Akut Karın Hastalarında Ameliyat Öncesi ve Ameliyat Sonrası Tiyol-Disülfid Düzeylerinin Karşılaştırılması

Öz

Amaç: Akut karın takibinde yeni bir oksidatif stres belirteci olan tiyol ve disülfit homeostazının rolünü araştırmak. Gereç ve Yöntem: Bu çalışma prospektif olarak planlanmıştır. Bu çalışmaya akut karın(AK) tanılı 107 (62 erkek ve 45 kadın) hasta dahil edildi.107 hastanın yaşı, cinsiyeti, akut karın sebepleri, pre-operatif yatış anındaki ve post-operatif 3. gündeki native thiol (-SH), total thiol (tSH) ve disülfit (-S-S-) seviyeleri prospektif olarak kaydedilmiş ve –SS-/-SH, -S-S -/tSH, -SH/tSH oranları hesaplanmıştır Bulgular: Akut karına neden olan sebepler incelendiğinde 72 hasta (67,29%) apandisit, 5 hasta (4,67%) alt GIS perforasyonu, 7 hasta (6,54%) peptik ulcus perforasyonu, 5 hasta (4,67%) sigmoid volvulus, 4 hasta (3,74%) strangüle herni, 14 hasta ise (13,08%) diğer nedenlerden opere olmuştu. Hastaların thiol ve disülfit seviyeleri tek parametre olarak incelendiğinde pre-operatif dönemde thiol düzeyi ortalaması 316,71±78,16 (327,5) iken post-operatif dönemde ortalama 264,00±72,85 (278,30) olarak hesaplandı, istatistiki anlamlı farklılık gösterecek şekilde post-operatif dönemde azalma saptandı (p<0,001).Thiol ve disülfit düzeylerinin birbirleri ile oranlarına bakıldığında pre-operatif dönemde disülfit/thiol oranı ortalaması 5,17±1,56 (5,16) iken post-operatif dönemde ortalama 5,36±2,45 (5,28) olarak hesaplandı, istatistiki anlamlı farklılık gözlemlenmedi (p=0,563). Sonuç: Bu çalışma AK'lı hastalarda tiyol oksidasyonunun bir sonucu olarak ortaya çıkan bu parametrelerin takibinin, gerek preoperatif ve gerekse postoperatif donemde önem arz ettiği bulundu. Bu yeni oksidatif stres belirtecinin diğer yerleşik yaklaşımlarla birlikte kullanımını optimize etmek için daha ileri çalışmalar gereklidir.

Anahtar Kelimeler

• akut karın
• disülfid
• laboratuvar çalışması
• tiyol

Comparison of Pre-Operative and Post-Operative Thiol-Disulfide Levels in Acute Abdomen Patients

Öz

Aim: To evaluate role of thiol and disulfide homeostasis, a novel marker of oxidative stress, in the follow-up acute abdomen. Material and Method: This prospective study included 107 patients (62 men and 45 women) with a diagnosis of acute abdomen (AA). In all patients, age, gender and cause of acute abdomen were recorded. In addition, native thiol (-SH), total thiol (tSH) and disulfide (-S-S-) levels at baseline, admission and on postoperative day 3 were prospectively recorded and -SS-/-SH, -S-S-/tH and -SH/tSH ratios were calculated. Results: When the causes of acute abdomen were assessed, it was seen that 72 patients (67.29%) underwent surgery due to appendicitis while 5 patients (4.67%) due to lower GIS perforation, 7 patients (6.54%) due to perforated peptic ulcer, 5 patients (4.67%) due to sigmoid volvulus, 4 patients (3.74%) due to strangulated hernia and 14 patients (13.08%) due to miscellaneous reasons. When thiol and disulfide levels were assessed as a single parameter, mean thiol level was 316.71±78.16 (327.5) at preoperative period and 264.00±72.85 (278.30) at postoperative period. The mean thiol level was significantly decreased at postoperative period (p<0.001). The disulfide//thiol ratio was 5.17±1.56 (5.16) at preoperative period and 5.36±2.45 (5.28) at postoperative period, indicating no significant difference (p=0.563). Conclusions: In this study, it was found that monitoring these parameters resulting from thiol oxidation are valuable at both preoperative and postoperative period in patients with acute abdomen. Further studies are needed to optimize use of oxidative stress marker together with other established marker.

