Derin ven trombozu hastalarında endotel disfonksiyonu, oksidatif stres ve inflamasyon süreçlerinin değerlendirilmesi ile hastalığın risk faktörleri ve tanısı için alternatif belirteçlerin geliştirilmesi
Evaluation of endotely dysfunction, oxidative stress and inflammation processes in deep vein thrombosis patients and development of alternative markers for risk factors and diagnosis of the disease
Yazar: AYDIN TOPAL
Danışman: DOÇ. DR. SALİM NEŞELİOĞLU
Sağlık Bilimleri Üniversitesi / Ankara Bilkent Şehir Hastanesi / Tıbbi Biyokimya Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2021
Konu: Biyokimya = Biochemistry
Dizin: D-dimer = D-dimer ; Endotelyum = Endothelium ; Ferroksidaz = Ferroxidase ; Miyeloperoksidaz = Myeloperoxidase ; Oksidatif stres = Oxidative stress ; Risk faktörleri = Risk factors ; Tiyoller = Thiols ; Tromboz = Thrombosis ; Venöz tromboz = Venous thrombosis ; İnflamasyon = Inflammation

Özet:
Derin Ven Trombozu (DVT), patofizyolojisinde günümüzde geçerliliği devam eden mekanizma 19. Yüzyıl başlarında ünlü patolog Virchow tarafından venöz staz, damar endotel hasarı ve hiperkoagülabilite olarak tanımlanıp, tüm bunların esas temelini inflamatuvar mekanizmalar oluşturmaktadır. Bundan dolayı oluşan oksidatif stres ve endotelyal hasar multifaktöriyel olarak lümen içerisinde tromboz oluşmasına ve buna bağlı olarak DVT'nin en önemli komplikasyonu olan pulmoner emboli (PE)'ye neden olur. PE, mortalite ve morbiditesi yüksek, nüks edebilen, bazen tanısı güç olan ve önlenebilir bir hastalıktır. DVT hastalarına erken tanı ve doğru tedavi erkenden başlanırsa DVT'nin ölümcül bir komplikasyonu olan PE yüksek oranda önlenebilir.
Gerçekleştirdiğimiz çalışmada, DVT hastalarında; endotelyal disfonksiyon, oksidatif stres ve inflamasyon süreçlerinin bir arada değerlendirilmesi amacıyla, klinik verilerden de yararlanarak bu süreçlerde rol alan nitrik oksit, nitrozotiyol, tiyol disülfid homeostaz testleri (nativ tiyol, total tiyol, disülfid), iskemi modifiye albümin, lipid hidroperoksit, ferroksidaz ve myeloperoksidazın hangi düzeylerde değiştiğini araştırdık. 
  Derin Ven Trombozu hastalarında nativ tiyol/MPO, NOx/D-dimer, nativ tiyol/ferroksidaz oranı kullanılarak oksidatif stres, endotel disfonksiyon ve inflamasyon sürecinin birlikte değerlendirilmesini, klinik veriler ile beraber bu parametreler kullanılarak DVT hastalığının risk faktörleri ve tanısı hakkında alternatif kantitatif veriler elde etmeyi amaçladık.
Yapmış olduğumuz çalışmada elde ettiğimiz sonuçlara göre serum ferroksidaz düzeyleri, hasta grubunu oluşturan  DVT'li bireylerde  (109,91 ± 26,22 U/L), kontrol grubunu oluşturan bireylere göre (92,61 ± 21,27 U/L) istastiksel olarak anlamlı olarak yüksek bulundu  (p<0,001).
  Elde ettiğimiz sonuçlara göre serum MPO düzeyleri, hasta grubunu oluşturan DVT'li bireylerde, (104,65 ± 32,43U/L), kontrol grubunu oluşturan bireylere göre (96,43 ± 32,23U/L) istastiksel olarak anlamlı bir fark bulunmadı  (p=0,171).
            Sonuçlardan elde ettiğimiz verilere göre serum NOx düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (12,98 ± 5,62 µmol/L), kontrol grubunu oluşturan bireylere göre (8,52 ± 3,65 µmol/L) istastiksel olarak anlamlı olarak yüksek bulundu  (p<0,001).
            Araştırmamızdan elde ettiğimiz verilere göre serum nitrozotiyol düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (1,47 ± 0,37 µmol/L), kontrol grubunu oluşturan bireylere göre (1,30± 0,2937 µmol/L) istastiksel olarak anlamlı olarak yüksek bulundu  (p=0,005).
