ارزش تشخیصی اندکس های پلاکتی در بیماران مشکوک به آمبولی ریه در بخش اورژانس

Abstract

هدف مطالعه،بررسی تغییرات اندکس های پلاکتی شامل پهنای گستره ی پلاکت،حجم متوسط پلاکت و حجم پلاکتی در ترومبوآمبولی ریه بوده و بررسی ارزش تشخیصی هر یک ازآنها در رابطه با این بیماری می باشد.مواد و روش:مطالعه ما شامل 173 بیمار مشکوک به آمبولی ریه بوده که به دو گروه بر اساس سی تی آنژیوگرافی تقسیم شدند.گروه یک شامل 125 بیمار بوده که ترومبوآمبولی ریه در این بیماران با سی تی آنژیوگرافی تایید شده است و گروه دو شامل 48 بیمار بوده که ترومبوآمبولی ریه با سی تی آنژیوگرافی در آن ها رد شده وبعنوان گروه شاهد می باشند.تغییرات در میزان پهنای گستره ی پلاکت،حجم متوسط پلاکت ، حجم پلاکتی و متغیرهای دیگر در دو گروه آنالیز شدند. نتایج:اندکس های پلاکتی( MPV - PDW - PCT ( بین دو گروه بیماران با ترومبوآمبولی ریه و گروه شاهدی که وارد مطالعه شدند مقایسه گردید(حجم متوسط پلاکت:حساسیت64 %،اختصاصیت 54%،ارزش اخباری مثبت و منفی به ترتیب 58% و 62%،زیر منحنی 0.596 ، Cut off:9.45 و p value<0.05. پهنا گستره پلاکت:حساسیت59%،اختصاصیت 54%،ارزش اخباری مثبت و منفی به ترتیب 56% و 56%،زیر منحنی 0.578 ، Cut off:12.15 و p value<0.05 و حجم پلاکتی:حساسیت56 %،اختصاصیت 63%،ارزش اخباری مثبت و منفی به ترتیب 65% و 58%،زیر منحنی 0.593 ، Cut off:23.25 و p value<0.05).طبق آنالیز آماری داده ها ما بین دو گروه تفاوت چشمگیر درمیزان اندکس های پلاکتی وجود ندارد.جهت تعیین حساسیت، اختصاصیت وCut off point اندکس های پلاکتی برای تشخیص ترومبوآمبولی ریه از منحنی ROC استفاده شد که به علت پایین بودن AUC برای هرکدام از اندکس های پلاکتی و حساسیت و اختصاصیت پایین ، این تست ها دقت کافی جهت تشخیص یا رد ترومبوآمبولی ریه ندارند, Congenital malformations of the head and neck are the most common congenital anomalies in infants. Meanwhile, lip and palate cleft are the most common of them. This study is to investigate the growth curve, growth parameters and developmental status of patients with cleft in the first two years of life, and compared the growth parameters in syndromic and non-syndromic patients.Method: In this descriptive- comparative study of 100 infants between 2-6 years or were completely 2 years at the end of this project and had undergone operation in Tabriz Children's Hospital or were preparing for that action in over a year (2011-2012) were reviewed.100 normal infants with no known disease were selected from kindergartens randomly as controls. All samples divided I two groups: case (syndromic and non-syndromic)- control (normal).Results: of 100 patients, 60% patients were males and 40% were female. There was no correlation between two case and controls in terms of growth arrest after birth, head circumference and infant BMI; but in terms of feeding with pasteurized milk, formula feeding, breastfeeding, nutrition education, weight, height and residency there was a significant difference between two case and controls, so that breastfeeding in normal infants was higher than cases with cleft and conversely feeding with pasteurized milk or formula feeding was higher than normal infants. There was no significant difference between two syndromic and non-syndromic groups in terms of gender, residency, height, weight, head circumference, BMI, growth arrest after birth, nutrition education, breastfeeding, formula feeding, pasteurized milk feeding and growth arrest after operation. Also observed that assistance nutrition in the syndromic group was started earlier in comparison with non-syndromic group.The girls with op were taller than boys but the boys with CL were taller than girls. The boys with CL alone or cp alone were heavier than girls.Head circumference in children wit clp was smaller than the others.Failure to thrive was significantly seen in boys with oral cleft.There was significant difference bet ween infants with cleft and control group in failure to thrive (p<0.001) but the kirl of cleft had no effete in ftt(p=0.435)In this study, between infants with failure to thrive in cleft group (n=27 paitients), 5 infants had Growth hormone deficiency.