| Abstract | Cilj istraživanja: je istražiti koncentraciju čimbenika privlačenja monocita-1 ili MCP-1 (engl. monocyte chemoattractant protein-1) u serumu bolesnika s psorijatičnim artritisom (PsA) i analizirati međuodnos MCP-1 i aktivnosti bolesti, funkcijskog statusa bolesnika, metaboličkog sindroma, upale i duljine trajanja PsA, zahvaćenosti kožnih promjena psorijazom i subkliničkih oblika kardiovaskularne (KV) bolesti. Ispitanici i metode: Bolesnici sa PsA (n 92) i zdravi ispitanici (n 25) su regrutirani u bolnici “Thalassotherapia - Opatija“ i jednokratno im je uzorkovano 10 ml venske krvi za određivanje sedimentacije, C-reaktivnog proteina, krvne slike, jetrene i bubrežne funkcije, troponina, NTproBNP (engl. N-terminal proBrain Natriuretic Peptide) na hematološkom, odnosno biokemijskom analizatoru. Koncentracija MCP-1 u serumu se analizirala s ELISA (engl. Enzyme Linked Immuno Sorbant Assay). Na reumatološkom pregledu procjenjena je aktivnost osnovne bolesti upitnicima BASDAI (engl. Bath Ankylosing Spondylitis Disease Activity Index) i DAPSA (engl. Disease Activity Index in PSoriatic Arthritis), upala sakroilijakalnog zgloba magnetskom rezonancijom, funkcijska aktivnost bolesnika s BASFI (engl. Bath Ankylosing Spondylitis disease Functional Index) i zahvaćenost kožnih promjena psorijazom BSA (engl. Body Surface Area). Kardiološkom obradom je izmjeren krvni tlak (periferni i centralni) i krutost perifernih arterija, učinjena je ergometrija, višeslojna kompjuterizirana tomografija koronarnih žila bez primjene kontrasta, ultrazvuk srca i ultrazvuk karotidnih arterija. Rezultati: Koncentracija MCP-1 u serumu bolesnika s PsA je viša nego u zdravih ispitanika (P = 0,004) i u statistički je značajnom pozitivnom međuodnosu s koncentracijom ukupnog kolesterola, LDL-kolesterola i glukoze u plazmi, pušenjem cigareta, brojem bolnih zglobova (0-68), izračunom DAPSA, pojedinim sastavnicama BASFI (pitanje 4 - ustajanje iz sjedećeg položaja bez pomoći ruku; pitanje 5 - ustajanje s poda bez pomoći, pitanje 6 - stajanje bez smetnji i pridržavanja 10 minuta i pitanje 9 - obavljanje fizički zahtjevnih poslova), dok izračun BASFI i BASDAI nisu bili povezani s MCP-1. BASFI pitanja 4, 5, 6 i 9 su u statistički značajnom pozitivnom međuodnosu s pulsom, koncentracijom ukupnog kolesterola i LDL-kolesterola. Također su pitanja 4, 5, 6 u negativnom međuodnosu s koncentracijom HDL-kolesterola u plazmi bolesnika s PsA. U statistički značajnom pozitivnom međuodnosu su BASFI pitanja 5, 6 i 9 i indeks tjelesne mase; BASFI pitanje 4 i izračun Framingham ljestvice; BASFI pitanje 5 i koncentracija glukoze, sistolički krvni tlak i tlak pulsa. Ukupna vrijednost DAPSA ljestvice je u značajnom pozitivnom međuodnosu s koncentracijom ukupnog kolesterola, LDL-kolesterola, s vrijednošću sistoličkog krvnog tlaka, tlaka pulsa i pulsom. Broj bolnih zglobova od 0 - 68, je u statistički značajnom međuodnosu s koncentracijom ukupnog kolesterola, LDL-kolesterola, HDL-kolesterola, te sistoličkim krvnim tlakom i pulsom u bolesnika s PsA. Plak u karotidnim arterijama ima 60% bolesnika s PsA. Koncentracija MCP-1 nije povezana s izračunom Framingamske ljestvice, brzinom širenja pulsnog vala, ulaganjem kalcija u koronarne krvne žile, ishodom ergometrije, istisnom frakcijom i globalnim longitudinalnim naprezanjem lijeve klijetke, dimenzijama srčanih šupljina, degenerativnim promjenama aortalnog zalistka, širinom uzlazne aorte, maksimalnom brzinom trikuspidalne regurgitacije, E valom, stupnjem naprezanja pretklijetke u jedinici vremena u ranoj fazi dijastole u bolesnika sa PsA i NTproBNP. Međutim, koncentracija MCP-1 jest u statistički značajnom međuodnosu s E/A omjerom, s A valom, omjerom E/Eʹ, Eʹ valom kao i s naprezanjem pretklijetke u fazi sistole, stupnjem naprezanja pretklijetke u jedinici vremena u kasnoj fazi dijastole. Koncentracija MCP-1 u bolesnika bez porasta NTproBNP ukazuje na dijastoličku disfunkciju u bolesnika s PsA, sa specifičnošću od 86,36% i osjetljivošću od 55%. Zaključak: Istraživanje je doprinjelo boljem shvaćanju patogeneze PsA posredovane s MCP-1 i razvoju komorbiditeta na KV sustavu, odnosno otkrivanju bolesnika s PsA i visokim KV rizikom neovisno o klasičnim čimbenicima rizika. Koncentracija MCP-1 je značajan i neovisan prognostički pokazatelj asimptomatske dijastoličke disfunkcije. |
