Tip 2 Diabetes Mellitus'ta akciğer alveoler bazal membranının incelenmesi
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Tarih
2000
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET Diabetes Mellitus Tip II olgularında, mikrovasküler yapıya sahip olan akciğer bazal membranındaki histopatolojik değişiklikleri ortaya koymak için akciğer solunum fonksiyon testi olarak CO diffüzyon kapasitesi ile Tc-99m-DTPA aerosol sintigrafisini kullanarak, akciğer alveolo kapiller bazal membran hasannı saptamayı ve diabet komplikasyonlan ile aralarındaki ilişkiyi amaçladık. Sigara içmeyen, geçirilmiş veya mevcut akciğer hastalığı olmayan, hemoglobin değeri 12.5 gr/dl üzerinde olan, Trakya Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Endokrinoloji Bilim Dalı'nın Diabetes Mellitus Polikliniği'nde takip edilen beş yıllık Diabetes Mellituslu Tip II 25 hasta ve 15 gönüllü kontrol vakası, Trakya Üniversitesi Tıp Fakültesi Nükleer Tıp Anabilim Dalı ve Fizyoloji Anabilim Dalı'nın işbirliği ile incelendi. Mikroanjiopatik komplikasyonlara sahip 19 nöropati, 18 retinopati, 2 nefropati, 2 komplikasyonsuz olguların 24 saatlik idrarları toplanarak, kreatinin klirensi ve esbach değerleri hesaplanarak nefropatileri değerlendirildi. Yaş, VKÎ, Hb düzeyileri arasında fark olmayan 25 NIDDM ile 15 kontrol grubuna uyguladığımız akciğer CO diffüzyon kapasitesi öğeleri (Dlco ve Dlcç/VA) arasında fark saptamadık. Diabet grubu ile kontrol grubu aerosol sintigrafisi karşılaştırmada alındığında, belirgin farklılık olduğunu, diabet grubunda alveoler kapiller membran kalınlaşmasına paralel olarak Tc-99m-DTPA T lA miktarının arttığım saptadık. Diabetin metabolik durumunu bildiren HbAlc değerine göre iyi ve kötü kontrollü diabetik gruplar arasında akciğer CO diffüzyon kapasitesinde farklılık bulamadığımız halde, aerosol sintigrafisinde her iki grubun da sonuçlan kontrollere oranla anlamlı yüksek bulundu. Ancak diabetin metabolik durumunu bildiren HbAlc ile her iki parametre 60arasında korelasyon saptamadık. Diabet olgularını tümünü değerlendirdiğimizde, hem diabet süresi uzun olan grupta, hem de mikroanjiopatisi olan grupta CO difftizyon kapasitesinde bir anlamlılık saptamadığımız halde Tc-99m-DTPA aerosol sintigrafisi sonuçlarım belirgin anlamlı bulduk. Mikroanjiopati çeşidine göre alt gruplara ayırdığımız hasta olgularının kendi içinde karşılaştırmamızda CO diffüzyon kapasitesi ile Tc-99m-DTPA aerosol sintigrafi sonuçlarında belirgin anlamlılık bulamadık. Ne diabet grubunda ne de kontrol grubunda, Tc-99m-DTPA aerosol sintigrafisi ve CO diffüzyon kapasitesinde ile biyolojik yaş arasında korelasyon yoktu. Sonuç olarak akciğer CO diffüzyon kapasitesinin ölçümünde önemli olan uygulanan kişilerin uyumu, eğitim düzeyleri ve ölçüm yapan ekipmandır. Oysa Tc-99m-DTPA aerosol sintigrafisi kişiye bağımlılığı az, daha özgül bir test olarak görülmektedir. 61
SUMMARY In this study, we investigated pulmoner alveolar capillary basal membran changes using carbon monoxide diffusing capacity test and Tc-99-DTPA aerosol scintigraphy and correlations between these changes and complications of diabetes in patients with NİDDM. Control group was consisted of 15 healty persons and Patient group was consisted of 25 patients with NIDDM who have diabetes for 5 years and were been following by Department of Endocrinology in Trakya University Medical Faculty..None of patients and healty persons have any improved or active lung disease, smoking cigarettes and hemoglobin value below 12.5gr/dl.Department of Endocrinology, Nuclear Medicine and Medical Physiology in Trakya University Medical Faculty worked together in this study. Diabetic Neuropathy, Retinopathy, Nephropathy were seen in 19, 18, 2 patients with NIDDM, respectively.No diabetic complication was seen in 2 patients with NIDDM.Control group and Patients group persons were investigated for nephropaty as collecting urine for 24 hours to define levels of creatinin clearence and esbach. There was no difference between