Abstract | Cilj istraživanja:
Cilj je istraživanja da se utvrdi povezanost između Syntax score-a (SS) bolesnika
kojima je napravljena koronarna angiografija i njihovih razina upalnih parametara C3, C4 i
CRP.
Sudionici:
Ispitanici su bolesnici upućeni iz kardioloških ambulanti na širem području Dalmacije.
Na osnovu testiranja koronarne rezerve pomoću ergometrije ili scintigrafije miokarda talijem
u opterećenju postavljena je indikacija za koronarografiju. Iz ispitivanja su isključeni
bolesnici koji u anamnezi imaju podatak o liječenju ili se aktivno liječe od sistemske bolesti
vezivnog tkiva.
Pacijenti su podijeljeni u tri grupe ovisno o njihovom SS-u. Prvu su grupu sačinjavali
bolesnici procijenjeni kao „low score“, koji imaju koronarnu bolest nižeg stupnja. Drugu su
grupu sačinjavali bolesnici procijenjeni kao “intermedium score“, koji imaju srednje izraženu
koronarnu bolest. Treću su grupu sačinjavali bolesnici koji su procijenjeni kao “high score“
koji imaju visoko izraženu koronarnu bolest.
Ustroj istraživanja:
Radi se o studiji bolesnika koji su upućeni na koronarografiju u KBC-u Split. Sve
bolesnike uputili su kardiolozi iz šireg područja Dalmacije. Nakon kliničkoga pregleda,
ovisno o kliničkoj slici bolesnika, postavljena je indikacija za testiranje koronarne pričuve.
Bolesnici kojima je ergometrijsko testiranje pozitivno ili je scintigrafijom miokarda talijem u
opterećenju pronađena ishemija miokarda upućeni su na koronarografiju. Stupanj oštećenja
koronarnih arterija procijenjen je s pomoću ocjenske ljestvice Syntax score (31). Navedeni
sustav procjene stupnja oštećena koronarnih arterija temelji se na anatomski i morfološki vrlo preciznim smjernicama te se bolesnici razmještaju u tri skupine: niski rezultat (<22), srednji
rezultat (23-32), visoki rezultat (33<) (31). Svim je bolesnicima prije koronaragrafije iz
seruma određena razina CRP-a i komponenta komplementa C3, C4.
Mjesto istraživanja:
Klinika za unutarnje bolesti Kliničkog bolničkog centra Split, Odjel za bolesti srca i
krvnih žila, Odjel za laboratorijsku dijagnostiku.
Glavne mjere ishoda:
Glavna su mjere ishoda serumske razine CRP-a, i komponenata komplementa C3 i C4
u odnosu na stupanj koronarnoga oštećenja.
Rezultati:
Nije utvrđena značajna razlika između vrijednosti parametara upale pojedinih Syntax
skupina. Isti zaključak je dobiven analizom vrijednosti parametara upale među spolovima i
različitim dobnim skupinama unutar iste Syntax skupine. Izuzetak je u Syntax skupini 1 gdje
su vrijednosti C4 statistički različite u muškaraca u odnosu na žene (p<0,034).
U skupini 3 postoji jaka korelacija između C3 i CRP (p<0,05; r=0,979) u dobnoj
skupini ispod 70 godina kao i između C3 i C4 (p<0,05; r=0,93) u dobnoj skupini iznad 70
godina. Pronašli smo slabu pozitivnu korelaciju između C3 i C4 (p<0,05; r=0,44) unutar
skupine 1. Korelacija između CRP i C3 (p<0,05; r=0,856) unutar skupine 3 je jaka i
pozitivna, dok je korelacija između CRP i C4 (p<0,05; r=0,669) umjerena i pozitivna u istoj
skupini.
Pronašli smo opću slabu pozitivnu korelaciju između SS-a i kolesterola (p<0,05;
r=0,335). Opća slaba pozitivna korelacija je između triglicerida i kolesterola (p<0,05;
r=0,399) također je prisutna, kao i korelacija između C3 i C4 (p<0,05; r=0,548).
Kod žena postoji umjerena opća pozitivna korelacija između kolesterola i Syntax
skupine (p<0,05; r=0,719), kao i između triglicerida i CRP-a (p<0,05; r=0,582).
