Regülatör hücrelerin kronik böbrek hastalığına bağlı vaskülopatideki rolü
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kronik Böbrek Hastalığında (KBH) en önemli morbidite ve mortalite nedeni kardiyovasküler hastalıklardır (KVH). KBH'li çocuklarda KVH, gizli ve sinsi olarak başlamaktadır. KVH oluşumunda metabolik ve immünolojik faktörler sorumlu tutulmaktadır ve kardiyovasküler tutulumun KBH'nin hangi evresinde başladığı, sıklığı ve nedeni hakkında kanıtlanmış kesin bir bilgi yoktur. İmmün sistem hücrelerinden T lenfosit ve alt gruplarının ( Th1, Th2, Th17 ), B lenfosit ve alt gruplarının ve bu hücrelerden salınan sitokinler aracılığıyla KBH'ye bağlı KVH ve ateroskleroza katkısı olduğu bildirilmiştir. Fakat immün sistemin hücrelerinin ve salgıladıkları sitokinlerin KVH ve aterosklerozdaki hücresel mekanizması hakkında net bir bilgi yoktur. Bu tez çalışmasında da KBH'ye sahip çocuklarda kardiyovasküler tutulum risklerinin değerlendirilmesi için AIx (Augmentasyon İndeksi), PWV (Nabız Dalga Boyu), CIMT (Karotis İntima-Media Kalınlığı), SVKİ (Sol Ventrikül Kitle İndeksi) gibi arteriyal kalınlık belirteçleri kullanılarak tutulumun hastalığın hangi evresinde başladığı ve bu evrelerdeki Treg (Regülatör T hücresi) hücre düzeyinin tutulumla ilişkisi araştırılmak istenmiştir. Her hastaya ve kontrol grubuna yukarıda sayılan kardiyovasküler tutulum değerlendirme testleri ve Treg hücre düzeyini saptamak için flow sitometrik test uygulanmıştır. Hastaların öncelikle K/DQOI kriterlerine göre KBH evrelendirilmesi yapılmıştır. Hastalar evrelerine göre İki gruba ayrılmıştır. Evre 1,2,3 olanlar grup 1'e; evre 4,5 olanlar grup 2'ye alınmıştır. Grup 1 (n:12) ve grup 2'ye (n:13) alınan her hastada kardiyovasküler tutulum parametreleri değerlendirildiğinde ortalama AIx, ortalama PWV, ortalama CIMT, ortalama SVKİ değeri sağlıklı gruba göre yüksek ve istatistiksel olarak anlamlı saptanmıştır (p<0,05). Grup 1 ve grup 2 kendi aralarında karşılaştırıldığında ortalama AIx değerinin grup 2'de grup 1'ye göre anlamlı yüksek olduğu (p<0,05); ortalama PWV, ortalama CIMT ve ortalama SVKİ değerinin de yüksek olduğu ama istatistiksel bir anlamı olmadığı saptanmıştır (p>0,05). Literatürde KBH'ye bağlı KVH'de Treg hücrelerin hücresel mekanizmada rolünün olup olmadığını bildiren herhangi bir yayın yoktur. Bu çalışmamızda hastalığın evresi arttıkça kardiyovasküler tutulumun arttığı ve Treg hücrelerin düzeyinin düştüğü saptanmıştır. Bu sonuçtan yola çıkarak Treg hücrelerin KBH'li çocuklarda kardiyovasküler tutulumda rolü olabileceğini düşünmekteyiz. Bu tez çalışmasında elde edilen sonuçlar önerilen hipotezi destekler niteliktedir. Hastalığın evresi arttıkça Treg hücre düzeyinin anlamlı derecede düştüğü ve kardiyovasküler riskin de arttığı saptanmıştır
Cardiovascular diseases are an important risk factor for morbidity and mortality on patients with chronic kidney disease (CKD). On patient with CKD, in general cardiovascular diseases (CVD) began as hidden and it has caused of heavy mortality in children. A variety of metabolic and immunologic factors in the development of CVD is being advocated and in which stage begins early cardiovascular involvement is not known. It's reported that T lymphocytes and their subgroups (Th1, Th2, Th17), B lymphocytes and their subgroups and their cytokines are contributed to CKD dependent CVD and atherosclerosis. But, there are no clear knowledge about cellular mechanism of immune cells and their cytokines in CVD and atherosclerosis. In this study we want to determine CVD involvement begin which stage of CKD with using arterial stiffness marker ex. Aix (Augmentation Index), PWV (Pulse Wave Velocity), CIMT (Carotis Intima-Media Thickness), LVMI (Left Ventricul Mass Index) and determine relation between Treg (Regulatory T cell) levels and CVS involvement in those stages in children with CKD. Cardiovascular involvement assessment test which listed above was applied and flow cytometric test was applied to determine Treg levels of each patient and control groups. First, CKD staging were made according to K/DQOI criteria in patient. Patients were classify in accordance with CKD stage. Stage 1,2,3 CKD patients were attached to group 1 and stage 4,5 patients were attached to group 2. When the group 