Kalp kapak kalsifikasyonu olan ve olmayan olguların paratiroid hormon ve kalsiyum düzeylerinin karşılaştırılması
Abstract
Özet
Amaç. Hastalarda görülen kalp kapak darlık ve yetmezliklerinde kalsifikasyonun rolü önemlidir. Bu yüzden valvuler kalsifikasyonun sebeplerinin ayrıntılı tespiti bu patolojilerin ilerlemesini azaltabilir. Bu çalışmada kalp kapak kalsifikasyonu olan hastalarda parathormon (PTH) ve kalsiyum seviyeleri ile ilişkili olup olmadığını araştırmak amaçlanmıştır. Yöntem. Ekokardiografisinde valvuler kalsifikasyon tespit edilen 30 hasta (Grup A), valvuler kalsifikasyon görülmeyen 30 hasta (Grup B), serum parathormon, kalsiyum, iyonize kalsiyum, fosfor, kreatinin, açlık kan şekeri (AKŞ) ve arteriyel tansiyon ölçümleri açısından karşılaştırılmıştır. Bulgular. Gruplar arasında PTH değerleri karşılaştırıldığında valvüler kalsifikasyonu olan hastalarda parathormon düzeyleri (117,9) valvüler kalsifikasyonu olmayan hastalara (53,6) göre daha yüksek bulunmuştur (P<0,05). Total kalsiyum ve iyonize kalsiyum seviyelerine bakıldığında valvüler kalsifikasyonu olan grupta diğer gruba göre biraz daha düşük değerlerde olmasına rağmen istatistiksel olarak anlamlı bir fark tespit edilememiştir. (P>0,05) Serum fosfor değerleri de her iki grupta benzer seviyelerde tespit edildi (P>0,05). Her iki grupta da Ca x P düzeyleri 55'in altında bulunmuştur. Grup A'da ortalama 32,1, Grup B'de ortalama 30,8 idi. Kreatin klirensi hipertansiyon ve diyabet açısından anlamlı bir fark tespit edilemedi. Sonuçlar. Çalışmamızda valvuler kalsifikasyonlu olgularda serum parathormon seviyelerinin anlamlı olarak yüksek bulunması, valvuler kalsifikasyonla karşılaştığımızda bu hormonun analizinin de yapılmasının faydalı olabileceğini göstermiştir. Parathormon yüksekliği olanlarda sebep aydınlatılıp tedavi edilmesinin valvüler kalsifikasyonların ilerlemesini önleyebileceği kanaatine varılmıştır.
Anahtar kelimeler: Kalp kapak kalsifikasyonu, parathormon, iyonize calsiyum
Abstract
Aim. Calcification has an important role in valvular stenosis and failures that seen in patients. Because of this detailed establishing of valvular calcification reasons can be decreased progression of these pathologies. In this study we aimed to investigate that are there any relationship between parathormone (PTH) and calcium levels in patients which have cardiac valve calcification. Methods. Serum parathormone, calcium (Ca), ionize calcium, phosphor (P), creatinin, hunger blood glucose levels and arterial blood pressure measurements were compared between 30 patients with valvuler calcification in echocardiography (Group A) and 30 patients with no valvular calcification (Group B). Results. When each group compared, PTH levels were high in patients that have valvular calcification (117.9) according to non-calcific patients (53.6) (p< 0.05). Although total calcium and ionize calcium levels was small lower in patients that have valvular calcification, there was no significantly difference as statistical determination (P>0.05). Serum phosphor levels was similarly observed (P>0.05). Ca x P levels were observed under 55 in each group. Mean creatinin clirens was observed 32.1 in Group A, 30.8 in Group B. There was no significant difference in creatinin clirens levels, hypertension and diabetes between each groups. Conclusions. In our study: PTH levels were observed significantly higher in patients who have cardiac valve calcification. That point out observation of this hormone can be useful when we determinated valvular calcification. To our opinion, clarification of reason and application of treatment in cases with high PTH levels can be preventing progression of valvular calcification.
