Akut pulmoner emboli tanısı alan hastalarda çözünebilir CD40 ligand düzeyi ve ekokardiyografik parametreler
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Tarih
2010
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Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmamızda, hayatı tehdit edici ve görece sık karşılaşılan acil bir kardiyovaskuler patoloji olan akut PE'nin patogenezini daha fazla aydınlatabilmek, erken tanı ve risk sınıflamasına katkıda bulunabilmek amacıyla özellikle enflamasyon ve tromboz ile ilişkili çCD40L düzeylerinin akut PE hastalarında benzer demografik özelliklere sahip olan kontrol grubu ile kıyaslanması hedeflenmiştir. Bunun yanında Akut PE hastalarında konvansiyonel ve doku Doppler ekokardiyografik parametrelerindeki farklılıklar ve bunların çCD40L değerleri ile ilişkisi araştırılmıştır. Metod: Tanımlayıcı ve kesitsel çalışmamıza, Ocak 2010 ve Temmuz 2010 tarihleri arasında Selçuk Üniversitesi Meram Tıp Fakültesi Hastanesi'nde akut PE tanısı konan 65 hasta ve hastalar ile benzer demografik özellikleri ve komorbiditeleri olan sağlıklı 29 gönüllü dâhil edildi. Hastaların tümünün, kontrol grubunun 21'nin çCD40L değerleri ELİSA yöntemi ile eBioscience (BenderMed Systems, Avusturya) kiti kullanılarak çalışıldı. Hasta ve kontrol grubunun geleneksel iki boyutlu ve Doppler ekokardiyografik verileri yanında doku Doppler ekokardiyografik parametreleri kaydedildi. Hasta ve kontol grubunda elde edilen değişkenler karşılaştırıldı. Bulgular: Hasta ve kontrol grupları arasında demografik özellikler ve komorbiditeler açısından istatiksel farklılık yoktu. çCD40L düzeyinin akut PE hastalarında (5.3 ng/ml), kontrol grubuna(1.4 ng/ml) göre istatiksel olarak anlamlı düzeyde artmış olduğu görüldü (P<0.001). çCD40L kestirim değeri 0.7 ng/ml olarak alındığında PE olgularını tanıma yönünden duyarlılık 0.71, özgüllük 0.52, pozitif tahmin değeri 0.82, negatif tahmin değeri 0.37 ve tanısal doğruluğu 0.65 olarak hesaplandı. çCD40L değerleri ile akut PE ciddiyetinin göstergesi olan ekokardiyografi parametreler arasında istatiksel anlamlı ilişki izlenmedi. Hasta grubunda SğV EF belirgin düşük (46.2 karşı 60.5 P<0.001), PAB anlamlı yükek (45 mmHg karşı 24.7 mmHg P<0.001) ve İVC kollaps indeksi istatiksel anlamlı düzeyde düşük (0.36 karşı 0.62 P<0.001) tespit edildi. Pulsed wave doku Doppler tekniği ile değerlendirilen SğV MPİ'nin akut PE hastalarında kontrol grubuna göre alamlı düzeyde arttığı (0.53 karşı 0.43 P<0.001), SğV E/Em oranının anlamlı olarak daha yüksek olduğu (6.5 karşı 5,0 P: 0.04) ve SğV İVRZ'nin anlamlı şekilde uzadığı(67msn karşı 57msn P<0.001) tespit edildi. Sonuç: çCD40L daha önce yapılan çalışmalarda aterotromboz ve enflamasyonda gösterilmiş olan rolü yanında venöz tromboz patogezinde de rolü olduğu, ilk olarak gösterilmiştir. Prediktif ve prognostik değeri açısından ileri çalışmalara ihtiyaç duyulmaktadır. Bunun yanında özellikle SğV EF, İVC kollpaps indeksi, Sm, MPİ, E/Em gibi ekokardiyografik parametreler PE olgularının tanısında kullanılabilecek değişkenler olarak tespit edilmiştir.
