Akut pulmoner embolide EPAS-1'in tanısal ve prognostik önemi
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Tarih
2023
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmadaki amacımız pulmoner tromboemboli hastalarında başvuru anında bakılan laboratuvar parametreleri ve skorlama sistemlerine ek olarak hipoksi ile artışı kanıtlanan bir biyomarker olan EPAS-1 düzeylerinin tanı anında ve tedavi sonrasında değişimlerini ortaya koymaktır.
Yöntem: Çalışmamıza Kardiyoloji kliniğinde takip edilen tanı konulmuş 60 adet pulmoner emboli hastası ve Kardiyoloji polikliniğine muayene olup pulmoner embolisi olmayan benzer demografik özelliklere sahip 60 adet kontrol grubu dahil edilmiştir. Hastalara başvuru anında belirlenen laboratuar parametreleri bakılmış, elektrokardiyografik, ekokardiyografik ölçümleri kaydedilmiştir. Ayrıca pulmoner emboli risk ve şiddet skorlamaları uygulanmış buna ek olarak EPAS-1 düzeyleri çalışılmıştır. Tedavi yanıtını belirlemek için 3 gün sonra EPAS-1 düzeylerinin kontrolü yapılmış ve kontrol grubu ile karşılaştırılmıştır.
Bulgular: Her iki grup arasında demografik özellikler, hipertansiyon, diyabetes mellitus, koroner arter hastalığı ve akciğer hastalığı açısından fark yoktu. EPAS-1 düzeyleri tanı anında kontrol grubuna kıyasla daha yüksek bulundu ((3,6±1,42/1,57±0,45), p<0.001). Hasta grubunda PESI şiddet skoru ve risk skoru ile istatistiksel anlamlı şekilde pozitif yönde korelasyon gösterdi. EPAS-1 düzeylerinin hastaların tedavileri ile gerilediği ve tedavi çeşitlerine göre düşme eğilimlerinin farklı olduğu gösterildi. Exitus olan hastalarda ise tedaviye rağmen EPAS-1 düzeylerinin artmaya devam ettiği gösterildi (p:0.014)
Sonuç: Pulmoner tromboemboli hastalarında halen tanı koydurucu veya dışlama kriteri olarak kullanılabilecek bir biyomarker bulunmamaktadır. EPAS-1 düzeylerinin pulmoner emboli hastalarında tanı anında yükseldiği tespit edilmiş, medikal tedavi başarısı sonrasında düşüşü gösterilmiştir. Çalışmamız, pulmoner emboli hastalarında skorlama sistemleri ve diğer kullanılan laboratuar parametreleri ile anlamlı ve korele seyreden EPAS-1 seviyelerinin, hastalığın tanı sürecinde öngördürücü bir değer olarak
kullanılabilmesi ve tedavi yanıtının değerlendirilmesinde tamamlayıcı bir rol alması açısından önem arz etmektedir.
Objective: Our aim in this study is to reveal the changes in EPAS-1 levels, a biomarker proven to increase with hypoxia, at the time of diagnosis and after treatment, in addition to the laboratory parameters and scoring systems examined at the time of admission in patients with pulmonary thromboembolism. Materials and Methods: Our study included 60 diagnosed pulmonary embolism patients who were followed up in the Cardiology clinic and 60 control groups with similar demographic characteristics who were examined in the Cardiology outpatient clinic and did not have pulmonary embolism. Laboratory parameters determined at the time of admission were examined, and electrocardiographic and echocardiographic measurements were recorded. Additionally, pulmonary embolism risk and severity scores were applied and EPAS-1 levels were studied. To determine the treatment response, EPAS-1 levels were checked after 3 days and compared with the control group. Results: There was no difference between the two groups in terms of demographic characteristics, hypertension, diabetes mellitus, coronary artery disease and lung disease. EPAS-1 levels were found to be higher at the time of diagnosis compared to the control group ((3.6±1.42/1.57±0,45), p<0.001). It showed a statistically significant positive correlation with PESI severity score and risk score in the patient group. It was shown that EPAS-1 levels decreased with the treatments of the patients and their tendency to decrease was different depending on the treatment types. It was shown that EPAS-1 levels continued to increase in patients who died despite treatment (p:0.014). Conclusion: There is currently no biomarker that can be used as a diagnostic or exclusion criterion in patients with pulmonary thromboembolism. EPAS-1 levels were found to be increased in pulmonary embolism patients at the time of diagnosis, and were shown to decrease after the success of medical treatment. Our study is important in that EPAS-1 levels, which are significant and correlated with scoring systems andother laboratory parameters used in pulmonary embolism patients, can be used as a predictive value in the diagnosis process of the disease and play a complementary role in the evaluation of treatment response.
Objective: Our aim in this study is to reveal the changes in EPAS-1 levels, a biomarker proven to increase with hypoxia, at the time of diagnosis and after treatment, in addition to the laboratory parameters and scoring systems examined at the time of admission in patients with pulmonary thromboembolism. Materials and Methods: Our study included 60 diagnosed pulmonary embolism patients who were followed up in the Cardiology clinic and 60 control groups with similar demographic characteristics who were examined in the Cardiology outpatient clinic and did not have pulmonary embolism. Laboratory parameters determined at the time of admission were examined, and electrocardiographic and echocardiographic measurements were recorded. Additionally, pulmonary embolism risk and severity scores were applied and EPAS-1 levels were studied. To determine the treatment response, EPAS-1 levels were checked after 3 days and compared with the control group. Results: There was no difference between the two groups in terms of demographic characteristics, hypertension, diabetes mellitus, coronary artery disease and lung disease. EPAS-1 levels were found to be higher at the time of diagnosis compared to the control group ((3.6±1.42/1.57±0,45), p<0.001). It showed a statistically significant positive correlation with PESI severity score and risk score in the patient group. It was shown that EPAS-1 levels decreased with the treatments of the patients and their tendency to decrease was different depending on the treatment types. It was shown that EPAS-1 levels continued to increase in patients who died despite treatment (p:0.014). Conclusion: There is currently no biomarker that can be used as a diagnostic or exclusion criterion in patients with pulmonary thromboembolism. EPAS-1 levels were found to be increased in pulmonary embolism patients at the time of diagnosis, and were shown to decrease after the success of medical treatment. Our study is important in that EPAS-1 levels, which are significant and correlated with scoring systems andother laboratory parameters used in pulmonary embolism patients, can be used as a predictive value in the diagnosis process of the disease and play a complementary role in the evaluation of treatment response.
Açıklama
Anahtar Kelimeler
Pulmoner emboli, EPAS-1, Wells skoru, Geneva skoru, PESI skoru, Pulmoner arter basıncı, Kronik hipoksi, Derin ven trombozu, Travma, Dispne, Pulmonary embolism, EPAS-1, Wells score, Geneva score, PESI score, Pulmonary artery pressure, Chronic hypoxia, Deep vein thrombosis, Trauma, Dyspnea
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Künye
Şahin, A. T. (2023). Akut pulmoner embolide EPAS-1'in tanısal ve prognostik önemi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kardiyoloji Anabilim Dalı, Konya.
