Kronik gastritli hastalarda plazma total homosistein konsantrasyonları ve helicobacter pylori enfeksiyonu ile ilişkisi

Abstract

ÖZET Homosistein sülfür içeren bir aminoasit olup, vücutta diyetle alınan metionin metabolizması sonucu oluşur. Bu metabolik yolda kompleks enzimatik sitem rol alır ve bu enzimler vitamin B12, B6 ve folatı kofaktör olarak kullanırlar. Vitamin B12 ve folat yetersizliklerinde plazma total homosistein seviyeleri yükselir. Kobalamin ve folat yetersizliklerinde ve bu iki vitamin yetersizliğinin birbirinden ayırımında total homosistein seviyeleri önemlidir. Hafif hiperhomosisteinemi kardiovasküler kalp hastalıkları için bağımsız risk faktörüdür. Açıklanamayan serum kobalamin düzeyi düşüklüğü olan hastalarda Helicobacter pylori infeksiyonunun rolü olduğu düşünülmektedir. Hp tedavisinden sonra serum kobalamin seviyeleri artmaktadır. Bu çalışmanın amacı, Helicobacter pylori tedavisi ile plazma total homosistein seviyelerinde düşme olup olmadığını ve bunların vitamin B12 ve folat ile ilişkisini araştırmak. Bu çalışmaya Hp(+) kronik gastritli 49 hasta dahil edildi. Hastaların hiçbirinde herhangi bir hastalık yoktu ve hastalar herhangi bir ilaç kullanmıyorlardı. Bu hastalara bir haftalık omeprazol (40mg/g), klaritromisin (1gr/g) ve amoksisilin (2gr/g) tedavisi verildi. Bütün hastaların tedaviden önce ve tedaviden bir ay sonra vitamin B12l folat ve total plazma homosistein konsantrasyonları ölçüldü. 49 hastanın 35'inde (%71.4) Hp eradikasyonu sağlandı. Tedaviden sonra plazma total homosistein seviyelerinde azalma gözlendi (p<0.01). Vitamin B12 seviyelerinde belirgin(p<0.001), folat seviyelerinde hafif artma tespit edildi (p>0.05). Plazma total homosistein seviyeleri ile yaş ve kolesterol arasında kuvvetli korelasyon vardı (p<0.01). Fakat üre, kreatinin B12 folat ve trigliseritler arasında herhangi bir korelasyon yoktu (p>0.05). 40Sonuç olarak, Homosistein kardiovasküler kalp hastalığı için bağımsız bir risk faktörüdür. Helicobacter pylori ile homosistein arasındaki ilişkiye dayanarak, Helicobacter pylori kardiovasküler kalp hastalıkları için bir risk faktörüdür denilebilir. Hp(+) hastalarda, beraberinde kardiovasküler risk faktörlerinden biri varsa Hp tedavisi mutlaka yapılmalıdır. 41SUMMARY Plasma Total Homocysteine Concentrations in Patients with Chronic Gastritis and Its Relation with Helicobacter pylori Infections Homocysteine is a sulfur containing amino acid that is formed by demethylation of dietary methionine. Its metabolic pathways are regulated by complex enzymatic systems, which inturn, depend on B12, B6, folat vitamins as cofactors. In deficiencies of folat and B12 vitamins are always contrubute to elevated levels of plasma total homocysteine. Total homocysteine levels are important in diagnosing patients with cobolamin and folat deficiency and in distinguishing between these two vitamin deficiencies. Mild hyperhomocysteinemia is an independent risk factor for cardiovascular heart disease. It is considered that Helicobacter pylori infection has a role in patients with unexplained low serum cobolamin levels, serum cobalamin levels increased after Hp treatment. The aim of this study is, to investigate after Helicobacter pylori treatment plasma homocysteine levels will decrease or not, and is there any relation with vitamin B12 and folat status. 49 Hp(+) patients with chronic gastritis were included in this study. They have no other health problems and they did not take any medications. These patients were received therapy with omeprazole (40mg/d), clarithromycin (1gr/d) and amoxcillin (2gr/d) for one week. We measured all of them vitamin B12, folat and total plasma homocysteine concentrations before treatment and one month after treatment. Hp eradication were achieved in 35 of 49 patients (%71.4). Plasma total homocysteine levels decreased (p<0.01), vitamin B12 levels increased more than folat levels after treatment (p<0.001, p>0.05). There was a significant corelations between plasma homocysteine, age and cholestherol (p<0.01). But no corelations between blood ure nithrogen, creatinine, Bi2, folat and triglycerides (p>0.05). 42

SUMMARY Plasma Total Homocysteine Concentrations in Patients with Chronic Gastritis and Its Relation with Helicobacter pylori Infections Homocysteine is a sulfur containing amino acid that is formed by demethylation of dietary methionine. Its metabolic pathways are regulated by complex enzymatic systems, which inturn, depend on B12, B6, folat vitamins as cofactors. In deficiencies of folat and B12 vitamins are always contrubute to elevated levels of plasma total homocysteine. Total homocysteine levels are important in diagnosing patients with cobolamin and folat deficiency and in distinguishing between these two vitamin deficiencies. Mild hyperhomocysteinemia is an independent risk factor for cardiovascular heart disease. It is considered that Helicobacter pylori infection has a role in patients with unexplained low serum cobolamin levels, serum cobalamin levels increased after Hp treatment. The aim of this study is, to investigate after Helicobacter pylori treatment plasma homocysteine levels will decrease or not, and is there any relation with vitamin B12 and folat status. 49 Hp(+) patients with chronic gastritis were included in this study. They have no other health problems and they did not take any medications. These patients were received therapy with omeprazole (40mg/d), clarithromycin (1gr/d) and amoxcillin (2gr/d) for one week. We measured all of them vitamin B12, folat and total plasma homocysteine concentrations before treatment and one month after treatment. Hp eradication were achieved in 35 of 49 patients (%71.4). Plasma total homocysteine levels decreased (p<0.01), vitamin B12 levels increased more than folat levels after treatment (p<0.001, p>0.05). There was a significant corelations between plasma homocysteine, age and cholestherol (p<0.01). But no corelations between blood ure nithrogen, creatinine, Bi2, folat and triglycerides (p>0.05). 42In conclution, homocysteine is an independent risk factor for cardiovascular heart disease. According to relation with Helicobacter pylori and homocysteine, Hp is a risk factor for cardiovascular heart disease. Hp(+) patients, if they have high risk of cardiovascular heart disease Hp treatment must be given. 43