Koncentracije N-terminalnog prohormona B-tipa natrijuretskog peptida i neuregulina-1 beta nakon perkutane koronarne intervencije

master's thesis

• Title (english): Concentrations of N-terminal prohormone of B-type natriuretic peptide and neuregulin-1 beta after percutaneous coronary intervention
• Author: Roberta Halusek
• Mentor: Nada Vrkić (mentor)
• Committee member: Nada Vrkić (predsjednik povjerenstva)
• Committee member: Olga Gornik (član povjerenstva)
• Committee member: Sandra Šupraha Goreta (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of medical biochemistry and haematology); Zagreb
• Defense date and country: 2018-03-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Medical Biochemistry

Abstract

Akutni infarkt miokarda (AIM) jedan je od vodećih uzroka hospitalizacije i smrti u razvijenim zemljama. Akutni
infarkt miokarda sa ST-elevacijom (STEMI) nastaje kao posljedica potupne okluzije koronarnih krvnih žila trombom.
Od kako je perkutana koronarna intervencija uvedena kao terapijska metoda, značajno se poboljšao ishod bolesnika sa
STEMI-jem. No, ona ne mora uvijek biti uspješna. Zbog toga je vrlo bitno što ranije prepoznati pacijente kod kojih je
reperfuzija bila neuspješna kako bi se poduzele odgovarajuće mjere. Istraživači stoga nastoje otkriti specifične i
osjetljive pokazatelje uspješnosti reperfuzije. NT-proBNP i neuregulin-1β našli su se na meti istraživača kao
potencijalni biomarkeri prognoze i ishoda bolesnika sa STEMI-jem. NT- proBNP nastaje cjepanjem proBNP-a na
BNP i NT-pro BNP. BNP ima zaštitnu funkciju kod AIM zbog čega njegove koncentracije u krvi rastu. Neuregulin-1β
je faktor rasta ključan za funkcioniranje živčanog sustava. Neuregulin-1β također pokazuje potencijalnu zaštitnu
funkciju, međutim dinamika vrijednosti neuregulina- 1β u krvi nakon AIM nije razjašnjena kao kod BNP-a. Cilj ovog
rada bio je ispitati dinamiku NT-proBNP-a i neuregulina-1β u krvi pacijenata prije i nakon perkutane koronarne
intervencije. U istraživanju je sudjelovalo 104 pacijenata oboljelih od akutnog infarkta miokarda sa ST-elevacijom.
Krv je uzrokovana tri puta: prije PCI-e, 6 i 12 sati nakon PCI-e. Koncentracija NT-proBNP-a/NRG-a-1β u serumu
određivana je ELISA (engl. Enzyme-Linked Immunosorbent Assay) metodom, čija se reakcija temelji na
nekompetitivnom sendvič principu. Istraživanje je pokazalo pravilnu dinamiku rasta koncentracija NT-proBNP-a
nakon PCI-e s time da je porast izraženiji kod žena. Vrijednosti neuregulina-1β razlikuju se samo između prvog i
trećeg vremena uzrokovanja, a toj razlici uglavnom pridonose vrijednosti muškaraca koje rastu kroz 12 sati nakon
intervencije. Kod žena vrijednosti neuregulina-1β rastu unutar 6 sati nakon intervencije, nakon čega se vraćaju na
početne vrijednosti. Koncentracije NT-proBNP-a i neuregulina-1β uglavnom ne koreliraju s dobi. Također, nije
nađena korelacija između NT-proBNP-a i neuregulina-1β. Na temelju ovog istraživanja ne možemo donjeti generalni
zaključak o dinamici ovih biomarkera nakon PCI-e, međutim uzimajući u obzir druge studije, NT-proBNP bi mogao
biti klinički koristan biomarker u praćenju pacijenata nakon PCI-e. Dinamika neuregulin-1β, naprotiv, nije dovoljno
istražena pa se o njemu još ne može govoriti kao potencijalnom biomarkeru u praćenju ishoda bolesnika.

Abstract (english)

Acute Myocardial Infarction (AIM) is one of the leading causes of hospitalization and death in developed countries.
Acute myocardial infarction with ST elevation (STEMI) is the result of the occlusion of coronary vessel with
thrombus. Since percutaneous coronary intervention (PCI) was introduced as a therapeutic method, the outcome of
patients with STEMI was significantly improved. But it is not always successful. Therefore, it is very important to
early identify patients in which the reperfusion was unsuccessful in order to take appropriate measures. Researchers
are therefore trying to find specific and sensitive reperfusion performance indicators. NT-proBNP and neuregulin-1β
are targets of reasearch as potential prognosis and outcome biomarkers of patients with STEMI. NT-proBNP is
generated by cleaving proBNP to BNP and NT-pro BNP. BNP has a protective function in AIM due to which its blood
concentration increases. Neuregulin-1β is a growth factor crucial for the functioning of the nervous system.
Neuregulin-1β also exhibits a potential protective function, but the dynamics of neurelguline 1β in blood after AIM is
not as clear as in BNP. The aim of this study was to examine the dynamics of NT-proBNP and neuregulin-1 in the
blood of patients before and after percutaneous coronary intervention. The study included 104 patients with acute
myocardial infarction with ST elevation. Blood was sampled three times: before PCI, 6 and 12 hours after PCI. NTproBNP
/ NRG-α-1β concentration in serum was determined by an ELISA (Enzyme-Linked Immunosorbent Assay)
method, in which reaction is based on a non-competitive sandwich principle. Research has shown a fair growth
dynamics of NT-proBNP concentration after PCI, with increased growth in women. Neuragulin-1β values differ only
between the first and third time of causation, and this difference mainly contributes to the values of men who grow 12
hours after the intervention. In women the value of neuregulin-1β increases within 6 hours after the intervention, after
which they return to the initial values. NT-proBNP and neuregulin-1β concentrations generally do not correlate with
age. Also, there was no correlation between NT-proBNP and neuragulin-1β. Based on this study we can not make a
general conclusion about the dynamics of these biomarkers after PCI, but considering other studies, NT-proBNP could
be a clinically useful biomarker in PCI tracking patients. Dynamics of neuregulin-1β, on the contrary, have not been
sufficiently studied and can not yet be said to be a potential biomarker for monitoring patient outcomes.

• Keywords: akutni infarkt miokarda; perkutana koronarrna intervencija; B-tip natrijuretskog peptida (BNP); neuregulin-1 (NRG-1); ELISA
• Keywords (english): acute myocardial infarction; percutaneous coronary intervention; B-type natriuretic peptide (BNP); neuregulin-1 (NRG-1); ELISA
• Language: croatian
• URN:NBN: urn:nbn:hr:163:909866
• Study programme: Title: Medical biochemistry; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra medicinske biokemije (magistar/magistra medicinske biokemije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-12 16:31:34