الفهرس 
Review of literatureOnly 14 pages are availabe for public view
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Abstract
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المقدمة
اثبتت الدراسات السابقه ان هناك علاقه وطيده بين ارتفاع ضغط الدم الشرياني والتغيرات السلبيه التي تحدث للقلب والاوعيه الدمويه بما في ذلك تضخم البطين الايسر.
يعتبر تضخم البطين الايسرعامل خطر مستقل ومؤشر لحدوث المضاعفات وكذلك الوفيات المتعلقه بالقلب والاوعيه الدمويه .
هناك العديد من العوامل التي تؤثر علي درجه تضخم البطين الايسر منها مستوي ضغط الدم - مده ارتفاع ضغط الدم - العمر - السمنه - النظام الغذائي..........الخ.
تظهر ادله متزايده علي ان العوامل الوراثيه مرتبطه ايضا بتضخم البطين الايسر للقلب وقد تمت دراسه عدد الجينات المرشحه لان تكون مسئوله عن تضخم البطين الايسرفي مجموعات عرقيه مختلفه ولكن نتائج هذه الدراسات غير متناسقه.
جين استيوبروتوجرين هو أحد اعضاء اسره نخر الورم الفائقة من السيتوكينات وهو ايضا مستقبل قابل للذوبان لمنشط مستقبلات رابطة ك.ب النووية. ويشارك جين استيوبروتوجرين في إعادة تشكيل الأوعية الدموية والخلل الوظيفي في النوع 1 والنوع 2 من داء السكري . و تم الاعلان عن ترابط جين اسيوبروتوجرين و تضخم البطين الأيسر في البالغين من أصل إفريقي أمريكي مع ارتفاع ضغط الدم وفي عموم السكان .
يمثل جين استيوبروتوجرين البشري الموجود على الكروموسوم 8 جينًا يمثل نسخة واحدة مع 5 اكسونات و يمتد إلى 29 كيلو بايت من الجينوم البشري. تحتوي منطقة المروج لجين استيوبروتوجرين البشري على مواقع ربط مختلفة قادرة على التوسط في تحفيز تعبير جين استيوبروتوجرين . تم الوصول لعدة أشكال تحورية لجين الاستيوبروتوجرين لتكون مرتبطة مع مورفولوجيا الأوعية الدموية والوظيفية في مجموعات سكانية مختلفة .
لم يتم عمل دراسه لتحور جين استيوبروتوجرين ودوره في تضخم البطين الايسرفي مرضي ضغط الدم المرتفع لذلك كانت دراستنا هذه عن الترابط بين تحور جين استيو بروتوجرين وتضخم البطين الايسر للقلب في مرضي ضغط الدم المرتفع .
يشارك بروتين اكس ار سي سي 3 في إعادة التركيب المتماثلة و في مسار إصلاح فواصل الضفيرة المزدوجة (DSBs) ويؤدى نقص جين اكس ار سي سي 3 الى خلل في إعادة التركيب وينتج عنه زيادة في عملية النسخ الداخلى. التكاثر النهائي هو تكرار الجينوم النووي بدون انقسام خلوي لاحق , هذه العملية تؤدي إلى تعدد الكروموسومات وزيادة في حجم الخلية.
أهداف الرساله
1 – تقييم الترابط بين التحور الجينى لجين استيوبروتوجرين و حدوث تضخم لجدار البطين الايسر فى مرضى ارتفاع ضغط الدم .
2 – تقييم الترابط بين التحور الجينى لجين اكس ار سي سي 3 فى حدوث تضخم لجدار البطين الايسر فى مرضى ارتفاع ضغط الدم .
خصائص العينه:
1- شروط اختيار العينة
المرضى بقسم القلب جامعة بنها الذين يعانون من ارتفاع مزمن بضغط الدم فقط .
2- شروط استبعاد العينة
- مرضى ارتفاع ضغط الدم الثانوى .
- مرضى ارتفاع ضغط الدم المصابين بمرض السكر.
- مرضى ارتفاع ضغط الدم المصابين بأمراض مزمنه فى الكلى .
- مرضى ارتفاع ضغط الدم المصابين بأمراض فى صمامات القلب او عيوب خلقية بالقلب
- مرضى اعتلال عضلة القلب .
التصميم التنفيذي
تم أخذ التاريخ المرضي كاملا لكل المرضى موضع الدراسة و اجراء الفحص السريري التفصيلي و بعد ذلك تم سحب عينات الدم و تمثل 2 ملى من الدم الوريدي ووضع فى انبوبة اختبار مضاف اليها ايديتا .
تم استخراج الحمض النووي من عينات الدم ثم تم تضخيم كل عينة من الحمض النووي في بى سي ار ، للكشف عن التحور فى جين استيوبروتوجرين وجين اك س ار سي سي 3 .
تم تقسيم العينة بعد ذلك الى مجموعتين :-
المجموعة الأولى مرضى ارتفاع ضغط الدم مع وجود تضخم فى جدار البطين الايسر .
المجموعة الثانية مرضى ارتفاع ضغط الدم مع عدم وجود تضخم فى جدار البطين الايسر .
النتائج
أظهرت نتائج الدراسة ما يلي:
• وجود فرق ذو دلالة احصائية بين عمر الحالات في المجموعتين.
• كان متوسط مدة الاصابة بالمرض في الحالات بالمجموعة الأولى أكبر من الثانية مع وجرد فرق ذو دلالة احصائية.
• كان متوسط ضغط الدم الانقباضي في الحالات بالمجموعة الأولى أكبر من الثانية مع وجرد فرق ذو دلالة احصائية.
• لم يظهر ضغط الدم الانبساطي و معدل ضربات القلب و درجة ضيق التنفس وذمة الطرف السفلي عن فروق ذات دلالة إحصائية بين المجموعتين.
• كانت هناك 9 حالات مع مؤشر سوكولو ليون الإيجابي في المجموعة (أ) ولا يوجد حالات في المجموعة (ب) مع وجود فرق ذات دلالة إحصائية بين المجموعتين.
• كان النمط الوراثي CC موجودًا في 20٪ من الحالات في المجموعة A وفي 32٪ من
الحالات في المجموعة B ، كان النمط الوراثي لـ CG موجودًا في 44٪ من الحالات في المجموعة A و 48٪ من الحالات في المجموعة B بينما النمط الوراثي لـ GG تم العثور على 36 ٪ من الحالات في المجموعة A و 20 ٪ من الحالات في المجموعة B مع عدم وجود فروق ذات دلالة إحصائية بين المجموعتين.
• كان النمط الوراثي Thr / Met موجودًا في 48٪ من الحالات في المجموعة A وفي 16٪ من الحالات في المجموعة B بينما كان النمط الوراثي Thr / Thr موجودًا في 52٪ من الحالات في المجموعة A و 84٪ من الحالات في المجموعة B مع اختلاف كبير إحصائيا بين المجموعتين.
الاستنتاجات
• ارتفاع ضغط الدم هو مرض شائع بين السكان المصريين.
• ارتفاع معدل انتشار المرض يبدأ من العقد الرابع.
• تضخم البطين الأيسر هو مضاعفات خطيرة ومشتركة لارتفاع ضغط الدم.
• جين أستيوبروتوجرين وجين اكس أر سي سي جينان لهما عدة تحورات جينية توجد في مرضى تضخم البطين الأيسر.
• من الممكن استخدام الجينات السابقة كمؤشر مسبق لمرضى تضخم البطين الأيسر.