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Hemodiyaliz Hastalarında Karotis İntima Medya Kalınlığıyla Subklinik Aterosklerozun İlişkisi ve Klamidya ve Sitomegalovirüs İnfeksiyonunun Rolü

Inflammation as a Risk Factor for Carotid Intimal- Medial Thickening, a Measure of Subclinical Atherosclerosis in Hemodialysis Patients and the Role of Chlamydia and Cytomegalovirus Infection

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Abstract (2. Language): 
Objectives: Atherosclerotic vascular disease (AVD) is the most frequent complication seen in hemodialysis (HD) patients. Eviden¬ ce suggests that inflammation may play a role in the pathogenesis and progression of atherosclerosis. Our a im was to evaluate the causative role of inflammation in atherosclerosis among HD patients. Methods: Intima-media thickness (IMT) in carotid arteries was determined in 54 HD patients and 52 controls. Plasma levels of lipids, glucose, albumin and several acute phase proteins, and IgG titers against Chlamydia and C M V were measured in all subjects. Results: Mean carotid IMT was significantly greater in HD patients than in controls (0.75 mm versus 0.56 mm, p<0.005). Increasing carotid IMT was associated with advancing age in both groups. While plasma levels of CRP, SAA, Lp(a), fibrinogen and ferritin were higher in HD pa¬ tients, albumin levels were lower. In HD patients, carotid IMT was correlated positively with CRP (R=0.29, p=0.019), SAA (R=0.69, p<0.001), Lp(a) (R=0.42, P=0.001), fibrinogen (R=0.57, p<0.001), and with Chlamydia pneumonia IgG titers (R=0.50, p<0.001), and negatively with albu¬ min levels (R=-0.33, p=0.02); there was no relationship between carotid IMT and hypertension, plasma lipid levels, and CMV. Moreover, CRP and SAA were positively correlated with fibrinogen, Lp(a) and Chlamydia, and inversely with albumin levels in HD patients. Conclusions: We conclude that atherosclerotic changes are more common in HD patients than controls, and that inflammatory processes may play a role in the pathogenesis of atherosclerosis. Also, past Chlamydial infection might be more atherogenic than CMV.
Abstract (Original Language): 
Giriş: Aterosklerotik vasküler hastalık (AVH) hemodiyaliz (HD) hastalarında en sık görülen komplikasyondur. Elde edilen veriler inflamasyonun aterosklerozun patogenezinde ve progresyonunda rol oynadığını düşündürmektedir. Bu çalışmadaki amacımız HD hastalarında aterosklerozun inflamasyon üzerindeki etkisini araştırmaktı. Yöntem: 54 HD hastasında ve 52 kişilik kontrol grubunda intima medya kalınlığı (İMK) ölçüldü. Çalışmaya katılanların tümünde plazma lipid, glukoz, albümin, akut faz proteinleri ve klamidya ve CMV için IgG düzeyleri ölçüldü. Bulgular: Ortalama İMK kontrol grubuna göre anlamlı olarak artmış bulundu (0.75 mm ve 0.56 mm, p<0.005). İki grupta da yaş ile İMK arasında ilişki saptandı. HD hastalarında CRP, SAA, Lp(a), fibrinojen ve ferritin seviyeleri artmış olarak bulunurken, albümin seviyeleri azalmıştı. Hastalarda İMK, CRP (R=0.29, p=0.019), S AA (R=0.69, p<0.001), Lp(a) (R=0.42, P=0.001), fibrinojen (R=0.57, p<0.001), ve klamidya pneumonia IgG seviyeleri (R=0.50, p<0.001) ile pozitif, albümin ile negatif korele idi. Karotis İMK ile; hipertansiyon, plazma lipid seviyeleri ve C M V arasında ilişki saptanmadı. Bu¬ nunla beraber, CRP ve S A A ; fibrinojen, Lp(a) ve klamidya ile pozitif albümin seviyeleri ile negatif korele bulundu. Sonuç: HD hastalarında aterosklerotik değişikliklerin daha fazla olduğu görüldü ve inflamatuar sürecin ateroskleroz patogenezinde rol oynayabileceği sonucuna varıldı. Ayrıca bu çalışma geçirilmiş klamidyal infeksiyonların CMV infeksiyonlarından daha aterojenik olabileceğini düşündürmektedir.
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