1 and group 2 patients evaluated any CVS involvement in cardiovascular parameters, AIX average, average PWV, the average CIMT, the average LVMI was higher and that value is significantly higher than the healthy group (p<0,05). Group 1 and group 2 compared themselves AIX average value of the group 2 which is significantly higher than group 1 (p <0.05); The average PWV, the average was higher in the value of CIMT and the average LVMI but were not found statistically significant (p> 0.05). Patients in both groups, CD4 + CD25 + FoxP3 + cells Treg) that were analyzed was found to be significantly lower than normal levels of value (p<0,05).Group 2 patients CD4 + CD25 + FoxP3 + Treg cell level compared with patients in group 1 was found to be lower (p<0,05). In the literature there are no reports describing CKD dependent CVD on whether the cellular mechanism of the role of Treg cells. In this study we determined when the stage of the disease was increased, cardiovascular involvement was increased and Treg cells level was decreased. We think that Treg cells may play role in cardiovascular involvement on children with CKD based on this result. The results that obtained in this studies also support the proposed hypothesis. It was determined that as the stage of the disease increased, Treg cells level declined and cardiovascular risk was increased.
Cardiovascular diseases are an important risk factor for morbidity and mortality on patients with chronic kidney disease (CKD). On patient with CKD, in general cardiovascular diseases (CVD) began as hidden and it has caused of heavy mortality in children. A variety of metabolic and immunologic factors in the development of CVD is being advocated and in which stage begins early cardiovascular involvement is not known. It's reported that T lymphocytes and their subgroups (Th1, Th2, Th17), B lymphocytes and their subgroups and their cytokines are contributed to CKD dependent CVD and atherosclerosis. But, there are no clear knowledge about cellular mechanism of immune cells and their cytokines in CVD and atherosclerosis. In this study we want to determine CVD involvement begin which stage of CKD with using arterial stiffness marker ex. Aix (Augmentation Index), PWV (Pulse Wave Velocity), CIMT (Carotis Intima-Media Thickness), LVMI (Left Ventricul Mass Index) and determine relation between Treg (Regulatory T cell) levels and CVS involvement in those stages in children with CKD. Cardiovascular involvement assessment test which listed above was applied and flow cytometric test was applied to determine Treg levels of each patient and control groups. First, CKD staging were made according to K/DQOI criteria in patient. Patients were classify in accordance with CKD stage. Stage 1,2,3 CKD patients were attached to group 1 and stage 4,5 patients were attached to group 2. When the group 1 and group 2 patients evaluated any CVS involvement in cardiovascular parameters, AIX average, average PWV, the average CIMT, the average LVMI was higher and that value is significantly higher than the healthy group (p<0,05). Group 1 and group 2 compared themselves AIX average value of the group 2 which is significantly higher than group 1 (p <0.05); The average PWV, the average was higher in the value of CIMT and the average LVMI but were not found statistically significant (p> 0.05). Patients in both groups, CD4 + CD25 + FoxP3 + cells Treg) that were analyzed was found to be significantly lower than normal levels of value (p<0,05).Group 2 patients CD4 + CD25 + FoxP3 + Treg cell level compared with patients in group 1 was found to be lower (p<0,05). In the literature there are no reports describing CKD dependent CVD on whether the cellular mechanism of the role of Treg cells. In this study we determined when the stage of the disease was increased, cardiovascular involvement was increased and Treg cells level was decreased. We think that Treg cells may play role in cardiovascular involvement on children with CKD based on this result. The results that obtained in this studies also support the proposed hypothesis. It was determined that as the stage of the disease increased, Treg cells level declined and cardiovascular risk was increased.
Açıklama
Anahtar Kelimeler
Nefroloji, Nephrology
