D-dimer Düzeyi Koroner Arter Baypas Cerrahisinden Sonra İskemi/Reperfüzyon Hasarının Bir Bulgusudur

Year 2019, Volume: 22 Issue: 3, 198 - 204, 24.12.2019

Hasan Erdem Kamil Çakalağaoğlu Emre Selçuk Gökhan Keskin Özge Altaş Cengiz Köksal

Abstract

Giriş: Miyokardiyal İskemi-Reperfüzyon (I-R) hasarı kalp cerrahisi sonrası birçok kardiyovasküler duruma neden olmaktadır. I-R’nin patogenezi oldukça karışık bir süreç olup, birçok sistemik ve lokal proinflamatuvar yolağın uyarılmasını ve düzenlenmesini içerir. İskemik miyokardiyuma tekrar sağlanan kan akımı paradoksal olarak reperfüzyonun faydalı etkilerini azaltabilir. Bu çalışmanın amacı miyokardiyal hasarın birer göstergesi olarak, I-R’de kreatin kinaz MB (CK-MB) ve troponin I (cTnI) ile D-dimer seviyeleri arasındaki ilişkiyi ortaya koymaktr.

Hastalar ve Yöntem: Çalışmamız prospektif olarak tasarlanmış ve 50 ardışık CABG hastası çalışmaya dahil edilmiştir. Ameliyat öncesi ve sonrası kan örnekleri çalışma protokolüne uygun olarak alınmış ve CK-MB, cTnI ve D-dimer değerleri ölçülmüştür.

Bulgular: CK-MB, cTnI ve D-dimer değerlerinin postoperatif dönemde anlamlı olarak yükseldiği tespit edildi. D-dimer seviyeleri ameliyat sonrası ilk zirve değerine 1. saatte, ikinci zirve değerine ise 12. saatte ulaştı. Ancak CK-MB ve cTnI ise zirve değerlerine sırası ile 6. ve 12. saatlerinde ulaştı.

Sonuç: Reperfüzyon sırasında oluşan trombinin bir göstergesi olan D-dimer seviyeleri, ameliyat sonrası dönemde miyokardiyal hasarın göstergesi olarak kabul edilen diğer iki belirteçe paralel olarak yükselmiştir. Başka bir deyiş ile D-dimer I-R aracılı miyokardiyal hasarın bir göstergesi olarak değerlendirilebilir.

Keywords

Miyokardiyal reperfüzyon hasarı, fibrin fragmanı D, trombin

D-dimer Level is an Early Marker of Ischaemia/ reperfusion Injury After Coronary Artery Bypass Surgery

Abstract

Introduction: Myocardial Ischaemia-Reperfusion (I-R) injury produces a spectrum of clinical cardiovascular outcomes after cardiac surgery. The pathogenesis of I-R injury is complex and involves the activation and amplification of several systemic and local proinflammatory pathways. The process of restoring blood flow to the ischaemic myocardium can induce injury and paradoxically reduce the beneficial effects of myocardial reperfusion. The objective of this study was to determine the correlation between cardiac markers such as the Mb fraction of the creatine kinase (CK-MB), troponin I (cTnI) and D-dimer levels as a marker of myocardial injury secondary to I-R injury after coronary artery bypass surgery.

Patients and Methods: Herein, a prospective study was designed that included 50 consecutive coronary artery bypass grafting (CABG) patients. Pre and postoperative blood samples were taken due to study protocol and such markers as Mb fraction of the creatine kinase (CK-MB), troponin I (cTnI) and D-dimer were measured.

Results: All three markers were significantly elevated in postoperative blood samples. The D-dimer level reached its peak at the first and another peak at 12th hour postoperatively. However, the peak serum values of CK-MB and cTnI occurred at 6th and 12th hour, respectively.

Conclusion: We demonstrated that D-dimer levels as a marker of generated thrombin during reperfusion correlated with other well-known biochemical markers of myocardial damage in the postoperative period. In other words, D-dimer levels may stand as a marker of I-R-induced myocardial damage.

Keywords

Myocardial reperfusion injury, fibrin fragment D, thrombin

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