OSAS'lı hastalarda PAPP-a düzeyleri ve OSAS şiddeti ile ilişkisinin değerlendirilmesi
Küçük Resim Yok
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Obstrüktif uyku apne sendromu (OSAS) uyku sırasında üst hava yolunun sürekli olarak tekrarlayan tıkanmaları ile seyreden kardiyovasküler ve serebrovasküler olaylar için bilinen risk faktörü olan bir hastalıktır. Patogenezi tam olarak aydınlatılamamakla birlikte inflamasyonun rolü olduğunu bildiren çalışmalar mevcuttur. OSAS'ta tekrarlayan hipoksi ataklarının, çeşitli inflamatuvar mediatörlerin salınımına ve inflamatuar sürecin başlamasına yol açtığı ileri sürülmüştür. Bir metalloproteinaz olan gebelikle ilişkili plazma proteini-A'nın (PAPP-A) enflamatuar yolaklarda rol oynadığı düşünülmektedir ve son yıllarda birçok hastalıkta çalışılmıştır. OSAS' ta PAPP-A seviyelerinin nasıl olduğunu gösteren ve OSAS PAPP-A ilişkisine dair yayınlanmış bir çalışma bulunmamaktadır. Bu çalışmada; OSAS hastalarında PAPP-A düzeyleri, PAPP-A düzeyleri ile OSAS şiddeti, apne hipopne indeksi (AHI), uyku evreleri, O2 düzeyleri ve vücut kitle indeksi (VKİ) arasında ilişki olup olmadığının belirlenmesi amaçlanmıştır. Materyal Metot: Bu çalışmaya 44 OSAS 'lı hasta ve 44 sağlıklı yetişkin dahil edildi. OSAS tanılı hastalar AHI' ye göre hafif (5-15), orta (16-30) ve ağır (>30) OSAS olmak üzere üç grupta sınıflandırıldı. OSAS tanılı hastalardan romatolojik veya sistemik inflamatuvar hastalığı olanlar, diyabetes mellitus (DM), karaciğer yetmezliği, kronik böbrek yetmezliği, serebrovasküler hastalığı, kalp yetmezliği, hipertansiyon, gebelik, prerenal azotemi, son 6 ayda majör cerrahi ve travma öyküsü, inhale nazal yada sistemik kortikosteroid kullanımı ya da diğer antiinflamatuvar ilaç kullanımı, astım, KOAH, rinit veya atopi öyküsü olanlar ve <18 yaş olanlar çalışma dışı bırakıldı. Hastaların rutin tetkiklerine ek olarak serum PAPP-A değerleri enzim-linked immunosorbent assay (ELISA) kitleri sandwich immünölçüm metodu ile çalışıldı. Çalışmanın istatistiksel değerlendirmesi SPSS 17.0 paketi kullanılarak yapıldı ve p<0.05 değerleri anlamlı kabul edildi. Bulgular: Bu çalışmada OSAS'lı hastaların serum PAPP-A seviyeleri (2.350 ng/ml (0.641- 4.796)) kontrol grubuna göre (0.971 ng/ml (0.109-2.679)) anlamlı olarak yüksek bulundu (p<0.001). OSAS'lı hastalar hastalık şiddetine göre sınıflandırılıp, gruplar serum PAPP-A seviyelerine göre karşılaştırıldığında istatiksel fark saptandı. AHI 5-15 (hafif şiddette OSAS) olanlarda PAPP-A 1.26 ng/ml (0.64-2.99), AHI 16-30 (orta şiddette OSAS) olanlarda PAPP-A 4.26 ng/ml (2.75-4.79), AHI>30 (ağır şiddette OSAS) olanlarda PAPP-A 1.74 ng/ml (1.00-2.65), p<0.001) idi. PAPP-A düzeyleri ile gece minimum (p= 0.042, r=0.309), ve ortalama oksijen düzeyleri (p= 0.006, r=0.407) arasında pozitif korelasyon gözlenirken, AHI ile PAPP-A düzeyleri arasında (p=0.002, r=-0.460) negatif korelasyon olduğu saptandı. Sonuç: Serum PAPP-A düzeyleri OSAS'lı hasta grubunda sağlıklı kontrollere göre belirgin olarak daha yüksek bulundu ve orta şiddetli OSAS hastalarında PAPP-A düzeyleri hafif ve ağır OSAS'lı hastalara göre daha yüksekti. Çalışmamızın bu konudaki ilk çalışmalardan biri olması nedeni ile, PAPP-A'nın OSAS'taki yerini belirleyebilmek için geniş çaplı prospektif çalışmalar yapılması gerektiğini düşünmekteyiz. Anahtar Kelimeler: OSAS, Serum PAPP-A düzeyleri, OSAS şiddeti
Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of upper airway obstruction during sleep with associated intermittent hypoxia. OSAS is an increased risk for cardiovascular and cerebrovascular conditions and events. Although pathogenesis of OSAS is debated, inflammation has been indicated as a potential mechanism. And also, OSAS has indeed been associated with elevated levels of various circulating inflammatory markers. Pregnancy associated plasma protein-A (PAPP-A) is one of zinc-binding metalloproteinase that has an important role in inflammatory processes. It has been studied in many inflammatory and immunological diseases in recent years. In our knowledge there are no published studies on the relationship between OSAS and serum PAPP-A levels. In this study, we aimed to investigate serum PAPP-A levels in patients with OSAS and the relationship between PAPP-A levels and severity of OSAS, apnea-hypopnea index (AHI), O2 levels, sleep stages and body mass index (BMI). Material method: 44 patients with OSAS and 44 healthy adults were included in this study. The exclusion criteria's were rheumatic or systemic inflammatory disease, advanced liver or kidney failure, diabetes, heart failure, known hypertension, pregnancy, prerenal azotemia, known history of coronary artery disease (CAD), history of major trauma or surgery with in six 6 months, inhaled nasal or systemic corticosteroid use or other anti-inflammatory