Akut pankreatit hastalarında serum supar (çözünür ürokinazplazminojen aktivatör reseptör) düzeyi ile hastalık şiddetiarasındaki ilişkinin değerlendirilmesi
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Tarih
2023
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Akut pankreatit (AP) şiddetli karın ağrısına, pankreatik nekroza ve çoklu organ disfonksiyonuna neden olabilen, %1-5'lik bir mortalite oranına sahip, pankreasın yaygın inflamatuar bir hastalığıdır. Hafif AP (MAP), organ yetmezliği olmaması ve lokal veya sistemik komplikasyon olmaması ile karakterizedir. Orta şiddetli AP (MSAP), geçici organ yetmezliği (48 saat içinde düzelir) ya da lokal, sistemik komplikasyonların olmasıdır. Şiddetli AP (SAP) bir veya daha fazla organı tutabilen kalıcı organ yetmezliği (48 saatten uzun süren) gelişmesidir. SuPAR proteini hücre yüzeyinden ayrıldıktan sonra kanda ve diğer organik sıvılarda bulunur. Hücre adezyonu, migrasyon, kemotaksis, proteoliz, immün aktivasyon, doku yeniden şekillenmesi, invazyon ve sinyal transdüksiyonu dahil olmak üzere çeşitli immünolojik fonksiyonlarda yer alır. Çalışmamızda AP hasta grubu şiddetine göre sınıflanıp, serum SuPAR düzeyi ile AP şiddeti arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamız 30.10.2021 ve 30.06.2022 tarihleri arasında hastanemize başvuran 18-80 yaş arası 130 akut pankreatitli ve 50 sağlıklı gönüllü ile yapılmıştır. Hastalar demografik özellikleri, hastalığın etiyolojisi, laboratuvar parametreleri ve Atlanta sınıflamasına göre gruplandırıldı. Akut pankreatitli hastalar MAP, MSAP ve SAP olarak sınıflandırıldı. Hasta ve kontrol grubu serum SuPAR düzeylerine göre değerlendirildi. Elde edilen verilerin istatistiksel analizi yapıldı. Bulgular: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi’nde yapılan bu çalışmaya 130 AP hastası ve 50 sağlıklı birey dahil edildi. Hastaların %53,1’i (n=69) kadın, %46,9’u (n=61) erkekti. Kontrol grubunun %54’ü (n=27) kadın, %46’sı (n=23) erkekti. AP hastalarının yaş ortalaması 55,53 ± 18,01 yıl, kontrol grubunun yaş ortalaması ise 51,20 ± 6,6 yıl olarak tespit edildi. AP hastalarında etiyolojik sebepler incelendiğinde %76,9 (n=100) ile safra taşı ilk sırada yer almaktaydı. AP hastalarının %20’sinde (n=26) AKI (Akut Kidney Injury) geliştiği saptandı. AKI saptanan hastaların %84,6’sı (n=22) evre 1 olarak bulundu. AP grubunda hematolojik parametrelerden lökosit, nötrofil, RDW (Eritrosit dağılım genişliği) değerleri kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek (p<0,001); lenfosit, hematokrit (Hct), platelet (PLT) değerleri istatistiksel olarak anlamlı düzeyde düşük tespit edildi (p değerleri sırasıyla; p<0,001, p=0,011, p=0,038). Evreden
vi
bağımsız olarak SuPAR düzeyi AP hasta grubunda kontrol grubuna göre daha yüksek tespit edildi. Hasta grubunda NLR (Nötrofil Lenfosit Oranı), PLR (Platelet Lenfosit Oranı), SII İndeks (Sistemik İmmun İnflamasyon İndeks), SIRI (Sistemik İnflamatuar Yanıt İndeksi) değerleri kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek tespit edildi (p<0,001). Hasta grubunda CRP (C reaktif protein), AST (Aspartat Transaminaz), ALT (Alanin Transaminaz), LDH (Laktat dehidrogenaz), amilaz, lipaz, glukoz değerleri kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek tespit edildi (p<0,001). Hastaların %51,6’sında (n=67) hafif şiddette AP, %44,6’sında (n=58) orta şiddetli AP, %3,8’inde (n=5) SAP saptandı. Hafif, orta ve şiddetli AP karşılaştırılmasında yatış süresi, lökosit, nötrofil, monosit, CRP, kreatinin, kalsiyum, SuPAR değerlerinde istatistiksel olarak anlamlı fark saptandı (p değerleri sırasıyla; p<0,001, p=0,006, p=0,021, p=0,016, p=0,015, p=0,014, p=0,026, p=0,028). SuPAR ile Ranson skoru arasında pozitif yönde anlamlı korelasyon tespit edildi (r=0,183, p=0,037). SuPAR ile Bısap skoru arasında pozitif yönde anlamlı korelasyon tespit edildi (r=0,193, p=0,028). SuPAR ile Atlanta sınıflaması arasında pozitif yönde anlamlı korelasyon tespit edildi (r=0,263, p=0,002). SuPAR ile AKI arasında pozitif yönde istatistiksel olarak anlamlı korelasyon saptandı (r=0,288, p=0,001). SuPAR ile yatış süresi arasında pozitif yönde anlamlı korelasyon tespit edildi (r=0,183 p=0,037). SuPAR’ın SAP’ı öngörmedeki yerini belirlemek için ROC eğrisinin altında kalan alan hesaplandı; AUC=0,687, p=0,15 olarak sonuçlandı. İnflamatuar biyobelirteç olarak SuPAR düzeyinde hastalık şiddeti ile artış tespit edildi ancak istatistiksel olarak anlamlı sonuç elde edilemedi. Sonuç: Çalışmamızda AP şiddeti ile artan serum SuPAR düzeyleri, SuPAR’ın AKI ile korelasyonu umut vadedicidir. Ancak çalışmamızda hasta sayısı sınırlı olup daha geniş hasta popülasyonunun yer aldığı çalışmalara ihtiyaç vardır.
