Ulus Travma Acil Cerrahi Derg. 2018; 24(6): 507-513 | DOI: 10.5505/tjtes.2018.69710

Akut mezenterik iskemi hasarýnýn kritik zaman tahmini ve reversibilitesi

Ayhan Aköz¹, Kenan Ahmet Türkdoðan¹, Nesibe Kahraman Çetin², Selen Kum³, Ali Duman¹, Mevlüt Türe⁴, Ahmet Ender Demirkýran^5
1Adnan Menderes Üniversitesi Týp Fakültesi, Acil Týp Ana Bilim Dalý, Aydýn
²Adnan Menderes Üniversitesi Týp Fakültesi, Patoloji Ana Bilim Dalý, Aydýn
³Adnan Menderes Üniversitesi Týp Fakültesi, Histoloji Ana Bilim Dalý, Aydýn
⁴Adnan Menderes Üniversitesi Týp Fakültesi, Biyoistatistik Ana Bilim Dalý, Aydýn
⁵Adnan Menderes Üniversitesi Týp Fakültesi, Genel Cerrahi Ana Bilim Dalý, Aydýn

AMAÇ: Bu çalýþmada akut mezenterik iskemide yeni iskemik biyobelirteçler olan ENDOCAN ve SCUBE-1'in erken evre hasar, taný ve irreversibýl hasar deðerlerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: 54 sýçan ile deneysel bir mezenterik iskemi reperfüzyon modeli tasarlandý. Dokuz grup oluþturuldu; Kan ve doku örneklerinin sadece örneklendiði üç sahte grup [Grup I (30.dakika), IV (2. saat) ve VII (6.saat)]; superior mezenterik arter (SMA) baðlandýktan sonra kan ve doku numuneleri örneklenen üç iskemi grubu [Grup II (30. dakika), V (2. saat) ve VIII (6.saat)]; ve SMA dekompresyonundan sonra kan ve doku numuneleri örneklendirilen ve reperfüzyon 1 saat süreyle indüklenen üç reperfüzyon grubu [Grup III (30. dakika), VI (2. saat) ve IX (6. saat)]. SCUBE-1 ve ENDOCAN için kan örnekleri alýndý ve histopatolojik olarak doku örnekleri incelendi.
BULGULAR: SCUBE-1 düzeyleri Ýskemi grubunda sahte gruba göre daha yüksek iken(p <0.05), geç iskemi (6. saat) grubunda ENDOCAN düzeyleri belirgin olarak farklýydý. Bu iki belirteç, histopatolojik incelemeye göre irreversýble mezenterik hasar için birlikte kullanýldýðýnda, reversible-irrreversible hasar ayýrýmýný % 94,1 sensitivite, % 73,7 spesifite ile belirledi.
TARTIÞMA: SCUBE-1'in tek baþýna yükselmesi laboratuvar sýçanlarýnda erken mezenterik iskemiyi öngörmede önemli olarak gözükmektedir. Bununla birlikte, SCUBE-1 ve ENDOCAN eþ zamanlý kullanýmý irreversible baðýrsak hasarýnýn tespitinde daha kullanýlýþlý olabilir.

Anahtar Kelimeler: SCUBE 1, ENDOCAN, akut mezenter iskemi, irreversiblite

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Predicting critical duration and reversibility of damage in acute mesenteric ischemia: An experimental study

Ayhan Aköz¹, Kenan Ahmet Türkdoðan¹, Nesibe Kahraman Çetin², Selen Kum³, Ali Duman¹, Mevlüt Türe⁴, Ahmet Ender Demirkýran^5
1Department of Emergency Medicine, Adnan Menderes University Faculty of Medicine, Aydýn-Turkey
²Department of Pathology, Adnan Menderes University Faculty of Medicine, Aydýn-Turkey
³Department of Histology, Adnan Menderes University Faculty of Medicine, Aydýn-Turkey
⁴Department of Biostatistics, Adnan Menderes University Faculty of Medicine, Aydýn-Turkey
⁵Department of General Surgery, Adnan Menderes University Faculty of Medicine, Aydýn-Turkey

BACKGROUND: The objective of the current study was to investigate the value of the ischemic biomarkers endothelial cell-specific molecule-1 (endocan) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in the diagnosis and assessment of early-stage and irreversible damage in acute mesenteric ischemia.
METHODS: An experimental mesenteric ischemia reperfusion model was designed using 54 rats. Nine groups were created: Three sham groups [Groups I (30th minute), IV (2nd hour), and VII (6th hour)], in which only blood and tissue specimens were sampled; 3 ischemia groups [Groups II (30th minute), V (2nd hour), and VIII (6th hour)], in which blood and tissue specimens were sampled after ligation of the superior mesenteric artery (SMA); and 3 reperfusion groups [Groups III (30th minute), VI (2nd hour), and IX (6th hour)], in which blood and tissue specimens were sampled after declamping the SMA and reperfusion for 1 hour. SCUBE-1 and endocan samples obtained from blood and tissue were examined histopathologically.
RESULTS: The SCUBE-1 level was higher in the ischemia groups when compared with the sham groups (p<0.05), and the endocan level was markedly different in the late ischemia (6th hour) group. When these 2 markers were used together to assess irreversible mesenteric damage in the histopathological examination, the sensitivity in distinguishing between reversible or irreversible damage was 94.1% with a specificity of 73.7%.
CONCLUSION: The elevation of SCUBE-1 alone seems to be significant for predicting early mesenteric ischemia in laboratory rats. The combination of SCUBE-1 and endocan may be useful to detect irreversible intestinal damage.

Keywords: Acute mesenteric ischemia, endocan, irreversibility; signal peptide-CUB-EGF domain-containing protein-1.

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