Koroner Arter Hastalarında Lipoprotein (a), homosistein, Yüksek Duyarlı C-Reaktif Protein ve Fibrinojen Etkinliğinin Tanısal Değerlendirilmesi

Amaç: Koroner arter hastalığında (KAH) Lipoprotein (Lp) (a), homosistein (Hcy), yüksek duyarlıklı C-reaktif protein (hs-CRP) ve fibrinojen gibi majör ve diğer risk faktörlerinin tanısal değerini araştırmak amaçlanmıştır. Metotlar: Çalışmaya koroner anjiyografi sonucuna gore 118"i KAH ve 105"i KAH olmadığı belirlenen toplam 223 kişi dahil edildi. Lipoprotein (a), Hcy, hs-CRP ve fibrinojen düzeyleri sırasıyla, immünoturbidometrik, flöresan polarizasyon immünoassay ve nefelometrik yöntemlerle ölçüm yapıldı. Açlık glukoz ve düşük dansiteli lipoprotein kolesterol (LDL-K) dışındaki lipid parametrelerine enzimatik kolorimetrik yöntemlerle bakılmış olup, LDL-K düzeyleri Fridewald formülüne göre hesaplanmıştır. Bulgular: Lojistik regresyon modelinde biyokimyasal değişkenlerden en önemlileri göre Lp (a), Hcy, hs-CRP ve fibrinojen olarak belirlenmiştir. Lipoprotein (a), Hcy, hs-CRP ve fibrinojenin herbir ünitesinin sırasıyla, 1.029, 1.177, 1.027 ve 1.013 kat KAH riskini artırdığı gösterilmiştir. Bu parametrelerden KAH için öngörüsü en hassas ve etkili olanın fibrinojen olduğu gösterilmiştir. Sonuç: Lipoprotein (a), Hcy, hs-CRP ve fibrinojen KAH için bağımsız risk faktörleri olması yanında bunların arasında en önemlisinin fibrinojen olduğu belirlenmiştir. Fibrinojen, klinik uygulamada KAH için güvenilir bir risk factör olarak kullanılabilir.

Anahtar Kelimeler:

Koroner arter hastalığı, risk faktörleri, Lipoprotein (a), Homosistein, hs-CRP, fibrinojen.

Assessment of Diagnostic Efficiency of Lipoprotein (a), Homocysteine, High Sensitive C-Reactive Protein and Fibrinogen in Patients with Coronary Artery Disease

Backround: To evaluate the diagnostic value of major and other risk factors as lipoprotein (Lp) (a), homocysteine (Hcy), high sensitive C-reactive protein (hs-CRP) and fibrinogen in CAD patients. Methods: A total of 223 subjects (118 patients and 105 controls) were included in the study according to their coronary angiographic results. Lipoprotein (a), Hcy, hs-CRP and fibrinogen levels were measured using immunoturbidometric, florescent polarization immunoassay and nefelometric methods, respectively. Fasting glucose and lipid parameters, except low density lipoprotein cholesterol (LDL-C), are determined by enzymatic colorimetric methods and the LDL-C levels were calculated by the Fridewald formula. Results: Logistic regression analysis showed that when the biochemical variables in placed in a model, the most important variables were Lp (a), Hcy, hs-CRP and fibrinogen. We showed that each unit of Lp (a), Hcy, hs-CRP and fibrinogen increases the risk of CAD 1.029, 1.177, 1.027 and 1.013 fold, respectively. Among these, fibrinogen level was the most sensitive and efficient parameter in prediction of CAD. Conclusion: Although Lp (a), Hcy, hs-CRP and fibrinogen are independent risk factors for CAD, fibrinogen was the most important one. Fibrinogen can be used as a reliable risk factor for CAD in clinical practice.

Keywords:

Coronary artery disease, risk factors, Lipoprotein (a), Homocysteine, hs-CRP, fibrinogen.,

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Yazışma Adresi / Address for Correspondence: Dr. Ebru Dundar Yenilmez Çukurova University, School of Medicine, Department of Medical Biochemistry, 01330, Adana, Turkey. Tel: +90-322 3386947 (Dahili: 3466) e-mail: edundar@cu.edu.tr & geliş tarihi/received :13.02.2013 kabul tarihi/accepted:29.03.2013