| Abstract (english) | Aim of the study: is to investigate the concentration of monocyte chemoattractant protein-1 or MCP-1 (monocyte chemoattractant protein-1) in the serum of patients with psoriatic arthritis (PsA) and to analyze the relationship between MCP-1 and disease activity, patient functional status, metabolic syndrome, inflammation and length duration of PsA, involvement of skin changes with psoriasis and subclinical forms of cardiovascular (CV) disease. Material and Methods: Patients with PsA (n 92) and healthy subjects (n 25) were recruited in the hospital "Thalassotherapia - Opatija" and 10 ml of venous blood was sampled once for the determination of sedimentation, C-reactive protein, blood count, liver and kidney function, troponin, NTproBNP (N-terminal proBrain Natriuretic Peptide) on a hematological or biochemical analyzer. The concentration of MCP-1 in serum was analyzed with ELISA (Enzyme Linked Immuno Sorbant Assay). During the rheumatological examination, the activity of the underlying disease was assessed using the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and DAPSA (Disease Activity Index in PSoriatic Arthritis), inflammation of the sacroiliac joint by magnetic resonance, the functional activity of patients with BASFI (Bath Ankylosing Spondylitis disease Functional Index) and involvement of skin changes with psoriasis BSA (Body Surface Area) were estimated. Blood pressure (peripheral and central) and stiffness of peripheral arteries were measured by cardiology, and ergometry, multi-layer computerized tomography of the coronary vessels without the use of contrast, ultrasound of the heart and ultrasound of the carotid arteries were performed. Results: The concentration of MCP-1 in the serum of patients with PsA is higher than in healthy subjects (P = 0.004) and has a statistically significant positive correlation with the concentration of total cholesterol, LDL cholesterol and glucose in the plasma, cigarette smoking, number of painful joints (0 - 68), DAPSA, individual components of BASFI (question 4 - getting up from a sitting position without the help of hands; question 5 - getting up from the floor without help, question 6 - standing without holding for 10 minutes and question 9 - performing physically demanding tasks), while the calculation BASFI and BASDAI were not associated with MCP-1. BASFI questions 4, 5, 6 and 9 have a statistically significant positive correlation with heart rate, total cholesterol and LDL-cholesterol concentration. Also, questions 4, 5, 6 are negatively correlated with HDL-cholesterol concentration in the plasma of patients with PsA. There is a statistically significant positive correlation between BASFI questions 5, 6 and 9 and body mass index; BASFI question 4 and Framingham scale calculation; BASFI question 5 and glucose concentration, systolic blood pressure and pulse pressure. The total value of the DAPSA scale has a significant positive correlation with the concentration of total cholesterol, LDL -cholesterol, with the value of systolic blood pressure, pulse pressure and pulse. The number of painful joints from 0 - 68 has a statistically significant correlation with the concentration of total cholesterol, LDL-cholesterol, HDL-cholesterol, and systolic blood pressure and pulse in patients with PsA. 60% of patients with PsA have plaque in the carotid arteries. The concentration of MCP-1 is not related to the calculation of the Framingham scale, pulse wave velocity, calcium investment in coronary blood vessels, ergometry outcome, ejection fraction and global longitudinal strain of the left ventricle, the dimensions of the heart cavities, degenerative changes of the aortic valve, the width of the ascending aorta, the maximum velocity of tricuspid regurgitation, E wave, degree of atrial strain per unit time in the early phase of diastole in patients with PsA and NTproBNP. However, the concentration of MCP-1 has a statistically significant relationship with the E/A ratio, with the A wave, the E/E' ratio, the E' wave as well as with the atrial strain in the systole phase, the degree of atrial strain per unit of time in the late diastole phase. The concentration of MCP-1 in patients without an increase in NTproBNP indicates diastolic dysfunction in patients with PsA, with a specificity of 86.36% and a sensitivity of 55%. Conclusion: The research contributed to a better understanding of the pathogenesis of PsA mediated by MCP-1 and the development of comorbidities on the CV system, i.e. the detection of patients with PsA and high CV risk independent of classic risk factors. MCP-1 concentration is a significant and independent prognostic indicator of asymptomatic diastolic dysfunction. |
