PLASMA FIBRINOGEN AND D-DIMER LEVELS IN THE ACUTE EXACERBATIONS OF COPD PATIENTS

Yıl 2002, Cilt: 16 Sayı: 1, 1 - 13, 01.05.2002

Mehmet Gülpek Fevziye Tuksavul Özgür Uslu Salih Güçlü

Öz

Plasma fibrinogen and D-dimer concentrations of 35 COPD and 25 control cases were measured in order to predict the predisposition to coagulation causing thrombosis. Statistical differences were found between the plasma fibrinogen and Ddimer concentrations of COPD and control cases. In the COPD and control group,no statistical significance were found between the plasma fibrinogen concentrations of smokers and ex-smokers .We observed a statistical correlation between arterial blood gases and plasma fibrinogen concentrations of COPD patients. We concluded that plasma fibrinogen and D-dimer concentrations were found to be elevated in COPD patients and these parameter are useful to determine the risk groups and the coagulation state differences.

Anahtar Kelimeler

COPD, Fibrinogen, D-dimer

KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLGULARININ AKUT ATAK PLAZMA FİBRİNOJEN VE D-DİMER DÜZEYLERİ

Öz

KOAH'lı hastalarda trombozise zemin hazırlayan koagülasyon artışını saptamak amacıyla, 35 KOAH ve 25 kontrol grubu olgu üzerinde, fibrinojen ve D-dimer plazma konsantrasyonlarına bakıldı. Çalışmanın istatistiksel değerlendirmesi sonucunda KOAH'lı olgular ile kontrol grubu arasında, plazma fibrinojen ve D-dimer konsantrasyonu açısından anlamlı fark bulundu. KOAH'lı grup içinde sigara içenler / bırakanlar arasında ve kontrol grubundaki sigara içenler / içmeyenler arasında plazma fibrinojen konsantrasyonları yönünden anlamlı fark bulunmadığı belirlendi. KOAH'lı olgularda, arteriyel kan gazları ile plazma fibrinojen konsantrasyonu arasında istatistiksel düzeyde anlamlı ilişki olduğu izlendi. Sonuç olarak plazma fibrinojen ve D-dimer kosantrasyonunun KOAH'lı hastalarda anlamlı artış gösterdiği, koagülasyon artışı ve risk gruplarının belirlenmesinde bu parametrelerin yararlı olabileceği sonucuna varıldı.

