The influence of biologic and immunosuppressive therapy on cardiac injury markers in patients with ulcerative colitis

[M. M. Cvetković]

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Uvod: Ulcerozni kolitis je zapaljenska bolest creva koja zahvata sluznicu debelog creva i karakteriše je hronično, rekurentno zapaljenje. Inflamacija u ulceroznom kolitisu značajno povećava rizik od kardiovaskularnih neželjenih događaja. Cilj:Glavni cilj ovog istraživanja je ispitati poveznost biološke i imunosupresivne terapije ulceroznog kolitisa sa markerima oštećenja miokarda pre i nakon primene terapije, i korelaciju kliničkih, endoskopskih i patohistoloških parametara pacijenata obolelih od ulceroznog kolitisa sa markerima oštećenja miokarda. Materijal i metode: U ovoj studiji je uključeno 84 pacijenta sa umereno-teškim ili teškim oblikom ulceroznim kolitisom. Pacijenti su bili podeljeni u tri grupe, na osnovu modaliteta daljeg lečenja: azatioprin, infliksimab, adalimumab. Svim pacijentima smo merili vrednosti srčanih biomarkera (CK, CKMB, proBNP, NTproBNP, troponin) pre terapije, 6 časova nakon terapije, kao i 3 meseca nakon početka terapije. Rezultati: Pacijenti lečeni anti-TNF terapijom su imali više vrednosti natriuretskih peptida pre započinjanja terapije. U sve tri grupe pacijenata je 6 časova nakon primene terapije zabeležen porast natriuretskih peptida, a najizraženiji porast je bio u azatioprin grupi. U dve anti-TNF grupe je nakon 3 meseca lečenja došlo do pada srčanih biomarkera, dok je u azatioprin grupi registrovan dalji porast. Zaključak: Najizraženiji kratkoročni i dugoročni neto efekat na natriuretske peptide je zabeležen u azatioprin grupi. Potrebna su dalja istraživanja o bezbednosti i potencijalnoj koristi primene infliksimaba i adalimumaba kod pacijenata sa ulceroznim kolitisom i istovremeno prisutnom srčanom slabošću, u odnosu na azatioprin.

Introduction: Ulcerative colitis is an inflammatory bowel disease that affects the colonic mucosa and is characterized by chronic, recurrent inflammation. The inflammatory process in ulcerative colitis significantly increases the risk of cardiovascular adverse events. Aim: The main objective of this study was to examine the association between biological and immunosuppressive therapy in ulcerative colitis and markers of myocardial injury before and after treatment, as well as to analyze the correlation between clinical, endoscopic, and histopathological parameters and myocardial injury markers in patients with ulcerative colitis. Materials and Methods: This study included 84 patients with moderate to severe ulcerative colitis. Patients were divided into three groups based on the treatment modality: azathioprine, infliximab, and adalimumab. Cardiac biomarkers (CK, CKMB, proBNP, NT-proBNP, and troponin) were measured in all patients before therapy, 6 hours after therapy, and 3 months after treatment initiation. Results: Patients treated with anti-TNF therapy had higher baseline values of natriuretic peptides prior to treatment initiation. In all three groups, an increase in natriuretic peptide levels was observed 6 hours after therapy administration, with the most pronounced increase recorded in the azathioprine group. After 3 months of treatment, a decrease in cardiac biomarkers was observed in both anti-TNF groups, while a further increase was registered in the azathioprine group. Conclusion: The most pronounced short- and long-term net increase in natriuretic peptides was observed in the azathioprine group. Further studies are needed to evaluate the safety and potential benefits of infliximab and adalimumab therapy in patients with ulcerative colitis and concomitant heart failure, compared with azathioprine.

ulcerozni kolitis, srčani biomarkeri, infliksimab, adalimumab, azatioprin

ulcerative colitis, cardiac biomarkers, infliximab, adalimumab, azathioprine

616.34-002-082:616.127(043.3)

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