Diyabetli Hastalarda Miyokard Perfüzyon Sintigrafisinde Miyokard İskemisini Öngörmede Ürik Asit-HDL Kolesterol Oranının Rolü

Diyabetli Hastalarda Miyokard Perfüzyon Sintigrafisinde Miyokard İskemisini Öngörmede Ürik Asit-HDL Kolesterol Oranının Rolü Öz Amaç: Diabetes Mellitus (DM) başta miyokardiyal iskemi olmak üzere kardiyovasküler hastalıklar için önemli bir risk faktörüdür. Hem diabetes mellitus tip 2 hem de kardiyovasküler durumlar, yüksek bir inflamatuar yük ile karakterizedir. Ürik Asit -Yüksek Yoğunluklu Lipoprotein kolesterol oranı (UHR), metabolik ve enflamatuar hastalıkların yeni bir belirteci olarak önerilmiştir. Bu nedenle, bu çalışma diyabetik hastalarda Miyokard Perfüzyon Sintigrafisi (MPS) ile saptanan miyokard iskemisinde Ürik Asidin Yüksek Yoğunluklu Lipoprotein kolesterol oranının (UHR) öngörmedeki rolünü araştırmıştır. Gereç ve Yöntemler: Bu çalışmaya Ocak 2022 ile Mart 2023 tarihleri arasında Abant İzzet Baysal Üniversitesi Hastanesi Nükleer Tıp Anabilim Dalı'nda MPS uygulanan hastalar dahil edildi. MPS sonuçlarına göre katılımcılar normal perfüzyon ve miyokard iskemisi olarak iki gruba ayrıldı. Gruplar arasında yaş, cinsiyet, lökosit sayısı, hemoglobin, hematokrit, trombosit sayısı, serum ürik asit, üre, kreatinin, total kolesterol, LDL-kolesterol, HDL-kolesterol, trigliserit, transaminaz, kan açlık glikozu, C-reaktif protein ve serum albümini gibi değişkenler kaydedildi ve karşılaştırıldı. Bulgular: Diyabetli 73 hastanın 37'sinde miyokardiyal iskemi, 36'sında normal MPS mevcuttu. Serum ürik asit düzeyleri iskemik grupta (6.3 ± 1.5 mg/dL) normal gruba (5.1 ± 1.8 mg/dL) göre daha yüksekti (p<0.05). İskemik gruptaki UHR, normal MPS grubundakinden (0.11 ± 0.04) anlamlı derecede yüksekti (0.15 ± 0.05). Serum UHR, miyokard iskemisi ile anlamlı olarak pozitif korelasyon gösterdi (r=0.36, p=0.002) )(p<0.05). Cut off değeri ≥ 0.11 olan UHR, miyokard iskemisini saptamada % 76 duyarlılık ve % 58 özgüllük sergiledi (p<0.05). Sonuç: Yüksek UHR, diyabetli ve koroner arter hastalığı olan hastalarda miyokard iskemisi için bağımsız bir prediktör ve tanı aracıdır. Keywords: Uric Acid to High-Density Lipoprotein cholesterol ratio, Myocardial Ischemia, Myocardial Perfusion Scintigraphy, Diabetes Mellitus, Biomarkers

The Role of Uric Acid to HDL Cholesterol Ratio in Predicting Myocardial Ischemia in Myocardial Perfusion Scintigraphy in Diabetic Patients

