Zekiye HASBEK, Taner ERSELCAN, Serdar Savaş GÜL

Pulmoner emboli tanısında D-dimer düzeyleri ile ventilasyon/perfüzyon sintigrafisindeki bulgular arasındaki ilişki

Amaç. Pulmoner emboli (PE) ölüm riskinin yüksek olması ve PE kuşkusu ile başlananantikoagülan tedavinin yüksek kanama riski taşıması, tanının en kısa sürede doğrulanmasını ya dadışlanmasını gerektiren kardiovasküler hastalıktır. Ventilasyon/perfüzyon (V/P) sintigrafisi PEşüphesinde yaygın kullanılan testlerden biridir. D-dimer fibrin yıkımının bir ürünüdür. Ancak akuttrombozlar için spesifik değildir. Bu çalışmada amacımız, D-dimer düzeyleri ileventilasyon/perfüzyon sintigrafisindeki perfüzyon defekt sayısı arasındaki ilişkiyi araştırmaktı.Yöntem. Çalışmamızda, PE ön tanısı ile takip edilen 100 olgunun D-dimer düzeyleri ile V/Psintigrafileri arasındaki ilişki araştırıldı. Hastaların sintigrafik bulguları perfüzyon defektiaçısından; perfüzyon defekti yok , subsegmenter tutulum , bir segment tutulum , iki segmenttutulum , üç segment tutulum ve üçten fazla segment tutulum şeklinde altı gruba; pulmoneremboli olasılığı açısından ise pulmoner emboli yok , düşük olasılıklı , orta olasılıklı veyüksek olasılıklı şeklinde dört gruba ayrıldı. D-dimer düzeyi referans aralığı 0,00-0,50 µg/mLidi. Bulgular. Çalışmaya alınan 100 hastanın 52si erkek 48i kadındı. Pulmoner emboli olmayan65 hastada D-dimer: 4,39 ±9 µg/mL; düşük olasılıklı 20 hastada D-dimer: 4,57 ±4 µg/mL; ortaolasılıklı olan 9 hastada D-dimer: 6,38 ±6 µg/mL; yüksek olasılıklı olan 6 hastada D-dimer: 8.0 ± 8 µg/mL olarak bulundu (p>0,05). Perfüzyon defekti izlenen segment sayısına göre; perfüzyondefekti olmayan 22 hastada D-dimer: 3,01 ±4 µg/mL; subsegmenter defekti olan 8 hastada D- dimer: 3,62 ±3 µg/mL; 1 segment defekti olan 14 hastada D-dimer: 10,7 ±18 µg/mL; 2 segmentdefekti olan 11 hastada D-dimer: 3,16 ±2 µg/mL; 3 segment defekti olan 10 hastada D-dimer:3,86 ±3 µg/mL; 3ten fazla segment defekti olan 35 hastada D-dimer: 4,66 ±4 µg/mL olarakbulundu (p

Relationship between scintigraphic f indings in ventilation/perf usion scintigraphy and D-dimer levels in diagnosis of p ulmonary embolism

Aim. Pulmonary embolism (PE) is a cardiovascular disease that the diagnosis is needed urgentrecognition or exclusion, since the PE has high risk of death and anticoagulant treatment startingwith suspicion of PE has high risk of bleeding. Ventilation/perfusion(V/P) scintigraphy is one ofthe widely used tests in suspect of PE. D-dimer is a product of fibrin degradation. However, it isnot specific for acute thrombosis. The purpose of this study was to investigate the relation betweennumber of the defect in the ventilation/perfusion scintigraphy and D-dimer levels. Method. In ourstudy, the relation between D-dimer levels of 100 cases followed-up with PE pre-diagnosis andtheir V/P scintigraphy was investigated. Scintigraphic findings of the patients were divided into sixgroups regarding the perfusion detect as; no involvement , subsegmenter-involvement , one- segment involvement , two-segments involvement , three-segments involvement , more thanthree-segments involvement and also divided into four groups regarding the possibility ofpulmonary as; no pulmonary embolism , low-probability , intermediate-probability andhigh-probability . The reference range of D-dimer level was 0.00-0.50 µg/mL. Results. Of the100 patients studied on, 52 were male and 48 were female. In 65 patients without pulmonaryembolism D-dimer: 4.39 ±9 µg/mL; in 20 patients with low-probability D-dimer: 4.57 ±4µg/mL;in 9 patients with intermediate-probability D-dimer: 6.38 ±6 µg/mL and, in 6 patients withhigh-probability D-dimer:8.0 ±8 µg/mL (p>0.05). Regarding the number of segment monitoredperfusion defect; in 22 patients without perfusion defect D-dimer: 3.01 ±4 µg/mL;in 8 patientswith subsegmental defect D-dimer: 3.62 ±3 µg/mL; in 14 patients with one segment defect D- dimer:10.7 ±18 µg/mL; in 11 patients with 2 segments defect D-dimer: 3.16 ±2 µg/mL; in 10patients with 3 segments defect D-dimer: 3.86 ±3 µg/mL, in 35 patients with more than 3segments defect D-dimer: 4.66 ±4 µg/mL (p

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