             Bulduğumuz sonuçlara göre serum LOOH düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (7,21 ± 0,39 µmol/L), kontrol grubunu oluşturan bireylere göre (6,84 ± 0,60 µmol/L) istastiksel olarak anlamlı olarak yüksek bulundu  (p<0,001).
            Tespit ettiğimiz sonuçlar gösterdiki, serum tiyol düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (305,90 ± 55,95µmol/L), kontrol grubunu oluşturan bireylere göre (353,33 ±38,02µmol/L) istastiksel olarak anlamlı olarak düşük  bulundu  (p<0,001).
            Yapmış olduğumuz araştırmada elde ettiğimiz sonuçlara göre serum total tiyol düzeyleri, hasta grubunu    oluşturan DVT'li bireylerde (334,85 ± 59,40 µmol/L), kontrol grubunu oluşturan bireylere göre (382,42 ± 38,84 µmol/L) istastiksel olarak anlamlı olarak düşük bulundu (p<0,001).
            Elde   ettiğimiz   verilere   göre   serum   disülfid düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (14,47 ± 2,60µmol/L), kontrol grubunu oluşturan bireylere göre (14,54 ± 3,07µmol/L) istastiksel olarak anlamlı bir fark bulunamadı  (p=0,898).
            Aynı zamanda yapılan analizlerden sonra hesaplanan paramerteler olan tiyol disülfid homeostazı'nın değerlendirilmesinde kullanılan ve gerekli ölçümlerden sonra hesaplanarak elde edilen % disülfid / nativ tiyol oranı DVT'li bireylerde (4,80 ± 0,77), kontrol grubunu oluşturan bireylere göre (4,15 ± 0,96) istastiksel olarak anlamlı olarak yüksek bulundu  (p<0,001).
            Elde ettiğimiz sonuçlara göre serum IMA düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (100,11 ± 0,97ABSU), kontrol grubunu oluşturan bireylere göre (98,74 ± 5,09ABSU)  istastiksel olarak anlamlı bir fark bulunamadı  (p=0,440).
            Bulduğumuz   sonuçlara   göre   serum D-Dimer düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (2,35 ± 3,45 mg/L), kontrol grubunu oluşturan bireylere göre (0,20 ± 0,04 mg/L) istastiksel olarak anlamlı derecede yüksek bulundu  (p<0,001).
           Elde ettiğimiz sonuçlara göre hemoglobin (g/dL) düzeyleri, hasta grubunu oluşturan DVT'li bireylerde (13,13 ± 2,60), kontrol grubunu oluşturan bireylere göre (13,40 ± 2,58) istastiksel olarak anlamlı bir fark bulunamadı (p=0,580).
            Aynı zamanda yapılan analizlerden sonra hesaplanan parametreler olan ve gerekli ölçümlerden sonra hesaplanarak elde edilen tiyol/MPO oranı DVT'li bireylerde (3,24 ± 1,25), kontrol grubunu oluşturan bireylere göre (3,93 ± 1,35) istastiksel olarak anlamlı olarak düşük  bulundu  (p<0,001).
            Aynı zamanda yapılan analizlerden sonra hesaplanan parametreler olan ve gerekli ölçümlerden sonra hesaplanarak elde edilen tiyol/ferroksidaz oranı DVT'li bireylerde (3,02 ± 1,11), kontrol grubunu oluşturan bireylere göre (4,16 ± 1,34) istastiksel olarak anlamlı olarak düşük bulundu  (p<0,001).
            Aynı zamanda yapılan analizlerden sonra hesaplanan paramerteler olan ve gerekli ölçümlerden sonra hesaplanarak elde edilen NOx/D-Dimer oranı DVT'li bireylerde (17,65 ± 23,71), kontrol grubunu oluşturan bireylere göre (44,75 ± 20,20) istastiksel olarak anlamlı olarak düşük bulundu  (p<0,001).
            Yapmış olduğumuz çalışmada, ferroksisdaz, MPO, NOx, nitrozotiyol, LOOH, nativ tiyol, total tiyol, disülfid, IMA, ALB, HBG, D-Dimer parametreleri arasındaki  korelasyon  pearson  korelasyon  yöntemi ile bakıldı.  p<0,05 istatistiksel olarak anlamlı kabul edildi (Tablo 8).
