Huseyin ERDAL, Oğuzhan ÖZCAN, Faruk Hilmi TURGUT, Salim NEŞELİOĞLU, Özcan EREL

Kronik Böbrek Hastalığı Olan Hastalarda Dinamik Tiyol-Disülfid Dengesi ve İskemi Modifiye Albümin Düzeylerinin Değerlendirilmes

Amaç: Bu çalışmada Kronik böbrek hastalığı (KBH) olan hastalarda dinamik tiyol-disülfid dengesi ve iskemi modifiye albümin (IMA) düzeylerinin belirlenmesi amaçlanmıştır. Yöntem: Çalışmaya 30 hemodiyaliz (HD), 30 KBH hastası (evre 3-5) ve 30 kontrol dahil edildi. Dinamik tiyol-disülfid dengesi, Erel ve arkadaşları tarafından geliştirilen kolorimetrik yöntemle belirlendi. IMA seviyeleri Bar- Or ve ark. tarafından geliştirilen kobalt bağlama testi kullanılarak belirlendi. Bulgular: KBH ve HD hastalarının serbest ve toplam tiyol seviyeleri kontrol grubuna göre anlamlı derecede düşüktü (her ikisi için p=0.001). Ancak disülfid düzeyleri HD grubunda anlamlı olarak daha yüksekti (p=0.001), ancak kontrol ve KBH grupları arasında anlamlı fark yoktu (p=0.547). Serbest ve toplam tiyol seviyeleri ile IMA (r=-0.628;-0.631), BUN (r=-0.747;-0.747) ve kreatinin (r=-0.732;-0.721) arasında istatistiksel olarak anlamlı bir negatif korelasyon bulundu. GFR ile tiyol düzeyleri arasında anlamlı pozitif korelasyon vardı (r=0.835;0.824). Hasta gruplarında TrxR düzeyleri kontrollere göre anlamlı derecede yüksekti (p=0.001). Hasta gruplarının CRP düzeyleri kontrollere göre anlamlı derecede yüksekti (p=0.001). Sonuç: Dinamik tiyol-disülfid düzeylerinin kolorimetrik yöntem kullanılarak ölçülmesinin, rutin klinik biyokimya laboratuvarlarında kolaylıkla uygulanabilmesi ve KBH hastalarında hastalık şiddeti ile ilişkili olması nedeniyle bir belirteç olarak hastalığın tanı ve takibine katkı sağlayabileceğini gösterdik. Ayrıca plazma tiyol değerleri ile ilgili çalışmalarda diyaliz sürecine bağlı albümin düzeltmesinin dikkate alınması gerektiğini ve düzeltme işleminden sonra nihai sonuçların verilmesi gerektiğini gösterdik.

Anahtar Kelimeler:

Kronik Böbrek Hastalığı, Hemodiyaliz, Oksidatif Stres, Tiyol-disülfid Homeostazı, İskemi Modifiye Albümin

Evaluation of dynamic thiol-disulfide balance and ischemia modified albumin levels in patients with chronic kidney disease

Objective: In this study, it was aimed to determine the dynamic thiol-disulfide balance and ischemia modified albumin (IMA) levels in patients with chronic kidney disease (CKD). Method: Thirty hemodialysis (HD), 30 CKD patients (stage 3-5) and 30 controls were included in the study. The dynamic thiol-disulfide balance was determined by the colorimetric method developed by Erel et al. IMA levels were determined by using cobalt binding test developed by Bar- Or et al. Results: Native and total thiol levels of CKD and HD patients were significantly lower than that of the control group (p=0.001 for both). However, disulfide levels were significantly higher in the HD group (p=0.001), but there was no significant difference between control and CKD groups(p=0.547). A statistically significant negative correlation was found between the native and total thiol levels and IMA (r=-0.628; -0.631), BUN (r=-0.747; -0.747), and creatinine (r=-0.732; -0.721). There was a significant positive correlation between GFR and the thiol levels (r=0.835;0.824). TrxR levels were significantly higher in the patient groups compared to the controls (p=0.001). CRP levels of the patient groups were significantly higher compared to the controls (p=0.001). Conclusion: We have demonstrated that measurement of dynamic thiol-disulfide levels by using colorimetric method can contribute to the diagnosis and follow-up of the disease as a marker, because it is easily applicable in routine clinical biochemistry laboratories and related with disease severity in CKD patients. Also, we showed that albumin correction due to dialysis process should be consider in studies dealing with plasma thiol values and the final results should be given after the correction process.

Keywords:

Chronic kidney disease, hemodialysis, oxidative stress, thiol- disulphide homeostasis, ischemia modified albumin,

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