SARKOİDOZ HASTALARINDA D-DİMER DÜZEYİ

Year 2011, Volume: 25 Issue: 3, 167 - 175, 01.12.2011

Gülru -duygu- Ufuk Polat-ünalmış-yılmaz

Abstract

Bu çalışmada yeni tanı konulan sarkoidoz hastalarında, serum D-Dimer (DD) düzeyinin hastanın klinik bulguları, solunum fonksiyon testleri ve hatsalığın evresi ile ilişkisini araştırmayı amaçladık. Otuzyedi yeni tanı konmuş sarkoidozlu hastayı kapsayan prospektif bir çalışmadır. DD düzeyi ile olguların cinsiyet, yaş ve sigara içme alışkanlıkları, başvuru yakınmaları, fizik muayene ve laboratuar bulguları, akciğer grafileri, toraks bilgisayarlı tomografileri (BT), solunum fonksiyon testleri ve karbonmonoksit difüzyon kapasitesi (DLCO) ve tedavi arasındaki ilişki değerlendirildi. Olguların %73'ü kadın olup, ortalama yaş 46.14±11.02 idi. 37 olgunun 12'sinde (%32.4) DD düzeyi yüksek bulundu. Çalışmada, olguların yaşı, hastalığın evresi ve sedimantasyon hızı arttıkça DD düzeyinin arttığı izlendi. DD kronik progresif öksürük ve dispne nedeniyle tedavi alan olgularda genel olarak pozitif bulundu. DD'in sarkoidozda tedavi başlama kararını vermede, tedaviye cevabı değerlendirmede yardımcı olabilecek bir markır olarak kullanılabileceğini araştırmak üzere ileri çalışmaların yapılmasına gereksinim vardır.

Keywords

Sarkoidoz, d-dimer

D-DIMER LEVELS IN PATIENTS WITH SARCOIDOSIS

Abstract

Coagulation and fibrinolytic systems have both been implicated in the pathogenesis of sarcoidosis. D-dimer (DD) is a fibrin degradation product and can be used as a marker of fibrinolytic system activity. The purpose of the present study was to determine the relationship between serum D-dimer (DD) levels and clinical findings, pulmonary function test results, and stage of the disease in patients with sarcoidosis. Thirty-seven patients with newly diagnosed sarcoidosis were included in this prospective study. The relationship of DD levels with age, gender, smoking habits, complaints at the time of admission, treatment status and prognosis, findings on physical examination, laboratory testing, chest radiography, thoracic computed tomography, pulmonary function tests, and single-breath carbon monoxide diffusion capacity was evaluated. Of the 37 patients, 73% were females and the mean age was 46.14±11.02 years. DD positivity was noted in 12 patients (32.4%). It was observed that the DD levels increased with age, stage of the disease, and sedimentation rate. The patients with sarcoidosis who were under treatment due to chronic progressive cough and dyspnea were generally DD-positive. Further studies are warranted to confirm the possible use of DD as a marker in the decision making process for recommending initiation of treatment, and in the evaluation of the response to treatment in patients with sarcoidosis.

Keywords

Sarcoidosis, d-dimer

References

• 1. Costabel U. Sarcoidosis: clinical update. Eur Respir J 2001; 18: 56-68.
• 2. Moller DR. Systemic Sarcoidosis. In: Fishman AP, Elias JA, Fishman JA, Fishman’s Pulmonary Diseases and Disorders. 1998; 1055-1084.
• 3. Fanburg BL, Villa O. Sarcoidosis. In: Murray JF, Nadel JA (eds) Textbook of Respiratory medicine. 3rd WB. Saunders Company London 2000; 1717-1733.
• 4. Hunninghake GW, Costabel U, Ando M, et al. AT/ERS//WASOG statement on sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 1999; 16: 149-73.
• 5. Chapman HA, Allen CL, Stone OL. Abnormalities in pathways of alveolar fibrin turnover among patients with interstitial lung disease. Am Rev Respir Dis 1986; 133: 437-43.
• 6. Hasday JD, Bachwich PR, Lynch JP 3rd, Sitrin RG. Procoagulant and Plasminogen activator activities of broncho-alveolar fluid in patients with pulmonary sarcoidosis. Exp Lung Res 1988; 14: 261-78.
• 7. Kobayashi H, Gabazza EC, Taguchi O, Wade H, Takeya H, Nishioka J, et al. Protein C anticoagulant system in patients with interstitial lung disease. Am J Respir Crit Care Med 1998; 157: 1850-4.
• 8. Shorr AF, Hnatiuk OW. Circulating D dimer in patients with sarcoidosis. Chest 2000; 117: 1012-6.
• 9. Inoh M, Tokuda M, Kiuchi H, Kurata N, Takahara J. Evaluating systemic lupus erythematosus disease activity using molecular markers of hemostasis. Arthritis Rheum 1996; 39: 287-91.
• 10. Souto JC, Martínez E, Roca M, et al. Prothrombotic state and signs of endothelial lesion in plasma of patients with inflammatory bowel disease. Dig Dis Sci 1995; 40: 1883-9.
• 11. Chapman HA Jr, Bertozzi P, Reilly JJ Jr. Role of Enzymes mediating thrombosis and thrombolysis in lung disease. Chest 1988; 93: 1256-63.
• 12. Vassalli JD, Baccino D, Belin D. A cellular binding site for the Mr 55,000 form of the human pla sminogen activator, urokinase. J Cell Biol 1985; 100: 86-92.
• 13. Chapman HA Jr, Vavrin Z, Hibbs JB Jr. Macrophage fibrinolytic activity: identification of two pathways of plasmin formation by intact cells and of a plasminogen activator inhibitor. Cell 1982; 28: 653-62.
• 14. Hillyard CJ, Blake AS, Wilson K, Rylatt DB, Miles S, Bunch R, Elms MJ, Barnes A, Bundesen PG. A latex agglutination assay for D-dimer: Evaluation and application for the diagnosis of thrombotic disease. Clin Chem 1987; 33: 1837-40.
• 15. Gupta D, Gupta S, Balamugesh T, Aggarwal AN, Das R. Circulating D dimers as a marker of disease activity in pulmonary sarcoidosis. Indian J Chest Dis Allied Sci 2005; 47: 175-9.
• 16. Perez RL, Duncan A, Hunter RL, Staton GW Jr. Elevated D dimer in the lungs and blood of patients with sarcoidosis. Chest 1993; 103: 1100-6.
• 17. Tuncer LY, Sevim T, Mihmanli A, et al. 48 Sarkoidoz Olgusunun Degerlendirilmesi. 21. Ulusal Turk Tuberkuloz ve Gogus Hastal›klar› Kongresi Özet Kitabi 1996; SB20.
• 18. Yaln›z E, Komurcuoglu A, Polat G, et al. Sarkoidozda Klinik, Radyolojik, Laboratuvarla Ilgili Parametreler ve Tani Yontemleri. Toraks Dergisi 2003; 4(1): 48-52.
• 19. American Thoracic Society. Statement on Sarcoidosis. Am J Respir Care Med 1999; 736-55.
• 20. Musellim B, Kumbasar O, Ongen G, et al. Epidemiological features of Turkish patients with sarcoidosis. Respiratory Medicine 2009; 103(6): 907-12.
• 21. Tabak L, Kilicarslan Z. 147 Sarkoidoz Hastas›n›n Klinik Özellikleri. Solunum 2001; 3: 80-8.