The relationship between hypoxia, inflammation, and airway obstruction with carotid intima-media thickness in Chronic Obstructive Pulmonary Disease (COPD)
Öz
The present study aimed to determine
whether there is a relationship between intima-media
thickness (IMT) changes in peripheral vessels (carotid
and vertebral artery) and inflammatory
mediators (C-reactive protein (CRP), leucocytes,
etc.), artery blood gas changes and airway obstruction in COPD patients. This
study included 60 patients with COPD and 40 healthy control subjects. We used
the GOLD criteria for COPD diagnosis. The
patient group differentiated according to arterial blood gas values and the presence or absence of pulmonary failure, and
its type if any was present. In all
patients and control group members, blood leucocytes
and CRP values were measured. The carotid,
vertebral artery thickness, and total
cerebral blood flow were measured using a Doppler
USG device and standardized 7 MHz linear
transducer. There was no significant relationship
between age, sex, body mase index (BMI) and intima-media thickness between the two groups. In the present study, we found out that the CRP levels were
higher in COPD patients than in the control group. In progressive COPD patients, CRP levels were the highest. Furthermore, we found out the CIMT was
higher in COPD patients compared to the control group. In conclusion, the CIMT and atherosclerosis risk increased in COPD
patients. Systemic inflammation causes a higher carotid intima-media thickness in COPD
patients. This finding was used as an early
risk factor for cardiovascular disease.
Doppler USG was used to identify a carotid
artery pathology
early. Systematic inflammation continuing during a stable
period causes increased carotid artery intima-media thickness. This entity plays a role
in atherosclerosis etiology.
Anahtar Kelimeler
Kaynakça
- 1- Bartu Saryal S, Acıcan T. (eds) Epidemiyoloji ve risk faktörleri. In: Güncel Bilgiler Işığında KOAH, Bilimsel Tıp Kitabevi, Ankara 12-32, 2003.
- 2- Pauwels RA, Buist AS, Calverley PM, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Iniative for chronic obstructive lung disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 163:1256 -1276, 2001
- 3- Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc. Am. Thorac. Soc, 2: 8-11, 2005
- 4- O’Leary DH, Polak JF. Intima-media thickness: a tool for atherosclerosis. Am. J. Cardiol, 90:18-21, 2002.
- 5- Fabri LM, Romagnoli M, Corbetta L, Casoni G, Busljetic K, Turato G ve ark. Differences in airway inflamation in patients with fixed airflow obstruction due to asthma or chronic obstructive lung disease. Am J Respir Crit Care Med, 167: 418-424, 2003.
- 6- Global Initiative For Chronic Obstructive Lung Disease (GOLD) 4: 24-30, 2008.
- 7- Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med, 340:115-126, 1999.
- 8- Torres JP ve ark. C-reactive protein levels and clinically important predictive outcomes in stable COPD patiens. Eur Respir J, 27: 902–907, 2006.
- 9- Torres JP, Pinto-Plata V, Casanova C, Mullerova H, Cordoba-Lanus E, Muros de Fuentes M ve ark. C-reactive protein levels and survival in patients with moderate to very severe COPD. Chest, 133:1336-1343, 2008;.
- 10- Fogarty AW, Jones S, Britton JR, Lewis SA, McKeever TM. Systemic inflammation and decline in lung function in a general population: a prospective study. Thorax, 62:515-520, 2007.
- 11- Gökırmak M. KOAH’da Oksijen Tedavisi. Saryal S.B, Acıcan T. Kronik Obstrüktif Akciger Hastalıgı, 179-189, 2003.
- 12- Gök H. Klinik Kardiyoloji 1.Baskı Nobel Kitabevi, İstanbul, 97-171, 1996.
- 13- Salonen R, Salonen JT. Progression of carotid atherosclerosis and its determinants: a population-based US study. Atherosclerosis, 81: 33-40, 1990.
- 14- Veller MG, Fisher CM, Nicolaides AN, Renton S, Geroulakos G, Stafford NJ, et al. Measurement of the ultrasonic intimamedia complex thickness in normal subjects. J Vasc Surg, 17: 719-725, 1993.
- 15- Gavin C. Donaldson, Terence A. R. Seemungal, Irem S. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest, 128:1995–2004, 2005.
- 16- Kenji Minoguchi, Takuya Yokoe, Toshiyuki Tazaki. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am. J Respir. crit. Care Med 172: 625-630, 2005.
- 17- O’Leary DH, Polak SF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. New Engl J Med, 340:14-22, 1999.
- 18- Geroulakos G, O’Gorman D, Nicolaides A ve ark. Carotid intima-media thickness: correlation with the British regional heart study risk score. J Intern Med, 235:431-433, 1994.