The Role of Uric Acid to HDL Cholesterol Ratio in Predicting Myocardial Ischemia in Myocardial Perfusion Scintigraphy in Diabetic Patients Abstract Objective: Diabetes Mellitus (DM) is a significant risk factor for cardiovascular diseases, particularly myocardial ischemia. Both diabetes mellitus type 2 and cardiovascular conditions are characterized by a high burden of inflammation. The uric Acid to High-Density Lipoprotein cholesterol ratio (UHR) has been suggested as a novel marker of metabolic and inflammatory diseases. Hence, this study investigated the predictive role of the Uric Acid to High-Density Lipoprotein cholesterol ratio (UHR) in myocardial ischemia detected by Myocardial Perfusion Scintigraphy (MPS) in diabetic patients. Materials and Methods: This study included patients who underwent MPS between January 2022 and March 2023 at the Nuclear Medicine Department of Abant Izzet Baysal University Hospital. Based on the MPS results, the participants were divided into normal perfusion and myocardial ischemia. Variables such as age, sex, leukocyte count, hemoglobin, hematocrit, platelet count, serum uric acid, urea, creatinine, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, transaminase, blood fasting glucose, C-reactive protein, and serum albumin were recorded and compared between the groups. Results: Among the 73 diabetic patients, 37 had myocardial ischemia, and 36 had normal MPS. Serum uric acid levels were higher in the ischemic group (6.3 ± 1.5 mg/dL) than in the normal group (5.1 ± 1.8 mg/dL) (p<0.05). The UHR in the ischemic group was significantly higher (0.15 ± 0.05) than that in the normal MPS group (0.11 ± 0.04). Serum UHR was significantly positively correlated with myocardial ischemia (r=0.36, p=0.002) )(p<0.05). With a cut-off value of ≥ 0.11, UHR exhibited 76% sensitivity and 58% specificity in detecting myocardial ischemia (p<0.05). Conclusions: High UHR is an independent predictor and diagnostic tool for myocardial ischemia in patients with diabetes and coronary artery disease. Routine use of UHR as an independent predictive marker is recommended for diabetic patients with myocardial ischemia who undergo MPS.

