Introduction The growth Stimulation expressed gene 2 (ST2) (or interleukin 1 receptor-like 1, also known as IL1RL1) is considered a biomarker of poor prognosis in cardiovascular diseases. The aims of this study are to investigate ST2 in the pericardial fluid (PF) of coronary artery disease patients and to contribute to the understanding of the pathophysiology of coronary artery disease. Methods 40 patients (blood plasma and PF) who underwent coronary artery bypass surgery and 40 controls (blood plasma only) were included in this study. Soluble ST2 (sST2) level was determined by enzyme-linked ımmunosorbent assay method in plasma and PF, and sST2 gene expression was determined by quantitative real-time polymerase chain reaction (QRT-PCR) method. Results The sST2 level was found to be 44.89 ng/ml and 390.357 ng/ml in the control and patient groups’ plasma, and 223.992 ng/ml in the PF of the patient group. An increase in sST2 level was detected in the patient group compared to the control group ( P <0.001). The sST2 expression in plasma was higher in the patient group than in the control group. Additionally, sST2 was more expressed in the plasma of the patient group than PF ( P <0.001). Conclusion The fact that sST2 was detected for the first time in a high level in PF showed that this biomarker was closely related with the heart and strengthened its potential to be used as a biomarker. Therefore, sST2 can contribute to the understanding of the pathophysiology of coronary artery disease.
Bu çalışmada, kardiyopulmoner bypass yöntemi ile kardiyovasküler cerrahi geçiren hastaların farklı zamanlarda alınan hemogram örneklerinin değerlendirilmesi amaçlanmıştır. Materyal ve Metot: Prospektif olan çalışmamıza çeşitli sebeplerden dolayı kardiyovasküler cerrahi geçiren 30 hastadan preoperatif, anestezi indüksiyonu sonrası, aortik kross klemp sonrası, KPB çıkışından hemen sonra ve postoperatif 5.gün olmak üzere beş farklı zamanda hemogram tüpüne kan örnekleri alındı. Numuneler tam kan sayım cihazında çalışıldı ve istatistiksel analizleri yapıldı.
Özet Amaç: Yaptığımız bu çalışmada Kardiyopulmoner bypass (KPB) sırasında homosistein, vitamin B12 ve folik asit parametrelerinin değişimlerine bakılarak birbirleri ile olan ilişkilerinin araştırılması amaçlanmıştır. Materyal ve Metod: Göğüs Kalp Damar Cerrahisi bölümünde çeşitli sebeplerden dolayı KPB cerrahisi ile ameliyat olan hastalardan ameliyat öncesi, pompaya (kalp akciğer makinesi) giriş, kross klemp sonrası ve protamin verilmesi sonrası olmak üzere 4 jelsiz tüpe kan alınarak bir çalışma grubu oluşturuldu. Alınan kanlarda serum Vitamin B12 düzeyi ve serum Folik asit düzeyi Kemilüminesans yöntemi ile serum Homosistein düzeyi ise Kolorimetrik yöntem ile ölçülmüştür. Bulgular: Vitamin B12, pg/MI değeri; Ameliyat öncesi 206.30 ±64.76, Pompaya Giriş108.03 ± 35.75, Kross Klemp Sonrası 128.53 ± 38.43, Protamin Sonrası 141.33 ± 39.21, p<0,001 olarak bulunmuştur. Folik Asit, ng/MI değeri sırasıyla; 10.04 ± 2.89, 6.53 ± 1.84, 6.53 ± 1.95, 9.02 ± 2.83 ve p<0,001 olarak bulunmuştur. Homosistein, μmol/L değeri sırasıyla;14.40 ± 4.48, 7.63 ± 2.30, 9.44 ± 2.62, 9.15 ± 2.55 ve p<0,001 olarak bulunmuştur. Sonuç: Pompaya girişte homosistein, vitamin B12 ve folik asit düzeyi prime solüsyondan dolayı sayısal olarak düşerken; pompa girişinden kross klemp sonrasına kadar homosisteinde anlamlı artış olmuş, folik asit düzeyinde artış olmamış, vitamin B12 oranındaki artış ise homosistein kadar olmamıştır. Bu durum Vitamin B12 ve Folik asit