Prognostički značaj vrednosti homocisteina, folne kiseline i vitamina V12 u krvi obolelih od malignih tumora mozga

Abstract

Uvod: Poslednjih godina se sve više ukazuje na moguće efekte homocisteina i jedinjenja uključenih u njegov metabolizam u karcinomima nervnog tkiva. U tom smislu, može se uočiti da je efekat homocisteina, folne kiseline i vitamina V12 na formiranje, razvoj i ishod lečenja kod pacijenata sa karcinomima mozga veoma intrigantno pitanje, čiji odgovor zahteva dodatno eksperimentalno i kliničko istraživanje. U literaturi nema dovoljno podataka o učestalosti povišenih nivoa Hcy u krvi, kao ni o poremećajima folne kiseline i vitamina B12 kod malignih tumora mozga. Cilj: Generalni cilj ove studije je bio da utvrdi prognostički značaj vrednosti homocisteina, folne kiseline i vitamina V12 u krvi kod pacijenata adultne populacije sa malignim tumorima mozga. Metode: Studijom je bilo obuhvaćeno 100 ispitanika oba pola koji su u periodu od 24 meseca bili praćeni i hirurški lečeni od malignih i benignih neurohirurških patoanatomskih supstrata na Neurohirurškoj klinici Kliničkog centra Srbije. Mesec dana, tri meseca i šest meseci nakon operacije kod ispitanika i sa malignim i benignim tumorom sakupljani su uzorci krvi radi određivanja koncentracije sledećih parametara: ukupni homocistein, vitamin B12 i folna kiselina; rutinske biohemijske analize (krvna slika, lipidni profil, hepatogram, urea i kreatinin); markera inflamacije (C-reaktivni protein, fibrinogen, prokalcitonin). Rezultati: Koncentracija homocisteina bila je značajno veća kod pacijenata kod kojih je bolest uznapredovala u poređenju sa pacijentima kod kojih bolest nije uznapredovala, čak i šest meseci nakon hirurškog odstranjivanja tumora, ali ostajući u fiziološkim granicama. Ovo potencijalno znači da se merenje vrednosti homocisteina može eventualno razmotriti kao marker progresije malignih oboljenja mozga. Potrebna su dalja i kompleksnija istraživanja na većem broju ispitanika kako bi se svi prethodno izneti zaključci potvrdili i time povećala relevantnost i klinička primenjivost naših rezultata.

Introduction: The use of mineral waters for medicаl purposes is largely based on theoretical assumptions (which take into account the relationship between their mineral composition and pathophysiological substrate within a disease) and much less on relevant data from basic and clinical research. Most of the data that indicate that certain types of these waters can alleviate the progression of various diseases and even be associated with complete remission come from non-academic and scientifically unfounded sources. In addition, the mechanisms by which these positive effects are realized are almost unknown. Objective: The overall aim of this study was to determine the prognostic significance of homocysteine, folic acid and vitamin B12 levels in the blood of adult patients with malignant brain tumors. Methods: The study included 100 subjects of both genders who were followed and surgically treated for malignant and benign neurosurgical pathoanatomical substrates at the Neurosurgical Clinic of the Clinical Center of Serbia for a period of 24 months. One month, three months, and six months after surgery, blood samples were collected from subjects with both malignant and benign tumors to determine the concentration of the following parameters: total homocysteine, vitamin B12, and folic acid; routine biochemical analyzes (blood count, lipid profile, hepatogram, urea and creatinine); markers of inflammation (Creactive protein, fibrinogen, procalcitonin). Results: Homocysteine concentrations were significantly higher in patients in whom the disease progressed compared to patients in whom the disease did not progress, even six months after surgical removal of the tumor, but remaining within physiological limits. This potentially means that measuring homocysteine levels can potentially be considered as a marker of the progression of malignant brain diseases. Further and more complex research is needed on a larger number of respondents in order to confirm all the previously presented conclusions and thus increase the relevance and clinical applicability of our results.