Biyobelirteçler ve Laboratuvar Bulguları
Özet
Pulmoner hipertansiyon (PH), pulmoner vasküler dirençte artış ve ilerleyici sağ ventrikül yetmezliği ile karakterize, yüksek morbidite ve mortaliteye sahip kompleks bir klinik sendromdur. Tanı ve hastalık takibinde sağ kalp kateterizasyonu altın standart yöntem olarak kabul edilmekle birlikte, invaziv yapısı nedeniyle klinik kullanımda sınırlılıkları bulunmaktadır. Ayrıca altı dakikalık yürüme testi ve Dünya Sağlık Örgütü (DSÖ) fonksiyonel sınıflaması gibi geleneksel değerlendirme yöntemleri, hastalığın biyolojik heterojenitesini tam olarak yansıtamamaktadır. Bu nedenle, pulmoner hipertansiyonun erken tanısı, prognoz tayini ve tedavi yanıtının değerlendirilmesinde biyobelirteçlerin rolü giderek artmaktadır. Günümüzde natriüretik peptidler ve troponinler gibi kardiyak stres belirteçleri klinik pratikte yaygın olarak kullanılmakla birlikte; endotelyal disfonksiyon, inflamasyon, oksidatif stres, metabolik değişiklikler ve fibrozis ile ilişkili yeni biyobelirteçler üzerine yoğun araştırmalar sürmektedir. Son yıllarda proteomik, genomik, multi-omik yaklaşımlar sayesinde hastalığın moleküler altyapısına ilişkin daha kapsamlı bilgiler elde edilmiş ve yeni biyobelirteç adayları tanımlanmıştır. Bu bölümde, pulmoner hipertansiyonda kullanılan güncel biyobelirteçler patofizyolojik mekanizmalar temelinde sınıflandırılarak tanısal, prognostik ve terapötik değerleri açısından değerlendirilmiştir.
Pulmonary hypertension (PH) is a complex clinical syndrome with high morbidity and mortality, characterized by increased pulmonary vascular resistance and progressive right ventricular failure. Although right heart catheterization is accepted as the gold standard method in diagnosis and disease follow-up, its invasive nature imposes limitations on clinical use. Furthermore, traditional assessment methods such as the six-minute walk test and the World Health Organization (WHO) functional classification cannot fully reflect the biological heterogeneity of the disease. For this reason, the role of biomarkers in the early diagnosis, prognostic assessment, and evaluation of treatment response in pulmonary hypertension is steadily increasing. Today, cardiac stress markers such as natriuretic peptides and troponins are widely used in clinical practice, while intensive research continues on new biomarkers related to endothelial dysfunction, inflammation, oxidative stress, metabolic alterations, and fibrosis. In recent years, proteomic, genomic, and multi-omic approaches have provided more comprehensive insights into the molecular basis of the disease and have led to the identification of new candidate biomarkers. In this chapter, current biomarkers used in pulmonary hypertension are classified on the basis of their pathophysiological mechanisms and evaluated in terms of their diagnostic, prognostic, and therapeutic value.
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