Ahmet KARAGÖZ, İbrahim KOCAOĞLU, Özgül UÇAR, Serkan SERDAR, Emre ERTÜRK, Begüm SAYIN YETİŞ, Ender ÖRNEK

Akut koroner sendromlu hastalarda endotelyal progenitör hücre sayımı

Amaç. Endotelyal progenitör hücreler mekanik olarak endotel hücrelerinin hasarlanarakuzaklaştırılması ile ya da sitokinlerin uyarımı ile kemik iliğinden periferik kana göç ederek hasarbölgesindeki endotel hücrelerinin yerine geçerek ilgili alanı onarmaktadırlar. Daha önce buhücrelerin stabil koroner arter hastalarında kronik süreçte azaldığı, akut koroner sendromhastalarında ise sayıca arttığı gösterilmişti. Bu çalışmanın amacı akut koroner sendrom tanısı ilekoroner yoğun bakım ünitesine yatırılan hastalarda hastalığın alt grupları arasında (ST elevasyonlumiyokard infarktüsü, ST elevasyonlu olmayan miyokard infarktüsü ve anstabil angina pektoris )endotelyal progenitor hücre sayıları bakımından fark olup olmadığının incelenmesidir. Yöntem.Çalışma verileri iki aşamada analiz edildi. İlk aşamada akut koroner sendrom sınıflamasında yeralan üç alt grup (n=112) arasında endotelyal progenitor hücre sayıları arasında fark olup olmadığıaraştırıldı. Analizin ikinci aşamasında ise unstabil angına pektoris ön tanısı ile hospitalize edilenfakat enzim yüksekliği olmayan, koroner anjiografi ve ekokardiyografileri normal olarak saptanan13 hasta daha değerlendirmeye alındı. Hastalar, enzim yüksekliği saptanmayan yani kardiyakhasarın olmadığı unstabil angına pektoris hastaları ve koroner anjiografide normal koronerarterlerin saptandığı hastalar bir grup (Grup A, n=41), kardiyak enzim yüksekliği saptanan yanikardiyak hasarın dökümente olduğu, ST elevasyonlu miyokard enfarktüsü ve ST elevasyonsuzmiyokard enfarktüsü hastaları diğer bir grup (Grup B, n=84) olmak üzere iki gruba ayrıldı ve buiki grup arasında endotelyal progenitor hücreler sayıları açısından fark olup olmadığına bakıldı.Bulgular. Çalışma bulgularımız iç grup arasında arasında endotelyal progenitor hücre sayısıaçısından istatistiksel olarak anlamlı farklılık olmadığını göstermiştir (sırasıyla 3,87 ± 2,74, 5,46 ±6,38 ve 3,95 ± 2,94, p=0,232). Yapılan istatistiksel analiz sonucunda Grup A ve Grup B arasındada endotelya progenitor hücre sayıları açısından anlamlı farklılık saptanmadı (3,89 ± 2,81ekarşılık 4,80 ± 5,22; p=0,302). Sonuç. Bu bilgiler ışığında, tedavi modalitelerindeki gelişmelererağmen halen tedavi direnci sorununun gündemde olduğu koroner arter hastalığında bu hücrelerinterapötik yaklaşımlarda kullanılması için kemik iliğinde ve periferik kandaki sayı ve fonksiyonları,hedef dokudaki etkileri ve bu hücreleri etkileyen düzenleyici faktörler konusunda daha ileri klinikçalışmalara ihtiyaç duyulmaktadır.

Endothelial progenitor cell count in patients with acute coronary syndrome

Aim. Endothelial progenitor cells repair related region by removal of damaged endothelial cellsmechanically or replacing endothelial cells via migration from bone marrow to peripheric bloodpool with stimulus of cytokines. Previously, it has been shown that number of these cells decreasein chronic stage of stable coronary heart disease, whereas they increase in number in acutecoronary syndromes. The aim of this study is to investigate the difference in the number ofendothelial progenitor cells among subgroups of acute coronary syndrome (ST elevationmyocardial infarction, non-ST elevation myocardial infarction and unstable angina pectoris ) inpatients hospitalized in coronary intensive care unit. Method. The study data were analysed in twosteps. In the first step, it has been investigated whether there were any differences regardingendothelial progenitor cell count among three subgroups of acute coronary syndrome (n=112). Inthe second step, a further 13 patients who were hospitalized with a prediagnosis of unstabil anginapectoris and subsequently reported to have normal echocardiography and coronary angiographywere also enrolled. The patients were divided into two groups; the patients with unstabil anginapectoris of whom no increase in cardiac enzymes detected indicating the absence of any cardiacdamage and patients with normal coronary angiography findings constituted the first group (GrupA, n=41) and the patients with ST elevation myocardial infarction and non-ST elevationmyocardial infarction of whom an increase in cardiac enzymes detected indicating a documentedcardiac damage constituted the second group (Grup B, n=84). We investigated whether there wereany differences regarding endothelial progenitor cell count between these two groups. Results.Our results indicate that the number of endothelial progenitor cells did not differ significantlyamong these three groups in the first step (3.87 ± 2.74, 5.46 ± 6.38 and 3.95 ± 2.94, respectively;p=0.232). The results of the statistical analysis also revealed no differences between Grup A andGrup B regarding EPC counts (3.89 ± 2.81 vs 4.80 ± 5.22; p=0.302). Conclusion. In the light ofthese data, in coronary heart disease in which resistance to treatment is a topical problem despiteimprovements in therapeutic modalities, further clinical studies are needed about the number andthe functions of these cells in the bone marrow and peripheric blood, their effects on target tissuesand the factors regulating them, for theurapeutic use of these cells.

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