Akut taşlı kolesistitte serum prokalsitonin düzeyi ile serum C-reaktif protein düzeyinin karşılaştırılması
Comparing serum procalcitonin level with serum C-reactive protein level at acute cholecystitis
Yazar: ESENGÜL TAYMUŞ
Danışman: DOÇ.DR. İBRAHİM İKİZCELİ
Erciyes Üniversitesi / Tıp Fakültesi / Acil Tıp Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2006
Konu: İlk ve Acil Yardım = Emergency and First Aid

Özet:
ÖZETAmaç: Bu çal3Dmada; akut taDl3 kolesistit ve safra koliBi ile baDvurankolelitiazis hastalar3nda, serum prokalsitonin düzeyinin enflamasyon Diddetinintahmin edilmesinde ve komplikasyonlar3n erken tespitindeki yeri ve c-reaktif proteindüzeyi ile karD3laDt3r3lmas3 amaçland3.Materyal-Metod: Çal3Dmada randomize olarak seçilen, yaDlar3 16'dan büyüktoplam 60 kiDiden oluDan üç grup kullan3ld3.Grup I'e kar3n aBr3s3 ile baDvurup ultrason bulgusu ve/veya Murphy pozitifliBiolan, ateD, lökositoz gibi klinik bulgulardan biri pozitif olup akut taDl3 kolesistit tan3s3konan 20 hasta al3nd3. Grup II'ye kar3n aBr3s3 ile baDvurup ultrasonda safra kesesindetaD saptanan 20 kolelitiazis hastas3 al3nd3. Grup III'e öykü ve fizik muayenedeenfeksiyon ve enflamasyon belirtisi olmayan 20 saBl3kl3 kiDi al3nd3.Serum prokalsitonin ve c-reaktif protein ölçümleri için Grup I ve II'dekihastalardan baDvurudan sonra ilk 24 saat içinde, 72. saatte ve 7. günde kan örneklerial3nd3. Grup III'den ise sadece bir kez kan örneBi al3nd3.Bulgular: lk 24 saatte bak3lan c-reaktif protein düzeylerinde tüm gruplararas3nda anlaml3 fark olduBu saptand3. Grup I ve II aras3nda 72. saat ve 7. gündebak3lan c-reaktif protein deBerleri aras3nda fark olmad3B3 tespit edildi.C-reaktif protein ile uygulanan tedavi yöntemleri karD3laDt3r3ld3B3nda;laparoskopi ve aç3k cerrahi uygulanan gruplarda 7. günde anlaml3 fark oluDtuBusaptand3.viiiviProkalsitonin düzeylerinde ilk 24 saat içinde Grup I ve II aras3nda anlaml3 farkoluDtuBu tespit edildi. Aç3k cerrahi uygulananlarda ilk 24 saatte bak3lan prokalsitonindüzeyleri medikal tedavi uygulananlara göre anlaml3 olarak yüksekti..Sonuç: Prokalsitonin safra kesesi hastal3klar3nda enflamasyonun Diddeti vekomplikasyonlar3n erken deBerlendirilmesinde c-reaktif protein ile birliktekullan3labilir.Anahtar kelimeler: Akut kolesistit, c-reaktif protein, kolelitiazis,prokalsitoninixvii

Abstract:
COMPAR NG SERUM PROCALC TON N LEVELW TH SERUM C-REACT VE PROTE N LEVELAT ACUTE CHOLECYST T SABSTRACTObjective: The aim of this study is to examine role of serum procalcitoninlevel in predicting severity of inflammation and development of complications, andto compare serum procalcitonin level with C-reactive protein in patients with acutecalculeous cholecystitis and biliary colic.Material and Method: Three groups of randomly selected patients older than16 years were evaluated in the study, each consisting of 20 patients.Group I included the patients with the following clinical properties: abdominalpain, positive ultrasonographic finding and/or positive Murphy?s sign, and at leastone of the clinical findings such as fever and leucocytosis. Group II included thepatients with abdominal pain and stone in the gall bladder detected withultrasonography. Group III included healthy persons who had no infectious orinflammatory symptoms or signs in history and physical examination.xviiiBlood samples were taken from the patients in Groups I and II for measurementof serum procalcitonin and C-reactive protein within the first 24 hours, at 72nd hourand 7th day. Blood samples were taken from the Group III once only.Results: Significant difference was found between all the groups in respect ofC-reactive protein levels determined within the first 24 hours. No significantdifference was found between the Groups I and II in respect of C-reactive proteinlevels determined at 72nd hour and 7th day.Comparison of C-reactive protein levels with treatment methods showed asignificant difference in the patients treated with laparoscopy or open surgery onthe7th day.Significant difference was found between the Groups I and II in respect ofprocalcitonin levels determined within the first 24 hours. Serum procalcitonin levelwithin the first 24 hours was significantly higher in those who underwent opensurgery than in those who received medical treatment.Conclusion: Serum procalcitonin level in association with C-reactive proteinlevel may be used for early evaluation of inflammation severity and complications ingall bladder diseases.Key words: acute cholecystitis, c-reactive protein, cholelithiasis, procalcitoninxiix