Öz
Aim. Pulmonary embolism (PE) is a cardiovascular disease that the diagnosis is needed urgent recognition or exclusion, since the PE has high risk of death and anticoagulant treatment starting with suspicion of PE has high risk of bleeding. Ventilation/perfusion(V/P) scintigraphy is one of the widely used tests in suspect of PE. D-dimer is a product of fibrin degradation. However, it is not specific for acute thrombosis. The purpose of this study was to investigate the relation between number of the defect in the ventilation/perfusion scintigraphy and D-dimer levels. Method. In our study, the relation between D-dimer levels of 100 cases followed-up with PE pre-diagnosis and their V/P scintigraphy was investigated. Scintigraphic findings of the patients were divided into six groups regarding the perfusion detect as; “no involvement”, “subsegmenter-involvement”, “onesegment involvement”, “two-segments involvement”, “three-segments involvement”, “more than three-segments involvement” and also divided into four groups regarding the possibility of pulmonary as; “no pulmonary embolism”, “low-probability”, “intermediate-probability” and “high-probability”. The reference range of D-dimer level was 0.00-0.50 µg/mL. Results. Of the 100 patients studied on, 52 were male and 48 were female. In 65 patients without pulmonary embolism D-dimer: 4.39 ± 9 µg/mL; in 20 patients with low-probability D-dimer: 4.57 ± 4 µg/mL;in 9 patients with intermediate-probability D-dimer: 6.38 ± 6 µg/mL and, in 6 patients with high-probability D-dimer:8.0 ± 8 µg/mL (p>0.05). Regarding the number of segment monitored perfusion defect; in 22 patients without perfusion defect D-dimer: 3.01 ± 4 µg/mL;in 8 patients with subsegmental defect D-dimer: 3.62 ± 3 µg/mL; in 14 patients with one segment defect Ddimer:10.7 ± 18 µg/mL; in 11 patients with 2 segments defect D-dimer: 3.16 ± 2 µg/mL; in 10 patients with 3 segments defect D-dimer: 3.86 ± 3 µg/mL, in 35 patients with more than 3 segments defect D-dimer: 4.66 ± 4 µg/mL (p<0.05). Conclusion. In consequence of our study that we researched relations between D-dimer levels and scintigraphic findings in ventilation/perfusion scintigraphy; D-dimer level was found high in the group with perfusion defect in one segment, but however it was found lower at the group in more than three segments defects. This situation makes us think that the cases with one segment defect are ones coherent with real acute PE, and the cases with more segment defects are the cases who rather has chronic diseases.
Anahtar Kelimeler
D-Dimer pulmonary embolism ventilation/perfusion scintigraphy
Kaynakça
- Ödev K. Toraks Radyolojisi. Bölüm 19. Pulmoner Vasküler Hastalıklar. Nobel Tıp Kitabevleri Ltd. Şti. İstanbul 2005; 331-55.
- Arseven O, Sevinç C, Alataş F, Ekim N, Erkan L, Fındık S. Türk Toraks Derneği pulmoner tromboembolizm tanı ve tedavi uzlaşı raporu. Turk Toraks Derg 2009; 10: 1-47.
- Uresandi F, Blanquer J, Conget F, de Gregorio MA, Lobo JL, Otero R, Pérez Rodríguez E, Monreal M, Morales P. Guidelines for the diagnosis, treatment, and follow-up of pulmonary embolism. Arch Bronconeumol 2004; 40: 580-94.
- Bĕlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol 2013; 18: 129Gottschalk A, Sostman HD, Coleman RE, Juni JE, Thrall J, McKusick KA, Froelich JW, Alavi A. Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med 1993; 34: 1119-26.
- Duru S, Ergün R, Dilli A, Kaplan T, Kaplan B, Ardıç S. Pulmoner embolide klinik, laboratuvar ve bilgisayarlı tomografi pulmoner anjiyografi sonuçları: 205 hastanın retrospektif değerlendirmesi. Anadolu Kardiyol Derg 2012; 12: 142-9.
