak lökosit formülü yapýldý. Çalýþmaya alýnan hastalarýn 9'u (%11.3) kadýn, 71 'i (%88.7) erkek idi. Yaþ ortalamalarý 54.4 ± 10.5 (28-70) yýl bulundu. Albumin, eritrosit sedimentasyon hýzý, CRP, lökosit sayýsý, hematokrit, platelet, polimorf nüveli lökosit (PNL), lenfosit, monosit ve eozinofil düzeylerindeki 1. ve 7. günler arasýnda deðiþim istatistiksel olarak anlamlý bulunurken, ASO düzeylerindeki deðiþimde ise istatistiksel olarak anlamlý fark saptanmamýþtýr. ESH, ASO, CRP, lökosit sayýsý, hematokrit, platelet, PNL, lenfosit, monosit ve eozinofil düzeylerindeki deðiþimler trombolitik tedavi uygulanan ve uygulanmayan gruplar arasýnda deðerlendirildiðinde ESH, ASO, hematokrit, platelet, PNL ve lenfosit düzeyleri açýsýndan gruplar arasýndaki fark istatistiksel olarak anlamlý bulunmuþtur. CRP, lökosit, monosit ve eozinofil düzeyleri açýsýndan ise istatistiksel olarak anlamlý fark saptanmamýþtýr. AMÝ'nin l., 3. ve 7. günlerinde bakýlan CRP düzeylerinin 3. günde en yüksek olduðu ve bu artýþýn akut koroner olaylardaki inflamasyonla iliþkili bulunduðu görülmektedir. Çalýþmamýzda incelenen diðer bir akut faz reaktaný olan albüminin 1. ve 7. günlerdeki deðerlerine bakýlmýþ, anlamlý bir düþme olduðu görülmüþtür. Çalýþmamýzda 1., 3. ve 7. günlerde bakýlan eritrosit sedimentasyon hýzýnda belirgin bir artýþ saptanmýþ, trombolitik tedavi uygulanan hastalarda eritrosit sedimentasyon hýzý, uygulanmayanlara göre anlamlý olarak daha düþük bulunmuþtur. Reperfüzyonun bir göstergesi olarak CRP ile trombolitik tedavi etkinliði arasýnda çalýþmamýzda anlamlý bir iliþki kurulamamýþtýr.

Anahtar Kelimeler: AKUT FAZ REAKTANLART, TROMBOLÝTÝK TEDAVÝ, AKUT MYOKARD ÝNFARKTÜSÜ

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THE VARIABILITY OF ACUTE PHASE REACTANS IN ACUTE MYOCARDIAL INFARCTION AND EFFICACY OF THROMBOLYTIC TREATMENT TO THESE VARIABILITY

Serdar Fenercioðlu¹, Mahmut Gümüþ¹, Ýbrahim Erbay¹, Haluk Sargýn¹, Mehmet Sargýn¹, Mehmet Aliustaoðlu¹, Taflan Salepçi¹, Ali Yayla¹
Dr.Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi Dahiliye Kliniði

Myocardial infarction (MI) is a regional necrosis of heart and caused by absolute or relative perfusion insuffiensy. The variability of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte levels which were acute phase reactants of inflammation, were seen in AMI and have data that showed their responsibilities from acute coronary syndrome, were investigated with thrombolytic treatment in our study. Fourty patients who were put on thrombolytic treatment because of AMI and other 40 patients who were also diagnosed as AMI but were not thought to have an indication for thrombolytic treatment, were included into the study. They were hospitalized in intensive coronary care unit of our hospital between January-December 2000. Blood samples for blood glucose, urea, creatinine, uric acid, cholesterol, tryglyceride, high density lipoprotein, liver function enzymes, total protein, albumin, globulin, sodium, potassium, ESR, anti-streptolysin O (ASO), CRP, hemogram were obtained in the first hour after hospitalization of the patients. Nine (%11.4) of patients were female and 71 (%88.7) were male. Mean age was 54.4(10.5 years. Statistically significant difference was found between the first and 7th day levels of albumin, ESR, CRP, leukocyte, monocyte and eosinophyl counts; but not for ASO levels. When we compared the results by separating the patients into two groups as who have had thrombolytic treatment or not, there was a statistically significant differences between the groups according to ESR, ASO, hematocrite, platelet, PNL and lymphocyte levels. There was no difference between groups according to the CRP, leukocyte, monocyte and eosinophyl levels. CRP was highest at 3rd day when we analysed the results of the first, third and 7lh day of AMI and that increase was seen in relation with inflammation in acute coronary syndrome. Other acute phase reactant albumin levels were also evaluated and a statistically significant decrease was found between the first and 7lh day. In our study, a significant increase was detected in ESR and ESR was significantly lower in patients who were used thrombolytic treatment than the others. There was no correlation between efficacy of thrombolytic treatment and CRP as an indicator of reperfusion.

Keywords: ACUTE PHASE REACTANTS, THROMBOLYTIC TREATMENT, ACUTE MYOCARDIAL INFARCTION

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ATIF KOPYALA