Semih KOT, Ayhan SARI, Kenan ÇETİN, Nüvit DURAKER

Akut Mezenterik İskemi Tanısında ve Akut Pankreatit ile Akut Kolesistitten Ayırıcı Tanısında D-Dimerin Önemi

Amaç: Kötü prognozu ve yüksek mortalite oranı nedeniy- le akut mezenterik iskemi (AMİ)nin erken tanısı sorun- dur. AMİnin tanısında serum belirteçlerinin yeri oldukça sınırlı olup son yıllarda D-dimer testi ile ilgili çalışmalar yapılmaktadır. Bu prospektif çalışmada AMİnin tanısında ve akut pankreatit ve akut kolesistitten ayırıcı tanısında plazma D-dimer düzeyinin önemini araştırdık. Yöntemler: Acil servisimize karın ağrısı şikayeti ile baş- vuran 89 hastayı çalışmamıza dahil ettik. Hastaların sa- yısı ve tanıları sırasıyla 17 AMİ, 42 akut pankreatit ve 30 akut kolesistit şeklindeydi. Tüm hastaların plazma D-di- mer düzeylerini lateks aglütinasyon immunoassay yön- temiyle ölçtük. Neticede D-dimer testinin AMİ tanısındaki duyarlık ve özgüllüğünü hesapladık. Bulgular: AMİnin özgüllüğü akut pankreatitten ayırıcı ta- nısında %50, akut kolesistitten ayırıcı tanısında %70, tüm kontrol gurubu için %58,3; duyarlığı %100 idi. Sonuç: AMİnin akut pankreatit ve akut kolesistitten ayı- rıcı tanısında plazma D-dimer konsantrasyonunun ölçü- mü yararlı olabilir. Ancak, D-dimerin tanısal değerini daha açık bir şekilde ortaya koyabilmek için eşik değerin yük- sek olarak belirlendiği ve ayırıcı tanıya giren diğer akut karın nedenlerinin de kontrol gurubuna katıldığı daha ge- niş serili çalışmalara ihtiyaç vardı

The Value of D-Dimer in Diagnosis of Acute Mesenteric Ischemia and Differential Diagnosis from Acute Pancreatitis and Acute Cholecystitis

Objective: Because of its poor prognosis and high mor- tality rate, early diagnosis of acute mesenteric ischemia (AMI) is a challenge. The value of serum markers in the diagnosis of AMI is limited and the studies related with the D-dimer test carried out in recent years. In this prospec- tive study we investigated the value of the level of plasma D-dimer in the diagnosis of AMI and the differential diag- nosis from acute pancreatitis and acute cholecystitis. Methods: We included 89 patients who admitted to our emergency department with abdominal pain. The number and the diagnosis of the patients were 17 AMI, 42 acute pancreatitis and 30 acute cholecystitis, respectively. We measured the levels of plasma D-dimer of all patients by using a latex agglutination immunoassay method. Even- tually we calculated the sensitivity and specificity of D- dimer test in the diagnosis of AMI. Results: We determined the specificity of the D-dimer test in the differential diagnosis of AMI as 50% from acute pancreatitis, 70% from acute cholecystitis, 58.3% from all the control group and the sensitivity was 100%. Conclusion: The measurement of plasma D-dimer con- centration may be useful in the differential diagnosis of AMI from acute pancreatitis and acute cholecystitis. How- ever, to reveal the diagnostic value of D-dimer test more clearly, further studies with larger series are needed, where cut-off value is highly defined, and other patients with acute abdominal pain are added into the control group.

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