- Douma RA, Tan M, Schutgens RE, Bates SM, Perrier A, Legnani C, Biesma DH, Ginsberg JS, Bounameaux H, Palareti G, Carrier M, Mol GC, Le Gal G, Kamphuisen PW, Righini M. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded. Haematologica 2012; 97: 1507-13.
- Kumar V, Cotran RS, Robbins SL. Temel Patoloji (Basic Pathology). Çevikbaş U (Çeviri Editörü). Akciğerler ve Üst Solunum Yolları. 13. Bölüm. Nobel Tıp Kitabevleri Ltd. Şti 2000; 393-438.
- Huisman MV, Klok FA. How I diagnose acute pulmonary embolism. Blood. 2013; 121: 4443-8.
- Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med 2013; 54: 1588-96.
- Le Roux PY, Robin P, Delluc A, Abgral R, Le Duc-Pennec A, Nowak E, Couturaud F, Le Gal G, Salaun PY. V/Q SPECT interpretation for pulmonary embolism diagnosis: Which criteria to use? J Nucl Med 2013; 54: 1077-81.
- Howarth DM, Booker JA, Voutnis DD. Diagnosis of pulmonary embolus using ventilation/perfusion lung scintigraphy: more than 0.5 segment of ventilation/perfusion mismatch is sufficient. Intern Med J 2006; 36: 281-8.
- Dursun AB, Güven SF, Saka D, Sarıoğlu N, Şipit T. Klinik Pratikte Pulmoner Tromboemboliye Yaklaşım (Approach to the Pulmonary Thromboembolism in Clinical Practice).Tuberk ve Toraks 2001; 49: 464-70.
- Mahdavi R, Caronia J, Fayyaz J, Panagopoulos G, Lessnau KD, Scharf SC, Mina B, Allred C, DiFabrizio L. Agreement between SPECT V/Q scan and CT angiography in patients with high clinical suspicion of PE. Ann Nucl Med 2013; 27: 834-8.
- Gutte H, Mortensen J, Jensen CV, von der Recke P, Petersen CL, Kristoffersen US, Kjaer A. ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism. Clin Physiol Funct Imaging 2010; 30: 466Aujesky D, Roy PM, Guy M, Cornuz J, Sanchez O, Perrier A. Prognostic value of D-dimer in patients with pulmonary embolism. Thromb Haemost 2006; 96: 478Galle C, Papazyan JP, Miron MJ, Slosman D, Bounameaux H, Perrier A. Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. Thromb Haemost 2001; 86: 1156-60. Eichinger S, Minar E, Bialonczyk C, Hirschl M, Quehenberger P, Schneider B, Weltermann A, Wagner O, Kyrle PA. D-dimer levels and risk of recurrent venous thromboembolism. JAMA 2003; 290: 1071-4.
- Akpinar EE, Hoşgün D, Doğanay B, Ataç GK, Gülhan M. Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD? J Thorac Dis 2013; 5: 430-4.
- Noyan T. Klinik Tanı ve Laboratuvar Pratiğinde D-dimer Testi (D-dimer Testing in Clinical Diagnosis and Laboratory Practice). Turk Klinik Biyokimya Derg 2012; 10: 35-40.
- Lindner G, Funk GC, Pfortmueller CA, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK, Puig S. D-Dimer to rule out pulmonary embolism in renal insufficiency. Am J Med. 2013; 16: 1071-1.