Keywords: Cardiac valvular calcification, parathormone, ionize calcium
Keywords
References
- Lafferty FW. Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests. Arch Intern Med. 1981; 141: 1761-6.
- Kovács L, Góth MI, Szabolcs I, Dohán O, Ferencz A, Szilágyi G. The effect of surgical treatment on secondary hyperaldosteronism and relative hyperinsulinemia in primary hyperparathyroidism. Eur J Endocrinol. 1998; 138: 543-7.
- Rayner HC, Hasking DJ. Hyperparathyroidism associated with severe hypercalcaemia and myocardial calcification despite minimal bone disease. Br Med J (Clin Res Ed). 1986; 293: 1277-8.
- Stefenelli T, Wikman-Coffelt J, Wu ST, Parmley WW. Calcium-dependent fluorescence transients during ventricular fibrillation. Am Heart J 1990; 120: 590-7.
- Nuzzo V, Tauchmanovà L, Fonderico F, Trotta R, Fittipaldi MR, Fontana D, Rossi R, Lombardi G, Trimarco B, Lupoli G. Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism. Eur J Endocrinol 2002; 147: 453-9.
- Stefenelli T, Mayr H, Bergler-Klein J, Globits S, Woloszczuk W, Niederle B. Primary hyperparathyroidism: incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy. Am J Med 1993; 95: 197-202.
- Längle F, Abela C, Koller-Strametz J, Mittelböck M, Bergler-Klein J, Stefenelli T, Woloszczuk W, Niederle B. Primary hyperparathyroidism and the heart: cardiac abnormalities correlated to clinical and biochemical data. World J Surg 1994; 18: 619-24.
- Garcia de la Torre N,Wass JA,Turner HE. Parathyroid adenomas and cardiovascular risk. Endocr Relat Cancer 2003; 10: 309-22.
- Niederle B, Stefenelli T, Glogar D, Woloszczuk W, Roka R, Mayr H. Cardiac calcific deposits in patients with primary hyperparathyroidism: preliminary results of a prospective echocardiographic study. Surgery 1990; 108: 1052-6; discussion 1056-7.
- Stefenelli T, Abela C, Frank H, Koller-Strametz J, Globits S, Bergler-Klein J, Niederle B. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab 1997; 82: 106-12.
- Ribeiro S, Ramos A, Brandão A, Rebelo JR, Guerra A, Resina C, Vila-Lobos A, Carvalho F, Remédio F, Ribeiro F. Cardiac valve calcification in haemodialysis patients: role of calcium-phosphate metabolism. Nephrol Dial Transplant 1998; 13: 2037-40.
- K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and stratification. Am J Kidney Dis 2002; 39 suppl 1: S17-S110
- Rajamannan NM, Gersh B, Bonow RO. Calcific aort stenosis:From bench to the bedside- emerging clinical and cellular concepts. Heart 2003; 89: 801-5.
- Andersson P, Rydberg E, Willenheimer R. Primary hyperparathyroidism and heart disease-a review. Eur Heart J 2004; 25: 1776-86.
- Heath H. Clinical spectrum of primery hyperparathyroidism: evolution with changes in medica technology. J Bone Miner Res 1991; 6: 63.
- Nestico PF, DePace NL, Kotler MN, Rose LI, Brezin JH, Swartz C, Mintz GS, Schwartz AB. Calcium phosphorus metabolism in dialysis patients with and without mitral anular calcium. Analysis of 30 patients. Am J Cardiol 1983; 51: 497-500.
- Maher ER,Young G,Smyth-Walsh B,Pugh S,Curtis JR.Aortic and miral valve calcification in patients with end-stage renal disease.Lancet 1987; ii:875-877.
- Rostand S, Sanders C, Kirk KA, Rutsky EA, Fraser RG. Miocardial calcification and cardiac dysfunction in chronic renal failure. Am J Med 1988; 85: 651-7.
- Mazzaferro S, Coen G, Bandini S, Borgatti PP, Ciaccheri M, Diacinti D, Ferranti E, Lusenti T, Mancini G, Monducci I, Pasquali M, Pellegrini F, Perruzza I, Taggi F, Cinotti GA. Role of ageing, chronic renal failure and dialysis in the calcification of mitral annulus. Nephrol Dial Transplant 1993; 8: 335-40.