Objective: Acute pancreatitis (AP) is a diffuse inflammatory disease of the exocrine pancreas that can cause severe abdominal pain, pancreatic necrosis and multiple organ dysfunction, with a mortality of 1-5%. Mild AP (MAP) is characterized by the absence of organ failure and no local or systemic complications. Moderate AP (MSAP) is characterized by transient organ failure (resolves within 48 hours) or local or systemic complications. Severe AP (SAP) is characterized by the development of permanent organ failure (lasting longer than 48 hours) involving one or more organs. SuPAR protein is found in blood and other organic fluids after leaving the cell surface. It is involved in various immunological functions including cell adhesion, migration, chemotaxis, proteolysis, immune activation, tissue remodeling, invasion and signal transduction. In our study, we aimed to classify the AP patient group according to severity and to evaluate the relationship between serum suPAR levels and AP severity. Materials and Methods: Our study was conducted with 130 patients with acute pancreatitis aged 18-80 years and 50 healthy volunteers admitted to our hospital between 30.10.2021 and 30.06.2022. Patients were grouped according to demographic characteristics, etiology of the disease, laboratory parameters and Atlanta classification. Patients were classified as MAP, MSAP and SAP. Patient and control groups were evaluated according to serum suPAR levels. Statistical analysis of the data obtained was performed. Results: In this study conducted at Necmettin Erbakan University Meram Medical Faculty Hospital, 130 FP patients and 50 healthy individuals were included. Among the patients, 53.1% (n=69) were female and 46.9% (n=61) were male. In the control group, 54% (n=27) were female and 46% (n=23) were male. The mean age of the acute pancreatitis patients was 55.53 ± 18.01 years and the mean age of the control group was 51.20 ± 6.6 years. When the etiologic causes were analyzed in AP patients, gallstones were ranked first with 76.9% (n=100). AKI (Acute kidney injury) developed in 20% (n=26) of AP patients. Of the patients with AKI, 84.6% (n=22) were found to be stage 1. Among the hematologic parameters, leukocyte, neutrophil, and RDW (Erythrocyte distribution width) values were statistically significantly higher (p<0.001) and lymphocyte, hematocrit (Hct), and platelet (PLT) values were statistically significantly lower in the AP viii group compared to the control group (p values, respectively p<0.001, p=0.011, p=0.038,). Regardless of the stage, suPAR level was not statistically significant in the AP patient group compared to the control group, but it was found to be higher in the patient group compared to the control group. NLR (neutrophil to lymphocyte ratio), PLR (platelet to lymphocyte ratio), SII Index (systemic immune inflammation index), SIRI (systemic immune response index) values were statistically significantly higher in the patient group compared to the control group (p<0.001). CRP (c reactive protein), AST (aspartate transaminase), ALT (alanine transaminase), LDH (lactate dehydrogenase), amylase, lipase, glucose values were statistically significantly higher in the patient group compared to the control group (p<0.001). Mild AP was found in 51.6% (n=67), moderate AP in 44.6% (n=58) and SAP in 3.8% (n=5) of the patients. Statistically significant differences were found in length of hospitalization, leukocyte, neutrophil, monocyte, CRP, creatinine, calcium, suPAR values when comparing mild, moderate and severe AP (p values respectively p<0.001, p=0.006, p=0.006, p=0.021, p=0.016, p=0.015, p=0.014, p=0.026, p=0.028,). There was a significant positive correlation between SuPAR and Ranson score (r=0.183, p=0.037). There was a significant positive correlation between SuPAR and Bisap score (r=0.193, p=0.028). There was a significant positive correlation between SuPAR and Atlanta classification (r=0.263, p=0.002). There was a statistically significant positive correlation between SuPAR and AKI (r=0.288, p=0.001). There was a significant positive correlation between SuPAR and length of hospitalization (r=0.183 p=0.037). The area under the ROC curve was calculated to determine the role of SuPAR in predicting SAP; AUC=0.687, p=0.15. SuPAR level as an inflammatory biomarker increased with disease severity, but no statistically significant results were obtained. Conclusion: In our study, serum suPAR levels increased with AP severity and the correlation of suPAR with AKI is promising. However, the number of patients in our study was limited and studies with a larger patient population are needed.