Pulmoner emboli tanısında D-dimer düzeyleri ile ventilasyon/perfüzyon sintigrafisindeki bulgular arasındaki ilişki
Öz
Amaç. Pulmoner emboli (PE) ölüm riskinin yüksek olması ve PE kuşkusu ile başlanan
antikoagülan tedavinin yüksek kanama riski taşıması, tanının en kısa sürede doğrulanmasını ya da
dışlanmasını gerektiren kardiovasküler hastalıktır. Ventilasyon/perfüzyon (V/P) sintigrafisi PE
şüphesinde yaygın kullanılan testlerden biridir. D-dimer fibrin yıkımının bir ürünüdür. Ancak akut
trombozlar için spesifik değildir. Bu çalışmada amacımız, D-dimer düzeyleri ile
ventilasyon/perfüzyon sintigrafisindeki perfüzyon defekt sayısı arasındaki ilişkiyi araştırmaktı.
Yöntem. Çalışmamızda, PE ön tanısı ile takip edilen 100 olgunun D-dimer düzeyleri ile V/P
sintigrafileri arasındaki ilişki araştırıldı. Hastaların sintigrafik bulguları perfüzyon defekti
açısından; “perfüzyon defekti yok”, “subsegmenter tutulum”, “bir segment tutulum”, “iki segment
tutulum”, “üç segment tutulum” ve “üçten fazla segment tutulum” şeklinde altı gruba; pulmoner
emboli olasılığı açısından ise “pulmoner emboli yok”, “düşük olasılıklı”, “orta olasılıklı” ve
“yüksek olasılıklı” şeklinde dört gruba ayrıldı. D-dimer düzeyi referans aralığı 0,00-0,50 µg/mL
idi. Bulgular. Çalışmaya alınan 100 hastanın 52’si erkek 48’i kadındı. Pulmoner emboli olmayan
65 hastada D-dimer: 4,39 ± 9 µg/mL; düşük olasılıklı 20 hastada D-dimer: 4,57 ± 4 µg/mL; orta
olasılıklı 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; perfüzyon
defekti olmayan 22 hastada D-dimer: 3,01 ± 4 µg/mL; subsegmenter defekti olan 8 hastada Ddimer:
3,62 ± 3 µg/mL; 1 segment defekti olan 14 hastada D-dimer: 10,7 ± 18 µg/mL; 2 segment
defekti olan 11 hastada D-dimer: 3,16 ± 2 µg/mL; 3 segment defekti olan 10 hastada D-dimer:
3,86 ± 3 µg/mL; 3’ten fazla segment defekti olan 35 hastada D-dimer: 4,66 ± 4 µg/mL olarak
bulundu (p < 0,05). Sonuç. D-dimer düzeyi ile ventilasyon/perfüzyon sintigrafisindeki sintigrafik
bulguların ilişkisini incelediğimiz çalışmamızın sonucunda, D-dimer seviyesi bir segmentte
perfüzyon defekti olan grupta yüksek, buna karşın üçten fazla segmentte tutulum olan grupta ise
daha düşük olarak bulundu. Bu durum, tek segment defekti olan vakaların gerçek akut PE ile
uyumlu vakalar olması ve daha fazla sayıda segment defekti olanların ise daha çok kronik
hastalıkları bulunan vakalar olduğunu düşündürmektedir.
Anahtar Kelimeler
Kaynakça
- Ödev K. Toraks Radyolojisi. Bölüm 19. Pulmoner Vasküler Hastalıklar. Nobel Tıp Kitabevleri Ltd. Şti. İstanbul 2005; 331-55.
- Arseven O, Sevinç C, Alataş F, Ekim N, Erkan L, Fındık S. Türk Toraks Derneği pulmoner tromboembolizm tanı ve tedavi uzlaşı raporu. Turk Toraks Derg 2009; 10: 1-47.
- Uresandi F, Blanquer J, Conget F, de Gregorio MA, Lobo JL, Otero R, Pérez Rodríguez E, Monreal M, Morales P. Guidelines for the diagnosis, treatment, and follow-up of pulmonary embolism. Arch Bronconeumol 2004; 40: 580-94.
- Bĕlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol 2013; 18: 129Gottschalk A, Sostman HD, Coleman RE, Juni JE, Thrall J, McKusick KA, Froelich JW, Alavi A. Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med 1993; 34: 1119-26.
