Buğra KERGET, Dursun AFŞİN, Ferhan KERGET, Abdullah Osman KOÇAK, Alperen AKSAKAL, Ahmet KIZILTUNÇ, Ömer ARAZ, Elif YILMAZEL UÇAR, Metin AKGÜN

Association of plasma netrin-1 level with inflammatory balance and comorbidities in patients with acute exacerbation of COPD

Association of plasma netrin-1 level with inflammatory balance and comorbidities in patients with acute exacerbation of COPD Introduction: Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow restriction and systemic inflammation. Netrin-1 is a protein mainly produced in the central nervous system and has proven anti-inflammatory activity. The aim of this study was to determine netrin-1 level and its relationship with comorbidities in patients with acute exacerbation of COPD. Materials and Methods: The study included 232 patients aged over 40 years who were divided into 3 groups: Group 1: ex-smokers (≥ 20 pack-years) with COPD hospitalized for COPD exacerbation (n= 142), Group 2: current-smokers (≥ 20 pack-years) without COPD (n= 30), Group 3: a control group comprising healthy non-smokers (n= 60). Plasma netrin-1 levels were measured using commercial enzyme-linked immunosorbent assay (ELISA) kit. Results: There were significant differences in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, C-reactive protein (CRP), and plasma netrin-1 levels between patients with acute exacerbation of COPD and current smokers without COPD, healthy controls (p= 0.001 for all). Netrin-1 levels at discharge were lower in COPD patients with diabetes mellitus (DM) compared to nondiabetic COPD patients (p= 0.01). Weak correlation was observed between netrin-1 level at admission and FEV1, FVC, partial pressure of oxygen, and CRP levels (r= 0.394, p= 0.01; r= -0.366, p= 0.01; r= -0.19, p= 0.05; r= 0.306, p= 0.01). Netrin-1 level at admission was also moderately correlated with smoking history (pack-years) (r= 0.579, p= 0.01). Conclusion: Netrin-1 was elevated in acute exacerbation of COPD and may be an important element in inflammatory balance. Patients with both COPD and DM were found to have lower netrin-1 levels at discharge after resolution of the acute exacerbation.

KOAH akut alevlenme hastalarında plasma netrin-1 düzeyinin inflamatuar denge ve komorbiditeler üzerine etkisi

Giriş: Kronik obstrüktif akciğer hastalığı (KOAH) hava akım kısıtlaması ve sistemik inflamasyon ile karakterize yaygın bir akciğer hastalığıdır. Netrin-1 ön planda santral sinir sisteminden sentezlenen anti-inflamatuar etkinliği tespit edilmiş bir proteindir. Çalışmamızda netrin-1 düzeyinin KOAH akut alevlenme ve komorbiditelerle ilişkisini tespit etmeyi amaçladık. Materyal ve Metod: Çalışmamıza 40 yaş üzeri 3 grupta 232 hasta dahil edildi. Grup 1: 20 paket/yıl üzeri sigara içmiş, ex-smoker ve KOAH akut alevlenme nedeniyle hastanede yatan hastalar (n= 142), grup 2: aktif sigara içen ve KOAH olmayan hastalar, grup 3 (n= 30) non-smoker sağlıklı grup (n= 60). Hasta ve sağlıklı gruplardan 5 cc periferik venöz kan alındı. Plazma netrin-1 seviyesi enzime bağlı immünosorbent (ELİSA) yöntemiyle ölçüldü. Bulgular: Çalışmamızda FEV1, FVC, FEV1/FVC, CRP ve plasma netrin-1 düzeyinde KOAH akut alevlenme ile gelen hastalarla, kontrol grubu ve aktif sigara içen grup arasında istatistiksel olarak anlamli düzeyde farkli idi (tüm parametreler için p= 0,001). KOAH akut alevlenme ile gelen ve diyabetes mellitusu (DM) olan hastalarda taburculuk sırasında yalnızca KOAH gözlenen hastalara nazaran daha düşük netrin-1 düzeyi tespit edildi (p= 0,01). Netrin-1’in başvuru anındaki düzeyinin FEV1, FVC, PaO2 ve CRP düzeyi ile yapılan korelasyon analizinde düşük düzeyde korelasyon gözlendi (sırasıyla r= -0,394, p= 0,01, r= -0,366, p= 0,01, r= -0,19, p= 0,05, r= 0,306, p= 0,01). Netrin-1’in başvuru anındaki düzeyi ile sigara içme süresi (paket/yıl) ile yapılan korelasyon analizinde ise pozitif yönlü orta düzeyde korelasyon gözlendi (r= 0,579, p= 0,01). Sonuç: KOAH akut alevlenmede artış gösteren netrin-1 inflamatuar dengenin sağlanmasında önemli olabilir. KOAH ile birlikte DM gözlenen hastalarda ise akut alevlenme tablosu geriledikten sonra taburculuk esnasında daha düşük plasma netrin-1 düzeyi tespit edildi.

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