Zühal KARACA KARAGÖZ, İbrahim ŞAHİN, Burhan Hakan KANAT, Feyzi KURT

HİPERTİROİDİLİ HASTALARDA TEDAVİNİN BEYİN NATRİÜRETİK PEPTİD DÜZEYİNE ETKİSİ

Amaç: Kardiyak problemi ve herhangi bir sistemik hastalığı olmayan hipertiroidili hastalarda beyin natriüretrik peptid ( BNP) düzeyini ve tedavinin BNP düzeyine etkisini değerlendirmeyi planladık. Gereç ve Yöntem: Çalışmaya 29 hipertiroidili ve 30 sağlıklı olgu dahil edildi. Hastalarda total T3, total T4, serbest T3, serbest T4, TSH, anti TPOAb, Anti TgAb ve BNP düzeylerine tedavi öncesinde ve ötiroid olduktan sonra bakıldı. Bulgular: Hipertiroidili hastalarının tedavi öncesi BNP düzeyleri kontrol grubuna göre anlamlı olarak daha yüksek bulunmuştur (P0.05). Ayrıca hastalarda Anti TgAb, ST3, ST4 ve TT4’de tedavi öncesi pozitif bir korrelasyon gözlenmiş (P0.05). Sonuç: Hipertiroidili hastalarda BNP düzeyi artmıştır. Antitiroid tedavi BNP düzeyini anlamlı olarak düşürmektedir .

Anahtar Kelimeler:

Hipertiroidi, Beyin natriüretrik peptid, Antitiroid Tedavi

PDF

___

1. İliçinG, BiberoğluK, Ünal S, Akalın S, Süleymanlar G. Temel iç hastalıkları cilt 2. Güneş Kitabevi. 1996; 1701-719
2. Özata M. Tiroid hastalıkları tanı ve tedavisi. GATA Basımevi. 2003: 42-78
3. Hatemi H, Kabalak T, Erdoğan G. Klinik tiroid. Kelebek Matbacılık 2001; 177-221 4.
4. Maeda K, Tsutamoto T, Wada A, Hisanaga T and Kinoshita M. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients. Am. Heart J. 1998; 135: 825-32
5. Hammerer-Lercher A, Neubauer E, Muller S, Pachineger O, Puschhendorf B, Mair J Head-to-head comparison of N-terminal pro-brain natriuretic peptide, brain natriuretic peptide and N-terminal pro-atrial natriuretic peptide in diagnosing left ventricular dysfunction. Clin. Chim. Acta. 2001 Aug 20; 310(2): 193-7.
6. Vasan RS, Benjamin EJ, Larson MG, Leip EP, Wang TJ, Wilson PW, Levy D. Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study JAMA. 2002; 288(10): 1252-9.
7. Morrison LK, Harrison A, Krishnaswamy P, Kazanegra R, Clopton P. Maisel A.Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol. 2002; 39(2): 202-9
8. Kohno M, Horio T, Yasunari K, et al. Stimulation of brain natriüretic peptide relase from the heart by thyroid hormone. Metabolism 1993; 42: 1059-64
9. Kohno M, Murakawa K, Yasunari K, et al. Circulating atrial natriüretic peptides in Hypertyroidizm and hipothyroidizm. Am J Med. 1987; 83:648 -652
10. Klein I, Ojama K, Thyroid hormone and the cardiovasküler system . N Engl J Med 2001; 344.501-9
11. Hunt, PJ, Richards, AM, Nicholls, M.G, Doughty, R.N.& Espiner, E. A Immunoreactive aminoterminal pro-brain natriüretic peptide(NT-PROBNP): anew marker of cardiac impairment. Clinical Endocrinology.1997; 47, 287-296
12. Wei T, Zeng C, Tian Y, Chen Q, Wang L B-type natriuretic peptide in patients with clinical hyperthyroidism. J Endocrinol Invest. 2005; 28: 8-11
13. Schultz M, Faber J, Kistorp C, Jarlov A, Pedersen F, Wiinberg N, Hildebrandt P. Nterminal-pro-B-type natriuretic peptide (NT-pro-BNP) in different thyroid function states. Clin Endocrinol (Oxf). 2004; 60(1): 54-9
14. Mair J, Hammerer-Lercher A, Puschendorf B. The impact of cardiac natriuretic peptide determination on the diagnosis and management of heart failure. Clin Chem Lab Med 2001;39(7): 571-88.
15. Itıh H, Pratt RE, Dzau VJ. Atrial natriüretic polipeptide inhibits hypertrophy of vasküler smooth muscle cells. J Clin İnvest 1990; 86: 1690-7.
16. Wei TM, Zeng CL, Chen LP; et al. Bedside tests of B-type natriüretic peptide in the diagnosis of left ventricular diastolic dysfunction in hypertensive patients. Eur J Heart Fail 2004.
17. Wozakowaska-Kaplon B. Effect of sinus rhythm restoration on of plasma brain natriüretic peptide in patients with atrial fibrillation. Am J Cadiol 2003,93:1555-8.
18. Klein I ,Levey GS.The cardiovasküler system in thyrotoxicocis İn: The thyroid.New York:Braverman ,L.E. Utige, R.U. eds.2000, 596-604.
19. Kohno M, Horio T, Yoshiyama M, et al: Accelerated secretion of brain natriüretic peptide from the hypertrophied ventricles in experimental malignant hypertension 1992, 19: 206-11.
20. Kohno M, Horio T, Toda I.et al: Cosecretion of atrial and brain natriüretic peptides during supraventricular tachyarrhythmias. Am Heart J 1992, 123: 1382-84.
21. Richards,A.M.,Doughty,R.,Nicholls,M.G.,MacMahon,S.,Sharpe,N.,Murpy,J.,Espiner, E.A.,Frempton, C.& Yandle, T: G. Plasma N-terminal pro-brain natriüretric peptide and adrenomedullin. Journal of the American College of Cardiology, 2001; 37, 1781-87.