doktorska disertacije
Meta Penko (Avtor), Radovan Hojs (Mentor), Ivan Krajnc (Član komisije za zagovor), Tanja Hojs-Fabjan (Komentor)

Povzetek

Glavni obliki srčnožilnih bolezni sta koronarna bolezen srca in ishemična možganska kap, ki sta tudi vodilna vzroka smrti v Evropi, Združenih državah Amerike in drugod v razvitih državah sveta. Na razvoj srčnožilnih bolezni vplivajo številni dejavniki tveganja, ki jih lahko delimo v tradicionalne in netradicionalne ali pa v skupino dejavnikov tveganja na katere lahko oz. ne moremo vplivati. Dejavniki, na katere ne moremo vplivati so spol, starost, genetski dejavniki, etična pripadnost, itd. Eden najpomembnejših dejavnikov tveganja za srčnožilne bolezni, na katerega lahko vplivamo, je arterijska hipertenzija, sledijo mu kajenje, sladkorna bolezen in dislipidemija. Tudi kronična ledvična bolezen (KLB), katere incidenca in prevalenca v svetu naraščata, je neodvisni dejavnik tveganja za srčnožilne bolezni, na katerega lahko potencialno vplivamo. KLB in srčnožilnim boleznim so skupni številni dejavniki tveganja za razvoj bolezni. S slabšanjem ledvične funkcije se prevalenca srčnih in žilnih zapletov veča. Prevalenca KLB je pri bolnikih s koronarno arterijsko boleznijo višja kot v splošni populaciji, o prevalenci KLB pri bolnikih po ishemični možganski kapi pa je le malo znanega. Prav tako ni veliko znanega o vplivu KLB na nadaljnji izhod bolnikov (preživetje, srčne in žilne zaplete) po preboleli ishemični možganski kapi. Bolniki in metode V našo raziskavo smo vključili 390 bolnikov, ki so bili v obdobju enega leta zdravljeni na Oddelku za nevrologijo Univerzitetnega kliničnega centra v Mariboru zaradi ishemične možganske kapi. Akutno ishemično možgansko kap smo opredelili po kriterijih Svetovne zdravstvene organizacije, potrdili smo jo z računalniško tomografijo. Raziskava je bila prospektivna, bolnike smo spremljali od dneva sprejema do dneva smrti oz. največ do 56 mesecev. Pri bolnikih smo opredelili naslednje dejavnike tveganja ob vključitvi v raziskavo: arterijsko hipertenzijo, sladkorno bolezen, debelost. Nekatere podatke smo pridobili s pomočjo vprašalnika (anamneza sedanjega ali preteklega kajenja, družinska obremenitev s hipertenzijo, možgansko kapjo). Bolnikom smo posneli EKG. Opravili smo osnovne laboratorijske preiskave za določitev nivoja serumskega kreatinina, serumskega holesterola (celotni, HDL holesterol in LDL holesterol), serumskih trigliceridov, hsCRP in serumskih albuminov. S pomočjo skrajšane enačbe raziskave Modification of Diet in Renal Disease (enačba MDRD raziskave) smo ocenili glomerulno filtracijo (GF) in nato bolnike uvrstili v skupine KLB. KLB je bila opredeljena pri vseh z GF manj kot 60 ml/min/1,73 m2. Za srčne in žilne zaplete smo opredelili akutni koronarni sindrom (nestabilno angino pektoris, akutni miokardni infarkt z ali brez dviga ST veznice ali nenadno srčno smrt), ponovno ishemično možgansko kap in dokumentirano periferno arterijsko bolezen. Ob sprejemu in ob odpustu smo bolnikom opravili oceno funkcijskega nevrološkega stanja s pomočjo National Institutes of Health Stroke Scale (NIHSS lestvice). Statistični izračuni so bili narejeni s programom SPSS za Windows 19.0.1. V statistični analizi smo uporabili naslednje statistične metode: aritmetično sredino in standardni odklon, t-test in Mann-Whitney test, korelacijo s korelacijskima koeficientoma po Pearsonu ali Spearmanu, Kaplan-Meierjevo metodo, Coxov regresijski model (prilagojen in neprilagojen). Pri preizkušanju hipotez smo šteli za statistično pomembne tiste ugotovitve, kjer je bilo tveganje napake manjše kot 5 % (vrednost p < 0,05). Rezultati Prevalenca KLB pri bolnikih po ishemični možganski kapi je bila ocenjena na 39,2 %, največ bolnikov je imelo KLB 3. stopnje. Ženske so imele višjo prevalenco KLB kot moški. V času opazovanja je umrlo 199 bolnikov (49 %), od tega 101 ženska in 90 moških. Pri bolnikih po ishemični možganski kapi smo ugotavljali visoko prevalenco srčnih in žilnih zapletov, ki so se pojavili kar pri 45,4 % bolnikov. Najpogosteje smo opazovali ponovno ishemično možgansko kap (26,2 %). Med umrlimi bolniki jih je 120