            Yapmış olduğumuz çalışmada serum ferroksidaz düzeyi, nativ tiyol  (p<0,001 r;042), total tiyol (p<0,001 r;0,40), hemoglobin (p<0,001 r;0,23)   düzeyleri   negatif   korelesyon   gösterirken, d- dimer (p<0,001 r;0,31), % SH/ SS (p<0,001 r;0,27)  ile pozitif  korele bulundu (Tablo 8).
            Serum MPO düzeyi, LOOH (p<0,001 r;0,49)  ile pozitif  korele  bulundu (Tablo 8).
            Serum NOx düzeyi, nitrozotiyol (p<0,001 r;0,30) düzeyi  ile pozitif  korele  bulundu (Tablo 8). 
            Serum nitrozotiyol düzeyi, LOOH (p=0,002 r;0,20)  düzeyi  ile pozitif  korele  bulundu (Tablo 8).
            Ölçülen serum LOOH düzeyi, nativ tiyol (p=0,002 r;0,22) ve total tiyol (p=0,002 r;0,21) düzeyleri ile negatif korele olduğu bulundu (Tablo 8).
            Serum nativ tiyol düzeyi, total tiyol (p<0,001 r;0,99), disulfid (p<0,001 r;0,33) HBG (p=0,003 r;0,20) ALB (p<0,001 r;0,45)  düzeyleri  ile pozitif  korelasyon, D- Dimer (p<0,001 r;0,38), %SH/SS (p<0,001 r;0,54)  düzeyleri ile negatif   korele olduğu belirlendi (Tablo 8).
            Serum total tiyol düzeyi, disulfid (p<0,001 r;0,42), HBG (p=0,003 r;0,20), ALB (p<0,001 r;0,45) düzeyleri ile pozitif  korele, d-dimer (p<0,001 r;0,37), %SH-SS (p<0,001 r;0,46) düzeyleri ile negatif korele olduğu belirlendi (Tablo 8).
            Serum disülfid düzeyleri, ALB (p=0,005 r;0,20),  %SH/SS (p<0,001 r;0,60) düzeyleri ile pozitif korele olduğu bulundu (Tablo 8).
           Serum IMA düzeyi, çalışılan diğer parametreler arasında korele bulunamadı (Tablo 8).
           Serum d-dimer düzeyi, %SH/SS (p<0,001 r;0,33) düzeyleri ile pozitif korele, ALB (p<0,001 r;0,28) düzeyleri ile negatif korele olduğu belirlendi (Tablo 8).
                     Anahtar Kelimeler; Derin ven trombozu, D-Dimer, MPO, nativ tiyol, toplam tiyol, ferrooksidaz, LOOH

Abstract:
The mechanism that is still accepted today in the pathophysiology of 
deep vein thrombosisis (DVT) the triad defined as venous stasis, vascular endothelial damage and hypercoagulability by the famous pathologist Virchow in the early 19th century, and all these are based on inflammatory mechanisms. In this sense, oxidative stress and endothelial damage cause multifactorial thrombosis in the lumen and consequently pulmonary embolism (PE), which is the most important complication of DVT. PE is a disease with high mortality and morbidity, recurrent, sometimes difficult to diagnose and preventable.  If DVT patients are diagnosed early and correct treatment is initiated early, PE, which is a mortal complication of DVT, can be prevented at a high rate.
             In our study, We examined the levels; nitric oxide (NO), nitrosothiol (RSNO), thiol, ıschemia modified albumin (IMA), lipid hydroperoxide (LOOH), ferroxidase and       myeloperoxidase (MPO) levels changes in DVT patients. 
       We aimed to evaluate oxidative stress and inflammation together in DVT patients by using the thiol / MPO, NOx/D-Dimer, tiyol/ferroksidaz ratio.  In addition, we aimed to obtain alternative quantitative data about the risk factors and diagnosis of DVT by using these parameters and new factors to be derived from these parameters together with clinical data.
            According to the results we obtained in our study, serum ferroxidase levels were statistically significant in individuals with DVT (109.91 ± 26.22 U / L) and healthy control group (92.61 ±21.27 U / L). was found to be significantly higher (p <0.001)
            According to the results we obtained, no statistically significant difference was found in serum MPO levels in individuals with DVT that make up the patient group (104.65 ± 32.43U / L) compared to individuals constituting the healthy control group (96.43 ± 32.23U / L). (p = 0.171).