Objective: Acute pancreatitis (AP) is a diffuse inflammatory disease of the exocrine pancreas that can cause severe abdominal pain, pancreatic necrosis and multiple organ dysfunction, with a mortality of 1-5%. Mild AP (MAP) is characterized by the absence of organ failure and no local or systemic complications. Moderate AP (MSAP) is characterized by transient organ failure (resolves within 48 hours) or local or systemic complications. Severe AP (SAP) is characterized by the development of permanent organ failure (lasting longer than 48 hours) involving one or more organs. SuPAR protein is found in blood and other organic fluids after leaving the cell surface. It is involved in various immunological functions including cell adhesion, migration, chemotaxis, proteolysis, immune activation, tissue remodeling, invasion and signal transduction. In our study, we aimed to classify the AP patient group according to severity and to evaluate the relationship between serum suPAR levels and AP severity. Materials and Methods: Our study was conducted with 130 patients with acute pancreatitis aged 18-80 years and 50 healthy volunteers admitted to our hospital between 30.10.2021 and 30.06.2022. Patients were grouped according to demographic characteristics, etiology of the disease, laboratory parameters and Atlanta classification. Patients were classified as MAP, MSAP and SAP. Patient and control groups were evaluated according to serum suPAR levels. Statistical analysis of the data obtained was performed. Results: In this study conducted at Necmettin Erbakan University Meram Medical Faculty Hospital, 130 FP patients and 50 healthy individuals were included. Among the patients, 53.1% (n=69) were female and 46.9% (n=61) were male. In the control group, 54% (n=27) were female and 46% (n=23) were male. The mean age of the acute pancreatitis patients was 55.53 ± 18.01 years and the mean age of the control group was 51.20 ± 6.6 years. When the etiologic causes were analyzed in AP patients, gallstones were ranked first with 76.9% (n=100). AKI (Acute kidney injury) developed in 20% (n=26) of AP patients. Of the patients with AKI, 84.6% (n=22) were found to be stage 1. Among the hematologic parameters, leukocyte, neutrophil, and RDW (Erythrocyte distribution width) values were statistically significantly higher (p<0.001) and lymphocyte, hematocrit (Hct), and platelet (PLT) values were statistically significantly lower in the AP viii group compared to the control group (p values, respectively p<0.001, p=0.011, p=0.038,). Regardless of the stage, suPAR level was not statistically significant in the AP patient group compared to the control group, but it was found to be higher in the patient group compared to the control group. NLR (neutrophil to lymphocyte ratio), PLR (platelet to lymphocyte ratio), SII Index (systemic immune inflammation index), SIRI (systemic immune response index) values were statistically significantly higher in the patient group compared to the control group (p<0.001). CRP (c reactive protein), AST (aspartate transaminase), ALT (alanine transaminase), LDH (lactate dehydrogenase), amylase, lipase, glucose values were statistically significantly higher in the patient group compared to the control group (p<0.001). Mild AP was found in 51.6% (n=67), moderate AP in 44.6% (n=58) and SAP in 3.8% (n=5) of the patients. Statistically significant differences were found in length of hospitalization, leukocyte, neutrophil, monocyte, CRP, creatinine, calcium, suPAR values when comparing mild, moderate and severe AP (p values respectively p<0.001, p=0.006, p=0.006, p=0.021, p=0.016, p=0.015, p=0.014, p=0.026, p=0.028,). There was a significant positive correlation between SuPAR and Ranson score (r=0.183, p=0.037). There was a significant positive correlation between SuPAR and Bisap score (r=0.193, p=0.028). There was a significant positive correlation between SuPAR and Atlanta classification (r=0.263, p=0.002). There was a statistically significant positive correlation between SuPAR and AKI (r=0.288, p=0.001). There was a significant positive correlation between SuPAR and length of hospitalization (r=0.183 p=0.037). The area under the ROC curve was calculated to determine the role of SuPAR in predicting SAP; AUC=0.687, p=0.15. SuPAR level as an inflammatory biomarker increased with disease severity, but no statistically significant results were obtained. Conclusion: In our study, serum suPAR levels increased with AP severity and the correlation of suPAR with AKI is promising. However, the number of patients in our study was limited and studies with a larger patient population are needed.
Açıklama
Anahtar Kelimeler
Akut Pankreatit, Çözünür Ürokinaz Plazminojen Aktivatör Reseptörü (SuPAR), AKI (Acute Kidney Injury), Acute Pancreatitis, Soluble Urokinase Plasminogen Activator Receptor (SuPAR), AKI (Acute Kidney Injury)
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Künye
Yanaç, H. (2023). Akut pankreatit hastalarında serum supar (çözünür ürokinazplazminojen aktivatör reseptör) düzeyi ile hastalık şiddetiarasındaki ilişkinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahilİ Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
