Koroner arter bypass cerrahisinde ramiprilin miyokardiyal hasar ve inflamatuvar yanıttaki etkisi üzerinde sitokin gen polimorfizmlerinin rolü

Yıl 2017, Cilt: 42 Sayı: 3, 436 - 445, 30.09.2017

Meral Urhan Küçük , Kerem Karaca Seyhan Şahan Fırat Özden , Vezir Necmiye Canacankatan Barlas Naim Aytaçoğlu Sema Erden Bahar Tunçtan Nehir Sucu

https://doi.org/10.17826/cutf.323386

Öz

Amaç: Ramipril, inflamatuar miyokardial hasarın tedavisinde TNF-α, IL-6 ve IL-8 gibi sitokin seviyelerini azaltarak etkili olmaktadır. Çalışmamızda, ramipril tedavisinin, koroner arter bypass cerrahisi esnasında oluşan inflamatuar yanıt ve miyokardiyal hasara yönelik etkisi üzerinde, sitokin gen polimorfizmlerinin herhangi bir rolü olup olmadığını araştırdık. 

Gereç ve Yöntem: Çalışmamıza, koroner arter bypass cerrahisi uygulanan hastalardan cerrahi öncesi ramipril alan 51, kontrol grubu olarak ise ramipril almayan  51 olmak üzere toplam 102 hasta dahil edildi. Her iki grupta, anestezi başlamadan hemen önce (t1), kros klemp sonrası 20. dakikada (t2), ameliyatın sonunda  (t3) ve anestezinin başlangıcından 24 saat sonra (t4) alınan kan örneklerinden TNFα, IL-6,  IL-8 ve TnT serum düzeyleri ELISA yöntemi ile, genotipleme ise PCR-RFLP yöntemleri ile belirlendi. 

Bulgular: Her iki grupta TNF-α artışı cerrahi ile başlarken, IL-6 ve IL-8 artışı kardiyopulmoner bypass sırasında kardiyak arrestle başlayıp ameliyat sonuna kadar devam etmiştir. Postoperatif dönemde ise sadece IL-8 kontrol grubunda yüksek kalırken; çalışma grubunda TNF-α, IL-6, IL-8 düşüşe geçmektedir. t3 zaman aralığında IL-6, t4 zamanında TNFα değerlerinde anlamlı azalma gözlenmiştir. 

Sonuç: Ramiprilin kardiyak arrest sonrası sitokin ve TnT düzeylerini azaltarak inflamatuar miyokardiyal hasarı önlemede yeri olabilir. 

Anahtar Kelimeler

ACE inhibitörleri, sitokin, polimorfizm

Role of cytokine gene polymorphisms on ramipril-altered inflammatory response and myocardial injury in patients undergoing coronary artery bypass surgery

Öz

Purpose: Ramipril is effective in treating inflammatory myocardial injury by reducing cytokines such as TNF-α, IL-6, and IL-8. In this study, we investigated the effect of cytokine gene polymorphisms on inflammatory response which might be reduced by ramipril.

Material and Methods: Of 102 patients undergoing on-pump coronary artery bypass grafting surgery, 51 were the treatment group which received ramipril and the remaining 51 were the non-treated  control group. TNF-α, IL-6, and IL-8 were measured with Enzyme-Linked Immuno Sorbent Assay (ELISA), before anesthesia induction (t1), at 20 min following cross clamping (t2), at the end of the operation (t3), and 24 hours after anesthesia (t4). Genotyping was performed with PCR method. 

Results: While TNF-α increase began with surgery, IL-6 and IL-8 increase began with cardiac arrest during cardiopulmonary bypass and continued until the end of the operation. In contrast, only IL-8 remained high in the control group during the postoperative period, while TNF-α, IL-6, and IL-8 began to decrease. The decreases in IL-6 at t3 and in TNF-α at t4 were significant. 

Conclusion: Ramipril might have a role in preventing inflammatory myocardial injury by reducing cytokine and TnT levels after cardiac arrest. 

Anahtar Kelimeler

ACE inhibitors; cytokines, polymorphism

Kaynakça

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