Uzun süreli sigara kullanımının sistemik ve renal vasküler fonksiyonlara etkisi
The effect of long term cigarette smoking on sistemic and renal vascular functions
Yazar: HASAN ÇAKIR
Danışman: PROF. DR. SANİYE ŞEN
Trakya Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı / Nefroloji Bilim Dalı
Derece: Tıpta Uzmanlık, 2011
Konu: Nefroloji = Nephrology
Dizin: Ateroskleroz = Atherosclerosis ; Böbrek hastalıkları = Kidney diseases ; Böbrek yetmezliği = Kidney failure ; Oksidatif stres = Oxidative stress ; Sigara dumanı kirliliği = Tobacco smoke pollution ; Sigara içme = Smoking ; Tütün = Tobacco ; Vasküler hastalıklar = Vascular diseases ; İnflamasyon = Inflammation

Özet:
Kardiyovasküler hastalıklarda birçok risk faktörünün bir arada oluşu, tek başına sigaraya bağlı riskin ortaya konmasını güçleştirmiştir. Çalışmamızda tanımlanmış hastalığı olmayan, ilaç kullanmayan, sağlıklı 40 sigara içmeyen ve 118 sigara içen bireyde sigara içim süre ve yoğunluğunun erken sistemik ve renal vasküler hasar göstergelerine etkisinin araştırılması amaçlandı. Yaş, kilo, bel çevresi, kan basınçları kontrol grubuna benzer, sigara içen grupta kontrol grubuna göre vücut kitle indeksi, açlık kan şekeri değerleri anlamlı düşük, hemoglobin, hematokrit, lökosit, ortalama eritrosit hacmi, fibrinojen, glomerül filtrasyon hızı değerleri anlamlı yüksek bulunarak (p<0.05), sigaranın metabolik, inflamatuvar ve hematolojik mekanizmalarla sistemik ve renal vasküler hasar oluşturduğu gözlendi. Sigara içen grup günlük içilen sigara tane sayısına, sigara içilen yıla ve paket/yıla göre üç gruba ayrılıp; kısa, orta ve uzun süreli sigara kullanımına göre sistemik ve renal vasküler hasar göstergeleri karşılaştırıldı. Sigara içilen yıla göre gruplar arasında yaş, diastolik kan basıncı, glomerül filtrasyon hızı, fibrinojen, lökosit, hemoglobin, ortalama eritrosit hacmi değerlerinin arttığı, paket/ yıla göre de sistolik kan basıncı, diastolik kan basıncı, glomerül filtrasyon hızı değerleri, lökosit, hemoglobin, c-reaktif protein, fibrinojen, idrar albümin ekskresyonunun idrar kreatinine oranı anlamlı yüksek, açlık kan şekerleri, total kolesterol düşük bulunmuştur (p<0.05). Günlük içilen sigara sayısı arttıkça hemoglobin, ortalama eritrosit hacmi, idrar endotelininin idrar kreatinine oranı, p-Selektin değerlerinin arttığı saptandı.Bulgularımız sağlık sorunu tanımlamayan, genç, yandaş kardiyovasküler risk faktörlerinin olmadığı erkek bireylerde sigaranın sistemik ve vasküler fonksiyonları bozduğunu, orta ve uzun süreli kullanımda renal vasküler etkilenmenin belirginleştiğini ortaya koymuştur.Anahtar kelimeler: Sigara, oksidatif stres, ateroskleroz, renal disfonksiyon

Abstract:
In cardiovascular diseases, many risk factors? taking place altogether has made the risk related to smoking to be put forth difficult. In this study, the effect of the duration and intensity of smoking to early systemic and renal vascular damage markers for 40 nonsmoker and 118 smokers whom have no characterized disease and are under no medical care has been aimed.As the ages, weights, waist perimeters and blood pressures similar to the control group, in the smokers group, the body mass index (0.046) and the fasting blood glucose (0.023) values have been determined to be significantly low, and the hemoglobin (0.0025), hematocrit (0.0001), leukocyte (0.0338), mean erytrocyte volume (0.007), fibrinogen (0.040), glomerular filtration rate (0.0003) values have been determined to be significantly high compared with the control group; as a result it has been observed that smoking has caused systemic and renal vascular damage with the metabolic, inflammatory and hematological mechanisms. Systemic and renal vascular damage markers according to the short-term, medium-term and long-term smoking have been compared by separating the smoking group into three groups according to the number of cigarettes smoked daily, number of years of smoking and the number of packages smoked/year. Among the group according to the number of years of smoking, the age (0.000), diastolic blood pressure (0.003), glomerular filtration rate (0.005), fibrinogen (0.007), leukocyte (0.042), hemoglobin (0.011), mean kerytrocyte volume (0.007) values have increased, and according to the number of packages smoked/year, systolic blood pressure (0.014), diastolic blood pressure (0.020), glomerular filtration rate values (0.017), leukocyte (0.012), hemoglobin (0.011), c-reactive protein (0.009), fibrinogen (0.017), the rate of urinary albumin excretion to urinary creatinine (0.006) have been determined to be significantly high, and the fasting blood glucose (0.002), total cholesterol (0.017) have been found to be low. It has been determined that as the number of cigarettes smoked daily increased, also the hemoglobin (0.003), mean erytrocyte volume (0.008), the rate of urinary endotelin to urinary creatinine (0.013), p-selectin (0.023) values have increased. A significant positive linear relation has been determined between the number of years of smoking and the values of fibrinogen (r = 0.223, p = 0.004), c-reactive protein (r = 0.244, p = 0.008), triglyceride (r = 0.223, p = 0.015), and the fasting blood glucose (r = 0.222, p = 0.016); and a significant negative linear relation has been found again between the number of years of smoking and the value of albumin (r = -0.436, p = 0.000). A significant positive linear relation has been determined between the number of cigarettes smoked daily and the rate of urinary endotelin to urinary creatinine (r = 0.230, p = 0.013) and also the rate of urinary albumin excretion to urinary creatinine (r = 0.213, p = 0.021). A positive linear relation between the number of packages smoked/year and the age (r = 0.639, p= 0.021), serum c-reactive protein (r = 0.258, p = 0.005), fasting blood glucose (r = 0.244, p = 0.008), total cholesterol (r = 0.202, p = 0.028), triglyceride (r = 0.198, p = 0.031), plasma fibrinogen (r = 0.186, p = 0.044) have been obtained, on the other hand, a significant negative linear relation between the number of packages smoked/year and the serum albumin (r = -0.327, p = 0.000) has been determined.The results we obtained showed that smoking has damaged systemic and vascular functions for the young men with no health problem or adherent cardiovascular risk factors; and as a result of medium and long-term smoking, renal vascular influence has become clear.Key words : Cigarette, oxidative stress, atherosclerosis, renal disfunction