Plevral Glukoz ve Adenozin Deaminaz: İntraplevral Streptokinaz Sonrası Cerrahi Gereksinimini Öngören Belirteçler

Öz

İntraplevral streptokinaz etkinliğinin incelenmesi amacıyla, enfekte plevral sıvıda intraplevral streptokinaz tedavi (İPST) takiben cerrahi ihtiyacı, opere olan ve olmayan olgularda plevral sıvı parametrelerinin bu ihtiyacı öngörmedeki etkisinin değerlendirilmesi planlanmıştır. Kliniğimizde beş yıllık periyotta İPST uygulanan olgular retrospektif olarak incelenmiştir. Tüberküloz plörezi olguları çalışma dışı bırakılmıştır. Çalışmaya dahil edilen İPST uygulanmış 72 hastanın 58’i parapnömonik efüzyon (PPE), 10’u komplike parapnömonik efüzyon (KPE) ve 4’ü ampiyem idi. İPST sonrası 72.saat, 24saat öncesi ile karşılaştırıldığında plevral sıvı drenajının anlamlı düzeyde arttığı gözlenmiştir [0 ml (0–1000) karşı 650 ml (0-2935), p<0.001]. Hastaların %76’sı cerrahi ihtiyacı olmadan başarılı bir şekilde tedavi edilmiş iken, %24’ünde intraplevral tedaviye rağmen cerrahi yapılmıştır. İki grupta İPST öncesi başlangıç plevral sıvı analizleri karşılaştırıldığında, opere olmayan grupta glukoz düzeylerinin daha düşük, plevral adenozin deaminaz (ADA) seviyesinin ise daha yüksek olduğu saptanmıştır [10 mg/dl (0-161) karşı 69 (5-148), 35 U/L (0-234) karşı 19 (3-82), p=0.026, p=0.003, sırasıyla ]. İPST plevral drenajı arttırıp, operasyon ihtiyacını azaltabilir. Bu çalışmada bulgular, İPST öncesinde plevral sıvı glukoz ve ADA düzeylerinin cerrahi gereksinimini, dolayısıyla İPST etkinliği ve başarısını tahmin etmek için kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

• intraplevral streptokinaz,intraplevral fibrinolitik,parapnömonik efüzyon,ampiyem

Pleural Glucose and Adenosine Deaminase: Surrogate Markers Predicting Requirement for Surgery Following Intrapleural Fibrinolysis

Öz

We aimed to asses clinical efficacy of intrapleural streptokinase, as well as to examine the relationship between the need for surgery follow-ing intrapleural streptokinase treatment (IPST) and, ability to predict surgery requirement of the pleural fluid parameters in operated and non-operated groups. We retrospectively analysed data of patients treated with intrapleural streptokinase, within a period of five years, in our clinic. Tuberculosis pleurosiy cases were excluded. Seventy-two patients treated with intrapleural streptokinase were recruited. Of the patients 58 with parapneumonic effusion (PPE), 10 with complicated parapneumonic effusion (CPE) and 4 were diagnosed with empyema. A significant increase was observed when the pleural fluid drainage on the 72nd hour of IPST was compared to that measured 24 hours before treatment [0 ml (0–1000) vs. 650 ml (0-2935), p<0.001]. While 76% of the patients were successfully treated without need for surgery, 24% underwent pleural surgery despite intrapleural therapy. When the two groups were compared in terms of initial pleural fluid examination, it was found that pleural fluid glucose levels were lower and adenosine deaminase (ADA) values were significantly higher for the non-operated group, before IPST [10 mg/dl (0-161) vs 69 (5-148), 35 U/L (0-234) vs 19 (3-82), p=0.026, p=0.003, respectively]. IPST improves pleural drainage and may decrease the need for operative intervention. This study has suggested that pleural fluid glucose and ADA levels prior to intrapleural streptokinase administration can be used to predict need for surgery, and hence IPST efficiency and success.

Anahtar Kelimeler

• Intrapleural streptokinase,Parapneumonic effusion,Empyema,Pleural glucose,Pleural ADA

Kaynakça

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