Kronik böbrek yetmezliğinde evre, shear wave elastografi ile fibrozis skorları, rezistivite indeksi ve fibrozis belirteçlerinin karşılaştırılması
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Dosyalar
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Kronik Böbrek Hastalığı (KBH) dünya çapında bir halk sağlığı sorunudur. Yaklaşık her 9-10 erişkinden birinde KBH olduğu düşünülmektedir. Erken tanı ve tedavinin progresyonu yavaşlattığı bilinmektedir. KBH patofizyolojisinde ve böbrek fonksiyonlarının kaybında renal fibrozis önemli yer tutmaktadır. Renal fibrozisi saptamanın KBH erken tanısında, prognozunun belirlenmesinde ve yeni tedavi seçenekleri geliştirilmesi konularında faydalı olabileceği düşünülmektedir. Renal biyopsi ile fibrozis tanısı ve derecesi belirlenebilmektedir ancak invaziv ve zor bir yöntem olduğundan tüm hastalarda uygulanması pratik değildir. Bu nedenle renal fibrozisi saptamada kullanılabilecek noninvaziv yöntemler bulmak için araştırmalar yapılmaktadır. Biz de çalışmamızda renal fibrozisi öngörebileceği düşünülen markerlardan Transforming Growth Factor-Beta1 (TGF-?1), Interleukin-6 (IL-6), Apelin-12; inflamasyon markerlarından High Sensitive C-Reaktive Protein (hs-CRP) kan düzeyleri, renal doppler ultrasonografi (US) ile saptanan rezistivite indeksi (RI), renal shear-wave elastografi ile ölçülen renal fibrozis skorları arasındaki ilişkiyi saptamayı amaçladık. Çalışmamız ile renal fibrozisin noninvaziv tanı yöntemleri kullanılarak saptanmasına katkıda bulunmayı umuyoruz. Gereç ve Yöntem: Çalışma prospektif bir vaka kontrol çalışması olarak tasarlandı. Çalışmaya Düzce Üniversitesi Eğitim Araştırma Hastanesi Şubat 2017 - Temmuz 2017 tarihleri arasında Dahiliye ya da Nefroloji polikliniğine başvuran 18 yaş üstü, Kidney Disease Improving Global Outcomes (KDIGO) kriterlerine göre evre 2,3,4,5 KBH tanısı olan 88 hasta dahil edildi. Dışlama kriterlerinden birini taşıdığı saptanan hasta kişi çalışma dışı bırakıldı. 68 hasta ve 19 kişilik kontrol grubu ile çalışma tamamlandı. Hasta grubunda 8 kişi evre 2, 27 kişi evre 3, 20 kişi evre 4, 13 kişi evre 5 KBH olarak belirlendi. Hasta ve kontrol grubundan yaş, cinsiyet, ek hastalık, vücut kitle indeksi (VKİ) bilgileri, kan örnekleri alındı, her iki gruba shear-wave elastografi ve renal doppler US ile ölçümler yapıldı. Bulgular: Çalışmamıza 68 kişi hasta, 19 kişi kontrol grubu olmak üzere toplam 87 kişi dahil edildi. Çalışmaya katılan kişilerin kadın erkek oranı benzer (p: 0.752), yaşları değerlendirildiğinde ise hasta grubunun yaş ortalaması daha yüksek saptanmıştır (p<0.001). Çalışmamızda hs-CRP, IL-6, Apelin-12 düzeyleri hasta grubunda anlamlı şekilde yüksek saptanmıştır (sırasıyla p: 0.001, p: 0.004, p: 0.009). Apelin-12 KBH evresi arttıkça daha yüksek değerlerde ölçülmüş olmasına karşın (p: 0.047), hs-CRP ve IL-6'da bu ilişki bulunamamıştır(sırasıyla p: 0.374, p: 0.224). TGF-?1 değerlerinde ise hasta grubunda kontrol grubuna göre yüksek değerler saptanmış ancak istatistiksel anlamlı bulunmamıştır (p: 0.313). TGF-?1 KBH evreleri arasında değerlendirildiğinde istatistiksel anlamlı farklılık saptanmamıştır (p: 0.196). Alt grup analizlerinde Apelin-12 düzeyi diyabetik hasta grubunda diyabetik olmayan hasta grubuna göre anlamlı derecede daha düşük değerlerde saptanmıştır (p: 0.009). RI, hem hasta grubunda kontrol grubuna göre yüksek saptanmış (p<0.001) hem de KBH evresi arttıkça daha yüksek değerlerde ölçülmüş olup (p: 0.015) her iki durumda da istatistiksel olarak anlamlı bulunmuştur. Elastisite skoru için ise hasta-kontrol grubu arasında ve KBH evreleri arasında fark saptansa da bu bulgu istatistiksel anlamlılığa ulaşmamıştır (sırasıyla p: 0.233, p: 0,203). Sonuç: Çalışmamızda KBH hastalarında Apelin-12, IL-6, hs-CRP ve RI düzeylerinde hasta grubunda kontrol grubuna göre istatistiksel anlamlı yükseklik saptanmıştır. Diyabetik alt grupta RI anlamlı yüksek, Apelin-12 anlamlı düşük saptanmıştır. KBH evresi arttıkça Apelin-12 ve RI değerlerinin de istatistiksel anlamlı şekilde arttığı görülmüştür. RI ve Apelin-12'nin renal fibrozisin indirekt göstergesi olarak kullanılabileceği düşünülmüştür. TGF-?1 ve elastisite skorunun hasta grubunda daha yüksek değerlerde ölçülmesine karşın istatistiksel anlamlılığa ulaşmamasının hasta sayısının kısıtlı olmasının bir sonucu olduğu düşünülmüştür. KBH hastalarında erken tanı ve takipte kullanılabilecek noninvaziv yöntemlere katkı sağlayabilecek anlamlı sonuçlar elde edilmiştir. Çalışmamızın, bu konularda yapılacak daha geniş ve kontrollü çalışmalara ışık tutacağını umuyoruz.
