Yaşlı Kadınlarda Homosistein Düzeyinin Kırılganlıkla İlişkisi

Year 2022, Volume: 5 Issue: 3, 64 - 71, 31.12.2022

Eral İdil , Alev Çam Mahşer , Mehmet Selman Öntan

https://doi.org/10.47141/geriatrik.1215466

Abstract

Amaç: Kırılganlık; düşme, sakatlık, uzun süreli bakım alma ve ölüm riski ile ilişkilendirilen bir geriatrik sendromdur. Bu nedenle kırılganlığın önceden saptanabilmesi ve önlenebilmesi için kırılganlık ile ilişkili olabilecek belirteçlerinin bulunması oldukça önemlidir. Vitamin B12 ve folik asit eksikliği hiperhomosisteinemiye (HHS) neden olmaktadır. HHS; ateroskleroz, tromboemboli, sarkopeni, kemik rezorbsiyonu gibi birçok olumsuz sonuç ile ilişkilendirilmektedir. Tüm bunlar HHS’yi kırılganlığın önemli bir risk faktörü olarak karşımıza çıkarmaktadır. Çalışmadaki amacımız yaşlı kadınlarda homosistein (HS) düzeyi ile kırılganlık ilişkisini ortaya koymaktır.

Gereç Yöntemler: Retrospektif olarak tasarlanan çalışmamıza 50 yaş üstü, dosya kayıtlarında eksik olmayan 275 kadın hasta dahil edildi. Hastalar HS düzeylerine göre 2 gruba ayrıldı. Hastaların plazma homosistein (HS) değeri için 75. persentile denk gelen 17,2 mmol/L değeri kesme değer olarak alındı. Tüm hastaların kullandıkları ilaç sayısı, sosyodemografik özellikleri, komorbiditeleri, geriatrik sendrom varlığı, laboratuvar sonuçları, ayrıntılı geriatrik değerlendirme (AGD) parametreleri ve kırılganlık durumları kaydedilerek gruplar arası karşılaştırma yapıldı.

Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 75,35±7,41’di. HS seviyesi normal olan hastaların %19,0’ında, HHS olanların %37,3’ünde demans tanısı vardı(p<0,01). Serum HS düzeyi ile serum vitamin B12 ve folik asit düzeyleri arasında düşük düzeyde negatif korelasyon; serum kreatinin düzeyi arasında ise orta düzeyde pozitif korelasyon vardı (p<0.01). HHS’nin, tükenmişlik, düşük yürüme hızı, düşük fiziksel aktiviteyle ilişkili olduğu; dolayısıyla kırılganlık riskini arttırdığı saptandı. Yaş, serum vitamin B12, folik asit, kreatinin düzeyleri ve demans faktörü düzeltildiğinde ise HHS ile kırılganlık arasındaki ilişkinin ortadan kalktığı gözlendi.

Sonuç: Plazma HS seviyesi kırılganlık ile ilişkili olabilir. Hastalarda HS’i yükselten faktörlerin düzeltilmesi, kırılganlığın önlenmesi için de önemli bir strateji olabilir.

Keywords

kırılganlık, homosistein, vitamin B12, folik asit

The Relationship Between Homocysteine Levels and Frailty in Older Women

Abstract

Aim: Frailty is a geriatric syndrome associated with an increased risk of falls, disability, long-term care, and death. Therefore, it is crucial to find indicators that may be associated with frailty in order to detect and prevent frailty in advance. Deficiencies of vitamin B12 and folic acid cause hyperhomocysteinemia (HHC). HHC is associated with many adverse outcomes, such as atherosclerosis, thromboembolism, sarcopenia, and bone resorption. All of these make HHC a critical risk factor for frailty. Our study aims to reveal the relationship between homocysteine (HC) levels and frailty in older women.

Material and Methods: In this retrospective study, we included 275 female patients over 50 years of age whose file records were thorough. The patients were divided into two groups according to their HS levels. 17.2 mmol/L, which corresponds to the 75th percentile, was taken as the patients' cut-off value for plasma homocysteine (HC) levels. For all patients, the number of drugs used, sociodemographic characteristics, comorbidities, presence of geriatric syndrome, laboratory results, comprehensive geriatric assessment (CGA) parameters and frailty status were recorded, and comparisons between groups were made.

Results: The mean age of the patients included in the study was 75.35±7.41 years. Dementia was diagnosed in 19.0% of patients with low HC and 37.3% with HHC (p<0.01). There was a low negative correlation between serum HC and serum vitamin B12 and folic acid levels and a moderate positive correlation between serum creatinine levels (p<0.01). HHS was associated with exhaustion, low walking speed, and low physical activity, increasing the risk of frailty. When age, serum creatinine, vitamin B12, folic acid levels, and dementia factors were corrected, it was observed that the relationship between HHC and frailty disappeared.

Conclusion: Plasma HC level may be associated with frailty. Correction of factors that increase HC in patients may also be an essential strategy for preventing frailty.

Keywords

homocysteine, vitamin B12, folic acid, frailty

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