Anahtar Kelimeler

• acute abdomen
• disulfide
• laboratory study
• thiol

Kaynakça

1. 1. Elhardello OA, MacFie J. Digital rectal examination in patients with acute abdominal pain. Emerg Med J 2018;35(9):579-580.
2. 2. Kaushal-Deep SM, Anees A, Khan S, Khan MA, Lodhi M. Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature. Int J Crit Illn Inj Sci 2018;8(2):90-99.
3. 3. Patterson JW, Kashyap S, Dominique E. Acute Abdomen. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2022.
4. 4. Koltuksuz U, Uz E, Ozen S, Aydinç M, Karaman A, Akyol O. Plasma superoxide dismutase activity and malondialdehyde level correlate with the extent of acute appendicitis. Pediatr Surg Int 2000;16(8):559-61.
5. 5. Ozdogan M, Devay AO, Gurer A et al. Plasma total anti-oxidant capacity correlates inversely with the extent of acute appendicitis: a case control study. World J Emerg Surg 2006;1:6.
6. 6. Satomi A, Hashimoto T, Murakami S et al. Tissue superoxide dismutase (SOD) activity and immunohistochemical staining in acute appendicitis: correlation with degree of inflammation. J Gastroenterol 1996;31(5):639-45.
7. 7. Ozyazici S, Karateke F, Turan U et al. A Novel Oxidative Stress Mediator in Acute Appendicitis: Thiol/Disulphide Homeostasis. Mediators Inflamm 2016;2016:6761050.
8. 8. Ercan Haydar FG, Otal Y, Şener A et al. The thiol-disulphide homeostasis in patients with acute pancreatitis and its relation with other blood parameters. Turk J Trau Emerg Surg 2020;26(1): 37-42.

9. 9. Avci V, Huyut Z, Altindağ F, Ayengin K, Alp HH. Thiol-disulphide homeostasis in ovarian torsion-detorsion: An experimental rat model. J Clin Obstet Gynecol 2020;30(1):1-7.
10. 10. Dumlu EG, Tokaç M, Bozkurt B et al. Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis. Clinics (Sao Paulo) 2014;69(10);677-82.
11. 11. Kaya M, Boleken ME, Kanmaz T, Erel O, Yucesan S. Total antioxidant capacity in children with acute appendicitis. Eur J Pediatr Surg 2006;16(1):34-8.
12. 12. Jones DP, Liang Y. Measuring the poise of thiol/disulfide couples in vivo. Free Radic Biol Med 2009;47(10):1329-38.
13. 13. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem 2014;47(18):326-32.
14. 14. Chianeh YR, Prabhu K. Protein thiols as an indicator of oxidative stress. Archives J Med Review 2014;23(3):443-456.
15. 15. Yuksel M, Ates I, Kaplan M et al. The dynamic thiol/disulphide homeostasis in inflammatory bowel disease and its relation with disease activity and pathogenesis. Int J Colorectal Dis 2016 ;31(6):1229-31.
16. 16. Akçay MN, Yıldırgan Mİ, Çapan MY et al. Diagnostic value of CRP in acute abdomen. Turk J Trau Emerg Surg 1996;2(1):100-103.
17. 17. Aktürk OM, Çakır M, Yıldırım D, Akıncı M. C-reactive protein and red cell distribution width as indicators of complications in patients with acute appendicitis. Arch Clin Exp Med 2019; 4(2): 76-80.
18. 18. Ünal Y, Barlas AM. Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis. Turk J Trau Emerg Surg 2019; 25(2):177-182.
19. 19. Ünsal A, Turhan VB, Öztürk D, Buluş H, Türkeş GF, Erel Ö. The predictive value of ischemia-modified albumin in the diagnosis of acute appendicitis: A prospective case-control study. Turk J Trau Emerg Surg 2022; 28(4):523-52.