Introduction: Chronic kidney disease (CKD) is a global health problem. Approximately one out of every 9 to 10 people is thought to have CKD. Early diagnosis and treatment are known to slow down the progression. Renal fibrosis has an important role in CKD pathophysiology and the loss of kidney function. Detection of renal fibrosis is thought to be useful in the early diagnosis of CKD, in determining its prognosis and in developing new treatment options. Fibrosis diagnosis and its grade can be determined by renal biopsy, but it is not practical to apply it to all patients since it is an invasive and difficult method. Therefore, research is being conducted to find noninvasive methods that can be used to detect renal fibrosis. In our study, we aimed to determine the relationship between the blood levels of renal fibrosis markers Transforming Growth Factor-Beta1 (TGF-?1), Interleukin-6 (IL-6), Apelin-12, inflammation marker high sensitivite C-reactive protein (hs-CRP), renal doppler ultrasonography (US) and rezistivity index (RI) and between the renal shear-wave elastography and the renal fibrosis scores. We hope to contribute to the detection of noninvasive methods in diagnosis of renal fibrosis. Materials and Method: The study was designed as a prospective case-control study. Eighty eight patients who referred to Düzce University Training and Research Hospital Internal Medicine or Nephrology clinic between February 2017 and July 2017, that are older than 18-years and with stage 2, 3, 4, 5 CKD according to Kidney Disease Improving Global Outcomes criteria (KDIGO), were included in the study. Twenty patients who were found to have one of the exclusion criteria were excluded from the study. The study was completed with 68 patients and a control group of 19 people. Eight patients were stage 2, 27 patients were stage 3, 20 patients were stage 4 and 13 patients were stage 5 CKD in the patient group. Age, gender, comorbidities and body mass index (BMI) of subjects were recorded, blood samples were taken and shear-wave elastography and renal doppler US were measured. Results: A total of 87 people were included in the study, including 68 patients and 19 healthy subjects. While the female to male ratio of the participants was similar (p: 0.752), mean age of the patient group was found higher (p<0.001). In our study, hs-CRP, IL-6, Apelin-12 levels were significantly higher in the patient group (p: 0.001, p: 0.004 and p: 0.009, respectively). Although Apelin-12 was measured at higher values with increasing CKD stages(p: 0.047), this correlation was not found in hs-CRP and IL-6 (p: 0.374 and p: 0.224, respectively). TGF-?1 values were higher in the patient group than the control group, but it was not found statistically significant (p: 0.313). There was no statistically significant difference between the CKD stages (p: 0.196). In subgroup analyzes, Apelin-12 levels were significantly lower in the diabetic patient group than in the non-diabetic patient group (p: 0.009). RI was found to be significantly higher in patient group than control group (p <0.001) and found to be increasing with increasing CKD stages, which was also statistically significant (p: 0.015). For the elasticity score, even though there is a difference between the patient-control groups and the CKD stages, it was not found to be statistically significant (p: 0.233 and p: 0,203, respectively). Discussion: In our study, Apelin-12, IL-6, hs-CRP and RI levels were significantly higher in patients with CKD compared to the control group. In the diabetic subgroup, RI was significantly higher and Apelin-12 was significantly lower. Apelin-12 and RI values were found to be increased with increasing CKD stages which was statistically significantly. RI and Apelin-12 are thought to be used as indirect indicators of renal fibrosis. Although TGF-?1 and elasticity score were measured higher in the patient group, the lack of statistical significance is correlated with the limited number of patients included in the study. Significant results have been obtained that can contribute to the noninvasive methods used in early diagnosis and follow-up in CKD patients. We hope that our study will shed light on more broader and controlled study done in these issues.