düzeyi ile serum homosistein konsantrasyonu arasında negatif bir korelasyon göstermiştir. Kross klemp sonrasından protamin sonrasına kadarki dönemde homosistein seviyesinde düşüş olmasına rağmen, Vitamin B12 ve folik asit seviyesinde yükselmeler olmuştur. Bu yükseklik homositeinin Vitamin B12 ve folik asit ile negatif ilişkisine destek olmaktadır. Perfüzyon süresi uzadıkça artan inflamatuar yanıt ve kullanılan ilaçlar ile homosistein seviyesinde değişimlere neden olmuş fakat bu etkileşimlerin homosistein, Vitamin B12 ve folik asit düzeyi ile ilişkisi istatistiksel olarak gösterilememiştir. INVESTIGATION OF THE RELATIONSHIP BETWEEN HOMOCYSTEINE, VITAMIN B12 AND FOLIC ACID LEVELS AND THEIR RELATIONSHIP BETWEEN THE CARDIOPULMONARY BYPASS ABSTRACT Background: The aim of this study was to investigate the association between homocysteine, vitamin B12 and folic acid parameters in cardiopulmonary bypass (CPB). Methods: In the thoracic cardiovascular surgery department, a study group was formed by taking 4 gel-free scales from pre-operative, pump (heart lung machine), after cross-clamp and protamine administration from patients who underwent surgery with CPB surgery for various reasons. Serum vitamin B12 level and serum Folic acid level were measured by chemiluminescence method and serum homocysteine level by Colorimetric method. Results: Vitamin B12, pg / mL value; Preoperatively 206.30 ± 64.76, Pump Entry 108.03 ± 35.75, Post Cross Clamp 128.53 ± 38.43, Post Protamine 141.33 ± 39.21, p <0.001. Folic Acid, ng / ml value respectively; 10.04 ± 2.89, 6.53 ± 1.84, 6.53 ± 1.95, 9.02 ± 2.83 and p <0.001 respectively. Homocysteine, μmol / L values were found to be 14.40 ± 4.48, 7.63 ± 2.30, 9.44 ± 2.62, 9.15 ± 2.55 and p <0.001 respectively. Conclusions: While homocysteine, vitamin B12 and folic acid levels were decreased by prime solu- tion in the pump, there was a significant increase in homocysteine from the pump inlet to the end of the cross clamp, no increase in folic acid level, and no increase in vitamin B12 as homocysteine. This showed a negative correlation between Vitamin B12 and Folic acid level and serum homocysteine concentration. Although there was a decrease in homocysteine levels after the crosstalk after protamine, there was a rise in vitamin B12 and folic acid levels. This elevation supports the negative association of homocyte with Vitamin B12 and folic acid. Increased duration of perfusion resulted in increased inflammatory response and changes in homocysteine levels with drugs used, but these interactions were not statistically related to homocysteine, Vitamin B12 and folic acid levels.
Cardiopulmonary bypass (CPB) is an extracorporeal circulatory model consisting essentially of a pump, reservoir and oxygenator. At the beginning of CPB, blood of the patient flows into the extracorporeal circulation, which does not contain the endothelial surface, from the patient and initiates the inflammatory process, that is developed by the cellular, extracellular or humoral components of the blood and this process varies according to the patient's genotype, peroperative parameters and complexity of the pathology. Acute renal injury among patients undergoing cardiac surgery appears to be associated with poor prognosis and increased mortality. Acute kidney injury (AKI) is a condition that increases the common mortality and morbidity in intensive care unit (ICU) patients and adversely affects the clinical course.
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