Acil serviste serebrovasküler hastalık tanısı alan hastalarda serum trombosit kaynaklı büyüme faktörü-beta (PDGF-β) düzeylerinin araştırılması
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Tarih
2022
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Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İnme yılda 13 milyondan fazla yeni vaka ile dünyada ölüm ve sakatlığın en sık ikinci sebebidir. Risk faktörlerinin önlenmesinin yanında erken tanı ve tedavi ile ölüm ve sakatlık oranlarının azaltılması önem taşımaktadır. Akut inme hastalarının acil hizmetleri sırasında erken tanı almaları, hastaların trombolitik ve endovasküler trombektomi yapılabilecek merkezlere erken yönlendirilmeleri açısından önemlidir. Çoğu kurumda inme şüphesi olan bir hastanın ilk değerlendirmesinde beyin BT kullanılmaktadır, ancak beyin BT akut iskemik inmede erken iskemik değişikliklere karşı duyarsızdır. MRI inmenin erken teşhisi için umut vaat etmektedir, özellikle difüzyon ağırlıklı görüntüleme parankimal değişiklikleri inmenin erken döneminde gösterir, ancak çoğu hastanede MRI imkanı bulunmamaktadır. Bu doğrultuda yaptığımız çalışmada serebrovasküler hastalık şüphesi taşıyan hastalarda veya ileri görüntüleme tetkiklerine imkanı bulunmayan hastanelerde SVH tanısı koymak ve hastalığın seyrini öngörmek amacıyla bir biyobelirteç olarak trombosit kaynaklı büyüme faktörü-beta (PDGF-ß)’nın kullanılıp kullanılamayacağını araştırdık. Çalışmaya Trakya Üniversitesi Tıp Fakültesi erişkin acil servisine başvuran ve acil serviste akut iskemik SVH tanısı alan 67 hasta, akut hemorajik SVH tanısı alan 26 hasta ve kontrol grubu olarak 50 sağlıklı gönüllü dahil edildi. Hastaların demografik özellikleri, komorbid hastalıkları, başvuru şikayetleri, başvuru ile semptom başlangıcı arasında geçen süre, vital bulguları, laboratuvar değerleri, GKS ve NIHSS skorları, infarkt ve kanama bölgeleri, klinik seyir ve mortalite oranları kaydedildi. Hasta ve kontrol gruplarında PDGF-ß düzeyleri incelendi. Çalışmada toplam 143 gönüllü yer almış olup bu kişilerin ortalama yaşı 60,71±19 olup %59,4’ü erkekti. SVH tanısı alan toplam 93 hastanın ortalama yaşı ise 67,6±14,6 ve %65,6’sı erkekti. Kontrol grubundaki kişilerin yaş ortalaması 47,86±19,7 iken iskemik SVH tanılı hastaların 71,16±11,2, hemorajik SVH tanılı hastaların 58,5±18,2 idi. SVH hastaları arasında en sık görülen komorbidite hipertansiyondu. Tüm SVH hastalarının başvuru şikayetleri arasında en sık rastlanan %29 oranı ile kas gücü kaybı şikayetiydi. SVH tanısı alan tüm hastalardan %55,9’unun servise yatışı yapılırken %40,9’unun YBÜ’de yatışı yapıldı. Toplam 93 SVH hastasının 30 günlük mortalite oranı %30,1’di. Yapılan çoklu karşılaştırmada, her bir gruptaki kişilerin PDGF-ß düzeyleri birbirinden farklıydı. PDGF-ß düzeyi en yüksek olan çalışma grubu iskemik SVH tanılı hastalar iken en düşük olan grup ise sağlıklı kişilerdi. Çalışmamızda elde ettiğimiz veriler ışığında PDGF-ß’nın özellikle iskemik SVH hastalarında yüksek bulunması tanısal bir laboratuvar testi olarak kullanılabileceğini göstermiştir. YBÜ yatışı olan hemorajik SVH hastalarında anlamlı derece yüksek olması bu hastaların klinik seyrinin öngörmede de kullanılabileceği görülmüştür. Çalışmamızda hastaların mortalitesi ile PDGF-ß düzeyleri arasında anlamlı ilişki bulunmamış olsa da hayatını kaybeden hemorajik SVH hastalarında PDGF-ß düzeyi anlamlı derecede yüksek bulunmuştur. Daha fazla sayıda gönüllü ile yapılacak bir araştırmanın mortalite açısından daha anlamlı sonuç vereceği düşünülmektedir. Bu konuda geniş katılımlı gönüllülerle yapılacak olan çalışmaların literatüre daha net katkı sağlayacağını düşünmekteyiz.
