15 research outputs found
Treatment of hypertension in diabetes
Celem leczenia nadci艣nienia t臋tniczego w cukrzycy
jest uzyskanie warto艣ci ci艣nienia poni偶ej 130/80 mm Hg,
ochrona wa偶nych dla 偶ycia narz膮d贸w, zmniejszenie
liczby incydent贸w sercowo-naczyniowych oraz
zmniejszenie og贸lnej 艣miertelno艣ci. Leczenie nadci艣nienia
t臋tniczego w cukrzycy ma charakter kompleksowy.
Terapia niefarmakologiczna obejmuje stosowanie
diety cukrzycowej oraz wysi艂ku fizycznego,
natomiast w leczeniu farmakologicznym stosuje si臋:
inhibitory konwertazy angiotensyny II (ACE, angiotensin-
converting enzyme), leki moczop臋dne lub
β-adrenolityczne oraz blokery kana艂贸w wapniowych.
Inne leki, kt贸re wykorzystuje si臋 w leczeniu, to blokery
receptora angiotensyny II (AT1), blokery α1-adrenergiczne
i agoni艣ci receptor贸w imidazolowych I1.
Inhibitory konwertazy angiotensyny II uwa偶a si臋 za
leki pierwszego rzutu w terapii nadci艣nienia t臋tniczego
u chorych na cukrzyc臋. Wykazano, 偶e dzia艂aj膮
one nefro- i kardioprotekcyjnie. Stosowanie inhibitor贸w
ACE zmniejsza ryzyko powik艂a艅 i zgonu z powodu
chor贸b uk艂adu kr膮偶enia. Lekami drugiego rzutu
stosowanymi w zale偶no艣ci od chor贸b wsp贸艂wyst臋puj膮cych
s膮 diuretyki lub leki β-adrenolityczne.
Wskazaniami do zastosowania lek贸w β-adrenolitycznych
s膮: choroba niedokrwienna serca, przebyty
zawa艂 lub zastoinowa niewydolno艣膰 serca. Blokery
kana艂贸w wapniowych nie nasilaj膮 zaburze艅 lipidowych,
a tak偶e nie pogarszaj膮 tolerancji glukozy; niedihydropirydynowi
antagoni艣ci wapnia zmniejszaj膮 bia艂komocz; lek贸w α1-adrenolitycznych nie zaleca si臋
w monoterapii u chorych na cukrzyc臋; AT1 podaje
si臋 w przypadkach z艂ej tolerancji inhibitor贸w ACE.
Obecnie nie ma d艂ugoterminowych bada艅 na temat
dzia艂ania agonist贸w receptor贸w imidazolowych I1.
W dotychczasowych obserwacjach nie wykazano ich
niekorzystnego wp艂ywu na metabolizm w臋glowodan贸w
i profil lipidowy. U chorych na cukrzyc臋 leczenie
nadci艣nienia t臋tniczego nale偶y ustala膰 indywidualnie
dla ka偶dego pacjenta w zale偶no艣ci od
schorze艅 towarzysz膮cych. Korzystne skutki powoduje
terapia skojarzona z zastosowaniem ma艂ych lub
艣rednich dawek lek贸w hipotensyjnych.The goal of the treatment of hypertension in diabetes
should include values of blood pressure below
130/80 mm Hg, protection of vital life organs, decrease
of cardio-vascular events and lowering general
mortality. Treatment of hypertension in diabetes
is very complex. Non-pharmacological treatment
includes following diabetic diet and exercise regime.
Pharmacological treatment includes angiotensin
I converting enzyme inhibitors (ACE-I), diuretics,
β-blockers, and calcium channel blockers. Other
agents used in hypertension treatment are angiotensin
II receptor blockers (AT1), α-blockers, imidazol
receptor agonists. ACE-I inhibitors are considered
first-choice drugs in the therapy of hypertension
in the patients with diabetes. It has been proved
that they exhibit nefro- and cardioprotective
properties. The use of ACE-I inhibitors decreases the
risk of complications and death due to cardiovascular
system complications. The agents, which
should be recommended as second-line, are diuretics and β-blockers depending on concomitant diseases.
