Arzu OR KOCA, Esin BEYAN, Şevket Murat HOKKAÖMEROĞLU, Derun Taner ERTUĞRUL, Kürşat DAL

ÖTİROİD HASTA SENDROMUNDA BEYİN NATİRÜRETİKPEPTİD (BNP)

Amaç: Kardiyovasküler (KV) homeostazda tiroid hormonarı (TH) önemli role sahiptir. Özellikle son yıllarda KV sistem üzerine TH’larının etkisi incelendiğinde “Ötiroid hasta sendromu (ÖHS)” dikkat çekmektedir. Bu çalışmada hastanede yatarak tedavi alan ve sistemik hastalığı bulunan hastalarda sıklıkla gözlenen ÖHS ile Beyin natirüretik peptid (BNP) düzeyi ilişkisini incelemeyi amaçladık.Materyal ve Metot: Kesitsel olarak dizayn edilen çalışmada; kalp yetersizliği (KY) klinik ve/veya laboratuar bulgusu olan, renal yetmezliği olan, kronik karaciğer hastalığı olan, renal parankim hastalığı olan, bilinen hipertiroidi ya da hipotiroidisi olan, tiroid hormon replasmanı alan, steroid kullanan, antitiroid ilaç kullanan, BNP düzeyini etkilediği bilinen ilaç kullanımı olan hastalar çalışma dışı bırakıldı. Çeşitli sistemik hastalıklar nedeni ile yatarak tedavi alan 78 ÖHS’lu hasta vaka, 67 ötiroid hasta kontrol grubuna alınarak serum BNP düzeyleri, biyokimyasal tetkikleri, akut faz reaktanları ve ekokardiyografi bulguları analiz edildi.Bulgular: ÖHS grubunda serum BNP düzeyinin kontrol gruba göre anlamlı olarak yüksek olduğu görülmüştür. Serum BNP düzeyi ile; serum serbest tiroksin (sT4) düzeyinin pozitif, serum serbest triiodotironin (sT3) ve tiroid uyarıcı hormon (TSH) düzeyleri ise negatif korele bulunmuştur. Ayrıca serum BNP düzeyinin pozitif akut faz reaktanları (yüksek duyarlıklı C reaktif protein, ferritin) ile pozitif, negatif akut faz reaktanı olan albüminle ise negatif korele olduğu saptanmıştır.Sonuç: ÖHS serum BNP artışı ile ilişkilidir. KV hastalığı olmayan kritik durumdaki hastalarda düşük sT3 düzeyi kardiyak disfonksiyon gelişimine katkıda bulunabilir. ÖHS’da BNP düzeyleri değerlendirilirken, tiroid hormonlarına ek olarak, hasta yaşının, yatış tanısının, akut faz reaktanlarının ve inflamatuar sitokinlerin göz önünde bulundurulması gerektiğini düşünmekteyiz.

BRAIN NATRIURETIC PEPTIDE (BNP) IN EUTHYROID SICK SYNDROME

Objectives: Thyroid hormones (TH) play a significant role in cardiovascular (CV) homeostasis. When the effectof TH on the CV system has been examined, especially in recent years, "euthyroid sick syndrome (ESS)" hasattracted attention. In this study, we aimed to investigate the correlation between ESS, which is frequentlyobserved in hospitalized patients with have systemic disease, and the brain natriuretic peptide (BNP) level. Materials and Methods: In this cross-sectional study, 78 ESS patients who were hospitalized for varioussystemic diseases and a control group of 67 euthyroid patients were included. Patients who have heart failure(HF) with clinical and/or laboratory findings, renal failure, chronic liver disease, renal parenchymal disease,known hyperthyroidism or hypothyroidism, taking a thyroid hormone, using steroids, using antithyroid drugs,known to affect the BNP level Patients using medication were excluded from the study. The serum brainnatriuretic peptide (BNP) levels, biochemical examinations, acute phase reactants, and echocardiographyfindings were analyzed. Results: Serum BNP was significantly higher in ESS patients compared to the control group. Serum freethyroxine (fT4) level was positively correlated, and serum free triiodothyronine (fT3) and thyroid stimulatinghormone (TSH) levels were negatively correlated with BNP. Furthermore, it was determined that serum BNPlevel was positively correlated with positive acute-phase reactants (high-sensitivity C-reactive protein,ferritin) and negatively correlated with albumin, which is a negative acute-phase reactant. Conclusion: ESS is associated with an increase in serum BNP. In critically ill patients without CV disease, a lowlevel of fT3 may contribute to the development of cardiac dysfunction. We consider that the patient's age,admission diagnosis, acute-phase reactants, and inflammatory cytokines should be considered in addition tothyroid hormones while evaluating BNP levels in ESS.

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