- Duru S, Ergün R, Dilli A, Kaplan T, Kaplan B, Ardıç S. Pulmoner embolide klinik, laboratuvar ve bilgisayarlı tomografi pulmoner anjiyografi sonuçları: 205 hastanın retrospektif değerlendirmesi. Anadolu Kardiyol Derg 2012; 12: 142-9.
- Douma RA, Tan M, Schutgens RE, Bates SM, Perrier A, Legnani C, Biesma DH, Ginsberg JS, Bounameaux H, Palareti G, Carrier M, Mol GC, Le Gal G, Kamphuisen PW, Righini M. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded. Haematologica 2012; 97: 1507-13.
- Kumar V, Cotran RS, Robbins SL. Temel Patoloji (Basic Pathology). Çevikbaş U (Çeviri Editörü). Akciğerler ve Üst Solunum Yolları. 13. Bölüm. Nobel Tıp Kitabevleri Ltd. Şti 2000; 393-438.
- Huisman MV, Klok FA. How I diagnose acute pulmonary embolism. Blood. 2013; 121: 4443-8.
- Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med 2013; 54: 1588-96.
- Le Roux PY, Robin P, Delluc A, Abgral R, Le Duc-Pennec A, Nowak E, Couturaud F, Le Gal G, Salaun PY. V/Q SPECT interpretation for pulmonary embolism diagnosis: Which criteria to use? J Nucl Med 2013; 54: 1077-81.
- Howarth DM, Booker JA, Voutnis DD. Diagnosis of pulmonary embolus using ventilation/perfusion lung scintigraphy: more than 0.5 segment of ventilation/perfusion mismatch is sufficient. Intern Med J 2006; 36: 281-8.
- Dursun AB, Güven SF, Saka D, Sarıoğlu N, Şipit T. Klinik Pratikte Pulmoner Tromboemboliye Yaklaşım (Approach to the Pulmonary Thromboembolism in Clinical Practice).Tuberk ve Toraks 2001; 49: 464-70.
- Mahdavi R, Caronia J, Fayyaz J, Panagopoulos G, Lessnau KD, Scharf SC, Mina B, Allred C, DiFabrizio L. Agreement between SPECT V/Q scan and CT angiography in patients with high clinical suspicion of PE. Ann Nucl Med 2013; 27: 834-8.
- Gutte H, Mortensen J, Jensen CV, von der Recke P, Petersen CL, Kristoffersen US, Kjaer A. ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism. Clin Physiol Funct Imaging 2010; 30: 466Aujesky D, Roy PM, Guy M, Cornuz J, Sanchez O, Perrier A. Prognostic value of D-dimer in patients with pulmonary embolism. Thromb Haemost 2006; 96: 478Galle C, Papazyan JP, Miron MJ, Slosman D, Bounameaux H, Perrier A. Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. Thromb Haemost 2001; 86: 1156-60. Eichinger S, Minar E, Bialonczyk C, Hirschl M, Quehenberger P, Schneider B, Weltermann A, Wagner O, Kyrle PA. D-dimer levels and risk of recurrent venous thromboembolism. JAMA 2003; 290: 1071-4.
- Akpinar EE, Hoşgün D, Doğanay B, Ataç GK, Gülhan M. Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD? J Thorac Dis 2013; 5: 430-4.
- Noyan T. Klinik Tanı ve Laboratuvar Pratiğinde D-dimer Testi (D-dimer Testing in Clinical Diagnosis and Laboratory Practice). Turk Klinik Biyokimya Derg 2012; 10: 35-40.
- Lindner G, Funk GC, Pfortmueller CA, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK, Puig S. D-Dimer to rule out pulmonary embolism in renal insufficiency. Am J Med. 2013; 16: 1071-1.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Temel Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 3 Haziran 2014 |
| Yayımlandığı Sayı | Yıl 2014 |