- 19- Iwamoto H, Yokoyama A, Kitahara Y, Ishikawa N, Haruta Y, Yamane K, et al. Airflow limitation in smokers is associated with subclinical atherosclerosis. Am J Respir Crit Care Med, 179: 35-40, 2009.
- 20- Ma SM, Wei CK, Liang CC, Chou MJ, Lee SY. The age correlation of the carotid intima-media thickness according to sex and side in asymptomatic subjects acta neurol, Taiwan, 20:29-34, 2011.
- 21- Tosetto A, Prati P, Baracchini C, Manara R, Rodeghiero F. Age-adjusted reference limits for carotid intima-media thickness as better indicator of vascular risk: population-based estimates from the VITA project. J Thromb Haemost, 3: 1224–30, 2005.
- 22-Youn YJ, Lee NS, Kim JY, Lee JW, Sung JK, Ahn SG, et al. Normative values and correlates of mean common carotid intima-media thickness in the Korean rural middle-aged population: the Atherosclerosis RIsk of Rural Areas in Korea General Population (ARIRANG) study. J Korean Med Sci, 26: 365-71, 2011.
- 23- Ridker PM, Rifai N, Rose LL, Buring JE, Cook NR. Comparison of C reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med, 347:1557-1565, 2002.
- 24- Sin Don D, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? Circulation, 107:1514-9, 2003.
- 25- Kim SJ, Yoon DW, Lee EJ, Hur GY, Jung KH, Lee SY, et al. Carotid atherosclerosis in patients with untreated chronic obstructive pulmonary disease. Int J Tuberc Lung Dis, 15: 1265-70, 2011.
- 26- Thorleifsson SJ, Margretardottir OB, Gudmundsson G, Olafsson I, Benediktsdottir B, Janson C, Buist AS, Gislason T. Chronic airflow obstruction and markers of systemic inflammation: Results from the BOLD study in Iceland. Respiratory Med, 103:1548-53, 2009.
Kronik Obstrüktif Akciğer Hastalığı (KOAH)' da karotis intima-media kalınlığı ile inflamasyon, hipoksi ve hava yolu obstrüksiyonu arasındaki ilişki
Öz
Çalışmamızın amacı; periferik damarlarda (karotis ve vertebral arter gibi) oluşan intima-media kalınlığı (İMK) değişiklikleri ile KOAH’ta inflamatuar proçesi gösteren mediyatörler (C-reaktif protein (CRP), lökosit, gibi), arter kan gazı değişiklikleri ve oluşan hava yolu obstrüksiyonu arasında ilişki olup olmadığını değerlendirmekti. Bu çalışmaya 60 KOAH hastası, 40 sağlıklı gönüllü alındı. KOAH tanısı GOLD kriterlerine göre kondu. Hasta grubu arter kan gazı (AKG) değerlerine göre solunum yetmezliği olup olmamasına ve varsa tipine göre ayrıldı. Tüm hasta ve sağlıklı kontrol grubunda bulunan kişilerin, periferik kan lökosit, CRP düzeyleri ölçüldü, Doppler Ultrasonografi cihazı ve standart 7 MHz lineer transdüser kullanılarak karotis, vertebral arterler ve total serebral kan akımları değerlendirildi. Çalışmamızda yaş, cinsiyet, VKİ ve İMK arasında anlamlı ilişkiye rastlanmadı. Hasta grubunda, kontrol grubuna göre CRP değerleri yüksek bulundu. Hastalarda, sağlıklı bireylere göre karotis intima media kalınlığı artmıştı. Hipoksik hastalarda intima media kalınlığı anlamlı oranda yüksek bulundu. Sonuç olarak, KOAH’ta sistemik inflamasyon ve bunun sonucu olarak artmış karotis arter İMK’nın saptanması serebrovasküler hastalık riski açısından erken bulgu olarak kabul edilebilir. Stabil dönemde devam eden sistemik inflamasyonun karotis arter İMK’da artışa yol açabileceği ve dolayısıyla aterosklerozun etiyolojisinde rol oynayabileceği sonucuna varıldı.
Anahtar Kelimeler
Kaynakça
- 1- Bartu Saryal S, Acıcan T. (eds) Epidemiyoloji ve risk faktörleri. In: Güncel Bilgiler Işığında KOAH, Bilimsel Tıp Kitabevi, Ankara 12-32, 2003.
- 2- Pauwels RA, Buist AS, Calverley PM, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Iniative for chronic obstructive lung disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 163:1256 -1276, 2001
- 3- Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc. Am. Thorac. Soc, 2: 8-11, 2005
- 4- O’Leary DH, Polak JF. Intima-media thickness: a tool for atherosclerosis. Am. J. Cardiol, 90:18-21, 2002.