            According to the data we obtained from the results, serum NOx levels were statistically significant in individuals with DVT (12.98 ± 5.62 µmol / L) in the patient group compared to individuals in the healthy control group (8.52 ± 3.65 µmol / L). was found to be high (p <0.001).
            Serum nitrosothiol levels were statistically significant (1.47 ± 0.37 µmol / L) compared to the healthy control group (1.30 ± 0.2937 µmol / L) in individuals with DVT constituting the patient group. found high (p = 0.005).
            According to the results we found, serum LOOH levels were statistically significantly higher in individuals with DVT (7.21 ± 0.39 µmol / L) in the patient group compared to individuals in the healthy control group (6.84 ± 0.60 µmol / L). found (p <0.001).
            The results we detected showed that serum thiol levels were statistically significantly lower in individuals with DVT (305.90 ± 55.95µmol / L) compared to the healthy control group (353.33 ± 38.02µmol / L). found (p <0.001).

            According to the results we obtained in the study we conducted, serum total thiol levels were found in the patients with DVT (334.85 ± 59.40 µmol / L) compared to the healthy control group (382.42 ± 38.84 µmol / L) It was found to be statistically significantly lower (p <0.001).
            According to the data we obtained,  no statistically significant difference was found in serum disulfide levels  in individuals with DVT (14,47 ± 2,60µmol / L) in the patient group compared to individuals constituting the healthy control group (14,54 ± 3,07µmol / L)  (p=0,898).
            At the same time, the disulfide / natural thiolX100 ratio, which is used in the evaluation of thiol tisulfide homeostasis, which is the paramertes calculated after the analyzes and obtained by calculating after the necessary measurements, is found in individuals with DVT (4.80 ± 0.77) compared to the healthy control group (4, 15 ± 0.96) was found to be statistically significantly higher (p <0.001).
            According to the results we obtained, no statistically significant difference was found in serum IMA levels in individuals with DVT (100.11 ± 0.97 ABSU) in the patient group compared to individuals in the healthy control group (98.74 ± 5.09 ABSU) (p = 0.440).
            According to the result we found,  serum  D-Dimer  levels  were  statistically  significant  in individuals with DVT (2.35 ± 3.45 mg / L) in the patient group compared to individuals in the healthy control group (0.20 ± 0.04 mg / L). was found to be high (p <0.001).
             According to the result we obtained, there was  no  statistically  significant  difference  in hemoglobin (g / dL) levels in individuals with DVT comprising the patient group (13.13 ± 2.60) compared to individuals constituting the healthy control group (13.40 ± 2.58). (p = 0.580).
            At the same time, the ratio of thiol / MPO ratio, which are the parameters calculated after the analysis   and   calculated   after   the   necessary   measurements, is   statistically  significant   in individuals with DVT   (3.24 ±  1.25) compared to individuals constituting thehealthy control group (3.93 ± 1.35). was found to be significantly low (p = 0.010).
            At the same time, the thiol / ferroxidase ratio ratio, which is the parameters calculated after the analysis   and   calculated   after   the   necessary   measurements, is   statistically significant   in individuals with DVT (3.02 ± 1.11) compared to individuals constituting the healthy control group (4.16 ± 1.34). was found to be significantly low (p <0.001).
             At the same time, the ratio of NOx/D-Dimer, which are the parameters calculated after the analysis and calculated after the necessary measurements, was determined in individuals with DVT (17.65 ± 23.71) compared to the healthy control group (44.75 ± 20.20). It was found to be statistically significantly lower (p <0.001).
            The correlation between the parameters (ferroxysdase, MPO, NOx, nitrosothiol, LOOH, native thiol, total thiol, disulfide, IMA, ALB, HBG, D-Dimer) that we looked at in the study we conducted was compared with the Pearson correlation  method views.
            Serum ferroxidase levels native thiol (p<0,001 r;042), total thiol (p<0,001 r;0,40). Hemoglobin (p<0,001 r;0,23) levels show negative correlation while D-Dimer (p<0,001 r;0,31) % SH / SS (p<0,001 r;0,27) was positively correlated with.
           Serum NOx level was positively correlated with nitrosothiol (p<0,001).
           Serum MPO level was positively correlated with LOOH  (p<0,001 r;0,49).
           Serum nitrosothiol levels were positively correlated with  LOOH (p=0,002 r;0,20).
