Prematürelerde kordon kanı vasküler endotelyal büyüme faktörü düzeyi ile patent duktus arteriyosus ilişkisinin değerlendirilmesi
The relationship between cord blood vascular endothelial growth factor levels and patent ductus arteriosus of premature infants
Yazar: HAYRETTİN YILDIZ
Danışman: PROF. DR. YILDIZ PERK
İstanbul Üniversitesi / Cerrahpaşa Tıp Fakültesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı / Neonatoloji Bilim Dalı
Derece: Tıpta Uzmanlık, 2009
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases

Özet:
Amaç: Prematürelerde kordon kanı vasküler endotelyal büyüme faktörü(VEGF)'nin patent duktus arteriyozus(PDA) ve diğer morbiditelere etkisini değerlendirmek.Gereç ve Yöntem: 58 pretermde (?34GH) kordon kanında ELISA yöntemiyle VEGF düzeyleri ölçüldü, postnatal 3.günde ekokardiyografiyle PDA varlığı araştırıldı. Olguların özellikleri, eşlik eden respiratuvar distres sendromu(RDS), intraventriküler kanama(İVK) varlığı incelendi.Bulgular: Olguların doğum ağırlığı ort.1619±476(660-2390)g, gebelik yaşı ort.31,3±2,5(25-34) haftaydı. Olgular PDA varlığına göre gruplandırıldı. PDA(+) grupta (n=13), doğum ağırlığı ort.1228±393g, gebelik yaşı ort.29,62±2,96 hafta, VEGF ort.240,4±189,8 pg/ml idi. PDA(-) grupta (n=45), doğum ağırlığı ort.1732±440g, gebelik yaşı ort.31,84±2,15 hafta, VEGF ort.435,1±303,2 pg/ml idi. PDA'lı grupta VEGF anlamlı derecede düşüktü(p=0,038). VEGF eşik değeri 393,35 pg/ml alındığında testin PDA'yı öngörme sensitivitesi %69,2 ve spesifitesi %51,1 bulundu.Olgular RDS varlığına göre gruplandırıldı. RDS(+) grupta (n=20) doğum ağırlığı ort. 1230±401g, gebelik yaşı ort. 29,10±2,61 hafta, VEGF ort.224,4±198,9 pg/ml idi. RDS(-) grupta (n=38) doğum ağırlığı ort.1824±378g, gebelik yaşı ort.32,53±1,43 hafta, VEGF ort.479,9±296,6 pg/ml idi. RDS'li grupta VEGF anlamlı derecede düşüktü (p=0,001). VEGF eşik değeri 353,5 pg/ml olarak alındığında testin RDS'yi öngörme sensitivitesi %75,0 ve spesifitesi %65,8 bulundu.Olgular İVK varlığına göre gruplandırıldı. İVK(+) grupta (n=11) doğum ağırlığı ort. 992±219g, gebelik yaşı ort.28,0±2,83 hafta, VEGF ort.259,2±200,8 pg/ml idi. İVK(-) grupta (n=47) doğum ağırlığı ort.1766±393g, gebelik yaşı ort.32,13±1,66 hafta, VEGF ort.422,4±302,8 pg/ml idi. Gruplar arasındaki VEGF farkı anlamsızdı(p=0,117).VEGF ile Hb düzeyi(r=0,356), trombosit sayısı(r=0,468), doğum ağırlığı(r=0,373) ve gebelik yaşı(r=0,331) arasında arasında anlamlı korelasyon mevcuttu.Sonuç: PDA ve RDS grubunda VEGF düzeyleri anlamlı derecede düşüktü. İVK ile VEGF arasında ilişki saptanmadı. VEGF ile gebelik yaşı, doğum ağırlığı, trombosit ve Hb düzeyleri korele idi. Kordon kanındaki düşük VEGF düzeyi, RDS, PDA, düşük Hb ve düşük trombosit değerleri ile ilişkili bulundu.Anahtar Kelimeler : VEGF, PDA, RDS, prematüre, yenidoğan

Abstract:
Aim: To determine relationship between cord blood vascular endothelial growth factor (VEGF), patent ductus arteriosus (PDA) and other morbidities in premature infants with ? 34 gestational weeks.Material and Method: In this study, cord blood of 58 premature infants (gestational age of 34 weeks and under) collected. Complete blood count, VEGF levels with ELISA method were measured. All cases was evaluated with Doppler echocardiography to determine existence of PDA. Gender, type of delivery, birth weight (BW), gestational age (GA), length of stay during hospitalisation, death rate, accompanying respiratory distress syndrome (RDS) and intraventricular haemorrhage (IVH) were also evaluated. Arithmetical mean, standard deviation, ROC curves, Chi-square, Pearson?s correlation, and Mann-Whitney U test was performed for statistical analysis.Results: Mean birth weight of all cases was 1619±476g and mean gestational age was 31,3±2,5 weeks. All cases were divided to two groups according to birth weight ((under and below 1500g). In the under 1500g group (n=20); mean BW was 