Emrah DURAL, Tülin SÖYLEMEZOĞLU, Hatice KOZLUCA, Gülseren KARABIYIKOĞLU

Kronik obstrüktif akciğer hastalığında pulmoner fonksiyonel parametreler ve kan kotinin düzeyi

Giriş: Sigara, kronik obstrüktif akciğer hastalığı (KOAH)’nın en önemli nedenidir ve kotinin tütün maruziyetinin güvenilir bir göstergesidir. Çalışmamızda KOAH’lı hastalarda ve kontrol grubu olarak sağlıklı gönüllülerde akciğer fonksiyon parametreleri (%FVC, FEV1, FEV1/FVC ve FEF%25-75), sigara öyküsü ve kan kotinin düzeyi arasındaki ilişkiyi araştırmayı amaçladık. Materyal ve Metod: Kliniğimize başvuran 102 KOAH’lı hasta ve 106 sağlıklı gönüllü çalışmaya dahil edildi. Hastaların ve gönüllülerin spirometrik incelemeleri yapıldı. Kan örneklerinde kotinin düzeylerinin belirlenmesi için basit, hızlı ve güvenilir bir gaz kromatografikütle spektrometresi (GC-MS) yöntemi kullanıldı. Gereç ve Yöntem: Kotinin düzeyi cut-off değeri 41.12 ng/mL olarak belirlendi (%97.2 sensitif ve %100 spesifik). Halen sigara içen grupta ortalama paket/yıl ve kotinin düzeyi arasında anlamlı bir ilişki gözlendi (p< 0.05). Ortalama kotinin düzeyleri; hiç sigara içmeyen, sigarayı bırakmış ve sigara içenler için sırasıyla 6.1, 8.8 ve 467.0 ng mL-1 idi. Kotinin düzeyi ile %FVC, %FEV1 ve FEV1/FVC arasında ilişki gözlenmedi (p> 0.05). Hasta grubunda FEF%25-75 ve kotinin düzeyi arasında ilişki bulunmamakla beraber sigara içen kontrol grubunda negatif korelasyon bulundu (p< 0.05; r= -0.372). Bulgular: Çalışmamızla kotininin tütün maruziyetini gösteren güvenilir bir belirteç olduğunu bir kez gözlemledik. Elde ettiğimiz en belirgin sonuç ise FEF%25-75 değeri ve kotinin düzeyi arasındaki negatif korelasyondur; bu bulgu KOAH'ın erken evresinde sigaranın periferik hava yollarındaki etkisinden kaynaklanabilir.

Pulmonary functional parameters and blood cotinine level in chronic obstructive pulmonary disease

Introduction: Smoking is the leading cause of chronic obstructive pulmonary disease (COPD) and cotinine is reliable marker oftobacco exposure. We aimed to investigate the relationship between pulmonary function tests (FVC%, FEV1, FEV1/FVC andFEF25-75%), smoking history and blood cotinine levels in healthy volunteers as a control and patients who have COPD in our study.Materials and Methods: One hundred and two COPD patients and 106 healthy volunteers who admitted to our institution wereincluded. Spirometric investigations of the patients and volunteers were performed. A simple, rapid and reliable gas chromatography-mass spectrometry (GC-MS) method was used for determination of cotinine levels in blood samples.Results: The cut-off value of cotinine was determined as 41.12 ng/mL (97.2% sensitivity and 100% specificity). A significant relationship was observed between average pack-year and cotinine level in current smoker group (p< 0.05). The mean cotinine levels were6.1, 8.8, and 467.0 ng mL-1 in never smokers, ex-smokers and current smokers, respectively. No relationship was observed betweencotinine level and FVC%, FEV1% and FEV1/FVC (p> 0.05). In patient group, there was also no relationship between FEF25-75% andcotinine level however, in control group-smokers a negative correlation was found (p< 0.05; r= -0.372).Conclusion: We observed once again with our study that cotinineis a reliable marker of tobacco exposure. The most obvious result isthe negative correlation between FEF25-75% value and cotininelevel and this result may be caused by the effect of smoking in theperipheral airways at early stages of COPD.

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