Anahtar Kelimeler

KOAH, Fibrinojen, D-dimer

Kaynakça

• 1. Umut S. Kronik obtrüktif akciğer hastalığı seminer notları. 1997 .
• 2. Curtis JR, Hudson LP. Emergent assessment and management of acute respiratory failure in COPD. Clin Chest Med 1994; 15: 481-500.
• 3. Alessandri C, Basili S, Violi P, Gazzaniga P et al. Hipercoagulability state in patients with chronic obstructive pulmonery disease. Thoromb Haemos 1994; 72: 343-6.
• 4. Wedzicha JA, Cotter FE, Empey PW. Platelet size in patients with chronic airflow obstruction with and without hipoxemia. Thorax 1988; 43: 61-4.
• 5. Cordova C, Violi Palessandri C, Basili S et al. Improvement of blood gas levels after calcium heparin treatment in patients with chronic obstructive pulmonary disease. Tromb Res 1992;68:435-40.
• 6. Eisenberg PR, Lucore C, Kaufman L et al. Fibrinopeptid A levels indicative of pulmonary vascular trombosis in patient with primary pulmonary hypertansion. Circulation 1990 ; 82: 841-7.
• 7. Mitchell RS, Silver GV, Det GA et al. Clinico- morphologic complications in chronic airways obstruction. Am Rev Respir Dis 1968; 97: 54-62.
• 8. Thompsen CB, Jakubovski SA, Guinn PG et al. Platelet size as a determinant of platelet function. J Lab Clin Med 1983; 101: 205-13
• 9. Cordova C, Musca A, Violi P et al. Platelet hyperfunction in patients with chronic airway obstruction. Eur J Respir Dis 1985; 66: 9-12.
• 10. Perier A, Desmarais S, Goehring C et al. D-dimer testing for suspected Pulmonary embolism in outpatients. Am J Respir Crit Care Med 1997; 156: 492-6.
• 11.Goldhaber SZ, Simons GR, Elliot CG et al. Quantitative plasma D-dimer levels among patients undergoing pulmonary angiography for suspected pulmonary embolism. JAMA 1993; 270: 2819-22.
• 12. Le roux G, Larmignat P, Marchal M et al . Haemostasis at high altitude. In J Sports Med 1992; 13: 49-51.
• 13. Gertler CP, Weibe DA, Ocasio VH et al . Hypoxia induces procoagulant activity in cultered human venous endothelium. J Vasc Surg 1991; 13428-33.
• 14. Ogawa S, Sheenivas R, Brett J et al. The efffect of hypoxia on capillary endothelial cell fuction: Modulation of barrier and coagulant fuction. Br J Haematol 1990; 75: 517-24.
• 15. Kober J, Kaminski D et al. Pulmonary embolism as a serious complication of COPD. Pneumonol Alergol pol. 1994; 62: 138-42.
• 16. Mc Gee MP, Wallin R, Wheeler FB et al. İndication of the extrensic pathway of coagulation by human and rabit alveolar macrophages: A Kinetic study. Blood 1989; 74: 1583-90.
• 17. Lieberg T, Naxtad B, Hetland O et al. Procogulant activity in human bronchoalveolar lavage fluids derivated from alveolar macrophages. Eur Resp J 1990; 3:61-7.
• 18. Di Minno D, Mancini M, Druggs effecting plasma fibrinojen levels. Cardiovascular Drugs Ther 1992;6:25-7.
• 19. Arslantaş N, Uğurman F, Üçoluk GE, Samurkaşoğlu B. KOAH’ta plazma fibrinojen ve D-dimer düzeyleri. Solunum Hastalıkları Dergisi 2000 ; 1: 35-40.
• 20. Bijnen F, Feskens E, Gianpaoly S et al. Haemostatic parameters and life style factors in elderly men Italy and Netherlands. Thromb Heamos 1996;76:411.
• 21. Thomas AE, Green FR, Kelleher CH et al. Variation in the promoter region of the beta fibrinogen gene is associated with plasma fibrinogen levels in smokers and in non smokers. Thoromb Haemos 1991; 65: 487-90.
• 22. Uğurman F, Önde G, Kaya SU et al. Heparine appears to have no significant efffect on the blood gas levels in patients with COPD. Thromb Res 1996; 84: 295-6.
• 23. Bounamaux H, Cirafici P, Le Moerlose P et al. Measurement of D-dimer in plasma as diagnostic aid in suspected pulmonary embolism. Lancet 1991; 337: 196-200.
• 24. Becker DM, Philbrick JT, Bachhuher TL et al. D-dimer testing and acute venous thromboembolism: A short cut to accurate diagnosis? Arch Intern Med 1996; 156: 939-46.
• 25. Quinn DA, Fogel RB et al. D-dimer in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med. 1999 May; 159: 1445-9.
• 26. Lenzofer R, Wimmer R, et al. Prospective study of determining the value of Ddimer in diagnosing pulmonary embolism. Wien Klin Wochenschr . 1993; 105(17): 492-6.
• 27. Hartmann IJ, Hagen PJ, et al. Diagnosing acute pulmoner embolism : effect of COPD on the performance of d-dimer testing, Ventilasion/perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE study group. AM.J Respir Crit Care Med.2000 dec; 162(6): 2232-7.
• 28. Heit JA, Minor TA, et al. Determinants of plasma D-dimer sensitivity for acute pulmonary embolism as defined by pulmonary angiography. Arch Pathol Lab Med 1999 Mar; 123(3): 235-40.
• 29. Angelov A, Zekov C. Thrombotıc complications orginating in the lung in chronıc respiratory insufficiaency. Z Erkr Atmungsorgare 1984; 162: 256-61.
• 30. Xie M, Wang Z, Prethrombotic state in patients with COPD and treatment with heparin. Hua Xi Yi Ke Da Xue Xue Bao.1998 Dec; 29(4): 411-4.