Introduction: Chronic kidney disease (CKD) is a global health problem. Approximately one out of every 9 to 10 people is thought to have CKD. Early diagnosis and treatment are known to slow down the progression. Renal fibrosis has an important role in CKD pathophysiology and the loss of kidney function. Detection of renal fibrosis is thought to be useful in the early diagnosis of CKD, in determining its prognosis and in developing new treatment options. Fibrosis diagnosis and its grade can be determined by renal biopsy, but it is not practical to apply it to all patients since it is an invasive and difficult method. Therefore, research is being conducted to find noninvasive methods that can be used to detect renal fibrosis. In our study, we aimed to determine the relationship between the blood levels of renal fibrosis markers Transforming Growth Factor-Beta1 (TGF-?1), Interleukin-6 (IL-6), Apelin-12, inflammation marker high sensitivite C-reactive protein (hs-CRP), renal doppler ultrasonography (US) and rezistivity index (RI) and between the renal shear-wave elastography and the renal fibrosis scores. We hope to contribute to the detection of noninvasive methods in diagnosis of renal fibrosis. Materials and Method: The study was designed as a prospective case-control study. Eighty eight patients who referred to Düzce University Training and Research Hospital Internal Medicine or Nephrology clinic between February 2017 and July 2017, that are older than 18-years and with stage 2, 3, 4, 5 CKD according to Kidney Disease Improving Global Outcomes criteria (KDIGO), were included in the study. Twenty patients who were found to have one of the exclusion criteria were excluded from the study. The study was completed with 68 patients and a control group of 19 people. Eight patients were stage 2, 27 patients were stage 3, 20 patients were stage 4 and 13 patients were stage 5 CKD in the patient group. Age, gender, comorbidities and body mass index (BMI) of subjects were recorded, blood samples were taken and shear-wave elastography and renal doppler US were measured. Results: A total of 87 people were included in the study, including 68 patients and 19 healthy subjects. While the female to male ratio of the participants was similar (p: 0.752), mean age of the patient group was found higher (p<0.001). In our study, hs-CRP, IL-6, Apelin-12 levels were significantly higher in the patient group (p: 0.001, p: 0.004 and p: 0.009, respectively). Although Apelin-12 was measured at higher values with increasing CKD stages(p: 0.047), this correlation was not found in hs-CRP and IL-6 (p: 0.374 and p: 0.224, respectively). TGF-?1 values were higher in the patient group than the control group, but it was not found statistically significant (p: 0.313). There was no statistically significant difference between the CKD stages (p: 0.196). In subgroup analyzes, Apelin-12 levels were significantly lower in the diabetic patient group than in the non-diabetic patient group (p: 0.009). RI was found to be significantly higher in patient group than control group (p <0.001) and found to be increasing with increasing CKD stages, which was also statistically significant (p: 0.015). For the elasticity score, even though there is a difference between the patient-control groups and the CKD stages, it was not found to be statistically significant (p: 0.233 and p: 0,203, respectively). Discussion: In our study, Apelin-12, IL-6, hs-CRP and RI levels were significantly higher in patients with CKD compared to the control group. In the diabetic subgroup, RI was significantly higher and Apelin-12 was significantly lower. Apelin-12 and RI values were found to be increased with increasing CKD stages which was statistically significantly. RI and Apelin-12 are thought to be used as indirect indicators of renal fibrosis. Although TGF-?1 and elasticity score were measured higher in the patient group, the lack of statistical significance is correlated with the limited number of patients included in the study. Significant results have been obtained that can contribute to the noninvasive methods used in early diagnosis and follow-up in CKD patients. We hope that our study will shed light on more broader and controlled study done in these issues.
Açıklama
YÖK Tez No: 489988
Anahtar Kelimeler
Nefroloji, Nephrology, Biyobelirteçler, Biomarkers, Böbrek hastalıkları, Kidney diseases, Böbrek yetmezliği-kronik, Kidney failure-chronic, Elastografi, Elastography, Fibroz, Fibrosis, Teşhis, Diagnosis, Teşhis teknikleri ve prosedürleri, Diagnostic techniques and procedures, Ultrasonografi, Ultrasonography, kronik böbrek hastalığı, renal fibrozis, rezistivite indeksi, shear-wave elastografi, chronic kidney disease, renal fibrosis, resistivity index, shear-wave elastography