The indications for the application of β-blockers include
ischaemic heart disease, the history of myocardial
infarction and congestive heart failure. Calcium
channel blockers have no effect on lipid disturbances
and do not impair glucose tolerance. Non-dihydropirydyne
calcium antagonists decrease proteinuria.
Alpha-blockers are not recommended in
monotherapy for the patients with diabetes. AT1
receptor antagonists are to be considered in case of
ACE-I inhibitors intolerance. Recently there have
been no long-term studies available for the assessment
of imidazol — receptor agonists. Up till now
no observations have proved their influence on carbohydrates
metabolism and lipid profile. In the patients
with diabetes an individual treatment of hypertension
is important which should be also chosen
depending on co-existing diseases. Combined
treatment using small doses of hypotensive agents
is usually effective
The radiological situation before and after Chernobyl disaster
Najwi臋ksza katastrofa ekologiczna w historii ludzko艣ci -
wybuch w elektrowni j膮drowej w Czarnobylu - nast膮pi艂a
26 kwietnia 1986 roku. W niniejszej pracy om贸wiono dost臋pne
dane na temat tego zdarzenia, na tle innych naturalnych
i sztucznych 藕r贸de艂 promieniowania. Wed艂ug najnowszych
danych do atmosfery przedosta艂o si臋 oko艂o 5300 PBq
ca艂kowitej aktywno艣ci radionuklid贸w, wy艂膮czaj膮c gazy szlachetne,
w tym oko艂o 1760 PBq 131I i 85 PBq 137Cs. Najwi臋ksze
dawki promieniowania otrzymali „likwidatorzy” (0,8-16 Gy),
troch臋 mniejsze - ludno艣膰 ewakuowana i zamieszkuj膮ca
ska偶one tereny. W艣r贸d kraj贸w europejskich oddalonych od
miejsca zdarzenia 艣rednia roczna dawka promieniowania na
ca艂e cia艂o w pierwszym roku po awarii najwi臋ksza by艂a
w Bu艂garii (760 µSv), Austrii (670 µSv) i Grecji (590 µSv),
natomiast najni偶sza w Portugalii (1,8 µSv) i Hiszpanii (4,2 µSv).
W Polsce efektywny r贸wnowa偶nik dawki obci膮偶aj膮cej
w wyniku awarii w Czarnobylu szacowano 艣rednio na 932 µSv
i by艂 on zbli偶ony do dawki granicznej obowi膮zuj膮cej na terenie
kraju, kt贸ra wynosi 1 mSv/rok. Du偶e dawki napromieniowania
tarczycy otrzymali mieszka艅cy by艂ego wojew贸dztwa
bialskopodlaskiego, nowos膮deckiego oraz z regionu
p贸艂nocno-wschodniej Polski. Najmniejsze za艣 mieszka艅cy
by艂ego wojew贸dztwa s艂upskiego i rzeszowskiego.The nuclear reactor accident, which occurred on 26 April 1986
at Chernobyl, has been one of the greatest ecological disasters
in human history. In our study we discussed the most recent
data on the accident, and the natural and synthetic sources of
radiation. According to the recent data, the air at Chernobyl
had been contaminated with about 5300 PBq radionuclide activity
(excluding rare gases), including 1760 PBq 131I and 85 PBq
137Cs. The highest radiation received by the liquidators (0.8-16
Gy), lower doses were received by the population which was
evacuated or inhabited the contaminated areas (in which the
level of 137Cs activity deposited in the earth was 37 kBq/m2). In
the European countries the highest mean radiation dose per
year for the whole body in the first year after the accident was
in Bulgaria (760 µSv), Austria (670 µSv) and Greece (590 µSv),
while the lowest radiation dose was observed in Portugal (1.8
µSv) and Spain (4.2 µSv). In Poland the mean effective equivalent
dose resulting from Chernobyl accident was 932 µSv and
is close to the limited dose permitted in Poland, equalling 1
mSv/year. The highest radiation dose to thyroid was received
by inhabitants of the states previously known as Bielskopodlaskie,
Nowosadeckie and the north-east region of Poland.