Stroke is the second most common cause of death and disability in the world, with more than 13 million new cases per year. In addition to preventing risk factors, it is important to reduce mortality and disability rates with early diagnosis and treatment. Early diagnosis of acute stroke patients during emergency services is important in terms of early referral of patients to centers where thrombolytic and endovascular thrombectomy can be performed. Most institutions use brain CT in the initial evaluation of a patient with suspected stroke, but brain CT is insensitive to early ischemic changes in acute ischemic stroke. MRI holds promise for early diagnosis of stroke, especially diffusion-weighted imaging shows parenchymal changes in the early stages of stroke, however, most hospitals do not have MRI facilities. In this direction, in our study, in patients with suspected cerebrovascular disease or in hospitals that do not have the opportunity for advanced imaging examinations; We investigated whether platelet-derived growth factor-beta (PDGF-ß) can be used as a biomarker to diagnose cerebrovascular disease and predict the course of the disease. The study included 67 patients admitted to the Medical Faculty of Trakya University adult emergency department and diagnosed with acute ischemic CVD in the emergency department, 26 patients diagnosed with acute hemorrhagic CVD, and 50 healthy volunteers as the control group. Demographic characteristics of the patients, comorbid diseases, complaints on admission, time between admission and symptom onset, vital signs, laboratory values, GCS and NIHSS scores, infarct and bleeding sites, clinical course and mortality rates were recorded. PDGF-ß levels were examined in the patient and control groups. A total of 143 volunteers were included in the study, and the mean age of these individuals was 60.71±19, of which 59.4% were male. The mean age of 93 patients diagnosed with CVD was 67.6±14.6 years and 65.6% were male. While the mean age of the people in the control group was 47.86±19.7, it was 71.16±11.2 in patients with ischemic CVD and 58.5±18.2 in patients with hemorrhagic CVD. The most common comorbidity among CVD patients was hypertension. Loss of muscle strength was the most common complaint with a rate of 29% among the complaints of all CVD patients. While 55.9% of all patients diagnosed with CVD were admitted to the ward, 40.9% were hospitalized in the ICU. The 30-day mortality rate of a total of 93 CVD patients was 30.1%. In the multiple comparison, the PDGF-ß levels of the individuals in each group were different from each other. The study group with the highest PDGF-ß level was patients diagnosed with ischemic CVD, while the lowest group was healthy individuals. In the light of the data we obtained in our study, the fact that PDGF-ß was found to be high especially in ischemic CVD patients showed that it can be used as a diagnostic laboratory test. It has been seen that it can be used to predict the clinical course of these patients, as it is significantly higher in hemorrhagic CVD patients hospitalized in the ICU. Although there was no significant relationship between mortality and PDGF-ß levels in our study, PDGF-ß levels were found to be significantly higher in hemorrhagic CVD patients who died. It is thought that a study with more volunteers will yield more significant results in terms of mortality. We think that studies with large-participation volunteers will make a clearer contribution to the literature.
Stroke is the second most common cause of death and disability in the world, with more than 13 million new cases per year. In addition to preventing risk factors, it is important to reduce mortality and disability rates with early diagnosis and treatment. Early diagnosis of acute stroke patients during emergency services is important in terms of early referral of patients to centers where thrombolytic and endovascular thrombectomy can be performed. Most institutions use brain CT in the initial evaluation of a patient with suspected stroke, but brain CT is insensitive to early ischemic changes in acute ischemic stroke. MRI holds promise for early diagnosis of stroke, especially diffusion-weighted imaging shows parenchymal changes in the early stages of stroke, however, most hospitals do not have MRI facilities. In this direction, in our study, in patients with suspected cerebrovascular disease or in hospitals that do not have the opportunity for advanced imaging examinations; We investigated whether platelet-derived growth factor-beta (PDGF-ß) can be used as a biomarker to diagnose cerebrovascular disease and predict the course of the disease. The study included 67 patients admitted to the Medical Faculty of Trakya University adult emergency department and diagnosed with acute ischemic CVD in the emergency department, 26 patients diagnosed with acute hemorrhagic CVD, and 50 healthy volunteers as the control group. Demographic characteristics of the patients, comorbid diseases, complaints on admission, time between admission and symptom onset, vital signs, laboratory values, GCS and NIHSS scores, infarct and bleeding sites, clinical course and mortality rates were recorded. PDGF-ß levels were examined in the patient and control groups. A total of 143 volunteers were included in the study, and the mean age of these individuals was 60.71±19, of which 59.4% were male. The mean age of 93 patients diagnosed with CVD was 67.6±14.6 years and 65.6% were male. While the mean age of the people in the control group was 47.86±19.7, it was 71.16±11.2 in patients with ischemic CVD and 58.5±18.2 in patients with hemorrhagic CVD. The most common comorbidity among CVD patients was hypertension. Loss of muscle strength was the most common complaint with a rate of 29% among the complaints of all CVD patients. While 55.9% of all patients diagnosed with CVD were admitted to the ward, 40.9% were hospitalized in the ICU. The 30-day mortality rate of a total of 93 CVD patients was 30.1%. In the multiple comparison, the PDGF-ß levels of the individuals in each group were different from each other. The study group with the highest PDGF-ß level was patients diagnosed with ischemic CVD, while the lowest group was healthy individuals. In the light of the data we obtained in our study, the fact that PDGF-ß was found to be high especially in ischemic CVD patients showed that it can be used as a diagnostic laboratory test. It has been seen that it can be used to predict the clinical course of these patients, as it is significantly higher in hemorrhagic CVD patients hospitalized in the ICU. Although there was no significant relationship between mortality and PDGF-ß levels in our study, PDGF-ß levels were found to be significantly higher in hemorrhagic CVD patients who died. It is thought that a study with more volunteers will yield more significant results in terms of mortality. We think that studies with large-participation volunteers will make a clearer contribution to the literature.
Açıklama
Anahtar Kelimeler
Serebrovasküler hastalık, PDGF-ß, Biyomarker, Tanı, Cerebrovascular disease, Biomarker, Diagnosis