- Harnett JD, Parfrey PS, Griffiths SM, Gault MH, Barre P, Guttmann RD. Left ventricular hypertrophy in end-stage renal disease. Nephron 1988; 18: 107-15.
- London GM, Pannier B, Marchais SJ, Guerin AP. Calcification of the aortic valve in the dialyzed patient. J Am Soc Nephrol 2000; 11: 778-83.
- Ureňa P,Malergue MC,Goldfarb B,Prieur P,Gu èdon
- Rapoud C,Pètrover M. Evolutive
- aortic stenosis in hemodialysis patients: Analysis of risk factors. Nephrologie 1999; 20: 217-25.
- Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 1996; 27: 394-401.
Kalp kapak kalsifikasyonu olan ve olmayan olguların paratiroid hormon ve kalsiyum düzeylerinin karşılaştırılması
Abstract
Amaç. Hastalarda görülen kalp kapak darlık ve yetmezliklerinde kalsifikasyonun rolü önemlidir. Bu yüzden valvuler kalsifikasyonun sebeplerinin ayrıntılı tespiti bu patolojilerin ilerlemesini azaltabilir. Bu çalışmada kalp kapak kalsifikasyonu olan hastalarda parathormon (PTH) ve kalsiyum seviyeleri ile ilişkili olup olmadığını araştırmak amaçlanmıştır. Yöntem. Ekokardiografisinde valvuler kalsifikasyon tespit edilen 30 hasta (Grup A), valvuler kalsifikasyon görülmeyen 30 hasta (Grup B), serum parathormon, kalsiyum, iyonize kalsiyum, fosfor, kreatinin, açlık kan şekeri (AKŞ) ve arteriyel tansiyon ölçümleri açısından karşılaştırılmıştır. Bulgular. Gruplar arasında PTH değerleri karşılaştırıldığında valvüler kalsifikasyonu olan hastalarda parathormon düzeyleri (117,9) valvüler kalsifikasyonu olmayan hastalara (53,6) göre daha yüksek bulunmuştur (P0,05) Serum fosfor değerleri de her iki grupta benzer seviyelerde tespit edildi (P>0,05). Her iki grupta da Ca x P düzeyleri 55’in altında bulunmuştur. Grup A’da ortalama 32,1, Grup B’de ortalama 30,8 idi. Kreatin klirensi hipertansiyon ve diyabet açısından anlamlı bir fark tespit edilemedi. Sonuçlar. Çalışmamızda valvuler kalsifikasyonlu olgularda serum parathormon seviyelerinin anlamlı olarak yüksek bulunması, valvuler kalsifikasyonla karşılaştığımızda bu hormonun analizinin de yapılmasının faydalı olabileceğini göstermiştir. Parathormon yüksekliği olanlarda sebep aydınlatılıp tedavi edilmesinin valvüler kalsifikasyonların ilerlemesini önleyebileceği kanaatine varılmıştır
References
- Lafferty FW. Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests. Arch Intern Med. 1981; 141: 1761-6.
- Kovács L, Góth MI, Szabolcs I, Dohán O, Ferencz A, Szilágyi G. The effect of surgical treatment on secondary hyperaldosteronism and relative hyperinsulinemia in primary hyperparathyroidism. Eur J Endocrinol. 1998; 138: 543-7.
- Rayner HC, Hasking DJ. Hyperparathyroidism associated with severe hypercalcaemia and myocardial calcification despite minimal bone disease. Br Med J (Clin Res Ed). 1986; 293: 1277-8.
- Stefenelli T, Wikman-Coffelt J, Wu ST, Parmley WW. Calcium-dependent fluorescence transients during ventricular fibrillation. Am Heart J 1990; 120: 590-7.
- Nuzzo V, Tauchmanovà L, Fonderico F, Trotta R, Fittipaldi MR, Fontana D, Rossi R, Lombardi G, Trimarco B, Lupoli G. Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism. Eur J Endocrinol 2002; 147: 453-9.