Lowest dose was received by inhabitants of the areas previously
known as Slupski and Rzeszowski
Thiazolidinediones and insulin resistance
Tiazolidinediony s膮 stosunkowo now膮 grup膮 lek贸w przeciwcukrzycowych, kt贸re zwi臋kszaj膮
wra偶liwo艣膰 na insulin臋 tkanek w膮troby, kom贸rek t艂uszczowych i mi臋艣ni, a w efekcie
poprawiaj膮 obwodowe zu偶ycie glukozy. G艂贸wnym mechanizmem ich dzia艂ania jest pobudzanie
j膮drowego receptora aktywowanego proliferatorem peroksysom贸w PPARg
(agoni艣ci PPARg). Receptor ten kontroluje r贸偶nicowanie
adipocyt贸w, magazynowanie t艂uszcz贸w i wra偶liwo艣膰 na insulin臋. Tiazolidinediony
wp艂ywaj膮 na proliferacj臋 kom贸rek i parametry gospodarki lipidowej, zwi臋kszaj膮
bezt艂uszczow膮 mas臋 cia艂a, a zmniejszaj膮 ca艂kowit膮 zawarto艣膰 tkanki t艂uszczowej
w organizmie oraz ekspresj臋 leptyny i czynnika nekrotyzuj膮cego guza (TNF-a,
tumor nercosis factor).Thiazolidenediones - insulin sensitisers - are a relatively new class of antidiabetic
agents which enhance sensitivity to insulin in the liver, adipose tissue and muscles,
resulting in improved insulin-mediated glucose disposal. They works through activation
of the peroxisome proliferator - activated receptor g,
a nuclear receptor that expression of several genes involved in metabolism. This
receptor controls adipocyte differentiation, lipid storage and insulin sensitization.
Thiazolidinediones have effects on cell proliferation and tumorigenesis. Gliatazones
have influence on lipids parameters, increase lean body mass and decrease total
body fat. They reduce expression of leptin and tumor necrosis factor
The effect of Chernobyl accident on the development of non malignant diseases
Do wczesnych skutk贸w zdrowotnych katastrofy w Czarnobylu
nale偶y przede wszystkim ostra choroba popromienna,
kt贸rej objawy wyst膮pi艂y u 134 najbardziej nara偶onych
na promieniowanie jonizuj膮ce os贸b. W ci膮gu pierwszych
100 dni po katastrofie zanotowano 28 zgon贸w. W p贸藕niejszym
okresie w艣r贸d os贸b zamieszkuj膮cych ska偶one tereny
zaobserwowano wzrost wyst臋powania choroby wie艅cowej,
chor贸b hematologicznych, dermatologicznych i innych.
W niniejszej pracy om贸wiono wp艂yw promieniowania jonizuj膮cego
pochodz膮cego z elektrowni w Czarnobylu na
przebieg ci膮偶y i cz臋sto艣膰 wad wrodzonych. Zmiany, kt贸re
nast膮pi艂y po awarii w Czarnobylu, takie jak przesiedlenia
czy zamieszkiwanie na ska偶onych terenach w po艂膮czeniu
z przemianami politycznymi i ekonomicznymi sta艂y si臋
przyczyn膮 rozwoju depresji, l臋ku czy wr臋cz „epidemii” chor贸b
psychosomatycznych. W populacji dotkni臋tej katastrof膮
wykazano wzrost liczby samob贸jstw, okalecze艅, wypadk贸w
samochodowych, nadu偶ywania alkoholu i lek贸w. W艣r贸d
ukrai艅skich dzieci cz臋sto obserwowano nerwic臋 wegetatywn膮.