medications, asthma, COPD, rhinitis, or atopy and those with <18 years of age. In addition of the routine tests of the patients, serum PAPP-A levels were determined by Elisa method with the immune sandwich measuring method. Statistical analysis of the study was performed with SPSS 17.0 statistical analysis package program and p<0.05 was considered as significant. Results: In this study, serum PAPP-A levels of patients with OSAS (2.350 ng/ml (0.641-4.796)) was significantly higher (p<0.001) when compared with healthy controls (0.971 ng/ml (0.109-2.679)). There were statistically significant difference in serum PAPP-A levels between groups of OSAS patients according to the classification of OSAS severity. Between the groups of patients with OSAS, serum levels of PAPP-A in moderate group was significantly higher when compared with severe OSAS group (p<0.001). There was positive correlation between PAPP-A levels and night minimum (p= 0.042, r=0.309), and average oxygen levels (p= 0.006, r=0.407), and a negative correlation between PAPP-A levels and AHI (p=0.002, r=-0.460). Conclusion: Serum PAPP-A levels were significantly higher in patients with OSAS when compared with healthy controls. According to the classification of OSAS severity, serum levels of PAPP-A in moderate group was significantly higher than severe group. Due to the our study was the first investigation that evaluating serum PAPP-A levels of the patients with OSAS in the literature, large prospective studies are required to better elucidate the role played by PAPP-A in disease processes. Keywords: OSAS, serum PAPP-A levels, OSAS severity
Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of upper airway obstruction during sleep with associated intermittent hypoxia. OSAS is an increased risk for cardiovascular and cerebrovascular conditions and events. Although pathogenesis of OSAS is debated, inflammation has been indicated as a potential mechanism. And also, OSAS has indeed been associated with elevated levels of various circulating inflammatory markers. Pregnancy associated plasma protein-A (PAPP-A) is one of zinc-binding metalloproteinase that has an important role in inflammatory processes. It has been studied in many inflammatory and immunological diseases in recent years. In our knowledge there are no published studies on the relationship between OSAS and serum PAPP-A levels. In this study, we aimed to investigate serum PAPP-A levels in patients with OSAS and the relationship between PAPP-A levels and severity of OSAS, apnea-hypopnea index (AHI), O2 levels, sleep stages and body mass index (BMI). Material method: 44 patients with OSAS and 44 healthy adults were included in this study. The exclusion criteria's were rheumatic or systemic inflammatory disease, advanced liver or kidney failure, diabetes, heart failure, known hypertension, pregnancy, prerenal azotemia, known history of coronary artery disease (CAD), history of major trauma or surgery with in six 6 months, inhaled nasal or systemic corticosteroid use or other anti-inflammatory medications, asthma, COPD, rhinitis, or atopy and those with <18 years of age. In addition of the routine tests of the patients, serum PAPP-A levels were determined by Elisa method with the immune sandwich measuring method. Statistical analysis of the study was performed with SPSS 17.0 statistical analysis package program and p<0.05 was considered as significant. Results: In this study, serum PAPP-A levels of patients with OSAS (2.350 ng/ml (0.641-4.796)) was significantly higher (p<0.001) when compared with healthy controls (0.971 ng/ml (0.109-2.679)). There were statistically significant difference in serum PAPP-A levels between groups of OSAS patients according to the classification of OSAS severity. Between the groups of patients with OSAS, serum levels of PAPP-A in moderate group was significantly higher when compared with severe OSAS group (p<0.001). There was positive correlation between PAPP-A levels and night minimum (p= 0.042, r=0.309), and average oxygen levels (p= 0.006, r=0.407), and a negative correlation between PAPP-A levels and AHI (p=0.002, r=-0.460). Conclusion: Serum PAPP-A levels were significantly higher in patients with OSAS when compared with healthy controls. According to the classification of OSAS severity, serum levels of PAPP-A in moderate group was significantly higher than severe group. Due to the our study was the first investigation that evaluating serum PAPP-A levels of the patients with OSAS in the literature, large prospective studies are required to better elucidate the role played by PAPP-A in disease processes. Keywords: OSAS, serum PAPP-A levels, OSAS severity
Açıklama
Tıp Fakültesi, Göğüs Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Göğüs Hastalıkları, Chest Diseases