           Measured serum LOOH levels were positively correlated with negatively correlated with native thiol (p=0,002 r;0,22), total thiol (p=0,002 r;0,21) levels. was found.
           Serum native thiol levels were positively correlated with total thiol (p<0,001 r;0,99), disulfide (p<0,001 r;0,33) HBG (p=0,003 r;0,20) ALB (p<0,001 r;0,45) levels, D- Dimer (p<0,001 r;0,38), % SH / SS (p<0,001 r;0,54) levels were determined to be negatively correlated.
            Serum total thiol levels were positively correlated with disulfide (p<0,001 r;0,42) HBG (p=0,003 r;0,20) ALB (p<0,001 r;0,45) levels, D- Dimer (p<0,001 r;0,37), % SH-SS (p<0,001 r;0,37) levels were fo            The mechanism that is still accepted today in the pathophysiology of 
deep vein thrombosisis (DVT) the triad defined as venous stasis, vascular endothelial damage and hypercoagulability by the famous pathologist Virchow in the early 19th century, and all these are based on inflammatory mechanisms. In this sense, oxidative stress and endothelial damage cause multifactorial thrombosis in the lumen and consequently pulmonary embolism (PE), which is the most important complication of DVT. PE is a disease with high mortality and morbidity, recurrent, sometimes difficult to diagnose and preventable.  If DVT patients are diagnosed early and correct treatment is initiated early, PE, which is a mortal complication of DVT, can be prevented at a high rate.
             In our study, We examined the levels; nitric oxide (NO), nitrosothiol (RSNO), thiol, ıschemia modified albumin (IMA), lipid hydroperoxide (LOOH), ferroxidase and       myeloperoxidase (MPO) levels changes in DVT patients. 
       We aimed to evaluate oxidative stress and inflammation together in DVT patients by using the thiol / MPO, NOx/D-Dimer, tiyol/ferroksidaz ratio.  In addition, we aimed to obtain alternative quantitative data about the risk factors and diagnosis of DVT by using these parameters and new factors to be derived from these parameters together with clinical data.
            According to the results we obtained in our study, serum ferroxidase levels were statistically significant in individuals with DVT (109.91 ± 26.22 U / L) and healthy control group (92.61 ±21.27 U / L). was found to be significantly higher (p <0.001)
            According to the results we obtained, no statistically significant difference was found in serum MPO levels in individuals with DVT that make up the patient group (104.65 ± 32.43U / L) compared to individuals constituting the healthy control group (96.43 ± 32.23U / L). (p = 0.171).
            According to the data we obtained from the results, serum NOx levels were statistically significant in individuals with DVT (12.98 ± 5.62 µmol / L) in the patient group compared to individuals in the healthy control group (8.52 ± 3.65 µmol / L). was found to be high (p <0.001).
            Serum nitrosothiol levels were statistically significant (1.47 ± 0.37 µmol / L) compared to the healthy control group (1.30 ± 0.2937 µmol / L) in individuals with DVT constituting the patient group. found high (p = 0.005).
            According to the results we found, serum LOOH levels were statistically significantly higher in individuals with DVT (7.21 ± 0.39 µmol / L) in the patient group compared to individuals in the healthy control group (6.84 ± 0.60 µmol / L). found (p <0.001).
            The results we detected showed that serum thiol levels were statistically significantly lower in individuals with DVT (305.90 ± 55.95µmol / L) compared to the healthy control group (353.33 ± 38.02µmol / L). found (p <0.001).

            According to the results we obtained in the study we conducted, serum total thiol levels were found in the patients with DVT (334.85 ± 59.40 µmol / L) compared to the healthy control group (382.42 ± 38.84 µmol / L) It was found to be statistically significantly lower (p <0.001).
            According to the data we obtained,  no statistically significant difference was found in serum disulfide levels  in individuals with DVT (14,47 ± 2,60µmol / L) in the patient group compared to individuals constituting the healthy control group (14,54 ± 3,07µmol / L)  (p=0,898).
            At the same time, the disulfide / natural thiolX100 ratio, which is used in the evaluation of thiol tisulfide homeostasis, which is the paramertes calculated after the analyzes and obtained by calculating after the necessary measurements, is found in individuals with DVT (4.80 ± 0.77) compared to the healthy control group (4, 15 ± 0.96) was found to be statistically significantly higher (p <0.001).