Prowadzenie bada艅 epidemiologicznych nad skutkami
zdrowotnymi i wielko艣ci poch艂oni臋tej dawki promieniowania
jonizuj膮cego po wypadku w Czarnobylu jest do艣膰
trudne, mi臋dzy innymi ze wzgl臋du na brak wiarygodnych
danych dotycz膮cych zapadalno艣ci na poszczeg贸lne choroby
na terenach ska偶onych przed katastrof膮.The early medical complications of Chernobyl accident include
post radiation disease, which were diagnosed in 134
subjects affected by ionizing radiation. 28 persons died during
the first 100 days after the event. The increase occurrence
of coronary heart disease, endocrine, haematological,
dermatological and other diseases were observed after
disaster in the contaminated territories. We also discussed
the impact of ionizing radiation from Chernobyl accident
on pregnancy and congenital defects occurrence. Changes
following the Chernobyl accident, as the inhabitants migration
from contaminated regions, political and economic conversions,
led to depression, anxiety, and even to “epidemic”
of mental diseases. Increased suicide rate, car accidents,
alcohol and drug abuse have been observed in this population.
Nowadays vegetative neurosis is more often diagnosed
in Ukrainian children. Epidemiological studies were
conducted on the ionising radiation effect on the health and
on the dose of received radiation after Chernobyl accident
face numerous problems as the absence of reliable data regarding
diseases in the contaminated territories
The effect of Chernobyl accident on the development of malignant diseases - situation after 20 years
Wybuch, jaki mia艂 miejsce w elektrowni atomowej w Czarnobylu
w 1986 roku, spowodowa艂 uwolnienie do atmosfery
znacznych ilo艣ci izotop贸w promieniotw贸rczych, w tym jodu,
wzbudzaj膮c tym samym obawy dotycz膮ce mo偶liwo艣ci zaburze艅
struktury i funkcji gruczo艂u tarczowego, a szczeg贸lnie
schorze艅 nowotworowych. Wed艂ug niekt贸rych szacunk贸w
w nast臋pstwie awarii nast膮pi艂o 700 zgon贸w z powodu raka
tarczycy na terytorium Rosji, Ukrainy i Bia艂orusi.
W niniejszej pracy om贸wiono wyst臋powanie raka tarczycy
w r贸偶nych regionach 艣wiata, a szczeg贸lnie na najbardziej
ska偶onych terenach Ukrainy i Bia艂orusi. Zwr贸cono uwag臋
na zale偶no艣膰 mi臋dzy dawk膮 promieniowania jonizuj膮cego
na tarczyc臋 a rozwojem raka. W badaniach przeprowadzonych
w Mi艅sku stwierdzono 40-krotny wzrost liczby zachorowa艅
na raka tarczycy w latach 1986-1994 w por贸wnaniu
z okresem 1977-1985. Dane z innych kraj贸w r贸wnie偶 wskazuj膮
na zwi臋kszenie zapadalno艣ci na nowotwory tarczycy
po awarii w Czarnobylu w dalszym ci膮gu omawia si臋 wp艂yw
czynnik贸w, takich jak mo偶liwo艣ci diagnostyczne, poziom
opieki medycznej oraz czynniki socjalne i 艣rodowiskowe,
g艂贸wnie st臋偶enie jodu w wodach i glebie. W pracy om贸wiono
r贸wnie偶 wyniki bada艅 z zakresu biologii molekularnej w rakach, mi臋dzy innymi translokacj臋 RET - RET/PTC1
u doros艂ych i RET/PTC3 u dzieci oraz ekspresj臋 Axl i Gas6.
Dyskusji poddano tak偶e inne schorzenia tarczycy, wi膮zane
z oddzia艂ywaniem promieniowania jonizuj膮cego po awarii
w Czarnobylu, mi臋dzy innymi wole guzkowe, torbiele, zaburzenia
funkcji tarczycy i zaburzenia immunologiczne.