control and patient group's age, BMI, levels of hemoglobin and pulmonary CO diffusing capacity(DLco and Dlco/VA). Tc-99m-DTPA TV2 value was increased in diabetic group due to increased alveolar capillary membran thickening when compared with control group. There was no diffirence on pulmonary CO diffusing capacity between appropriatly controlled diabetes group and bed-controlled diabetes group(Appropriate and bed-control group were defined by levels of HbAic).Both of patient groups have similar 62aerosol scintigraphy results. Aerosol scintigraphy results of both patient groups were significantly higher than control group.There was no corraletion between levels of HbAic and CO diffusing capasity and aerosol scintigraphy. Tc~99m-DTPA aeorsol scintigraphy results were significantly different in groups that have diabetic microangiopathy and longer duration of diabetes, compared other groups. But, there was no diffirence at CO diffusing capasity test results between same groups. İn conclusion, accommodation of person to test directions, education level and equitmants that use for measurement are the most important factors those effects CO diffusing capasity test results. In contrast, Tc-99m-DTPA aerosol scintigraphy is slightly effected by individual characteristics and more specific than CO diffusing capacity test. 63
SUMMARY In this study, we investigated pulmoner alveolar capillary basal membran changes using carbon monoxide diffusing capacity test and Tc-99-DTPA aerosol scintigraphy and correlations between these changes and complications of diabetes in patients with NİDDM. Control group was consisted of 15 healty persons and Patient group was consisted of 25 patients with NIDDM who have diabetes for 5 years and were been following by Department of Endocrinology in Trakya University Medical Faculty..None of patients and healty persons have any improved or active lung disease, smoking cigarettes and hemoglobin value below 12.5gr/dl.Department of Endocrinology, Nuclear Medicine and Medical Physiology in Trakya University Medical Faculty worked together in this study. Diabetic Neuropathy, Retinopathy, Nephropathy were seen in 19, 18, 2 patients with NIDDM, respectively.No diabetic complication was seen in 2 patients with NIDDM.Control group and Patients group persons were investigated for nephropaty as collecting urine for 24 hours to define levels of creatinin clearence and esbach. There was no difference between control and patient group's age, BMI, levels of hemoglobin and pulmonary CO diffusing capacity(DLco and Dlco/VA). Tc-99m-DTPA TV2 value was increased in diabetic group due to increased alveolar capillary membran thickening when compared with control group. There was no diffirence on pulmonary CO diffusing capacity between appropriatly controlled diabetes group and bed-controlled diabetes group(Appropriate and bed-control group were defined by levels of HbAic).Both of patient groups have similar 62aerosol scintigraphy results. Aerosol scintigraphy results of both patient groups were significantly higher than control group.There was no corraletion between levels of HbAic and CO diffusing capasity and aerosol scintigraphy. Tc~99m-DTPA aeorsol scintigraphy results were significantly different in groups that have diabetic microangiopathy and longer duration of diabetes, compared other groups. But, there was no diffirence at CO diffusing capasity test results between same groups. İn conclusion, accommodation of person to test directions, education level and equitmants that use for measurement are the most important factors those effects CO diffusing capasity test results. In contrast, Tc-99m-DTPA aerosol scintigraphy is slightly effected by individual characteristics and more specific than CO diffusing capacity test. 63
Açıklama
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Tıpta Uzmanlık
Tıpta Uzmanlık
Anahtar Kelimeler
Endokrinoloji ve Metabolizma Hastalıkları, Endocrinology and Metabolic Diseases
