Hüseyin ALKIM, Selime AYAZ, CANAN ALKIM, Nurgül ŞAŞNAZ

Trombozla ilişkili gastrointestinal hastalıklarda protein C yolağı ve antitrombin

Giriş ve Amaç: Etyolojisinde tromboz olan ve/veya doğal seyrinde trombotik komplikasyonlarla sık karşılaşılan gastrointestinal hastalıklarda (portal ven trombozu, Budd-Chiari sendromu, karaciğer sirozu, inflamatuar barsak hastalığı ve gastrointestinal malignite) aktive protein C direnci sıklığı ile protein C, protein S ve antitrombin eksikliklerini araştırmak üzere bu prospektif çalışma planlandı. Gereç ve Yöntem: Hastalardan fonksiyonel yöntemlerle protein C, protein S, antitrombin aktiviteleri ve koagülasyon faktörü V’den yoksun test plazması kullanılarak modifiye yöntemle aktive protein C direnci araştırıldı. Bulgular: Protein C eksikliği siroz, malign ve sekonder portal ven trombozu gruplarında diğer gruplardan daha sıktı (p < 0.05). Primer portal ven trombozu ve Budd-Chiari sendromundaki protein C eksikliği ise kontrolden daha fazlaydı (p < 0.05). Protein S eksikliği Budd-Chiari sendromunda diğer tüm gruplardan istatistiksel önemde fazlaydı. ‹nflamatuar barsak hastalığı, malign ve her iki portal ven trombozu grubunda protein S eksikliği oranı siroz ve kontrolden yüksekdi (p < 0.05). Antitrombin eksikliği sirozda diğer tüm gruplardan daha fazlaydı. Aktive protein C direnci varlığı oranı tüm hasta gruplarında kontrolden istatistiksel önemde fazlalık gösteriyordu (p < 0.05). Budd-Chiari sendromunda aktive protein C direnci bulunma oranı ise diğer tüm gruplardan fazlaydı (p < 0.05). Ayrıca sirozlu ve maligniteli hastalarda tromboz varlığıyla aktive protein C direnci bulunması korelasyon gösteriyordu (p < 0.05). Trombofilik faktörlerden iki veya daha fazlasının birarada bulunması tromboz riskinde belirgin artışa neden olmaktaydı. Sonuç: Protein C, protein S ve antitrombin eksikliklerinin ve özellikle aktive protein C direnci varlığının; Budd-Chiari sendromu ve portal ven trombozu etyolojisinde rol oynayabileceği, sirozlu, inflamatuar barsak hastalıklı ve maligniteli hastalarda tromboz gelişme riskini arttırdığı saptandı.

Anahtar Kelimeler:

Tromboz, protein C, protein S, antitrombin, aktive protein C direnci, portal ven trombozu, Budd-Chiari sendromu, siroz, inflamatuar barsak hastalığı

Protein C pathway and antithrombin in thrombosis-related gastrointestinal disorders

Background and Aims: We aimed to determine the frequency of activated protein C resistance and deficiencies of protein C, protein S and antithrombin in different gastrointestinal diseases (portal vein thrombosis, Budd-Chiari syndrome, liver cirrhosis, inflammatory bowel disease and gastrointestinal malignancies), which related with thrombosis etiologically and/or pathogenetically. Materials and Methods: Protein C, protein S and antithrombin activities were measured by functional methods. Activated protein C resistance was detected by the modified method using factor V-deficient plasma. Results: Protein C deficiency in the cirrhosis, malignancy and secondary portal vein thrombosis groups was significantly higher than in the other groups (p

Keywords:

Thrombosis, protein C, protein S, antithrombin, activated protein C resistance, portal vein thrombosis, Budd-Chiari syndrome, cirrhosis, inflammatory bowel disease,

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