Wyniki bada艅 z region贸w bliskich Czarnobyla nie wykaza艂y
zwi臋kszonego ryzyka rozwoju bia艂aczki, ch艂oniak贸w ziarniczych
i nieziarniczych w latach 1986-1996. W pracy om贸wiono
ponadto epidemiologi臋 schorze艅 tarczycy w Polsce.The accident that occurred at the Chernobyl Nuclear Power
Plant in 1986, released large quantities of radionuclides
- among them radioiodine - into the atmosphere, thereby
raising public concerns about its influence on thyroid
structure and function, especially the development of malignancy.
There were even reports about 700 deaths due to
thyroid carcinoma in Russian Federation, Ukraine and Belarus,
resulting from the accident. In this review we discussed
the incidence of thyroid cancer in different parts of the
world, especially in heavily contaminated countries, as
Ukraine and Belarus, and the possible link between radioisotope
activity in the thyroid and the development of malignancy.
The study carried out in Minsk showed 40-fold increase of
the incidence of thyroid cancer in the years 1986-1994, in
comparison to the period 1977-1985. An increase of the incidence
of thyroid cancer has generally been observed in
many countries after the Chernobyl accident. We focused
on the factors that may have an influence on this phenomenon,
especially diagnostic tests, health care, social and
environmental factors, like iodine level in water and soil.
The results of molecular biology studies, e.g. RET translocation
in carcinoma type RET/PTC1 in elderly and RET/PTC3 in children, and expression Ax1 and Gas6 in children were
reviewed as well. We also mentioned other thyroid diseases,
like nodular goitre, cysts, the disturbance of thyroid
function and autoimmunity, possibly linked to the radiation
after Chernobyl accident. Data obtained from the regions
near Chernobyl showed no increased risk of other
types of malignancy (leukaemia, Hodgkin’s and non Hodgkin’s
lymphoma) in 1986-1996. In this article the epidemiology
of thyroid diseases in Poland was also reviewed
The influence of non-radioactive iodine (127I) on the outcome of radioiodine (131I) therapy in patients with Graves’ disease and toxic nodular goitre
BACKGROUND: The aim of the study was to achieve an effective
target dose in the thyroid by increasing the effective half-life
(Teff) of 131I by use of iodide (127I) two days after 131I therapy in
patients with hyperthyroidism with low Teff.
MATERIAL AND METHODS: The study was carried out in two
groups. Group A — 41 patients, and Group B — 14 patients,
all the patients were with hyperthyroidism with Teff less than 3
days qualified for 131I therapy. Only group A patients received
600 μg of iodide a day for 3 days, two days after 131I therapy.
Radioiodine uptake (RAIU) after 24 and 48 hours, thyroid
scintiscan and ultrasonography were done before and after 12
months of 131I therapy.
RESULTS: In group A a significant increase was seen in the Teff
(5 days on average) resulting in an increase in the energy target
dose by 28% and 37%, in patients with Graves’ disease (GD) and
toxic nodular goitre (TNG), respectively. After one year of therapy 50% of GD and 93% of TNG patients achieved euthyroidism;
28% of GD and 3% of TNG patients were in hypothyroidism. In
Group B, all the patients had radioiodine treatment failure and
received a second therapeutic dose of 131I.
CONCLUSIONS: Administration of 127I after 131I treatment can
lead to an increase in its effective half-life. This will also increase
the absorbed energy dose in thyroid tissue, thereby improving
therapeutic outcome without administration of a higher or
second dose of 131I. This may minimize whole-body exposure
to radiation and reduces the cost of treatment.
Nuclear Med Rev 2011; 14, 1: 9–1
Circulating monocyte chemoattractant protein-1 in women with gestational diabetes.
