Aytekin ALCELİK, Eyüp AYTEKİN, Mehmet TOSUN, Gülali AKTAŞ, Selim AYHAN, Serkan ÖZTÜRK, Mehmet ÖZLÜ, Haluk ŞAVLI, Mehmet YAZICI

Obez ve fazla kilolu kişilerde N-terminal pro-B-tip natriüretik peptid ve insülin direnci

Farklı obez popülasyonlarda B-tip natriüretik peptid (BNP) seviyelerini araştıran bazı çalışmalar yapılmıştır. Henüz tam açıklanamayan bir mekanizma ile obezlerde BNP düzeyleri sıklıkla düşük olarak saptanmaktadır. Bilinen kalp hastalığı olmayan bireylerde plazma NT-proBNP seviyeleri, obezite ve insülin direnci arasındaki ilişkiyi araştırmayı amaçladık. Çalışma popülasyonumuz iki gruptan oluşmaktaydı. Vücut kitle indeksi (VKİ) ≤25 kg/m2 olanlar zayıf grubuna (LG, n=30), >25 kg/m2 olanlar ise fazla kilolu ve obez grubuna (OG, n=78) alındı. Ciddi hipertansiyonu, kalp yetmezliği, iskemik kalp hastalığı, böbrek veya karaciğer yetmezliği, malignitesi olan hastalar, gebeler ve 65 yaş üstü hastalar çalışmaya alınmadı. Zayıf hastaların grubunda NT-proBNP ile kilo (r=-0,379, p=0,004) ve VKİ (r=-0,286, p=0,030) arasında negatif bir ilişki varken, obez grupta NT-proBNP ve VKİ arasında böyle bir ters korelasyon saptanmadı. Obezite seviyelerinin belirteçlerini saptamak için çok değişkenli lojistik regresyon analizleri yaptık. Bu belirteçler ile obezite arasında anlamlı ilişki saptanmadı. İnsülin seviyelerinin obezite ile güçlü bir ilişkisi vardı ancak yine de bu ilişki istatistiksel anlamlılık düzeylerine ulaşamıyordu (p=0,054). Zayıf hasta grubunda NT-proBNP ve VKİ arasında ters korelasyon vardı. Aynı grupta NT-proBNP ve homeastatik modelde değerlendirme (HOMA) ve insülin seviyeleri (r=- 0,035, p=0,789) arasında korelasyon yoktu, ancak obez grupta BNP ve HOMA (r=-0,219, p=0,009) ve insulin seviyeleri (r=-0,252, p=0,002) arasında istatistiksel olarak anlamlı ters ilişki vardı. Irk ve etnik köken bu farklılığa katkıda bulunuyor olabilir.

Anahtar Kelimeler:

NT-proBNP, Obezite, İnsülin direnci, Vücut kitle indeksi, Fazla kilolu, Bel çevresi

N-terminal pro-B-type natriuretic peptide and insulin resistance in overweight and obese subjects

Several studies have been conducted to investigate B-type natriuretic peptide (BNP) levels in different obese populations. However, in these studies BNP levels were lower in obese population with an unclear mechanism which has not been explained yet. We sought to investigate the relationship among plasma NT-proBNP levels, obesity and insulin resistance in subjects with no known heart disease. The study population consists of two groups. Subjects with a body mass indexs (BMI) of ≤25 kg/m2 were classified as lean group (LG, n=30), BMI of >25 kg/m2 were classified as overweight and obese group (OG, n=78). Severe hypertension, heart failure, ischemic heart disease, renal or hepatic insufficiency, age >65, pregnancy and malignancy were excluded. There was anegative correlation between NT-proBNP and weight (r=-0.379, p=0.004) and BMI (r=-0.286, p=0.030) in LG, but there was no such reverse correlation between NT-proBNP and BMI (r=-0.057, p=0.463) in OG. We performed multivariable logistic regression analyses to examine predictors of obesity levels. There were not any significant relation between these predictors and obesity. Insulin levels had a strong association with obesity level however this association was still insignificant (p=0.054). In LG group, there was a negative correlation between NT-proBNP and BMI. There was no correlation between NT-proBNP and homeostatic model assessment (HOMA) and insulin levels (r=-0.035, p=0.789) in LG group, but there was a statistically significant negative correlation between BNP and HOMA (r=-0.219, p=0.009) and insulin levels (r=-0.252, p=0.002) in OG group. Race and ethnicity may contribute this association.

Keywords:

NT-proBNP, Obesity, Insulin resistance, Body mass index, Overweight, Waist circumference,

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