Maraş otu ve sigaranın kardiyak otonomi üzerine etkileri

Abstract

Giri : Sigara kardiyovask ler hastal klar a s ndan en nemli nlenebilir risk fakt r d r.Dumans z t t n olarak bilinen ve T rkiye nin G neydo u Anadolu b lgesinde t ketilenMara otu nikotin ba ml l na neden olur. Mara otu sigara yerine veya sigaray b rakmaama l bukkal mukozaya yerle tirilerek kullan l r. Mara otunun kardiyovask ler sisteminas l etkiledi ine dair yeterli literat r verisi yoktur.Sigara inflamasyonu art r c etki g sterir. Total beyaz k re say s ve onun alt tipleriolan n trofil, lenfosit ve n trofil/lenfosit oran (NLO), rik asit, gama-glutamiltransferaz veC-reaktif protein (CRP) sistemik inflamasyonun belirteci olarak kullan labilir. NLO ciddikardiyovask ler hastal olan hastalarda k t sonlan mla ili kilendirilmi tir. Ama NLO nunsigara ve Mara otu kullan c lar ndaki rol ve anlam hakk nda hen z s n rl bilgiye sahibiz.Kardiyak otonomik sinir sistemi (OSS) normal kardiyak elektrofizyolojinin ayarlanmas ndave kardiyak aktivitenin d zenlenmesinde b t nle tirici rol oynar. G nl k pratikte kardiyakOSS yi de erlendirmemize olanak sa layan kalp h z toparlanmas (KHT), Kalp H zDe i kenli i (KHD), kronotropik yan t ve QT dinamisitesi gibi bir ok test vard r fakat butestler sigara ve Mara otu kullan c lar nda OSS nin de erlendirilmesinde uana kadarkullan lmam t r.Bu al ma sigara ve Mara otu kullan c lar nda KHT, KHD, kronotropik yan t, QTdinamisitesi ve inflamasyon durumunu de erlendirme ama l dizayn edildi.Y ntem: al maya 32 sa l kl g n ll , 32 sigara kullan c s ve 30 Mara otu kullan c solmak zere toplam 94 ki i al nd . Beyaz k re say s , rik asit, GGT ve CRP de erleri i inkan rne i al nd . NLO n trofil y zdesinin lenfosit y zdesine b l nmesiyle elde edildi.Kardiyak otonomik sistemin belirte leri olan KHT ve kronotropik yan t de erleri egzersizstres testi, KHD l mleri 24 saatlik Holter EKG parametreleri kullan larak hesapland . Tp-eintervali ve Tp-e/QT oran 12 derivasyonlu elektrokardiyografi kullan larak hesapland , Tp-eintervali kalp h z na g re d zeltildi. T m bu parametreler gruplar aras nda kar la t r ld .Bulgular: NLO, rik asit ve CRP de erlerinde gruplar aras nda farkl l k saptanmad(p>0.05). Lenfosit y zdesi ve GGT de erlerinde gruplar aras nda zay f ama nemli birfarkl l k bulundu (p<0.05). Zirve kalp h z Mara otu kullan c lar nda di er gruplara nazarannemli bir ekilde d k bulundu (p=0.003). Mara otu kullan c lar nda kontrol grubunaivg re nemli bir ekilde kronotropik yetersizlik y zdesi y ksek tespit edildi (p=0.02).D zeltilmi Tp-e intervali ve Tp-e/QT oran nda gruplar aras nda farkl l ksaptanmad (p>0.05).SDNN (T m NN intervallerinin standart sapmas )(p=0.009), RMSDD(Kom u NNintervallerinin aras ndaki farklar n karelerinin toplam al nd ktan sonra ortalamas n nkarek k )(p=0.01) ve LF (D k frekans) (p=0.02) de erleri Mara otu kullan c lar ndakontrol grubuna g re istatistiksel olarak farkl idi. Sigara kullan c lar nda PNN50 (24 saatlikkay tta aras nda 50 msn den daha fazla fark olan ard k NN interval iftinin say s n n totalNN interval say s na oran ) de eri kontrol grubuna g re anlaml olarak d kt (p=0.03).Sigara ve Mara otu kullan c lar n n SDANN (5 dakikal k segmentlerin ortalama NNintervallerinin standart sapmas )( s ras yla p=0.012, p=0.001), HF (Y ksek frekans) (s ras ylap=0.03, p=0.001) ve LF/HF oran (s ras yla p=0.005, p<0.0001) de erleri kontrol grubunag re istatistiksel olarak anlaml farkl l k g stermekte idi.Sonu lar: Mara otu kullan c lar nda ve sigara i enlerde, kontrol grubu ilekar la t r ld nda, 24 saatlik ritim holter EKG testi ile de erlendirilen KHD parametrelerianlaml olarak bozuk idi. NLO, serum rik asit seviyesi ve CRP ile l len inflamatuardurum t m gruplarda benzerdi. Ayn zamanda, ventrik ler repolarizasyonun belirteci olanTp-e intervali ve Tp-e/QT oran da bizim al mam zda t m gruplarda benzer bulundu.Mara otu kullan m n n egzersize kalp h z yan t n nemli bir ekilde azalttığı tespit edildi.Anahtar kelimeler: Kalp h z toparlanmas , Mara otu, N/L oran , sigara kullan m , Tp-eintervali, Tp-e/QT oranı