Monocyte chemoattractant protein 1 (MCP-1) has been implicated as a key factor in the recruitment and activation of peripheral blood leukocytes in atherosclerotic lesions and adipose tissue. Elevated levels of circulating MCP-1 have been found in patients with type 1 and type 2 diabetes, as well as with coronary artery disease. In this study we compared serum MCP-1 concentrations between pregnant women with normal glucose tolerance (NGT), gestational diabetes mellitus (GDM) and non-pregnant healthy women. The group studied consisted of 62 patients with GDM (mean age 30.1 +/- 5.0 years) at 29.0 +/- 3.5 week of gestation, 64 pregnant women with NGT (mean age 30.0 +/- 4.7 years) at 29.2 +/- 2.9 week of gestation and 34 non-pregnant healthy women (mean age 29.8 +/- 4.7 years). Serum MCP-1 concentration was measured using an enzyme - linked immunosorbent assay. Median MCP-1 concentrations did not differ significantly between women with GDM (median 342.3 [interquartile range 267.9-424.4] pg/ml) and NGT (338.0 [274.7-408.2] pg/ml), but were markedly lower than those found in non-pregnant women (485.2 [409.6-642.4] pg/ml,
Obesity and carbohydrate metabolism
Autorzy artyku艂u przedstawili problem narastaj膮cej oty艂o艣ci i zachorowa艅
na cukrzyc臋 typu 2 w ko艅cu XX i na pocz膮tku XXI wieku.
W niniejszej pracy om贸wiono przyczyny oty艂o艣ci, wp艂yw czynnik贸w
genetycznych i 艣rodowiskowych oraz podkre艣lono rol臋 centralnej
oty艂o艣ci w rozwoju cukrzycy i choroby niedokrwiennej serca.We evaluate the global epidemic of obesity and type 2 diabetes
mellitus in the 20th and the early 21 century. We take into the consideration
the genetic and environmental factors and their role in
the developing of obesity. We underline the role of central obesity
in the pathogenesis of type 2 diabetes and coronary heart disease
Selected markers of endothelial dysfunction in patients with subclinical and overt hyperthyroidism
Introduction: There are many factors causing endothelial
dysfunction. The aim was to observe chosen markers of
endothelial function in patients with subclinical and overt
hyperthyroidism.
Material and methods: We studied 97 patients with hyperthyroidism:
51 with subclinical (44 F/7 M; mean age 49.3 ± 15.9 y) and 46 patients with overt (39 F/7 M, mean age
50.4 ± 13.2 y). The control comprised of 39 healthy volunteers
(26 F/13 M, mean age 47.5 ± 11.8 y). Concentration of
TSH, FT3, FT4 were measured by MEIA, TPO Ab, TG Ab,
E-selectin, interleukin 6, VCAM-1, ICAM-1 by ELISA.
Results: The goiter was found in 71 persons 63F/8M, mean
age 49.9 ± 15.3 y, (42-subclinical, 29-overt). Morbus Graves-Basedow was diagnosed in 26 persons, 20 F/6 M, mean age
49.5 ± 12.8 y (9-subclinical, 17-overt). There were no significant
differences serum concentration of E-selectin, IL-6,
ICAM-1 in patients with subclinical and overt hyperthyroidism
compared to the control. Statistically significant differences
were shown between concentration of IL-6 in patients
with Graves-Basedow compared with the control (p < 0.05). Significance of VCAM-1 values were found in
the patients with subclinical and overt hyperthyroidism compared
to the control (p < 0.001; p < 0.001, respectively).
Conclusions: Among persons with overt and subclinical
hyperthyroidism occurs endothelial dysfunction which
doesn’t depends on exciting cause of thyrotoxicosis but on
degree of hyperthyroidism. Elevated concentrations of endothelial
markers may confirm that persons with thyroid
disorders are extremely exposed to the occurrence of the
cardiovascular diseases.Wst臋p: Istnieje wiele czynnik贸w, kt贸re powoduj膮 dysfunkcj臋
艣r贸db艂onka. Celem niniejszej pracy by艂a analiza wybranych
wska藕nik贸w uszkodzenia 艣r贸db艂onka u pacjent贸w
z jawn膮 i subkliniczn膮 nadczynno艣ci膮 tarczycy.
