Akut kolesistit tanısı alan hastalarda plazma YKL-40 düzeyinin araştırılması
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Dosyalar
Tarih
2021
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Akut kolesistit, en sık safra taşı nedeniyle ya da iskemi, bakteriyel enfeksiyonlar, molite bozukluğu vb. sebeplerle safra kesesinin enflamasyonu sonucu oluşan, tanısı; hikaye, fizik muayene, laboratuvar ve radyolojik görüntüleme yöntemleri ile beraber konulabilen, lokal ya da sistemik komplikasyonlara neden olabilen olan bir hastalıktır. YKL-40 bir çok hücre tipinden salgılanabilen, doğal immun yanıtın oluşmasında ve inflamasyonda görev alan bir glikoproteindir. Yapılan çalışmalarda bakteriyel pnömoni, sepsis, septik şok, romatoid artrit, apandisit gibi enflamatuvar hastalıklarda, kardiyak hastalıklarda alzhmeir gibi santral sinir sistemi hastalıklarında YKL-40’ın rolü araştırılmış ancak akut kolesistitle ilgili bir çalışmaya rastlanılmamıştır. Çalışmamızda plazma YKL-40 düzeylerinin akut kolesistit hastalarında tanı ve mortalitenin belirlenmesinde kullanılabilirliğini araştırmak planlandı. Çalışmamız acil servise başvuran akut kolesistit tanısı alan 80 hasta ile acil serviste ciddi müdahale gerektirmeyen tanılar alan 80 adet kontrol grubu ile gerçekleştirildi. Çalışmamıza dahil edilen 160 kişinin %58,8’ü kadın, %41’si erkek iken ortalama yaş 60,5±20,3 saptandı. Hasta grubunda YKL-40 ortanca değeri 804,15±206,9 pg/mL iken kontrol grubunda 383,77±103,1 pg/mL olarak bulundu. Yapılan ROC analizinde (Youden indeksi) kolesistit hastalığını saptamak için kesim noktası (cut-off değeri) 539,6 pg/mL olarak belirlendi. Bu kesim noktasına göre performans ölçüleri; duyarlılık %98,8, seçicilik %95, pozitif kestirim değeri %95,2 ve negatif kestirim değeri de %98,7 olarak bulundu. Akut kolesistit tanısı alan hastalarda kontrol grubuna göre plazma YKL-40 protein düzeyleri anlamlı derecede yüksek bulundu. Akut kolesistit tanılı hastaların yaş, cinsiyet, vital bulguları ile YKL-40 arasında anlamlı ilişki saptanmadı. Laboratuvar değerleri ile YKL-40 arasında; ALT, AST, LDH, GGT ve ALP arasında pozitif yönlü, zayıf doğrusal bir ilişkinin olduğu, diğer parametrelerle arasında ilişkinin olmadığı saptandı. Akut kolesistit hastalarında mortalite ile plazma YKL-40 düzeyleri arasında herhangi bir ilişki bulunmadı. Sonuç olarak akut kolesistit tanısında plazma YKL-40 protein düzeyinin yardımcı olduğu görüldü. Ancak mortaliteyi değerlendirme açısından yeterli olmadığı bulundu. Daha çok sayıda kişi ile yapılacak çalışmalarla akut kolesistit mortalite ve tanısı ilgili daha net bilgiler elde edileceğini düşünüyoruz.
Acute cholecystitis is disease caused by inflammation of the gallbladder, most often due to gallstones or ischemia, bacterial infections, motility disorder, etc. which can cause local or systemic complications, and can be diagnosed together with history, physical examination, laboratory findings and radiological imaging methods. YKL-40 is a glycoprotein that can be secreted from various number of cell types and is involved in the formation of natural immune response and inflammation. Studies have investigated the role of YKL-40 in inflammatory diseases such as bacterial pneumonia, sepsis, septic shock, rheumatoid arthritis, appendicitis, cardiac diseases and central nervous system diseases such as Alzheimer, but no study on acute cholecystitis has been found. In our study, it was planned to investigate the usability of plasma YKL-40 levels in diagnosis and determination of mortality in patients with acute cholecystitis. Our study was carried out with 80 patients who admitted to emergency department and diagnosed with acute cholecystitis and 80 individual control groups who didn’t require serious intervention in the emergency department. While 58.8% of 160 people included in our study were women, and 41% were men; the average age was 60.5 ± 20.3. In the ROC analysis (Youden index), the cut-off point (cut-off value) was assessed as 539.6 pg/mL to detect cholecystitis. Performance measures according to this cut-off point; sensitivity was 98.8%, selectivity 95%, positive predictive value 95.2% and negative predictive value 98.7%. Plasma YKL-40 protein levels were found to be significantly higher in patients with acute cholecystitis compared to the control group. There was no significant relationship between age, gender, vital signs of patients diagnosed with acute cholecystitis and YKL-40 levels. Between laboratory values and YKL-40 levels; It was found that there was a positive and weak linear relationship between ALT, AST, LDH, GGT and ALP, but no relationship was found with other parameters. No relationship was found between mortality and plasma YKL-40 levels in patients with acute cholecystitis. In conclusion, plasma YKL-40 protein levels were found to be helpful in the diagnosis of acute cholecystitis. However, it was found that it was not sufficient to evaluate mortality. We think that more precise information about mortality and diagnosis of acute cholecystitis will be obtained with studies to be conducted with more people.
Acute cholecystitis is disease caused by inflammation of the gallbladder, most often due to gallstones or ischemia, bacterial infections, motility disorder, etc. which can cause local or systemic complications, and can be diagnosed together with history, physical examination, laboratory findings and radiological imaging methods. YKL-40 is a glycoprotein that can be secreted from various number of cell types and is involved in the formation of natural immune response and inflammation. Studies have investigated the role of YKL-40 in inflammatory diseases such as bacterial pneumonia, sepsis, septic shock, rheumatoid arthritis, appendicitis, cardiac diseases and central nervous system diseases such as Alzheimer, but no study on acute cholecystitis has been found. In our study, it was planned to investigate the usability of plasma YKL-40 levels in diagnosis and determination of mortality in patients with acute cholecystitis. Our study was carried out with 80 patients who admitted to emergency department and diagnosed with acute cholecystitis and 80 individual control groups who didn’t require serious intervention in the emergency department. While 58.8% of 160 people included in our study were women, and 41% were men; the average age was 60.5 ± 20.3. In the ROC analysis (Youden index), the cut-off point (cut-off value) was assessed as 539.6 pg/mL to detect cholecystitis. Performance measures according to this cut-off point; sensitivity was 98.8%, selectivity 95%, positive predictive value 95.2% and negative predictive value 98.7%. Plasma YKL-40 protein levels were found to be significantly higher in patients with acute cholecystitis compared to the control group. There was no significant relationship between age, gender, vital signs of patients diagnosed with acute cholecystitis and YKL-40 levels. Between laboratory values and YKL-40 levels; It was found that there was a positive and weak linear relationship between ALT, AST, LDH, GGT and ALP, but no relationship was found with other parameters. No relationship was found between mortality and plasma YKL-40 levels in patients with acute cholecystitis. In conclusion, plasma YKL-40 protein levels were found to be helpful in the diagnosis of acute cholecystitis. However, it was found that it was not sufficient to evaluate mortality. We think that more precise information about mortality and diagnosis of acute cholecystitis will be obtained with studies to be conducted with more people.
Açıklama
Anahtar Kelimeler
Akut kolesistit, Mortalite, YKL-40, Acute cholecystitis, Mortality