- Stefenelli T, Mayr H, Bergler-Klein J, Globits S, Woloszczuk W, Niederle B. Primary hyperparathyroidism: incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy. Am J Med 1993; 95: 197-202.
- Längle F, Abela C, Koller-Strametz J, Mittelböck M, Bergler-Klein J, Stefenelli T, Woloszczuk W, Niederle B. Primary hyperparathyroidism and the heart: cardiac abnormalities correlated to clinical and biochemical data. World J Surg 1994; 18: 619-24.
- Garcia de la Torre N,Wass JA,Turner HE. Parathyroid adenomas and cardiovascular risk. Endocr Relat Cancer 2003; 10: 309-22.
- Niederle B, Stefenelli T, Glogar D, Woloszczuk W, Roka R, Mayr H. Cardiac calcific deposits in patients with primary hyperparathyroidism: preliminary results of a prospective echocardiographic study. Surgery 1990; 108: 1052-6; discussion 1056-7.
- Stefenelli T, Abela C, Frank H, Koller-Strametz J, Globits S, Bergler-Klein J, Niederle B. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab 1997; 82: 106-12.
- Ribeiro S, Ramos A, Brandão A, Rebelo JR, Guerra A, Resina C, Vila-Lobos A, Carvalho F, Remédio F, Ribeiro F. Cardiac valve calcification in haemodialysis patients: role of calcium-phosphate metabolism. Nephrol Dial Transplant 1998; 13: 2037-40.
- K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and stratification. Am J Kidney Dis 2002; 39 suppl 1: S17-S110
- Rajamannan NM, Gersh B, Bonow RO. Calcific aort stenosis:From bench to the bedside- emerging clinical and cellular concepts. Heart 2003; 89: 801-5.
- Andersson P, Rydberg E, Willenheimer R. Primary hyperparathyroidism and heart disease-a review. Eur Heart J 2004; 25: 1776-86.
- Heath H. Clinical spectrum of primery hyperparathyroidism: evolution with changes in medica technology. J Bone Miner Res 1991; 6: 63.
- Nestico PF, DePace NL, Kotler MN, Rose LI, Brezin JH, Swartz C, Mintz GS, Schwartz AB. Calcium phosphorus metabolism in dialysis patients with and without mitral anular calcium. Analysis of 30 patients. Am J Cardiol 1983; 51: 497-500.
- Maher ER,Young G,Smyth-Walsh B,Pugh S,Curtis JR.Aortic and miral valve calcification in patients with end-stage renal disease.Lancet 1987; ii:875-877.
- Rostand S, Sanders C, Kirk KA, Rutsky EA, Fraser RG. Miocardial calcification and cardiac dysfunction in chronic renal failure. Am J Med 1988; 85: 651-7.
- Mazzaferro S, Coen G, Bandini S, Borgatti PP, Ciaccheri M, Diacinti D, Ferranti E, Lusenti T, Mancini G, Monducci I, Pasquali M, Pellegrini F, Perruzza I, Taggi F, Cinotti GA. Role of ageing, chronic renal failure and dialysis in the calcification of mitral annulus. Nephrol Dial Transplant 1993; 8: 335-40.
- Harnett JD, Parfrey PS, Griffiths SM, Gault MH, Barre P, Guttmann RD. Left ventricular hypertrophy in end-stage renal disease. Nephron 1988; 18: 107-15.
- London GM, Pannier B, Marchais SJ, Guerin AP. Calcification of the aortic valve in the dialyzed patient. J Am Soc Nephrol 2000; 11: 778-83.
- Ureňa P,Malergue MC,Goldfarb B,Prieur P,Gu èdon
- Rapoud C,Pètrover M. Evolutive
- aortic stenosis in hemodialysis patients: Analysis of risk factors. Nephrologie 1999; 20: 217-25.
- Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 1996; 27: 394-401.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | March 16, 2009 |
| Published in Issue | Year 2009Volume: 31 Issue: 2 |