İdiyopatik Perikardiyal Efüzyon ile İnflamatuvar Belirteçler Arasındaki İlişki

Yıl 2017, Cilt: 20 Sayı: 1, 53 - 58, 03.04.2017

Cemil Zencir Mahmut Akpek Mithat Selvi Sevil Önay Hilal Bektaş Mustafa Yılmaz Mustafa Çetin Kayıhan Kahraman Çağdaş Akgüllü Hüseyin Elbi Hasan Güngör

Öz

Giriş: İnflamasyonun kardiyovasküler hastalıklardaki rolü hakkındaki kanıtların
gittikçe artmasıyla, çalışmalar inflamatuvar markerların hastalık aktivitesi ve
risk değerlendirmesindeki rolüne odaklanmıştır. Bu çalışmanın amacı
inflamatuvar belirteçlerin idiyopatik perikardiyal efüzyonla ile ilişkisini ve
hastalık aktivitesi ile olan korelasyonu olup olmadığının incelenmesidir.

Hastalar ve
Yöntem: Çalışma popülasyonu perikardiyal efüzyonu olan 107 hasta
ile yaş ve cinsiyet olarak benzer 35 sağlıklı gönüllülerden oluşmaktadır. Tüm
hastalar perikardiyal efüzyonun etyolojisine yönelik kapsamlı bir klinik
değerlendirmeye tabi tutulmuştur.

Bulgular: Plevral efüzyonu grubunda, yüksek sensitif C-reaktif protein (Hs-CRP),
nötrofil/lenfosit oranı (NLR) ve platelet/lenfosit oranı (PLR) (herbiri için
p< 0.001), sağlıklı gönüllülerin grubuna göre anlamlı olarak daha yüksekti.
Perikardiyal efüzyonu olan hastalar efüzyon miktarına göre 3 gruba bölündü.
Hs-CRP, NLR ve PLR perikardiyal efüzyon miktarıyla korele bir şekilde
artmaktadır. Çoklu analizde, NLR (OR 1.363, 95% CI 1.026-1.809; p= 0.033)  ve Hs-CRP (OR 1.090, %95 CI 1.030-1.152; p=
0.003), perikardiyal efüzyonu olan hastalarda ciddi perikardiyal efüzyonun
bağımsız bir prediktörleridir.

Sonuç: Hs-CRP, NLR ve PLR perikardiyal efüzyonu olan
hastalarda, hastalık aktivitesi, tedavi monitörizasyonunda ve risk
sınıflamasında kullanılabilir.

Anahtar Kelimeler

Yüksek sensitif C-reaktif protein, nötrofil/lenfosit oranı, perikardiyal efüzyon, platelet/ lenfosit oranı

The Relation of Inflammatory Markers to Idiopathic Pericardial Effusion

Öz

Introduction:
With
the growing evidence about the role of inflammation on cardiovascular
disorders, studies have been focused on inflammatory markers for risk
evaluation and disease activity monitoring. The aim of this study was to
investigate whether inflammation has a role in idiopathic pericardial effusion
(PE) and to reveal its correlation with the disease activity.

Patients
and Methods: The study population consisted of 107 patients with PE
and 35 age-matched and sex-matched healthy volunteers. Each patient underwent a
comprehensive clinical evaluation to identify the probable underlying systemic
diseases or other potential causes for PE.

Results: High-sensitivity
C-reactive protein levels (hs-CRP), neutrophil/lymphocyte ratio (NLR) and
platelet/lymphocyte ratio (PLR) (p< 0.001 for each) were significantly
higher in the PE group than in healthy volunteers. The patients with PE were
divided into three subgroups according to the amount of PE. hs-CRP, NLR and PLR
significantly correlated with the amount of PE. In the multivariate logistic
regression model NLR (OR 1.363, 95% CI 1.026-1.809; p= 0.033) and hs-CRP (OR
1.090, 95% CI 1.030-1.152; p= 0.003) remained as independent predictors of
severe PE in patients who have PE.

