Publication: Serum Ürik Asit Düzeyi ve Ürik Asit Kreatinin Oranının Koah Şiddeti( Stabil veya Akut Alevlenme) ve Kor Pulmonale Gelişimi İle İlişkisi
Abstract
AMAÇ: Ürik asit yüksekliğinin hipoksemi ve bazı hastalıklara sekonder olarak gelişen pulmoner hipertansiyonla ilişkisini bildiren çalışmalar mevcuttur. Bizim çalışmamızın amacı serum ürik asit düzeyi ve ürik asit/ kreatinin oranının KOAH alevlenmesi, alevlenmedeki hipoksemi ve KOAH'a sekonder gelişen kor pulmonale gelişimi ile ilişkisini araştırmaktır. GEREÇ VE YÖNTEM: Çalışmamıza Ondokuz Mayıs Üniversitesi Tıp Fakültesi acil servisine ve Göğüs Hastalıkları polikliniğine başvuran ve yazılı onamları alınan toplam 96 KOAH hastası alındı. Bu hastaların 43'ü alevlenme döneminde (Grup 1), 53'ü stabil dönemde (Grup 2) hastalardan oluşuyordu. Çalışmamıza; 40 yaş altı ve 80 yaş üstü hastalar, kronik böbrek yetmezliği, gut, interstisyel akciğer hastalığı, aktif malignitesi olanlar ve ürik asit yüksekliğine sebep olabilecek ilaç kullanımı olanlar alınmadı. Hastalarımızın tam kan sayımı, kan biyokimya (serum ürik asit düzeyi dahil), arter kan gazı analizleri yapıldı. Ayrıca spirometri ve ekokardiyografi bulgularına bakıldı. BULGULAR: Çalışmaya alınan toplam 96 hastadan 80'i erkek (%83,3), 16'sı kadın (%16,7), tüm hastaların yaş ortalaması 68,38±8,94 olarak bulundu. Grup 1'de ağır hipoksemisi olan 8, orta hipoksemisi olan 25 ve hafif hipoksemisi olan 8 kişi tespit edildi. Grup 2'de ise hipoksemisi olan hastamız yoktu. Grup 1'in serum ürik asit düzeyi 6,97±1,34, Grup 2'nin ise 4,30±1,01 idi (p<0,05). Serum ürik asit/ kreatinin oranları; Grup 1'de; 8,00±2,06, Grup 2'de; 5,52±1,57 idi (p<0,05). Orta-ağır hipoksemisi olan hasta grubunun serum ürik asit değeri 7,16±1,17, ürik asit/ kreatinin oranı 8,14±1,76, hipoksemik olmayan grubun serum ürik asit değeri 4,63±1,36, ürik asit/ kreatinin oranı 5,84±1,96 olarak bulundu. Hipoksemisi olan hastalarda serum ürik asit düzeyi ve serum ürik asit/kreatinin oranı hipoksemik olmayanlara göre anlamlı olarak daha yüksek bulundu (p<0,05). Ekokardiyografi ile kor pulmonale saptanan 19 kişi Grup 1'de, 5 kişi ise grup 2'de idi. Grup 1 ve 2'de kor pulmonale gelişen tüm hastaların ürik asit düzeyleri 6,37±1,61 iken kor pulmonale gelişmeyenlerde 5,03±1,74 mg/dl olarak bulundu (p<0,05). Kor pulmonale gelişen hastalarda ürik asit/kreatinin oranı 7,56±2,11 , kor pulmonale gelişmeyen hastalarda 6,04±2,10 olarak tespit edildi (p<0,05). Grup 1'in serum ürik asit düzeyi ve serum ürik asit/ kreatinin oranı Grup 2'ye göre anlamlı olarak daha yüksek bulundu (p=0,001). Kor pulmonale gelişen hastaların serum ürik asit düzeyi ve serum ürik asit/ kreatinin oranı kor pulmonale olmayan hastalara göre anlamlı olarak daha yüksek bulundu (p<0,05). SONUÇ: Serum ürik asit düzeyi ve serum ürik asit/kreatinin oranının KOAH'ın alevlenme dönemi hastalarında ve kor pulmonale gelişenlerde daha yüksek olduğu saptandı. Sonuç olarak serum ürik asit düzeyinin ve serum ürik asit/kreatinin oranının KOAH'ın şiddeti ve KOAH'a bağlı kor pulmonale gelişimi konusunda uyarıcı bir laboratuar testi olabileceğini düşündürmektedir. Anahtar Kelimeler: KOAH, Kor Pulmonale, Ürik Asit, Ürik Asit / Kreatinin Oranı
AIM: There are studies reporting that uric acid elevation is a marker for hypoxemia and pulmonary hypertension secondary to some diseases. The aim of our study is to investigate the relationship between serum uric acid level and uric acid / creatinine ratio with COPD exacerbation, hypoxemia in exacerbation and development of cor pulmonale developing secondary to COPD. MATERIAL and METHOD: A total of 96 COPD patients who were admitted to the Ondokuz Mayıs University Faculty of Medicine emergency department and Chest Diseases outpatient clinic and whose written consent was obtained, were included in our study. 43 of these patients were in the period of exacerbation (Group 1) and 53 were in the stable period (Group 2). Patients under 40 years old and over 80 years old, chronic kidney failure, gout, interstitial lung disease, those with active malignancy and those who use drugs that can cause uric acid elevation were not included in our study. Complete blood count, blood biochemistry (including serum uric acid level), and arterial blood gas analysis were performed in our patients. In addition, spirometry and echocardiography findings were examined. RESULTS: Of the 96 patients included in the study, 80 were male (83.3%), 16 were female (16.7%), and the mean age of all patients was 68.38 ± 8.94. In Group 1, 8 people with severe hypoxemia, 25 with moderate hypoxemia and 8 with mild hypoxemia were identified. In Group 2, we did not have a patient with hypoxemia. Serum uric acid level of Group 1 was 6.97 ± 1.34 and Group 2 was 4.30 ± 1.01 (p <0.05). Serum uric acid / creatinine ratios; in group 1; 8.00 ± 2.06 in group 2; It was 5.52 ± 1.57 (p <0.05). Serum uric acid value of the group