Acil Serviste Kırım Kongo Kanamalı Ateş Hastalığında Soluble Ürokinaz Plazminojen Aktivatör Reseptörünün Tanısal Değeri

Amaç: Ürokinaz tipi plazminojen aktivatör (uPA) sistemi, çeşitli hücrelerden salınan proteaz, reseptör (ürokinaz tipi plazminojen aktivatör reseptör, uPAR) ve inhibitörlerden oluşur. Literatürde, enfekte olan hücrelerden salgılanan solüble ürokinaz plazminojen aktivatör reseptörü (suPAR) düzeyinin Kırım-Kongo kanamalı ateşi (KKKA) hastalarında sağlıklı kontrollere göre daha yüksek olduğu gösterilmiştir. Bu çalışmada acil serviste KKKA'nın ayırıcı tanısında suPAR'ın tanısal değerinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: KKKA hastalığı ön tanısı alan 16 yaşın üstündeki bireyler gerçek zamanlı polimeraz zincir reaksiyonu (real time-polymerase chain reaction, RT-PCR) ve/veya IgM pozitif (KKKA grubu) ve RT-PCR ve/veya IgM negatif (kontrol grubu) olarak iki gruba ayrıldı. Bulgular: Bu çalışmaya 80 hasta dahil edildi. KKKA virus PCR ve/veya KKKA virus IGM’li 40 hasta KKKA grubu olarak ve 40 hasta negatif kontrol grup olarak belirlendi. Hastaların ortanca yaşı 45 (aralık, 16-91) yıldı ve 49 (%61,3) hasta erkekti. KKKA grubunda lökosit, trombosit ve fibrinojen seviyeleri istatistiksel anlamlı olarak düşüktü, kreatinin kinaz, aPTT ve D-dimer seviyeleri ise istatistiksel anlamlı olarak yüksekti. SuPAR için kontrol grubu ile KKKA grubu arasında istatistiksel olarak anlamlı bir farklılık yoktu (p=0.386). Ayrıca KKKA tanısı almayan kontrol grubu hastaları incelendiğinde, en sık bruselloz, influenza ve pnömoni olduğu bulundu. Sonuç: Acil serviste benzer bulgulara sahip hastaların ayırt edilmesinde bir biyobelirteç olarak suPAR'ın kullanımı araştırıldı ve tanısal değeri olmadığı bulundu.

Anahtar Kelimeler:

Hemorajik ateş virüsü, Kırım-Kongo, reseptörler, ürokinaz plazminojen aktivatör, Tanı

The Diagnostic Value of Soluble Urokinase Plasminogen Activator Receptor in Crimean-Congo Hemorrhagic Fever Disease in Emergency Department

Aim: The urokinase-type plasminogen activator (uPA) system consists of a protease, a receptor (urokinase-type plasminogen activator receptor, uPAR), and inhibitors that can be expressed on various cell types. Previous literature shows that the amount of soluble urokinase-type plasminogen activator receptor (suPAR) secreted from affected cells is higher in Crimean-Congo hemorrhagic fever (CCHF) patients than in healthy controls. Thus, we aimed to investigate the diagnostic value of suPAR in the differential diagnosis of CCHF in emergency services. Material and Methods: Individuals over 16 years old with a preliminary diagnosis of CCHF disease were divided into two groups as real time-polymerase chain reaction (RT-PCR) and/or IgM positive (CCHF group) and RT-PCR and/or IgM negative (control group). Results: Eighty patients were included in this study. Forty patients with CCHF virus PCR and/or CCHF virus IgM were identified as CCHF group and 40 patients included as negative control group. The median age of the patients was 45 (range, 16-91) years, and 49 patients (61.3%) were male. Leukocyte, platelet, and fibrinogen levels were significantly lower, while creatinine kinase, aPTT, and D-dimer levels were significantly higher in CCHF group. There was no statistically significant difference between the control group and CCHF group for SuPAR (p=0.386). In addition, control group patients not diagnosed with CCHF were examined, brucellosis, influenza, and pneumonia were found to be the most common. Conclusion: The use of suPAR as a biomarker in the differentiation of patients with similar findings in emergency services was investigated and found to have no diagnostic value.

Keywords:

Hemorrhagic fever virus, Crimean-Congo, receptors, urokinase plasminogen activator, Diagnosis,

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