- 5- Fabri LM, Romagnoli M, Corbetta L, Casoni G, Busljetic K, Turato G ve ark. Differences in airway inflamation in patients with fixed airflow obstruction due to asthma or chronic obstructive lung disease. Am J Respir Crit Care Med, 167: 418-424, 2003.
- 6- Global Initiative For Chronic Obstructive Lung Disease (GOLD) 4: 24-30, 2008.
- 7- Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med, 340:115-126, 1999.
- 8- Torres JP ve ark. C-reactive protein levels and clinically important predictive outcomes in stable COPD patiens. Eur Respir J, 27: 902–907, 2006.
- 9- Torres JP, Pinto-Plata V, Casanova C, Mullerova H, Cordoba-Lanus E, Muros de Fuentes M ve ark. C-reactive protein levels and survival in patients with moderate to very severe COPD. Chest, 133:1336-1343, 2008;.
- 10- Fogarty AW, Jones S, Britton JR, Lewis SA, McKeever TM. Systemic inflammation and decline in lung function in a general population: a prospective study. Thorax, 62:515-520, 2007.
- 11- Gökırmak M. KOAH’da Oksijen Tedavisi. Saryal S.B, Acıcan T. Kronik Obstrüktif Akciger Hastalıgı, 179-189, 2003.
- 12- Gök H. Klinik Kardiyoloji 1.Baskı Nobel Kitabevi, İstanbul, 97-171, 1996.
- 13- Salonen R, Salonen JT. Progression of carotid atherosclerosis and its determinants: a population-based US study. Atherosclerosis, 81: 33-40, 1990.
- 14- Veller MG, Fisher CM, Nicolaides AN, Renton S, Geroulakos G, Stafford NJ, et al. Measurement of the ultrasonic intimamedia complex thickness in normal subjects. J Vasc Surg, 17: 719-725, 1993.
- 15- Gavin C. Donaldson, Terence A. R. Seemungal, Irem S. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest, 128:1995–2004, 2005.
- 16- Kenji Minoguchi, Takuya Yokoe, Toshiyuki Tazaki. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am. J Respir. crit. Care Med 172: 625-630, 2005.
- 17- O’Leary DH, Polak SF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. New Engl J Med, 340:14-22, 1999.
- 18- Geroulakos G, O’Gorman D, Nicolaides A ve ark. Carotid intima-media thickness: correlation with the British regional heart study risk score. J Intern Med, 235:431-433, 1994.
- 19- Iwamoto H, Yokoyama A, Kitahara Y, Ishikawa N, Haruta Y, Yamane K, et al. Airflow limitation in smokers is associated with subclinical atherosclerosis. Am J Respir Crit Care Med, 179: 35-40, 2009.
- 20- Ma SM, Wei CK, Liang CC, Chou MJ, Lee SY. The age correlation of the carotid intima-media thickness according to sex and side in asymptomatic subjects acta neurol, Taiwan, 20:29-34, 2011.
- 21- Tosetto A, Prati P, Baracchini C, Manara R, Rodeghiero F. Age-adjusted reference limits for carotid intima-media thickness as better indicator of vascular risk: population-based estimates from the VITA project. J Thromb Haemost, 3: 1224–30, 2005.
- 22-Youn YJ, Lee NS, Kim JY, Lee JW, Sung JK, Ahn SG, et al. Normative values and correlates of mean common carotid intima-media thickness in the Korean rural middle-aged population: the Atherosclerosis RIsk of Rural Areas in Korea General Population (ARIRANG) study. J Korean Med Sci, 26: 365-71, 2011.
- 23- Ridker PM, Rifai N, Rose LL, Buring JE, Cook NR. Comparison of C reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med, 347:1557-1565, 2002.
- 24- Sin Don D, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? Circulation, 107:1514-9, 2003.
- 25- Kim SJ, Yoon DW, Lee EJ, Hur GY, Jung KH, Lee SY, et al. Carotid atherosclerosis in patients with untreated chronic obstructive pulmonary disease. Int J Tuberc Lung Dis, 15: 1265-70, 2011.
- 26- Thorleifsson SJ, Margretardottir OB, Gudmundsson G, Olafsson I, Benediktsdottir B, Janson C, Buist AS, Gislason T. Chronic airflow obstruction and markers of systemic inflammation: Results from the BOLD study in Iceland. Respiratory Med, 103:1548-53, 2009.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Medical Science Research Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2019 |
| Kabul Tarihi | 27 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2019 |