of patients with moderate to severe hypoxemia is 7.16 ± 1.17, uric acid / creatinine ratio is 8.14 ± 1.76, serum uric acid value of the non-hypoxemic group is 4.63 ± 1.36, uric acid / creatinine ratio was 5.84 ± 1.96. In patients with hypoxemia, serum uric acid level and serum uric acid / creatinine ratio were significantly higher than non-hypoxemic (p <0.05). Nineteen people who were found to have cor pulmonale by echocardiography were in Group 1 and 5 were in Group 2. While uric acid levels of all patients developing cor pulmonale in Groups 1 and 2 were 6.37 ± 1.61, it was found to be 5.03 ± 1.74 mg / dl in those who did not develop cor pulmonale (p <0.05). The uric acid / creatinine ratio was 7.56 ± 2.11 in patients who developed cor pulmonale and 6.04 ± 2.10 in patients who did not develop cor pulmonale (p <0.05). Serum uric acid level and serum uric acid / creatinine ratio of Group 1 were significantly higher than Group 2 (p <0.001). Serum uric acid level and serum uric acid / creatinine ratio of patients who developed cor pulmonale were significantly higher than patients without cor pulmonale (p <0.05). CONCLUSION: Serum uric acid level and serum uric acid / creatinine ratio were found to be higher in patients with exacerbation of COPD and those developing cor pulmonale. Consequently, it suggests that serum uric acid level and serum uric acid / creatinine ratio may be a stimulating laboratory test for the severity of COPD and the development of COPD based cor pulmonale. Keywords: COPD, Cor Pulmonale, Uric Acid, Uric Acid / Creatinine Ratio
AIM: There are studies reporting that uric acid elevation is a marker for hypoxemia and pulmonary hypertension secondary to some diseases. The aim of our study is to investigate the relationship between serum uric acid level and uric acid / creatinine ratio with COPD exacerbation, hypoxemia in exacerbation and development of cor pulmonale developing secondary to COPD. MATERIAL and METHOD: A total of 96 COPD patients who were admitted to the Ondokuz Mayıs University Faculty of Medicine emergency department and Chest Diseases outpatient clinic and whose written consent was obtained, were included in our study. 43 of these patients were in the period of exacerbation (Group 1) and 53 were in the stable period (Group 2). Patients under 40 years old and over 80 years old, chronic kidney failure, gout, interstitial lung disease, those with active malignancy and those who use drugs that can cause uric acid elevation were not included in our study. Complete blood count, blood biochemistry (including serum uric acid level), and arterial blood gas analysis were performed in our patients. In addition, spirometry and echocardiography findings were examined. RESULTS: Of the 96 patients included in the study, 80 were male (83.3%), 16 were female (16.7%), and the mean age of all patients was 68.38 ± 8.94. In Group 1, 8 people with severe hypoxemia, 25 with moderate hypoxemia and 8 with mild hypoxemia were identified. In Group 2, we did not have a patient with hypoxemia. Serum uric acid level of Group 1 was 6.97 ± 1.34 and Group 2 was 4.30 ± 1.01 (p <0.05). Serum uric acid / creatinine ratios; in group 1; 8.00 ± 2.06 in group 2; It was 5.52 ± 1.57 (p <0.05). Serum uric acid value of the group of patients with moderate to severe hypoxemia is 7.16 ± 1.17, uric acid / creatinine ratio is 8.14 ± 1.76, serum uric acid value of the non-hypoxemic group is 4.63 ± 1.36, uric acid / creatinine ratio was 5.84 ± 1.96. In patients with hypoxemia, serum uric acid level and serum uric acid / creatinine ratio were significantly higher than non-hypoxemic (p <0.05). Nineteen people who were found to have cor pulmonale by echocardiography were in Group 1 and 5 were in Group 2. While uric acid levels of all patients developing cor pulmonale in Groups 1 and 2 were 6.37 ± 1.61, it was found to be 5.03 ± 1.74 mg / dl in those who did not develop cor pulmonale (p <0.05). The uric acid / creatinine ratio was 7.56 ± 2.11 in patients who developed cor pulmonale and 6.04 ± 2.10 in patients who did not develop cor pulmonale (p <0.05). Serum uric acid level and serum uric acid / creatinine ratio of Group 1 were significantly higher than Group 2 (p <0.001). Serum uric acid level and serum uric acid / creatinine ratio of patients who developed cor pulmonale were significantly higher than patients without cor pulmonale (p <0.05). CONCLUSION: Serum uric acid level and serum uric acid / creatinine ratio were found to be higher in patients with exacerbation of COPD and those developing cor pulmonale. Consequently, it suggests that serum uric acid level and serum uric acid / creatinine ratio may be a stimulating laboratory test for the severity of COPD and the development of COPD based cor pulmonale. Keywords: COPD, Cor Pulmonale, Uric Acid, Uric Acid / Creatinine Ratio
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