4. DISCUSSION
In a study, it was stated that the serum prolidase (U/L) level increased
when patients with CAD were compared with control cases. In the same
study, serum prolidase (U/L) levels gave a statistically significant
result with Gensin Score. Since coronary atherosclerosis is a complex
multifactorial disease, it has been stated that it may play an important
key role in serum prolidase (U/L) level in patients with CAD with the
progression of atheroscleratic plaque. 22 These data
may show that the changes in serum prolidase (U/L) levels in the Bypass
Entry and Bypass outlet blood of the patients in group 1 in our study
may be caused by surgical trauma, cross clamp duration, cardiopulmonary
bypass technique and extracorporeal circulation and respiratory support.
Patients with ischemic mitral regurgitation exhibit different pathology
and clinical findings compared to mitral regurgitation due to other
etiologies, and also present with a higher risk of mortality, morbidity,
and poor prognosis.23
In a study, it was shown that vascular tissues lose tissue compatibility
with advancing age. In the study, it was stated that there was a similar
change between serum prolidase (U/L) activity and age. In this study, it
was proven that increased prolidase activity is not only associated with
aging and female gender, but also with the presence and duration of
hypertension. It is requested to draw attention to its importance in the
evaluation of prolidase activity in patients with hypertension. To the
best of our knowledge, this is the first study to show that hypertension
is associated with increased serum prolidase (U/L) activity. As a result
of this study, it has been shown that there is a significant increase in
serum prolidase (U/L) activity in patients with
hypertension.24
In a study, they conducted a study on aortic stiffness related to blood
and aortic tissue prolidase activity and immunohistochemical expression
of prolidase in aortic tissue. Previous studies have shown that serum
prolidase (U/L) activity is increased in patients with coronary artery
disease (CAD) and hypertension. However, this correlation was thought to
be related to prolidase secretion from other organs or drug use. They
reported that this study is the first to evaluate the correlation of
aortic stiffness with tissue prolidase activity and immunohistochemical
expression of prolidase in aortic tissue. They found that plasma
prolidase activity was higher in the study group than in the control
group, as in previous studies. In addition, patients with pulmonary
arterial pressure, diabetes mellitus (DM), dyslipidemia, tobacco use,
myocardial infarction and chronic obstructive pulmonary disease (COPD)
were reported to be in the majority in the study. Previous studies have
shown that aortic stiffness is higher in CAD patients, blood prolidase
activity is higher in DM and dyslipidemia patients, and lower in COPD
patients.25
In the study named serum prolidase (U/L) activity in degenerative and
rheumatic heart patients; The patient group who had valve replacement
due to rheumatic etiology was compared with a group of patients who had
valve replacement due to degenerative etiology and a group of healthy
volunteers. They measured prolidase activity in all groups. Their
conclusion was that prolidase activity was significantly higher in the
control group than in the patient groups. However, there was no
statistically significant difference between the patient groups in terms
of serum prolidase (U/L) activity. No correlation was found between
serum prolidase (U/L) activity and valve disease. In the light of these
findings, they concluded that rheumatic and degenerative heart disease
is associated with decreased serum prolidase (U/L)
activity.26 In our study; There was an increase in
prolidase level in group 2 bypass access and group 1 bypass access
blood, but it did not show a significant result. Prolidase level in
group 2 bypass outlet and group 1 bypass outlet blood increased, but it
did not show a significant result.
In another study, in the evaluation of serum prolidase (U/L) activity in
the patient group with coronary artery disease; stated that serum
prolidase (U/L) level increased significantly. They stated that serum
prolidase (U/L) levels were significant, but prolidase levels decreased
in the control groups when compared with coronary artery
disease.27 In our study, there was an increase in the
level of prolidase in the blood of group 2 patients, but it did not give
statistically significant results in our study.
When we look at the serum prolidase (U/L) levels in the blood of the
group 2 patients entering the surgery (1084.07 ± 260.09 U/L) and exiting
the surgery (1337.74 ± 397.61 U/L), this result gave us a statistically
significant difference. (p < 0.05). When the serum prolidase
(U/L) levels in the blood of the patients in Group 1 at the time of
entry to the operation (1038.28 ± 150.09 U/L) and after the operation
(1289.43 ± 357.34 U/L) were examined, the serum prolidase (U/L) levels
increased significantly, making the study result statistically
significant (p < 0.01). ). There was not much difference in
serum prolidase (U/L) levels in the blood entering the surgery of the
patients in group 2 and the patients in group 1 in the blood entering
the surgery. When the serum prolidase (U/L) levels in the postoperative
blood of the study group patients and the postoperative blood of the
control group patients were evaluated, the serum prolidase (U/L) level
increased in both patient groups compared to the access blood. However,
despite the increase in the output blood levels of both groups, this
serum prolidase (U/L) level increased at a more serious level in the
study group patients who underwent ischemic mitral regurgitation in
addition to bypass surgery. We have seen that patients who develop
ischemic mitral regurgitation and additionally performing cardiac
surgery cause a significant increase in serum prolidase (U/L) levels.
The main reason for this increase was that the patient had primarily
cardiac surgery and increased prolidase level due to this trauma (Figure
1).
A statistically significant difference was observed between serum
prolidase (U/L) levels in group 2 bypass blood and group 2 bypass blood
(p < 0.05) (Table 1). There is a significant difference
between serum prolidase (U/L) levels in group 1 bypass blood and group 1
bypass blood (p < 0.01) (Table 2). There was no statistically
significant difference between serum prolidase (U/L) levels in group 2
bypass blood and group 1 bypass blood (P = 0.686) (Table 3). There was
no statistically significant difference between serum prolidase (U/L)
levels in group 2 bypass blood and group 1 bypass blood (P = 0.463)
(Table 4).
In our study, it was observed that the serum prolidase (U/L) level of
the patients in group 2 was at a certain level at the entrance to the
bypass, while it increased at the exit of the bypass. While the serum
prolidase (U/L) level of the patients in Group 1 was at a certain level
at the entrance to the bypass, it increased at the exit of the bypass.
When we evaluated the serum prolidase (U/L) level of patients in group 2
and patients in group 1, there was no statistically significant
difference between the two groups, although there was an increase in
serum prolidase (U/L) values in both groups. The prolidase level
increased statistically significantly in both groups, but the serum
prolidase (U/L) level in the blood of the patients in group 2 was higher
than the serum prolidase (U/L) level in the blood of the patients in
group 1.