___

  • Poznyak A, Grechko AV, Poggio P, Myasoedova VA, Alfieri V, Orekhov AN. The Diabetes Mellitus-Atherosclerosis Connection: The Role of Lipid and Glucose Metabolism and Chronic Inflammation. Int J Mol Sci.. 2020;21(5):1835. doi:10.3390/ijms21051835
  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care, 34 Suppl 1(Suppl 1), S62–S69. Doi: 10.2337/dc11-S062. 2011
  • Koplay, M., and C. Erol. "Koroner arter hastalığı." Türk Radyoloji Seminerleri, 1; 57-69. 2013.
  • Efe SÇ, Özdemir CÖ, Gündoğan C, Öz A, Yüksel Y, Ayca B, et al. C-reactive Protein/Albumin Ratio for Predicting Ischemia in Myocardial Perfusion Scintigraphy. Mol Imaging Radionucl Ther. 2020; 29(3):112-117. doi: 10.4274/mirt.galenos.2020.88261. PMID: 33094574; PMCID: PMC7583749
  • Maguire EM, Pearce SWA, Xiao Q. Foam cell formation: a new target for fighting atherosclerosis and cardiovascular disease. Vascul Pharmacol. 2019; 112:54-71. doi 10.1016/j.vph.2018.08.002
  • Baweja PS, Sandesara PB, Ashraf MJ, et al.. Asymptomatic coronary artery disease in type II diabetes. Mo Med. 2014; 111(1):73-79. PMID: 24645303; PMCID: PMC6179518
  • Park B, Jung DH, Lee YJ. Predictive Value of Serum Uric Acid to HDL Cholesterol Ratio for Incident Ischemic Heart Disease in Non-diabetic Koreans. Biomedicines. 2022; 15;10(6):1422. doi 10.3390/biomedicines10061422. PMID: 35740443; PMCID: PMC9219787
  • Li F, Zhao D, Li Q, Lin X, Sun H, Fan Q. Uric Acid to High-Density Lipoprotein Cholesterol Ratio is a Novel Marker to Predict Functionally Significant Coronary Artery Stenosis. J Interv Cardiol. 2022; 9057832. doi:10.1155/2022/9057832. PMID: 36311279; PMCID: PMC9584719
  • Canbaz TF, Özdemir S, Şen F, Demir H, Özdemir E, Durmuş AG. Miyokardiyal Perfüzyon SPECT Uygulama Kılavuzu. Nucl Med Semin 2020;6:90-134. doi::10.4274/nts.galenos.2020.0010
  • Aktas G, Yilmaz S, Kantarci DB, Duman TT, Bilgin S, Balci SB, et al. Is the elevation of serum uric acid-to-HDL cholesterol ratio associated with diabetic kidney injury? Postgrad Med. 2023; 1–5.An advanced online publication doi: 10.1080/00325481.2023.2214058
  • Kurtkulagi O, Tel BMA, Kahveci G, Bilgin S, Duman TT, Ertürk A, et al. Hashimoto's thyroiditis is associated with elevated serum uric acid levels to a high-density lipoprotein-cholesterol ratio. Romanian Journal of Internal Medicine. Rom J Intern Med. 2021; 59 (4), 403-408. doi: 10.2478/rjim-2021-0023
  • Xuan Y, Zhang W, Wang Y, Wang B, Xia F, Zhang K, et al. Association between uric acid-to-HDL cholesterol ratio and diabetic complications in men and postmenopausal women. Diabetes Metab Syndr Obes. 2023;16:167-177. doi:10.2147/DMSO.S387726
  • Kocak M Z, Aktas G, Erkus E, Sincer I, Atak B, Duman T. Serum uric acid to HDL-cholesterol ratio strongly predicts metabolic syndrome in type 2 diabetes mellitus. Rev Assoc Med Bras (1992), 2019; 65 (1), 9–15. doi: 10.1590/1806-9282.65.1.9
  • Aktas G, Kocak MZ, Bilgin S, Atak BM, Duman TT, Kurtkulagi O. The Uric acid to HDL cholesterol ratio strongly predicts control in men with type 2 diabetes mellitus. The aging male: The Official Journal of the International Society for the Study of Aging Males. 2020; 23(5), 1098–1102. doi: 10.1080/13685538.2019.1678126
  • Kosekli MA, Kurtkulagii O, Kahveci G, Duman TT, Tel BMA, Bilgin S, et al. The association between serum uric acid to high-density lipoprotein cholesterol ratio and non-alcoholic fatty liver disease: An abund study. Rev Assoc Med Bras (1992). 2021; 67(4), 549–554. doi: 10.1590/1806-9282.20201005
  • Cheng Y, Zhang H, Zheng H, Yin H, Wang Y, Wang H, et al. Association between serum uric acid/HDL-cholesterol ratio and chronic kidney disease: A cross-sectional study on a health check-up population. BMJ Open. 2022; 29;12(12): e066243. doi: 10.1136/bmjopen-2022-066243. PMID: 36581406; PMCID: PMC9806076
  • Kocak MZ, Aktas G, Duman TT, Atak BM, Savli H. Is Uric Acid elevation a random finding or causative agent of diabetic nephropathy? Rev Assoc Med Bras (1992). 2019;65(9):1155-1160. doi:10.1590/1806-9282.65.9.1156
  • Khameneh BR, Najafi MN, Ahmadi M, Saberi M, Maleki M, Baradaran RV. Investigation of the Association between serum uric acid levels and HEART risk scores in patients with acute coronary syndrome. Physiol Rep. 2022; 10(22), e15513. doi: 10.14814/phy2.15513
  • Bao F, Wang Y, Ju SQ, Sun WJ, Li YH, Zhang Y C, et al. Correlation between serum uric acid and creatinine ratios and metabolic syndrome based on physical examination in the Nantong area. Zhonghua Yu Fang Yi Xue Za Zhi. [Chinese journal of preventive medicine]. 2022; 6; 56(11):1630–1635. doi:10.3760/cma.j. cn112150-20220617-00620
  • Chang YC, Lin CJ, Yeh TL, Tsai MC, Hsu LY, Chien KL. Lipid biomarkers and cancer risk: A population-based prospective cohort study in Taiwan. Lipids Health Dis. 2021; 10;20(1):133. doi: 10.1186/s12944-021-01570-1
  • Reiner Z, Muacević-Katanec D, Katanec D, Tedeschi-Reiner, E. Low HDL cholesterol–an important risk factor for cardiovascular diseases. Liječnički vjesnik. 2011; 133(3–4):111–116
Abant Tıp Dergisi-Cover
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 2012
  • Yayıncı: Bolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi Dekanlığı