Şehnaz OLGUN YILDIZELİ, Derya KOCAKAYA, MEHMET BARAN BALCAN, Aygün İKİNCİ, Rengin AHISKALI, Berrin CEYHAN

Astımlı hastalarda rosuvastatin tedavisinin havayolu inflamatuvar belirteçleri ve yaşam kalitesi göstergeleri üzerine etkisi

Amaç: Statinler kan lipid düzeylerinde azalma sağlamakla beraberaynı zamanda pleiotropik ve anti-inflamatuvar etkileri olan ilaçlardır.Statinlerin bir çok inflamatuvar hastalıkta yararlı etkileri gösterilmişolmasına karşın sonuçlar halen tartışmalıdır. Bu çalışmanın amacıastım hastalarında rosuvastatin tedavisinin klinik ve anti-inflamatuvaretkilerini incelemektir.Hastalar ve Yöntem: Astım hastalarında vaka-control çalışmasıplanlanmıştır. Toplam 136 astım hastası incelenmiş ve 74 hastaçalışmaya uygun bulunarak dahil edilmiştir. Elli bir hasta çalışmayıtamamlayabilmiştir. Hastalar başlangıçta yapılan kan tahlilinde serumdüşük dansiteli lipoprotein (LDL) seviyesine göre iki gruba ayrılmıştır,LDL düzeyi 130mg/dL üzerinde olan 25 hasta mevcut tedavilerine ekolarak 8 hafta boyunca 40mg rosuvastatin tedavisi alırken, 26 hastakontrol grubu olarak almakta oldukları tedaviye devam etmişlerdir.Her iki gruptaki hastalar, başlangıçta ve 8. haftanın sonunda solunumfonksiyon testi (SFT), bronş provokasyon testi (PD20), indüktebalgamda serum inflamatuvar belirteçleri, astım kontrol testi (AKT) veyaşam kalitesi skorları (QoL) ile değerlendirilmişlerdir.Bulgular: Statin kullanan grupta 8. hafta sonunda SFT’de FEV1/FVC (pp) (%85,8±11,1 vs .%90,2±8,8 P<0,043), FEF % 25-75 (%63,6±7,8 vs %74,6±8,4, P<0.0001) ve FEF25-75(L/sc) (3,51±0,4 vs4,1±0,4 P<0,05) düzelme saptanırken statin kullanmayan grupta anlamlıfark saptanmamıştır (P>0,05). Rosuvastatin tedavisi ile indükte balgameosinofilisinde (P<0,05); IL-6 ve TNF-alfa seviyelerinde azalma(P<0,05) saptanırken, AKT ve QoL skorları ve bronş provakasyontestinde anlamlı değişiklik saptanmamıştır.Sonuç: Bu çalışmada, astım hastalarında rosuvastatin 40mg ile8 haftalık tedavi sonrasında periferik eosinofili, total IgE seviyesi,indükte balgamda inflamatuvar belirteçlerde anlamlı düzeyde azalmasaptanmıştır. Yine SFT parametrelerinde düzelme izlenmiştir ancakbuna karşın AKT ve QoL skorlarında değişim saptanmamıştır.Busonuçlara göre rosuvastatin tedavisinin astım hastaları üzerinde birtakım potensiyel anti-inflamatuar etkileri bulunmaktadır. Rosuvastatininklinik etkilerinin saptanması için daha fazla sayıda randomize çalışmayaihtiyaç vardır.

Anahtar Kelimeler:

Astım, Havayolu inflamasyonu, Remodeling, Rosuvastatin, Statin

Influence of rosuvastatin treatment on airway inflammatory markers and health related quality of life domains in asthmatic patients

Objectives: Statins are lipid lowering agents which have pleiotropic andanti-inflammatory effects. Beneficial effects of statins have been shownin many inflammatory and asthmatic diseases. However, the results arestill not consistent. The aim of this study is to determine the clinical andanti-inflammatory effects of rosuvastatin in asthmatic patients.Patients and Metods: A case control study among asthmaticpatients was conducted. One hundred and thirty-six participants werescreened. Seventy-four patients were eligible. Fifty-one patientshave completed the trial. Twenty-five patients with blood levels oflow-density-lipoprotein (LDL) above 130mg/dL, were treated withrosuvastatin 40mg for 8 weeks in addition to their standard treatmentfor asthma; 26 asthmatic patients were followed as control group. Inboth groups baseline and 8th week evaluation were recorded includingpulmonary function test (PFT), bronchial provocation test (PD20),induced sputum and serum inflammatory markers, asthma control test(ACT) and quality of life scores (QoL).Results: Statin group showed improvement in FEV1/FVC (pp)(85.8±11.1% vs 90.2±8.8% P<0.043), FEF 25-75 % (63.6±7.8 %vs 74.6±8.4 %, P<0.0001) and FEF25-75(L/sc) (3.51±0.4 vs 4.1±0.4P<0.05) and no change was seen in non-statin group (P>0.05) at theend of the 8-week treatment. Treatment with rosuvastatin resulted indecreased sputum eosinophilia percentage (P<0.05); IL-6 and TNFalphalevels (P<0.05) however, bronchial challenge test, ACT and QoLdomains did not change in both groups (P>0.05).Conclusion: An 8-week treatment with 40mg rosuvastatin in asthmadecreased the peripheral eosinophilia, total IgE levels and inflammatorymarkers in the induced sputum samples. Beneficial effects in PFT havealso been observed. However, ACT and QoL domains were not affected.The implication of this study is that rosuvastatin could potentially haveanti-inflammatory effects on asthmatic airways. Prospective randomisedtrials to evalute the clinical effects of rosuvastatin are warranted.

Keywords:

Asthma, Airway inflammation, Remodelling, Rosuvastatin, Statin,

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