Background: The main aim of the study was to evaluate soluble CD40 Ligand(sCD40L) levels that is associated with inflamation and thrombosis in predicting early diagnosis and risk stratification of pulmonary embolism(PE) which is life threatening and relatively frequent emergency cardiovascular pathology. The sCD40L levels in patient with PE were compared with control group with similar demographic features and comorbidities. We also aimed to investigate differences in conventional and tissue Doppler echocardiographic parameters in patient with PE and their relationship with sCD40 L levels. Methods and Materials: Our descriptive and cross-sectional study populution included 29 healthy voluntary controls and 65 patients with diagnosis of PE who were admitted to Selcuk University, Meram School of Medicine Hospital between January 2010 to July 2010. The sCD40L levels of all of the PE patients and 21 patients of the control group were quantified by ELISA method eBioscience (BenderMed Systems, Austria). In addition to two-dimensional and Doppler echocardiaographic parameters, tissue Doppler parameters were also recorded and these parameters were compared between patient and control groups. Results: There was not statistically significant difference between two groups with regard to demographic features and comorbidities. sCD40L levels were significantly elevated in acute PE group compared to control group; 5.3 ng/ml and 1.4 ng/ml, respectively (p< 0.001). When sCD40L?s cut-off value is accepted as 0.7 ng/ml, the test sensitivity is 0.71 and the specificity is 0.52, the positive predictive value is 0.82, the negative predictive value is 0.37, and the diagnostic accuracy is 0.65. There was no correlation between sCD40L levels and echocardiographic paramaters which are indicators of severity of PE. Right ventricular EF was detected to be significantly lower (46.2 versus 60.5 P<0.001), whereas PAB was found to be significantly higher (45 mmHg versus 24.7 mmHg P<0.001) and inferior vena cava collaps index was also found to be significantly lower (0.36 versus 0.62 P<0.001) in patient group. Right ventricular myocardial performance index values were evaluated by pulsed wave tissue Doppler technique and significantly increased in PE group compared to control group; 0.53 versus 0.43, respectively. Furthermore, the right ventricular E/Em was found significantly higher (6.5 versus 5,0 P: 0.04) and right ventricular IVRT was significantly prolonged in PE group compared to control group (67 msec versus57 msec P<0.001). Conclusion: In addition to previous studies which showed association of sCD40L with atherothrombosis and inflammation, in the present study, we demonstrated a role of sCD40L in pathogenesis of venous thrombosis for the first time. Further studies are needed to clarify the predictive and prognostic value of sCD40L. Furthermore, especially right ventricular EF, inferior vena cava collaps index, Sm, myocardial performance index, E/Em were detected as new echocardiograhic parameters for the diagnosis of PE.
Background: The main aim of the study was to evaluate soluble CD40 Ligand(sCD40L) levels that is associated with inflamation and thrombosis in predicting early diagnosis and risk stratification of pulmonary embolism(PE) which is life threatening and relatively frequent emergency cardiovascular pathology. The sCD40L levels in patient with PE were compared with control group with similar demographic features and comorbidities. We also aimed to investigate differences in conventional and tissue Doppler echocardiographic parameters in patient with PE and their relationship with sCD40 L levels. Methods and Materials: Our descriptive and cross-sectional study populution included 29 healthy voluntary controls and 65 patients with diagnosis of PE who were admitted to Selcuk University, Meram School of Medicine Hospital between January 2010 to July 2010. The sCD40L levels of all of the PE patients and 21 patients of the control group were quantified by ELISA method eBioscience (BenderMed Systems, Austria). In addition to two-dimensional and Doppler echocardiaographic parameters, tissue Doppler parameters were also recorded and these parameters were compared between patient and control groups. Results: There was not statistically significant difference between two groups with regard to demographic features and comorbidities. sCD40L levels were significantly elevated in acute PE group compared to control group; 5.3 ng/ml and 1.4 ng/ml, respectively (p< 0.001). When sCD40L?s cut-off value is accepted as 0.7 ng/ml, the test sensitivity is 0.71 and the specificity is 0.52, the positive predictive value is 0.82, the negative predictive value is 0.37, and the diagnostic accuracy is 0.65. There was no correlation between sCD40L levels and echocardiographic paramaters which are indicators of severity of PE. Right ventricular EF was detected to be significantly lower (46.2 versus 60.5 P<0.001), whereas PAB was found to be significantly higher (45 mmHg versus 24.7 mmHg P<0.001) and inferior vena cava collaps index was also found to be significantly lower (0.36 versus 0.62 P<0.001) in patient group. Right ventricular myocardial performance index values were evaluated by pulsed wave tissue Doppler technique and significantly increased in PE group compared to control group; 0.53 versus 0.43, respectively. Furthermore, the right ventricular E/Em was found significantly higher (6.5 versus 5,0 P: 0.04) and right ventricular IVRT was significantly prolonged in PE group compared to control group (67 msec versus57 msec P<0.001). Conclusion: In addition to previous studies which showed association of sCD40L with atherothrombosis and inflammation, in the present study, we demonstrated a role of sCD40L in pathogenesis of venous thrombosis for the first time. Further studies are needed to clarify the predictive and prognostic value of sCD40L. Furthermore, especially right ventricular EF, inferior vena cava collaps index, Sm, myocardial performance index, E/Em were detected as new echocardiograhic parameters for the diagnosis of PE.
Açıklama
Anahtar Kelimeler
Akciğer hastalıkları, Lung diseases, Ekokardiyografi, Echocardiography, Kardiyovasküler sistem, Cardiovascular system, Pulmoner arter, Pulmonary artery, Pulmoner emboli, Pulmonary embolism
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kaya, Z. (2010). Akut pulmoner emboli tanısı alan hastalarda çözünebilir CD40 ligand düzeyi ve ekokardiyografik parametreler. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