Conclusion: hs-CRP, NLR and PLR may be used for disease
activity monitoring, treatment response evaluation and risk stratification of
patients with PE.

Anahtar Kelimeler

High-sensitivity C-reactive protein, neutrophil/lymphocyte ratio, pericardial effusion, platelet/lymphocyte ratio

Kaynakça

• 1. Spodick DH. The pericardium a comprehensive textbook. London: CRC Press, 1996;1-56.
• 2. Sagristà-Sauleda J, Mercé AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol 2011;26:135-43.
• 3. Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc 2010;85:572-93.
• 4. Lorbar M, Spodick DH. ‘Idiopathic’pericarditis-the clinician’s challenge [nothing is idiopathic]. Int J Clin Pract 2007;61:138-42.
• 5. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5-14.
• 6. Celikbilek M, Dogan S, Ozbakır O, Zararsız G, Kücük H, Gürsoy S, et al. Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal 2013;27:72-6.
• 7. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012;5:2.
• 8. Tousoulis D, Antoniades C, Koumallos N, Stefanadis C. Proinflammatory cytokines in acute coronary syndromes: from bench to bedside. Cytokine Growth Factor Rev 2006;17:225-33.
• 9. Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med 2014;9:232-5.
• 10. Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One 2013;8:e67688
• 11. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-67.
• 12. Jung HO. Pericardial effusion and pericardiocentesis: role of echocardiography. Korean Circ J 2012;42:725-34.
• 13. Buyukkaya E, Poyraz F, Karakas MF, Kurt M, Akcay AB, Akpinar I, et al. Usefulness of monocyte chemoattractant protein-1 to predict no-reflow and three-year mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013;112:187-93.
• 14. Maestroni S, Di Corato PR, Cumetti D, Chiara DB, Ghidoni S, Prisacaru L, et al. Recurrent pericarditis: autoimmune or autoinflammatory? Autoimmun Rev 2012;12:60-5.
• 15. Pankuweit S, Wädlich A, Meyer E, Portig I, Hufnagel G, Maisch B. Cytokine activation in pericardial fluids in different forms of pericarditis. Herz 2000;25:748-54
• 16. Imazio M, Brucato A, Doria A, Brambilla G, Ghirardello A, Romito A, et al. Antinuclear antibodies in recurrent idiopathic pericarditis: prevalence and clinical significance. Int J Cardiol 2009;136:289-93.
• 17. Caforio AL, Brucato A, Doria A, Brambilla G, Angelini A, Ghirardello A, et al. Anti-heart and anti-intercalated disk autoantibodies: evidence for autoimmunity in idiopathic recurrent acute pericarditis. Heart 2010;96:779-84.
• 18. Turak O, Ozcan F, Isleyen A, Tok D, Sokmen E, Buyukkaya E, et al. Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis. Am J Cardiol 2012;110:1405-10.
• 19. Akpek M, Kaya MG, Uyarel H, Yarlioglues M, Kalay N, Gunebakmaz O, et al. The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI. Atherosclerosis 2011;219:334-41.
• 20. Canpolat U, Aytemir K, Yorgun H, Şahiner L, Kaya EB, Kabakçı G, et al. Role of preablation neutrophil/lymphocyte ratio on outcomes of cryoballoon-based atrial fibrillation ablation. Am J Cardiol 2013;112:513-9.
• 21. Alexandrakis MG, Passam FH, Moschandrea IA, Christophoridou AV, Pappa CA, Coulocheri SA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol 2003;26:135-140.
• 22. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ergun G, Acikgoz SK, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 2014;114:972-8.
• 23. Onsrud M, Thorsby E. Influence of in vivo hydrocortisone on some human blood lymphocyte subpopulations. Scand J Immunol 1981;13:573-9.
• 24. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003;348:138-50.
• 25. Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621-7.
• 26. Kaya MG, Akpek M, Elcik D, Kalay N, Yarlioglues M, Koc F, et al. Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers. Am J Cardiol 2012;109:851-5.