Materia艂 i metody: Badaniu poddano 97 pacjent贸w z nadczynno艣ci膮
tarczycy: 51 z subkliniczn膮 (SNT; 44 K/7 M;
艣r. wieku 49,3 ± 15,9 roku) oraz 46 z jawn膮 nadczynno艣ci膮
tarczycy (JNT; 39 K/7 M; 艣r. wieku 50,4 ± 13,2 roku). Grupa
kontrolna sk艂ada艂a si臋 z 39 zdrowych ochotnik贸w (26 K/13 M;
艣r. wieku 47,5 ± 11,8 roku). St臋偶enie fT3, fT4 oraz TSH
oznaczono za pomoc膮 metody MEIA, natomiast st臋偶enia antyTPO,
antyTG, E-selektyny, interleukiny 6, VCAM-1
i ICAM-1 - przy u偶yciu metody ELISA.
Wyniki: Wole guzkowe stwierdzono u 71 os贸b (63 K/8 M),
a 艣rednia wieku wynosi艂a 49,9 ± 15,3 roku (42 - SNT,
29 - JNT). Chorob臋 Graves-Basedowa rozpoznano u 26 os贸b
(20 K/6 M), a 艣rednia wieku wynosi艂a 49,5 ± 12,8 roku (9 - SNT,
17 - JNT). Nie stwierdzono istotnych statystycznie r贸偶nic
w st臋偶eniach E-selektyny, IL-6, ICAM-1 u pacjent贸w z SNT
i JNT w por贸wnaniu z grup膮 kontroln膮. Istotnie wy偶sze
st臋偶enie IL-6 obserwowano u pacjent贸w z chorob膮 Graves-Basedowa w por贸wnaniu z grup膮 kontroln膮 (p < 0,05).
Natomiast istotnie statystycznie wy偶sze st臋偶enia VCAM-1
stwierdzono u pacjent贸w z JNT i SNT w por贸wnaniu
z grup膮 kontroln膮 (odpowiednio: p < 0,001; p < 0,001).
Wnioski: U os贸b z jawn膮 i subkliniczn膮 nadczynno艣ci膮 tarczycy
wyst臋puj膮 zaburzenia funkcji kom贸rek 艣r贸db艂onka
naczy艅, kt贸re nie zale偶膮 od przyczyny, ale od stopnia nasilenia
tyreotoksykozy. Wzrost st臋偶enia wska藕nik贸w uszkodzenia
艣r贸db艂onka mo偶e 艣wiadczy膰 o zwi臋kszonym ryzyku
wyst膮pienia chor贸b uk艂adu sercowo-naczyniowego
u os贸b z zaburzon膮 funkcj膮 tarczycy
Markers of endothelial dysfunction in patients with iodine induced hyperthyroidism
Introduction: It has been reported that hyperthyroidism is
associated with an altered endothelial function and increased
risk of arterial thromboembolism. The aim of our study
was to estimate chosen markers of endothelial dysfunction
in iodine-induced thyrotoxicosis (IIT).
Materials and methods: The groups studied consisted of
41 hyperthyroid subjects, who had been treated with amiodarone
(n = 6) or vitamin preparations supplemented with
iodine (n = 35) and 40 persons with normal thyroid function.
The following parameters were measured: thyroglobulin
antibodies (TG Ab), thyroid peroxidase antibodies
(TPO Ab), THS receptor antibodies (TR Ab), soluble adhesion
molecules: sVCAM-1 and sICAM-1, von Willebrand
factor (vWF), plasminogen activator inhibitor-1 (PAI-1),
C-reactive protein (CRP), fibrinogen and urine iodine concentration.
Results: Patients with IIT had significantly higher levels of
sVCAM-1 (p < 0.01), IL-6 (p < 0.005), fibrinogen (p < 0.005)
and CRP (p < 0.05) in comparison to healthy subjects, whereas
sICAM-1, PAI-1 and vWF concentrations did not differ
between the groups studied. The highest sVCAM-1 levels
were observed in patients with amiodarone induced thyrotoxicosis,
and fibrinogen and CRP - in subjects receiving vitamin preparations. There were significant correlations
between sVCAM-1 concentration and the levels of sICAM-1
(r = 0.341; p = 0.029) and PAI-1 (r = 0.347; p = 0.026), as
well as with urine iodine concentration (r = 0.448; p = 0.004).