1060±227g, mean GA was 28,9±2,3 weeks, male gender rate was 50%, mean VEGF levels was 240,8±203,7 pg/ml, cases with PDA was 10 (50%), cases with RDS was 14 (70%), cases with IVH was 11 (55%), mean lengh of stay was 31,7±25,2 days, death rate was 25%. In below 1500g group (n=38); mean BW was 1913±255g, mean GA was 32,6±1,4 weeks, male gender rate was 44,7%, mean VEGF levels was 470,8±302,1 pg/ml, cases with PDA was 3 (7,9%), cases with RDS was 6 (15,8%), mean lengh of stay was 7,8±6,4 days, there was not any cases of death or IVH. There was statistical significant difference between two groups according to PDA, RDS, IVH, and death rates, VEGF levels, and length of stay parameters (p<0,05).All cases were divided to two groups according to existence of PDA. In the group with PDA(+) cases (n=13); mean BW was 1228±393g, mean GA was 29,62±2,96 weeks, male gender rate was 38,5%, mean VEGF levels was 240,4±189,8 pg/ml, cases with RDS was 8 (61,5%), cases with IVH was 7 (53,8%), mean lengh of stay was 25,9±28,4 days, death rate was 30,8%. In the group with PDA(-) cases (n=45); mean BW was 1732±440g, mean GA was 31,84±2,15 weeks, male gender rate was 48,9%, mean VEGF levels was 435,1±303,2 pg/ml, cases with RDS was 12 (26,7%), cases with IVH was 4 (8,9%), mean lengh of stay was 13,2±14,9 days, death rate was 2,2%. VEGF levels of the cases of PDA(+) group was lower than cases of PDA(-) group at statistically significant degree (p=0,038). When VEGF threshold value specified as 393,35 pg/ml, test?s sensitivity to diagnose PDA was 69,2%, and specifity was 51,1%.All cases were divided to two groups according to existence of RDS. In the group with RDS(+) cases (n=20); mean BW was 1230±401g, mean GA was 29,10±2,61 weeks, male gender rate was 70,2%, mean VEGF levels was 224,4±198,9 pg/ml, cases with PDA was 8 (40,0%), cases with IVH was 9 (45%), mean lengh of stay was 26,9±25,1 days, death rate was 25,0%. In the group with RDS(-) cases (n=38); mean BW was 1824±378g, mean GA was 32,53±1,43 weeks, male gender rate was 34,2%, mean VEGF levels was 479,9±296,6 pg/ml, cases with PDA was 5 (13,2%), cases with IVH was 2 (5,3%), mean lengh of stay was 10,4±12,4 days, and there was not any death. VEGF levels of the cases of RDS(+) group was lower than cases of RDS(-) group at statistically significant degree (p=0,001). When VEGF threshold value specified as 353,5 pg/ml, test?s sensitivity to diagnose RDS was 75,0%, and specifity was 65,8%.All cases were divided to two groups according to existence of IVH. In the group with IVH(+) cases (n=11); mean BW was 992±219g, mean GA was 28,0±2,83 weeks, male gender rate was 45,5%, mean VEGF levels was 259,2±200,8 pg/ml, cases with PDA was 7 (63,6%), cases with RDS was 9 (81,8%), mean lengh of stay was 41,1±30,2 days, death rate was 36,4%. In the group with IVH(-) cases (n=47); mean BW was 1766±393g, mean GA was 32,13±1,66 weeks, male gender rate was 46,8%, mean VEGF levels was 422,4±302,8 pg/ml, cases with PDA was 6 (12,8%), cases with RDS was 11 (23,4%), mean lengh of stay was 10,2±8,8 days, death rate was 2,1%. There was not any significal difference between VEGF levels of two groups (p=0,117).Correlations were evaluated with Pearson?s method. Statistical significant correlations found between VEGF and birth weight (r=0,373), VEGF and gestational age (r=0,331), VEGF and Hb levels (r=0,356), VEGF and platelet counts (r=0,468), Hb and birth weight (r=0,447), platelet count and birth weight (r=3,44).Conclusion VEGF levels were lower in groups with cases of PDA and cases with RDS at statistically significant degree. There was not any relationship between IVH and VEGF levels. VEGF levels were correlated with gestational age, birth weight, Hb levels, and platelet counts. Lower cord blood VEGF levels were associated with RDS, PDA, low Hb levels, and low platelet counts.Key Words: VEGF, PDA, RDS, premature, newborn