Romatizmal kalp hastalığında serum eser element seviyelerinin değerlendirilmesi: Bir vaka kontrol araştırması

Amaç: Değişik kalp hastalıklarında bazı eser elementlerin önemli olduğu bilinmektedir. Bu çalışmada Romatizmal Kalp Hastalığı (RKH) olan hastaların serumunda bazı eser element konsantrasyonlarındaki değişiklikleri belirlemek ve bunun kronik RKH ve kapak tutulumunun şiddetiyle olan ilişkisinin ortaya konması amaçlanmıştır.Metod: RKH olan 61 hasta ve 60 sağlıklı birey çalışma kapsamına alındı. Bu çalışmaya alınan hasta grup, Wilkins skoruna, aort tutulumunun derecesine ve ayrıca pulmoner hipertansiyonun varlığı ve yokluğuna göre olmak üzere toplam altı alt gruba daha ayrıldı. Hastalara ayrıntılı fizik muayene ve laboratuvar incelemesinin yanında kan Se, Zn ve Cu analizleri yapıldı. Hasta ve kontrol guruplarına transtorasik ekokardiografi ile ölçümler standart görünümleri üzerinden yapıldı.Bulgular: Hasta grubunda serum Se ve Zn konsantrasyonu kontrol grubuna göre anlamlı ölçüde düşük bulundu (sırasıyla 43,08±1,83 µg/dL; 60,75±2,44 ‎µg/dL; p<0,001) ve 64,65±2,77‎ µg/dL; 87,34±3,33 µg/dL; p<0.001). Serum Cu konsantrasyonu hasta grubunda kontrol grubuna göre anlamlı ölçüde yüksek bulunmuştur (84,5±3,5 ‎µg/dL’ye karşılık 74,23± 3,08 µg/dL, p<0.05). Benzer şekilde Cu/Zn oranı hasta grubunda kontrol grubuna göre anlamlı ölçüde yüksek bulunmuştur (1,4±0,09 µg/dL’ye karşılık 0,9±0,04 µg/dL, p<0.001). Hasta grubunda serum eser element konsantrasyonları ve Cu/Zn oranı ile hastalığın tutulum şiddetini gösteren Wilkins skoru, aort tutulumu ve pulmoner hipertansiyon arasında anlamlı bir ilişki bulunmamıştır (p>0,05). Sonuç: Eser element konsantrasyonundaki değişiklikler RKH’nı predispoze edebileceği gibi hastalığın gelişimine yol açan bazı faktörlerin ortaya çıkmasına da katkı sağlayabilir. Ek olarak artmış serum Cu seviyesi ve Cu/Zn oranı devam eden inflamatuvar proçes markırları olarak kullanılabilir.

Anahtar Kelimeler:

Romatizmal kalp hastalığı, eser element, selenyum, çinko, bakır

Assessment of serum trace element levels in rheumatic heart disease: A case-control study

Aim: Some trace elements play important roles in various heart diseases. In this study, we aimed to determine the changes in some trace element concentrations in the serum of patients with rheumatic heart disease (RHD).Methods: Sixty-one patients with RHD and 60 healthy subjects were included in the study. Six subgroups were defined in the study group according to the Wilkins score, the degree of aortic involvement, and the presence or absence of pulmonary hypertension. Selenium (Se), Zinc (Zn), and Cupper (Cu) levels were measured, and transthoracic echocardiography was performed in all participants.Results: Serum Se and Zn concentrations were significantly lower in the patients compared to the controls (mean±SD and p 43.08±1.83 µg/dL vs. 60.75±2.44 µg/dL; t=-5.305‎, p=0.001 and 64.65±2.77 µg/dL vs. 87.34±3.33 µg/dL; t=-5.458, p=0.001, respectively). However, the serum Cu concentration was significantly higher in the patient group than in the control group (84.50±3.50 µg/dL vs. 74.23±3.08 µg/dL; t=2.309, p=0.023). Similarly, the Cu/Zn ratio in the patient group was found to be significantly higher than the control group (1.4±0.09 µg/dL vs. 0.9±0.04 µg/dL; t=5.267, p=0.001). In the patient group, there was no significant relationship between the Wilkins score, aortic involvement, pulmonary hypertension, the serum trace element concentrations, and Cu/Zn ratio (p>0.05 for all). Conclusions: We conclude that the changes in the concentrations of the measured trace elements can predispose ‎to RHD and play a role in the formation of certain factors that leads to the development of the ‎disease. Besides, serum Cu levels and Cu/Zn ratio can be used as inflammatory process markers.

Keywords:

rheumatic heart disease, trace elements, selenium, zinc, copper,

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