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Journal of Medical Biochemistry
2019, vol. 38, br. 2, str. 134-144
jezik rada: engleski
vrsta rada: izvorni naučni članak
objavljeno: 10/02/2020
PMC ID: PMC6411002
doi: 10.2478/jomb-2018-0026
Dvostruka uloga poremećaja biomarkera metabolizma minerala kod prevalentnih bolesnika lečenih hemodijalizom - u bolesti kostiju i u vaskularnim kalcifikacijama
aKlinički centar Srbije, Klinika za nefrologiju, Beograd
bKlinički centar Srbije, Klinika za nefrologiju, Beograd + Univerzitet u Beogradu, Medicinski fakultet
cUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za kardiologiju, Beograd
dKlinički centar Srbije, Centar za medicinsku biohemiju, Beograd
eKliničko-bolnički centar Zvezdara, Beograd
fUniverzitet u Beogradu, Medicinski fakultet
gKlinički centar Srbije, Centar za radiologiju i magnetnu rezonancu, Beograd

e-adresa: visnjalezaic@gmail.com

Projekat

Biomarkeri u nefrologiji: procena dijagnostičke i prognostičke vrednosti (MPNTR - 175089)

Sažetak

Uvod: Kalcifikacije krvnih sudova (VC) su prisutne kod velikog broja bolesnika lečenih dijalizom (HD), a njihov nastanak je uslovljen različitim mehanizmima. Postoji mišljenje da promoteri VC prevazilaze lokalni ili sistemski uticajinhibitora VC kod ovih bolesnika. VC povećavaju krutost krvnih sudova i izazivaju hipertrofiju leve komore (LVH). Ova studija je imala za ciljeve da ispita povezanost VC i remodelinga srčanog mišića i da analizira ulogu promotera VC (fibroblast growth factor 23-FGF23, Klotho, intakt parathormon-iPTH, vitamin D) kod 56 prevalentnih HD bolesnika (medijana: starost 54 godine, HD trajanje 82 meseca). Metode: Pored rutinskih laboratorijskih analiza, izmereni su FGF 23, Klotho, iPTH, 1 ,2 5-dihidroksi vitamin D; brzina pulsnog talasa (PWV); LVH pomoću sonografije; a skor VC je određen Adragao metodom. Rezultati: VC su nađene kod 60% a koncentrična i ekscentrična LVH kod 50% bolesnika. Trajanje HD (OR 1,025, p= 0,006), FGF23 (OR 1,006, p= 0,029) i S-magnezijum (OR 0.000, p= 0,04) bili su udruženi sa VC. Promene u geometriji miokarda su bile udružene sa muškim polom (beta=-0,273, p= 0,027), iPTH (beta 0,029, p= 0,027) i lečenjem sa vitaminom D (beta 25,49, p= 0,001). Bolesnici sa vecim VC skorom imali su najviše kategorije LVH. PWV je bila udružena sa starosti bolesnika, koncentracijom holesterola, dijastolnim krvnim pritiskom i LVH (pozitivno) i S-kalcijumom (negativno). Zaključak: Iako su različiti faktori rizika za VC i promene u geometriji miokarda, dobijeni rezultati bi mogli da ukažu na međusobno preplitanje ispitanih faktora kod bolesnika lečenih hemodijalizom. Zbog toga se savetuje pažljiva i stalna korekcija poremecaja u metabolizmu minerala.

Ključne reči

hemodijaliza; kalcifikacije krvnih sudova; remodelovanje miokarda; FGF23; Klotho

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