OŠTEĆENJE GASTRODUODENALNE SLUZNICE I TEŽINA KORONARNE ATEROSKLEROZE U BOLESNIKA S KORONARNOM BOLEŠĆU SRCA

Marko Banić, Damir Fabijanić, Duško Kardum, Branimir Anić, Željko Sutlić, Željko Romić, Lidija Petričušić, Damir Bonacin, Milan Kujundžić

Sažetak. Cilj: Zbog visokog stupnja metaboličke aktivnosti i zahtjeva za kisikom ishemija gastroduodenalne (GD) sluznice važan je čimbenik GD oštećenja. Uspoređujući težinu aterosklerotskih promjena na koronarnim arterijama, kao pokazatelj težine ateroskleroze s učestalošću i težinom GD oštećenja, željeli smo istražiti pridonosi li moguća ishemija GD sluznice njezinu oštećenju. Bolesnici i metode: U prospektivno istraživanje uključeno je 150 koronarnih bolesnika, 109 (72,7%) muškaraca i 41 (27,3%) žena, prosječne dobi 62,61±10,23 god. Bilježeni su kliničko-antropometrijski parametri, standard¬ni laboratorijski parametri, liječenje do uključivanja u istraživanje i standardni čimbenici kardiovaskularnog rizika. Težina koronarne bolesti srca (KBS) određena je temeljem: 1) broja zahvaćenih koronarnih arterija, 2) modificiranog Gensinijeva skora i 3) broja stenoza >50%. Težina GD oštećenja određena je modificiranim skorom po Lanzi, a pozitivnost na H. pylori histološkom analizom bioptata GD sluznice. Logističkom regresijom procijenjena je prediktivna vrijednost niza nezavisnih varijabli u odnosu na prisutnost GD oštećenja. Rezultati: Težina KBS u bolesnika s GD oštećenjem i bez njega nije se razlikovala ni po jednom od načina skoriranja: 1) broju zahvaćenih koronarnih arterija (2,15±0,85 prema 2,00±0,87, P=0,292), 2) modificiranom Gensinijevu skoru (71,22±51,78 prema 69,89±54,18, P=0,881), 3) broju stenoza >50% (3,89±2,05 prema 3,47±2,25, P=0,244). Također, nije opažena pozitivna korelacija težine KBS-a i težine oštećenja GD sluznice. Koreliranje broja zahvaćenih koronarnih arterija s Lanzinim skorom rezultiralo je s r=0,029, P=0,721, Gensinijeva skora i Lanzina skora s r=–0,019, P=0,082, a broja stenoza >50% s Lanzinim skorom s r=0,079, P=0,337. Zaključak: Prema dostupnom načinu procjene težine KBS-a, u koronarnih bolesnika ishemija sluznice nema ili ima tek manju ulogu u patogenezi GD oštećenja.

Summary. Aim: Due to high metabolic activity and oxygen demands, ischemia of gastroduodenal (GD) mucosa is an important factor in the pathogenesis of its impairment. Comparing the degree of coronary atherosclerosis, for evaluation of severity of atherosclerosis, with the prevalence and severity of GD mucosal lesions, we wanted to investigate the possible ischemia of GD mucosa could contribute to its impairment. Patients and methods: This prospective study included 150 coronary artery disease (CAD) patients, 109 (72.7 %) male and 41 (27.3 %) female, average age 62.61±10.23 years. We noted clinical and anthropometric parameters, standard laboratory findings, treatment until inclusion into the study and standard cardiovascular risk factors. The severity of CAD was assessed by several parameters: 1) number of coronary arteries affected with atherosclerosis, 2) modified Gensa score, and 3) number of coronary arteries with stenosis >50%. The severity of GD mucosal lesions was assessed by modified Lanza score, and Helicobacter pylori infection was confirmed by biopsy and pathohistological analysis of GD mucosa. Predictive value of different independent factors regarding the presence of GD mucosal lesions was assessed by multivariate analysis. Results: The severity of CAD in patients with or without GD mucosal lesions did not differ by any of used scoring methods: 1) number of coronary arteries affected by atherosclerosis (2.15±0.85 vs. 2.00±0.87, p=0.292), 2) modified Gensa score (71.22±51.78 vs. 69.89±54.18, p=0.881), 3) number of coronary arteries with stenosis >50% (3.89±2.05 vs. 3.47±2.25, p=0.244). We also noticed that there had been no correlation between severity of CAD and severity of GD mucosal lesions. Correlation of number of coronary arteries affected with atherosclerosis with Lanza score resulted in r=0.029, p=0.721, correlation of Genza score with Lanza score resulted in r=0.019, p=0.082, and correlation of the number of coronary arteries with stenosis >50% with Lanza score resulted in r=0.079, p=0.337. Conclusion: According to available method for evaluating the severity of CAD, in CAD patients ischemia has no or very minor role in pathogenesis of GD mucosa impairment.