            According to the results we obtained, no statistically significant difference was found in serum IMA levels in individuals with DVT (100.11 ± 0.97 ABSU) in the patient group compared to individuals in the healthy control group (98.74 ± 5.09 ABSU) (p = 0.440).
            According to the result we found,  serum  D-Dimer  levels  were  statistically  significant  in individuals with DVT (2.35 ± 3.45 mg / L) in the patient group compared to individuals in the healthy control group (0.20 ± 0.04 mg / L). was found to be high (p <0.001).
             According to the result we obtained, there was  no  statistically  significant  difference  in hemoglobin (g / dL) levels in individuals with DVT comprising the patient group (13.13 ± 2.60) compared to individuals constituting the healthy control group (13.40 ± 2.58). (p = 0.580).
            At the same time, the ratio of thiol / MPO ratio, which are the parameters calculated after the analysis   and   calculated   after   the   necessary   measurements, is   statistically  significant   in individuals with DVT   (3.24 ±  1.25) compared to individuals constituting thehealthy control group (3.93 ± 1.35). was found to be significantly low (p = 0.010).
            At the same time, the thiol / ferroxidase ratio ratio, which is the parameters calculated after the analysis   and   calculated   after   the   necessary   measurements, is   statistically significant   in individuals with DVT (3.02 ± 1.11) compared to individuals constituting the healthy control group (4.16 ± 1.34). was found to be significantly low (p <0.001).
             At the same time, the ratio of NOx/D-Dimer, which are the parameters calculated after the analysis and calculated after the necessary measurements, was determined in individuals with DVT (17.65 ± 23.71) compared to the healthy control group (44.75 ± 20.20). It was found to be statistically significantly lower (p <0.001).
            The correlation between the parameters (ferroxysdase, MPO, NOx, nitrosothiol, LOOH, native thiol, total thiol, disulfide, IMA, ALB, HBG, D-Dimer) that we looked at in the study we conducted was compared with the Pearson correlation  method views.
            Serum ferroxidase levels native thiol (p<0,001 r;042), total thiol (p<0,001 r;0,40). Hemoglobin (p<0,001 r;0,23) levels show negative correlation while D-Dimer (p<0,001 r;0,31) % SH / SS (p<0,001 r;0,27) was positively correlated with.
           Serum NOx level was positively correlated with nitrosothiol (p<0,001).
           Serum MPO level was positively correlated with LOOH  (p<0,001 r;0,49).
           Serum nitrosothiol levels were positively correlated with  LOOH (p=0,002 r;0,20).
           Measured serum LOOH levels were positively correlated with negatively correlated with native thiol (p=0,002 r;0,22), total thiol (p=0,002 r;0,21) levels. was found.
           Serum native thiol levels were positively correlated with total thiol (p<0,001 r;0,99), disulfide (p<0,001 r;0,33) HBG (p=0,003 r;0,20) ALB (p<0,001 r;0,45) levels, D- Dimer (p<0,001 r;0,38), % SH / SS (p<0,001 r;0,54) levels were determined to be negatively correlated.
            Serum total thiol levels were positively correlated with disulfide (p<0,001 r;0,42) HBG (p=0,003 r;0,20) ALB (p<0,001 r;0,45) levels, D- Dimer (p<0,001 r;0,37), % SH-SS (p<0,001 r;0,37) levels were found to be negatively correlated.
            Serum disulfide levels were found to be positively  correlated with  ALB (p=0,005 r;0,20),  % SH / SS (p<0,001 r;0,60)  levels.
            No correlation was found between serum IMA level and other parameters studied.
            Serum D-Dimer levels positively correlated with, % SH / SS (p<0,001 r;0,33) levels ALB (p<0,001 r;0,28) levels were found to be negatively correlated.
           Keywords; Deep Vein Thrombosis, D-Dimer, MPO, Native Thiol, Total Thiol, ferrooxidase, LOOH
und to be negatively correlated.
            Serum disulfide levels were found to be positively  correlated with  ALB (p=0,005 r;0,20),  % SH / SS (p<0,001 r;0,60)  levels.
            No correlation was found between serum IMA level and other parameters studied.
            Serum D-Dimer levels positively correlated with, % SH / SS (p<0,001 r;0,33) levels ALB (p<0,001 r;0,28) levels were found to be negatively correlated.
           Keywords; Deep Vein Thrombosis, D-Dimer, MPO, Native Thiol, Total Thiol, ferrooxidase, LOOH