Ključne besede

kardiovaskularne bolezni;dejavniki tveganja;akutni koronarni sindrom;periferna arterijska bolezen;bolniki;preživetje;

Podatki

Jezik: Slovenski jezik
Leto izida:
Tipologija: 2.08 - Doktorska disertacija
Organizacija: UM - Univerza v Mariboru
Založnik: [M. Penko]
UDK: 616.831-005.1-06:616.1(043.3)
COBISS: 269473792 Povezava se bo odprla v novem oknu
Št. ogledov: 2853
Št. prenosov: 220
Ocena: 0 (0 glasov)
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Sekundarni jezik: Angleški jezik
Sekundarni naslov: Cardiovascular events after ischemic stroke – impact of renal dysfunction
Sekundarni povzetek: The most common type of cardiovascular disease are coronary heart disease and cerebrovascular disease, manifested with ischemic cerebral stroke. Coronary heart disease and ischemic stroke are also the leading cause of death in Europe, in United States of America and in most developed countries around the world. A variety of factors are responsible for cardiovascular disease. The risk factors for cardiovascular disease can be classified as traditional and non-traditional. Another classification divide them into factors which may or may not be affected. In the group of factors which can not be affected are: gender, age, genetic factors, ethnic origin, etc. Arterial hypertension is one of the most important cardiovascular risk factor on which we can affect, followed by smoking cessation, diabetes, and dyslipidemia. Chronic kidney disease (CKD) is also an independent cardiovascular risk factor on which we can affect. The incidence and prevalence of CKD is rising. CKD and cardiovascular disease share many common risk factors. Prevalence of cardiovascular disease is rising with renal dysfunction. Patients with coronary artery disease have higher prevalence of CKD compared to general population. Little is known about the prevalence of CKD in patients with ischemic stroke. Also, not much is known about the impact of CKD in patients after ischemic stroke (survival, cardiovascular complications). Patients and methods In our prospective study 390 patients after ischemic stroke were included. They were all hospitalized on Department of Neurology on University Medical Centre in Maribor (for a period of one year). Acute ischemic stroke was defined according to WHO criteria and was confirmed by computer tomography. Patients were followed from the date of admission to the date of death or. maximum of 56 months. In patients, we identified the following risk factors at inclusion in the study: hypertension, diabetes, obesity. Some data were obtained using a questionnaire (current or history of smoking, family burden of hypertension, stroke). The ECG was recorded. We conducted basic laboratory investigations to determine the level of serum creatinine, serum cholesterol (total, HDL-cholesterol and LDL-cholesterol), serum triglycerides, hsCRP and serum albumins. The glomerular filtration (GF) was estimated using the abbrevated Modification of Diet and Renal Disease equation (MDRD study equation). Patients were then classified into groups of CKD. CKD was defined in all patients with GF less than 60 ml/min/1,73 m2. Cardiovascular complications were identified as acute coronary syndrome (unstable angina, acute myocardial infarction with or without ST elevation or sudden cardiac death), recurrent ischemic stroke and documented peripheral arterial disease. In all patients the evaluation of functional neurological status according to the National Institutes of Health Stroke Scale (NIHSS scale) at admission and at discharge was performed. Statistical calculations were performed with SPSS for Windows 19.0.1. In the statistical analysis the following statistical methods were used: arithmetic mean and standard deviation, t-test and Mann-Whitney test, correlation with a correlation coefficient of Pearson or Spearman, the Kaplan-Meier method, Cox regression model (adjusted and nonadjusted). When testing hypotheses the risk of error less than 5% (p-value <.05) was considered statistically significant. Results The prevalence of CKD in patients after ischemic stroke was estimated at 39.2 %, the most patients were in 3. stage of CKD. Women had a higher prevalence of CKD than men. During the observation 199 patients died (49 %), including 101 women and 90 men. In patients with ischemic stroke a high prevalence of cardiovascular complications were observed (45.4 %). Most often the recurrent ischemic stroke (26.2 %) was observed. Among the patients who died 120 (30.3 %) patients died of cardiovascular complications. The grade of level of neurological functional status regarding NIHSS scale was significantly higher in patients who died. When we c
Sekundarne ključne besede: Možganska kap;Disertacije;Komplikacije;Kronična ledvična bolezen;Prevalenca;
URN: URN:SI:UM:
Vrsta dela (COBISS): Doktorska disertacija
Komentar na gradivo: Univ. v Mariboru, Medicinska fak.
Strani: 141 f.
ID: 8727664