Purpose: Smoking is the most preventable risk factor for cardiovascular diseases. A kind ofsmokeless tobacco known as Maras powder, which is used in the southeastern region ofTurkey, causes nicotine dependence. Maras powder is used by the addicts through buccalmucosa instead of cigarette or to give up smoking. Its negative effects on cardiovascularsystem could not yet fully understood.Smoking leads to an increased inflammatory activity. The total white blood cell countand its subtypes, such as neutrophil, lymphocyte, and neutrophil/ lymphocyte ratio (NLR),uric acid, gamma-glutamyltransferase (GGT) and C-reactive protein (CRP) can be used as anindicator of systemic inflammation. NLR has been associated with poor outcomes in patientswith several cardiovascular diseases. However, there is limited data about the role of NLR insubjects with smokers and Maras powder users. Cardiac autonomic nervous system (ANS)plays an integral role in the modulation of normal cardiac electrophysiology and regulatingcardiac activity. In daily practice, cardiac ANS can be evaluated by several tools like heartrate recovery (HRR), heart rate variability (HRV), chronotropic response, and QTdynamicity; however, these methodologies has not been used to evaluate ANS in smokersand Maras powder users.The present study was designed to evaluate HRR, HRV, chronotropic response, QTdynamicity, and inflammatory status in smokers and Maras powder users.Design and Methods: Study population consisted of 92 male subjects: 32 non-smoker andnon Maras powder user healthy volunteers, 32 cigarette smokers, and 30 Maras powder users.Blood samples were taken for total white blood cell count, uric acid, GGT and CRP. The NLRwas calculated by dividing neutrophil percentage to lymphocyte. Cardiac ANS indicesincluding HRR and chronotropic response were calculated from exercise stress testparameters. HRV parameters were measured from 24-hour rhythm holter ECG. The Tp-einterval and Tp-e/QT ratio were measured from a 12-lead electrocardiogram, and the Tp-einterval corrected for heart rate. These parameters were compared among groups.Results: NLR,uric acid, and CRP were not different among groups (p>0.05). The percentageof lymphocytes and GGT levels were weakly but significantly different among groups(p<0.05). Peak heart rate was significantly lower in Maras powder users (p=0.003). Thepercentage of chronotropic incompetence in Maras powder users was significantly highervithan controls (p=0.02). Corrected Tp-e interval and Tp-e/QT ratio were not different amonggroups (p>0.05).SDNN (Standard deviations of all N N intervals) (p = 0.009), RMSDD (The rootmean square of the difference in successive R R intervals) (p = 0.01) and LF (lowfrequency) (p = 0.02) values were statistically different in Maras powder users than thecontrol group. PNN50 (the percentage of adjacent R-R intervals that varied by more than50ms) value was significantly lower in smokers than the control group (p = 0.03).Smoking and Maras powder users' SDANN ( the standard deviation of the averagednormal RR intervals for all 5-min segments ) (p = 0.012, p = 0.001), HF (high frequency) (p= 0.03, p = 0.001) and LF / HF ratio (p = 0.005, p <0.0001) parameters were statisticallydifferent than the control group.Conclusion: HRV parameters measured by 24-hour rhythm holter ECG in Maras powderusers and cigarette smokers, compared with the control group, were significantly impaired.Inflammatory status measured by NLR, serum levels of uric acid, and CRP were similar insubjects with healthy volunteers, smokers and Maras powder users. Also, Tp-e interval andTp-e/QT ratio as indices of ventricular repolarisation were similar in our study population.The use of Maras powder was significantly attenuated heart rate response to exercise.Key words: Heart rate recovery, Maras powder, N / L ratio, smoking, Tp-e interval,Tp-e/QT ratio