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Vojnosanitetski pregled
2019, vol. 76, br. 10, str. 979-984
jezik rada: engleski
vrsta rada: izvorni naučni članak
objavljeno: 09/11/2019
doi: 10.2298/VSP170905175M
Creative Commons License 4.0
Prognostički značaj biomarkera inflamacije kod bolesnika sa i bez dijabetesa koji su lečeni primarnom perkutanom koronarnom intervencijom zbog akutnog infarkta miokarda sa elevacijom ST segmenta
aVojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd
bVojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd

e-adresa: veljkomdr@gmail.com

Sažetak

Uvod/Cilj. Iako je poznat prognostički značaj inflamatornih biomarkera kao što su C-reaktivni protein (CRP) i fibrinogen, kod bolesnika sa akutnim infarktom miokarda sa elevacijom ST-segmenta (STEMI), postojanje razlike u zavisnosti od prisustva ili odsustva dijabetesa nije poznato. Metode. Istraživanje je sprovedeno u medicinskom centru tercijernog nivoa. Kod bolesnika sa STEMI, lečenih primarnom perkutanom koronarnom intervencijom (pPKI) merene su vrednosti CRP-a i fibrinogena, u toku prvih 48h od prijema. Bolesnici su bili podeljeni u dve grupe: grupu sa dijabetesom i grupu bez dijabetesa. Cilj rada bio je da se utvrdi prognostički značaj maksimalnih vrednosti ta dva biomarkera zapaljenja za nastanak intrahospitalne i šestomesečne smrtnosti u svakoj od grupa. Rezultati. Među 475 bolesnika, 126 (26,5%) je imalo dijabetes, a 349 (73,5%) nije imalo dijabetes. Bolesnici sa dijabetesom su imali značajno veću vrednost medijane CRP-a i fibrinogena u poređenju sa bolesnicima bez dijabetesa [29,6 (10,4-91,8) vs 22,4 (9,79-49,2) mg/L, p = 0,046 i 4,7 (3,6-6,3) g/L vs 4,3 (3,6-5,4) g/L, p = 0,026]. Međutim, korišćenjem Cox regresione multivarijantne analiza smrtnosti modela pokazano je da su kod bolesnika bez dijabetesa CRP i fibrinogen imali značajnu prognostičku vrednost za nastajanje intrahospitalne smrtnosti [hazard ratio - stopa rizika (HR) = 1,013 95% interval poverenja (CI) (1,004-1,022), p = 0.004 i HR = 1,529, 1,023-2,287 95%CI, p = 0,039]. Kada je u pitanju šestomesečna smrtnost, nije pronađena statistički značajna razlika. Ukupno preživljavanje je bilo najniže u četvrtom kvartilu CRP-a u grupi bolesnika bez dijabetesa. Zaključak. Visoke vrednosti CRP-a su nezavisan prediktor intrahospitalne i ukupne šestomesečne smrtnosti kod bolesnika sa STEMI koji nemaju dijabetes lečenih pPKI. Fibrinogen se takođe može koristiti kao prognostički marker za intrahospitalnu smrtnost kod nedijabetičara sa STEMI.

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