Karaciğer sirozu hastalarında terapötik parasentezin pro-BNP ve troponin üzerine etkileri
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2023
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info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Karaciğer sirozunun portal hipertansiyona bağlı gelişen en sık karşılaşılan komplikasyonu olan asit, önemli bir morbidite ve hastaneye yatış sebebidir. Yüksek volümlü parasentez dirençli refrakter asitte sık kullanılan bir tedavi seçeneğidir. Kardiyak musküler yapının gerilimine bağlı salınan BNP ve kardiyak iskemi göstergesi olarak hs-troponin gibi belirteçler günümüzde sıklıkla kullanılmakta olup karaciğer sirozunda yükseldikleri gösterilmiştir. Çalışmamızda yüksek volümlü parasentezle dinamik değişikliklerin kardiyak ön yük ve iskemi üzerindeki etkisini prospektif olarak pro-BNP ve hs-troponin ile değerlendirimeyi amaçladık.
Materyal ve Metod: Çalışmamıza 33 kompanse sirozlu ve 25 terapötik parasenetez ihtiyacı olan dekompanse siroz hastası dahil edilmiştir. Kardiyovasküler hastalık öyküsü, ileri derece astım-KOAH, hipotiroidi, evre 3 ve üzeri kronik böbrek hastalığı, aktif enfeksiyon veya aktif siroz komplikasyonu olan, transplantasyon öyküsü veya hepatoselüler karsinom dahil malignitesi olan, 18 yaş altı hastalar ve gebe hastalar ölçülen pro-BNP ve hs-troponin değerlerini etkilelememesi için çalışmadan dışlanan hasta gruplarıdır. Hastaların demografik özellikleri, laboratuvar değerleri, pro-BNP, hs-troponin seviyeleri, masif terapötik parasentez (MTP) grubunda parasentez sonrası 6. , 48. saat ve 7. gün pro-BNP değerleri ve rutin biyokimyasal parametreler, MTP sonrası 6.saatte hs-troponin değeri ölçülmüştür. MTP grubunda yapılan parasentez miktarları, albümin kullanımı ve ölçüm saatlerindeki arteriyel tansiyon değerleri de takip edilmiştir. Çalışma BAP desteğiyle etik kurul onayı alınarak yapılmıştır. Çalışma sonuçları değerlendirmesinde ağırlıklı olarak non-parametrik testlerden Wilcoxon signed rank test kullanılmıştır.
Bulgular: Çalışmamızın sonucunda MTP grubunda asiti olmayan hastalara göre bazal pro-BNP ve hs-troponin değerleri anlamlı yüksek bulunmuştur. MTP grubunda bazal pro-BNP değerleriyle 6. saat, 48. saat ve 7. gün ölçülen pro-BNP değerleri arasında istatiksel olarak
anlamlı fark saptanmamıştır. Parasentez öncesi hs-troponin değeri ile 6.saatte ölçülen hs-troponin değeri arasında da anlamlı fark bulunmamıştır.
Sonuç: Pro-BNP ve hs-troponin prognoz göstergesi olarak sirozun şiddeti ile koreledir. Yüksek volümlü parasentezin hastalarda kardiyak ön yük ve kardiyak iskemi üzerinde anlamlı etkisi olmadığı ve hem kardiyak hem renal fonksiyonlar açısından güvenli olabileceği saptanmıştır.
