PLEVRAL SIVILI HASTALARDA PLEVRAL SIVI VE SERUM D-DÝMER DÜZEYLERÝNÝN TANISAL DEÐERÝ

Amaç: Çeþitli etyolojilerle ortaya çýkan plevral effüzyonlu hastalarda D-dimer düzeylerinin tanýsal deðerini belirlemektir. Yöntem ve Gereç: Yaþ ortalamasý 66 yýl olan plevral efüzyonlu 122 hasta prospektif olarak çalýþmaya alýnmýþtýr. Eþ zamanlý serum ve plevra sývýsý örneklerinde D-dimer, laktat dehidrogenaz (LDH), total protein, albümin, glukoz, plevra sývýsý pH düzeyi ölçülmüþ, mikrobiyolojik ve sitolojik inceleme yapýlmýþtýr. Tanýlarý kesinleþen hastalar infeksiyon nedenli (n:38; pnömoni, tüberküloz, ampiyem) - infeksiyon dýþý nedenli (n:84; kojestif kalp yetmezliði, malignite ve paramalignite), malignite nedenli (n:47; malign ve paramalign) – malignite dýþý nedenli (n:75; konjestif kalp yetmezliði, tüberküloz, pnömoni, ampiyem) ve transüda (n:27) – eksüda (n:97) vasýflý plevra sývýlarý olmak üzere üç gruba ayrýlmýþtýr. Plevral sývý ve kan örnekleri eþ zamanlý alýnmýþtýr. Bulgular: Serum ve plevral sývý D-dimer seviyeleri eksüda grubunda transuda grubuna göre yüksek bulundu (p<0.05). Ýnfeksiyon nedenli plevra sývýlý hastalar grubunun plevra sývý D-dimer seviyeleri yüksek iken (p=0.01), serum D-dimer seviyelerindeki fark istatistiksel olarak anlamlý bulunmadý (p=0,998). Malignite nedenli ve malignite dýþý nedenli plevra sývýlarýnda, her iki grup arasýnda serum ve plevral sývý D-dimer seviyeleri arasýnda anlamlý fark izlenmedi (p =0,097 ve p=0,255). Plevral sývý D-dimer düzeyi ile plevral sývý proteini ve LDH’ý arasýnda pozitif korelasyon saptandý (r=0.257, p=0.004 ve r=0.240, p=0.008). Serum D-dimer düzeyi ile plevral sývý proteini, plevral sývý LDH’ý ve serum LDH’ý arasýnda pozitif korelasyon saptanýrken (r=0.198, p=0.030 ve r=0.195, p=0.032 ve r=0.250, p=0.006), plevral sývý glukozu ile negatif korelasyon (r=-0.187, p=0.040) tespit edildi. Sonuç: Plevral sývý D-dimer düzeyleri infeksiyon nedeniyle oluþmuþ plevral sývýlarda ve eksüdatif natürlü sývýlarda yüksektir. Malign plevral sývýlarda ise ayýrýcý deðildir.

THE DIAGNOSTIC CONTRIBUTION OF THE LEVEL OF PLEURAL FLUID AND SERUM D-DIMER IN PATIENTS WITH PLEURAL EFFUSION

Aim: To determine the diagnostic value of D-dimer levels in serum and pleural fluid in patients with pleural effusion caused by various pathologies. Material and Methods: One hundred-twenty two patients with pleural effusion with an average age of 66 years were included prospectively. D-dimer, lactate dehydrogenase (LDH), total protein, albumin, glucose levels were studied in serum and pleural fluid simultaneously. Pleural fluid pH, microbiologic and sitologic examinations were also done from pleural fluid samples. The study population was divided into three categories according to their etiologies as infective (n=38; pneumonia, tuberculosis, and empyema) or noninfective (n=84; congestive heart failure, malignancy, and paramalignancy), malignancy (n=47; malignancy and paramalignancy) or nonmalignancy (n=75; congestive heart failure, tuberculosis, pneumonia, and empyema), and transudate (n=27) or exudate (n=97). Pleural fluid and blood samples were obtained simultaneously in order to compare D-dimer, LDH, total protein, and pleural fluid pH. Results: Serum and pleural fluid D-dimer were significantly higher in exudate group than transudate group (p<0.05). Pleural fluid D-dimer was significantly higher in infective group (p=0.01), but the difference in serum D-dimer levels was not statistically different. Both serum and pleural fluid Ddimer was not different between malignancy and non-malignancy groups. Pleural fluid D-dimer was positively correlated with pleural fluid protein and LDH (r=0.257, p=0.004 and r=0.240, p=0.008; respectively). Serum D-dimer was positively correlated with pleural fluid protein, pleural fluid LDH, and serum LDH (r=0.198, p=0.030 and r=0.195, p=0.032 and r=0.250, p=0.006; respectively), while negatively correlated with pleural fluid glucose (r=-0.187, p=0.040). Conclusion: D-dimer levels are higher in exudative pleural fluids and pleural fluids caused by infection. It is not discriminating in malignant pleural fluids.