U muškaraca pronašli smo opću slabu povezanost C4 i SS-a (p<0,05; r=0,39). Ista
korelacija pronađena je između C3 i triglicerida (p<0,05; r=0,411), C4 i kolesterola (p<0,05;
r=0,443) i kod C3 i CRP-a (p<0,05; r=0,436). Umjerena pozitivna korelacija u muškaraca je
pronađena između C3 i C4 (p<0,05; r=0,597) kao i između triglicerida i kolesterola (p<0,05;
r=0,546).
Zaključci:
U svim je grupama pronađena je korelacija između Syntax skupine i kolesterola.
Postoji pozitivna korelacija između brojčane vrijednosti SS-a i razine C4 u muškaraca u kojih
su razine C4 povezane sa razinama C3 i razinama kolesterola. Zbog nasumičnog postupka
odabira ispitanika u studiji je bilo samo 9 bolesnika sa dokazanom aterosklerozom te je
daljnje istraživanje neophodno. |
Abstract (english) | Objectives:
This study was designed to establish a connection between Syntax score (SS) of
patients who have had a coronary angiography and their levels of inflammatory mediators C3,
C4 and CRP.
Participants:
Subjects were patients directed from cardiologic infirmaries in the wider area of the
Dalmatia. Based on testing of coronary reserve by exercise stress testing or myocardial
scintigraphy with thallium under load, the indication was set for coronary angiography.
Patients who are cured or were cured from systemic connective tissue diseases were excluded
from the research.
Patients were divided into three groups based on the SS calculation. First group was
composed of the patients assessed as a „low score“, who have lower levels of coronary heart
disease. Second group was composed of the patients assessed as „intermedium score“, who
have moderate heart disease. Third group was composed of patients assessed as „high score“,
who have highly expressed coronary heart disease.
Design:
This is a study of patients who were referred for coronary angiography in the
University hospital Split. All patients were referred by cardiologists from the wider area of
Dalmatia. After clinical examination, depending on the clinical picture of patients the
indication was set for testing of coronary reserve. Patients with a positive exercise test or in
whom thallium myocardial scintigraphy under load found myocardial ischemia were
submitted to coronary angiography. The degree of damage of the coronary arteries was
assessed using rating scales Syntax score. The system of assessing the level of damage
coronary arteries based on anatomical and morphological precise guidelines. Patients were divided into three groups: low score (<22), mean score (23-32), a high score (33<). Before
they underwent coronarography their levels of C3, C4 and CRP were determined.
Setting:
Research was conducted at the Department of Internal medicine at the University
Hospital Split, Department of heart disease and blood vessels, and Department of laboratory
medicine.
Main outcome measures:
Main outcome measures in the study were serum concentrations of C-reactive protein
and complement components C3 and C4 in relation to the degree of coronary damage.
Results:
No significant difference between the values of inflammatory mediators of particular
groups was found. The same conclusion was obtained by analyzing the value of inflammatory
mediators between the sexes and different age groups within the same Syntax group.
Exception to that was in group 1 were we found that values of C4 were statistically different
in males than in females (p<0,043).
In group 3 strong correlation between C3 and CRP (p<0,05; r=0,979) in age group
below 70 years and C3 and C4 (p<0,05; r=0,93) in the age group over 70 years were found.
We found a weak positive correlation between C3 and C4 (p<0,05; r=0,44) within Syntax
group 1. Correlation between CRP and C3 (p<0,05; r=0,856) within Syntax group 3 was
strong and positive, while correlation between CRP and C4 (p<0,05; r=0,669) was moderate
and positive in the same group.
We found general weak positive correlation between cholesterol and SS (p<0,05;
r=0,335). Weak positive correlation of triglycerides and cholesterol (p<0,05; r=0,399) in
general was also present, as was correlation between C3 and C4 (p<0,05; r=0,548).
In general in females there is a moderate positive correlation between cholesterol and
SS (p<0,05; r=0,719), as is between triglycerides and CRP (p<0,05; r=0,582).
In males there is a general weak connection between C4 and SS (p<0,05; r=0,39).
Same correlation was found between C3 and triglycerides also C4 and cholesterol as in C3
and CRP (p<0,05, p<0,05, p<0,05 respectively). Moderate positive correlations in males were
found between C3 and C4 (p<0,05; r=0,597) also between triglycerides and cholesterol
(p<0,05; r=0,546).
Conclusions:
In all groups correlation between Syntax group and cholesterol level exists. There is
positive correlation between SS and levels of C4 in male patients, in whom levels of C4
correlated with C3 and cholesterol levels. Due to randomized selection there were only 9
patients with proven atherosclerosis and further research is necessary. |