IL-6 concentration correlated with vWF (r = 0.456;
p = 0.003), TPO Ab (r = 0.328; p = 0.036) and PAI-1 level
(r = 0.319; p = 0.042).
Conclusion: Iodine induced thyrotoxicosis is associated
with an increase of sVCAM-1 and IL-6 levels, possibly reflecting
inflammatory and destructive processes in the thyroid
gland. However, increased procoagulant activity was
not found in patients with IIT.Wst臋p: Istniej膮 doniesienia na temat dysfunkcji 艣r贸db艂onka
i podwy偶szonego ryzyka powik艂a艅 zakrzepowo-zatorowych
w przebiegu nadczynno艣ci tarczycy. Celem naszej pracy
by艂a ocena wybranych wska藕nik贸w funkcji 艣r贸db艂onka
w nadczynno艣ci tarczycy indukowanej jodem (IIT, iodine-induced thyrotoxicosis).
Materia艂 i metody: Grup臋 badan膮 stanowi艂o 41 pacjent贸w
z nadczynno艣ci膮 tarczycy, kt贸re stosowa艂y d艂ugotrwale
amiodaron (n = 6) lub preparaty witaminowe zawieraj膮ce
jod (n = 35) oraz 40 os贸b z prawid艂ow膮 funkcj膮 tarczycy.
Oznaczono st臋偶enia przeciwcia艂 antytyreoglobulinowych
(TG Ab, thyroglobulin antibodies), antyperoksydazowych
(TPO Ab, thyroid peroxidase antibodies) i przeciwreceptorowych
(TR Ab, THS receptor antibodies), rozpuszczalnych form
cz膮steczek adhezyjnych: naczyniowej cz膮steczki adhezyjnej-1 (sVCAM-1, vascular cell adhesion molecule-1) i mi臋dzykom贸rkowej
cz膮steczki adhezyjnej 1 (sICAM-1, anti-intercellular
adhesion molecule-1), czynnika von Willebranda (vWF,
von Willebrand factor), inhibitora aktywatora plazminogenu-1
(PAI-1, plasminogen activator inhibitor-1), bia艂ka C-reaktywnego
(CRP, C-reactive protein) i fibrynogenu, oraz st臋偶enie
jodu w moczu.
Wyniki: U pacjent贸w z IIT wykazano istotnie wy偶sze st臋偶enia
sVCAM-1 (p < 0,01), interleukiny-6 (IL-6, interleukin-6)
(p < 0,005), fibrynogenu (p < 0,005) i CRP (p < 0,05)
w por贸wnaniu z grup膮 kontroln膮, natomiast st臋偶enia sICAM-1, PAI-1 i vWF nie r贸偶ni艂y si臋 znamiennie mi臋dzy
grupami. Najwy偶sze st臋偶enia sVCAM-1 obserwowano u pacjent贸w
przyjmuj膮cych amiodaron, natomiast fibrynogenu
i CRP - u os贸b stosuj膮cych preparaty witaminowe. Stwierdzono
istotne korelacje mi臋dzy st臋偶eniem sVCAM-1
a sICAM-1 (r = 0,341; p = 0,029), PAI-1 (r = 0,347; p = 0,026)
i joduri膮 (r = 0,448; p = 0,004). St臋偶enie IL-6 korelowa艂o ze
st臋偶eniem vWF (r = 0,456; p = 0,003), aTPO (r = 0,328;
p = 0,036) i PAI-1 (r = 0,319; p = 0,042).
Wnioski: Nadczynno艣膰 tarczycy indukowana jodem wi膮偶e
si臋 ze wzrostem st臋偶e艅 sVCAM-1 i IL-6, co mo偶e 艣wiadczy膰
o zmianach zapalnych i destrukcyjnych w tarczycy.
U pacjent贸w z IIT nie obserwuje si臋 natomiast zwi臋kszonej
aktywno艣ci prozakrzepowej