Derinin T hücreli lenfomalarında tümör m2 piruvat kinaz düzeyinin tanı ve tedavi takibindeki değeri

Abstract

ABSTRACTKirkpantur A. The association of coronary artery calcification, bone mineraldensitometry and serum fetuin-A levels in maintenance hemodialysis patients. HacettepeUniversity School of Medicine, Thesis in Nephrology, Ankara, 2007.Background. Patients with end stage renal disease have a very high prevalance and extent ofarterial calcification. A number of studies suggest that similar pathophysiologic mechanismsare responsible for development and progression of the calcification of atherosclerotic plaqueand bone formation. Fetuin-A of hepatic origin circulates in large amounts in serum, is apotent calcification inhibitor and also is expressed in bone, where it has not-yet well-definedfunctions. The aim of this study was to investigate the relation of bone densitometryparameters,coronary artery calcification and serum fetuin-A levels.Material-Methods. Participants were 72 maintenance hemodialysis patients (39 women and33 men, mean age 54±19 years, on hemodialysis thrice a week) who had radius, hip and spineBMD assessed by dual-energy x-ray absorptiometry and coronary artery calcium score(CACS) measured by electron-beam computed tomography. Coronary artery calcium scoreswere grouped into Group 1 (CACS=0-99) and Group 2 (CACSâ¥100). The associationsbetween site-specific BMD parameters, CACS and serum fetuin-A levels were studied.Results. The CACS, the mass and the volume of plaques in right coronary artery (RCA) andleft circumflex artery were significantly higher in patients with a T-score below (-2) thanabove that in the proximal region of the radius. The mass and the volume of plaques in leftmain coronary artery and in RCA were significantly higher in patients with a T-score below(-2) than above that in the neck region of the femur (hip). The CACS, the mass of plaques inleft anterior descending artery, the mass and the volume of plaques in RCA were more likelyto be high in patients with a T-score below (-2) than above that in the trochanter region of thefemur (p<0,05). Similarly, the mass and the volume of plaques in left main coronary arteryand in RCA were higher in patients with a T-score below (-2) than above that in the lumbarspine (p<0,05). The CACS (328±25 ve 72±6.7, p<0.05), the mass and the volume of plaquesin left main coronary artery (86±25 vS 12±8.3 mm3 and 34±12 ve 4.9±1.6 gr, p<0.05) andright coronary artery (72±18 vs 11±6 mm3 and 33.9±23 vs 26.8±9 gr, p<0.05) are higher inpatients with serum fetuin-A levels <0.6 g/L. Lower T-scores were observed in the proximalregion of the radius (-3.4±1.2 vs -1.8±1.4), the trochanter region of the femur (-2.5±1.6 vs -1.3±1.6) and lumbar spine L1-4 (-2.17±1.5 vs -1.3±1.2) in patients with serum fetuin-A levels<0.6 g/L.Conclusion. The results of the study demonstrates an association between decreased BMDparameters and increased coronary artery calcification in maintenance hemodialysis patients.Fetuin-A, due to its effects in bone metabolism and vascular calcification, appears to beimportant in this association.Key Words: Hemodialysis, vascular calcification, bone mineral density, fetuin-A

ABSTRACTKirkpantur A. The association of coronary artery calcification, bone mineraldensitometry and serum fetuin-A levels in maintenance hemodialysis patients. HacettepeUniversity School of Medicine, Thesis in Nephrology, Ankara, 2007.Background. Patients with end stage renal disease have a very high prevalance and extent ofarterial calcification. A number of studies suggest that similar pathophysiologic mechanismsare responsible for development and progression of the calcification of atherosclerotic plaqueand bone formation. Fetuin-A of hepatic origin circulates in large amounts in serum, is apotent calcification inhibitor and also is expressed in bone, where it has not-yet well-definedfunctions. The aim of this study was to investigate the relation of bone densitometryparameters,coronary artery calcification and serum fetuin-A levels.Material-Methods. Participants were 72 maintenance hemodialysis patients (39 women and33 men, mean age 54±19 years, on hemodialysis thrice a week) who had radius, hip and spineBMD assessed by dual-energy x-ray absorptiometry and coronary artery calcium score(CACS) measured by electron-beam computed tomography. Coronary artery calcium scoreswere grouped into Group 1 (CACS=0-99) and Group 2 (CACSâ¥100). The associationsbetween site-specific BMD parameters, CACS and serum fetuin-A levels were studied.Results. The CACS, the mass and the volume of plaques in right coronary artery (RCA) andleft circumflex artery were significantly higher in patients with a T-score below (-2) thanabove that in the proximal region of the radius. The mass and the volume of plaques in leftmain coronary artery and in RCA were significantly higher in patients with a T-score below(-2) than above that in the neck region of the femur (hip). The CACS, the mass of plaques inleft anterior descending artery, the mass and the volume of plaques in RCA were more likelyto be high in patients with a T-score below (-2) than above that in the trochanter region of thefemur (p<0,05). Similarly, the mass and the volume of plaques in left main coronary arteryand in RCA were higher in patients with a T-score below (-2) than above that in the lumbarspine (p<0,05). The CACS (328±25 ve 72±6.7, p<0.05), the mass and the volume of plaquesin left main coronary artery (86±25 vS 12±8.3 mm3 and 34±12 ve 4.9±1.6 gr, p<0.05) andright coronary artery (72±18 vs 11±6 mm3 and 33.9±23 vs 26.8±9 gr, p<0.05) are higher inpatients with serum fetuin-A levels <0.6 g/L. Lower T-scores were observed in the proximalregion of the radius (-3.4±1.2 vs -1.8±1.4), the trochanter region of the femur (-2.5±1.6 vs -1.3±1.6) and lumbar spine L1-4 (-2.17±1.5 vs -1.3±1.2) in patients with serum fetuin-A levels<0.6 g/L.Conclusion. The results of the study demonstrates an association between decreased BMDparameters and increased coronary artery calcification in maintenance hemodialysis patients.Fetuin-A, due to its effects in bone metabolism and vascular calcification, appears to beimportant in this association.Key Words: Hemodialysis, vascular calcification, bone mineral density, fetuin-A