Aralik 2010
Proton pompasi kullanan hastalarda serum homosistein seviyesi artmis midir?
Are serum homocysteine levels increased in patients using proton pump inhibitors?
- Ana Sayfa
- Sayılar
- Aralik 2010
- Proton pompasi kullanan hastalarda serum homosistein seviyesi artmis midir?...
Ümraniye Egitim ve Arastirma Hastanesi, 3Aile Hekimligi Klinigi, Istanbul
Özet
Giris ve Amaç: Hücre bölünmesi ve çogalmasi için gerekli olan DNA sentezi homosisteinin metionine dönüsmesiyle saglanmaktadir. Vitamin B12 bu reaksiyonda rol alan metionin sentetazin kofaktörüdür. Vitamin B12 eksikliginde homosistein birikimi olur. Hiperhomosisteinemi ise arterioskleroz ve serebral tromboemboli ile iliskili bulunmustur. Proton pompa inhibitörleri yaygin olarak kullanilan ilaçlardir. Bu ilaçlar paryetal hücrelerdeki proton pompasinda bulunan H+/K+-ATPazi inhibe ederek HCl?yi inhibe ederler. Vitamin B12?nin gidalardan ayrilmasinda HCl gerektiginden, proton pompa inhibitörü kullanimi vitamin B12 eksikligine bu da hiperhomosisteinemiye yol açabilir. Çalismamizda proton pompa inhibitörü kullaniminin vitamin B12 ve homosistein düzeyine etkisini arastirdik. Gereç ve Yöntem: Çalismaya Mart ve Temmuz 2009 arasinda poliklinigimize basvuran ve çesitli nedenlerle en az üç aydir proton pompa inhibitörü kullanan 44 (hasta grubu) ve daha önce hiç proton pompa inhibitörü kullanmamis 38 hasta (kontrol grubu) alindi. Hasta ve kontrol grubunun yasi, serum homosistein düzeyi, vitamin B12, folik asit ve MCV degerleri ve hastalarin proton pompa inhibitörü kullanim süresi kaydedildi. Ayrica proton pompa inhibitörü kullanan hastalar kendi arasinda, 2 yildan az ve fazla proton pompa inhibitörü kullananlar olarak açlik serum homosistein düzeyi, vitamin B12 vitamini, folik asit ve MCV degerleri açisindan karsilastirildi. Bulgular: Hasta grubunda proton pompa inhibitörü kullanim süresi ortalama 19.5 ay idi. Hasta ve kontroller arasinda yas (hasta grubu 39±14, kontrol grubu 41±5 p=0,7) ve cinsiyet (hasta grubunda19 erkek, 25 kadin; kontrol grubunda 13 erkek, 25 kadin p=0,4) açisindan anlamli bir fark yoktu. Hasta ve kontroller homosistein (hasta 9.98±4.79 kontrol 9.40±0.527 p=0.5), B12 vitamini (hasta 328±305 kontrol 264±105 p=0.2), folik asit (hasta grubunda 9.20±3.20 kontrol grubunda 8.91±2.94 p=0.7) ve MCV (hasta 83±11 kontrol 86±8 p=0.1) yönünden karsilastirildiginda iki grup arasinda anlamli bir fark saptanmadi. Hasta grubu kendi arasinda 2 yildan az ve fazla proton pompa inhibitörü kullananlar seklinde karsilastirildiginda homosistein düzeyi, vitamin B12, folik asit ve MCV degerleri açisindan anlamli bir fark saptanmadi. Sonuç: Çalismamiza göre, uzun süreli proton pompa inhibitörü kullaniminin vitamin B12 ve buna bagli olarak homosistein düzeyi üzerinde anlamli bir etkisinin olmadigi ve bu sebeple bu hastalarin hiperhomosisteineminin getirdigi kardiyovasküler risklere genel toplumdan daha fazla sahip olmadigi söylenebilir.
Abstract
Background and Aim: DNA synthesis, which is required for cell division and proliferation, is provided by transformation of homocysteine to methionine. Vitamin B12 is the cofactor of methionine synthesis that plays a role in this reaction. vitamin B12 deficiency causes the accumulation of homocysteine. Hyperhomocysteinemia has been associated with arteriosclerosis and cerebral embolism. Proton pump inhibitors are widely used drugs that inhibit H+/K+-ATPase, which is found in parietal cells. Because HCl is required for separation of vitamin B12 from food, the ingestion of proton pump inhibitors can cause vitamin B12 deficiency, which can lead to hyperhomocysteinemia. In our study, we investigated the effect of the use of proton pump inhibitors on vitamin B12 and serum homocysteine levels. Material and Methods: In this study, 44 patients who had been using proton pump inhibitorsfor at least 3 months because of various indications and 38 patients (control group) who had never used proton pump inhibitors who admitted to our outpatient clinic between March and July 2009 were included. The ages of the patients and the control group, serum levels of homocysteine, vitamin B12 and folic acid, mean corpuscular volume (MCV) values, and duration of proton pump inhibitors use were recorded. In addition, among the patients on proton pump inhibitors, the fasting serum levels of homocysteine, vitamin B12 and folic acid and MCV values were compared between patients using proton pump inhibitors for less than 2 years or more than 2 years. Results: The average duration of proton pump inhibitors use was 19.5 months in the patient group. There was no significant difference between patients and controls in mean age (in patient group: 39±14, in control group: 41±5; p=0.7) and gender (patient group: 19 men, 25 women, control group: 13 men, 25 women; p=0.4). No significant difference was detected between patient and control groups when comparing in terms of homocysteine (patients: 9.98±4.79, controls: 9.40±0.527; p=0.5), VB12 (patients: 328±305, controls: 264±105; p=0.2), folic acid (patients: 9.20±3.20, controls: 8.91±2.94; p=0.7), and MCV (patients: 83±11, controls: 86±8; p=0.1). There were no differences between homocysteine, vitamin B12, folic acid and MCV levels when the patients were compared among themselves regarding the use of proton pump inhibitorsfor more or less than 2 years. Conclusion: According to our study, long-term use of proton pump inhibitors showed no significant effect on the levels of vitamin B12 and consequently on the level of homocysteine. For this reason, we can say that these patients do not have greater cardiovascular risks caused by hyperhomocysteinemia with respect to the general population.