Objective: Ascites, the most common complication of liver cirrhosis due to portal hypertension, is a significant cause of morbidity and hospitalization. High-volume paracentesis is a frequently used treatment option in resistant refractory ascites. Markers such as BNP, which is released due to the tension of the cardiac muscular structure, and hs-troponin as an indicator of cardiac ischemia, are frequently used today and have been shown to increase in liver cirrhosis. In our study, we aimed to prospectively evaluate the effect of dynamic changes with high-volume paracentesis on cardiac preload and ischemia with pro-BNP and hs-troponin. Method: To our study 33 compansated and 25 decompansated who requires large volume paracentesis cirrhosis patients were included. Patients groups excluded from the study in order not to affect the measured pro-BNP and hs-troponin values: history of cardiovascular disease, advanced asthma-COPD, hypothyroidism, stage 3 and above chronic kidney disease, active infection or active complications of cirrhosis, trasplantation history, malignancy including hepatocellular carcinoma, patients under the age of 18 and pregnant. Patients demographic feautures, laboratuary results, levels of proBNP and hs-troponin, in majör therapeutic paracentesis (MTP) group 6th, 48th hour and 7th day proBNP levels and routine biochemical parameters were measured and also hs-troponin levels were measured after 6th hours of MTP. In the MTP group, the amount of paracentesis performed, albumin use, and arterial blood pressure at measurement times were also monitored. The study was conducted with the support of BAP and ethical approval was received. Wilcoxon signed rank test, one of the non-parametric tests, was mainly used in the evaluation of the study results. Findings: As a result of our study, basal pro-BNP and hs-troponin values were found to be significantly higher in the MTP group compared to patientes without ascites. In the MTP group, no statistically significant difference was detected between the basal pro-BNP values and the pro-BNP values measured at the 6th hour, 48th hour and 7th day. There was no significant difference between the hs-troponin value before paracentesis and the hs-troponin value measured at 6th hour. Result: Pro-BNP and hs-troponin are correlated with the severity of cirrhosis as prognosis indicators. It has been determined that high-volume paracentesis does not have a significant effect on cardiac preload and cardiac ischemia in patients and may be safe in terms of both cardiac and renal functions.
Objective: Ascites, the most common complication of liver cirrhosis due to portal hypertension, is a significant cause of morbidity and hospitalization. High-volume paracentesis is a frequently used treatment option in resistant refractory ascites. Markers such as BNP, which is released due to the tension of the cardiac muscular structure, and hs-troponin as an indicator of cardiac ischemia, are frequently used today and have been shown to increase in liver cirrhosis. In our study, we aimed to prospectively evaluate the effect of dynamic changes with high-volume paracentesis on cardiac preload and ischemia with pro-BNP and hs-troponin. Method: To our study 33 compansated and 25 decompansated who requires large volume paracentesis cirrhosis patients were included. Patients groups excluded from the study in order not to affect the measured pro-BNP and hs-troponin values: history of cardiovascular disease, advanced asthma-COPD, hypothyroidism, stage 3 and above chronic kidney disease, active infection or active complications of cirrhosis, trasplantation history, malignancy including hepatocellular carcinoma, patients under the age of 18 and pregnant. Patients demographic feautures, laboratuary results, levels of proBNP and hs-troponin, in majör therapeutic paracentesis (MTP) group 6th, 48th hour and 7th day proBNP levels and routine biochemical parameters were measured and also hs-troponin levels were measured after 6th hours of MTP. In the MTP group, the amount of paracentesis performed, albumin use, and arterial blood pressure at measurement times were also monitored. The study was conducted with the support of BAP and ethical approval was received. Wilcoxon signed rank test, one of the non-parametric tests, was mainly used in the evaluation of the study results. Findings: As a result of our study, basal pro-BNP and hs-troponin values were found to be significantly higher in the MTP group compared to patientes without ascites. In the MTP group, no statistically significant difference was detected between the basal pro-BNP values and the pro-BNP values measured at the 6th hour, 48th hour and 7th day. There was no significant difference between the hs-troponin value before paracentesis and the hs-troponin value measured at 6th hour. Result: Pro-BNP and hs-troponin are correlated with the severity of cirrhosis as prognosis indicators. It has been determined that high-volume paracentesis does not have a significant effect on cardiac preload and cardiac ischemia in patients and may be safe in terms of both cardiac and renal functions.
Açıklama
Anahtar Kelimeler
Yüksek volümlü parasentez, Asit, Pro-BNP, Hs-troponin, Siroz, Large volume paracentesis, Ascites, Cirrhosis
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Bilgen, H. (2023). Karaciğer sirozu hastalarında terapötik parasentezin pro-BNP ve troponin üzerine etkileri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
