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Are Hematological Parameters Useful In The Evaluation Of Behçet’s Disease?

Year 2019, Volume: 52 Issue: 3, 245 - 250, 21.12.2019

Abstract

Objective:
Behçet's disease (BD)
is an autoinflammatory disease. Hematological indices have been
investigated in many diseases as a marker of inflammation.
The aim of this study was to
evaluate hemogram parameters [
neutrophil–lymphocyte
ratio (NLR), platelet–lymphocyte ratio (PLR), mean platelet volume (MPV), red
blood cell distribution width (RDW), and platelet distribution width (PDW)]
in patients with BD as a marker of disease activity and to
determine associations with different clinical manifestations.

Material
and Methods:
This single-centre, cross-sectional study
included 141 (80 male, 61 female) Behcet’s disease (BD)
patients and 96 (51 male, 45 female) healthy subjects.
Hematological and inflammatory parameters including C-reactive protein (CRP),
and erythrocyte sedimentation rate (ESR) were examined in the BD and healthy
control groups. Disease activity in the BD patients was assessed using the
Behçet’s Disease Current Activity Form (BDCAF). 

Results:
The NLR
and RDW levels were found to be statistically significantly higher in the BD
group compared to the healthy control group. MPV levels were lower in the BD
group than in the control group. The level of hemogram parameters were similar
in active and inactive disease. NLR and PDW values were found to be
statistically higher in the BD group with major organ involvement group
compared to the mucocutaneous BD group.


























Conclusions: The
present study results demonstrated that inflammatory
indicators may not provide enough information about disease activity in
patients with BD
. NLR and PDW both showed
good association with major organ involvement in BD. NLR was found to be much
more suitable to follow up patients with uveitis, MPV for those with erythema
nodosum and PDW for neuro-Behcet and oral ulcers.

References

  • Reference1. Emmi G, Silvestri E, Squatrito D, et al. Behcet’s syndrome pathophysiology and potential therapeutic targets. Int Emerg Med 2014;9:257e65.
  • Reference2. Kisacik B, Tufan A, Kalyoncu U, et al: Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75: 291–94.
  • Reference3. Yazici S, Yazici M, Erer B, et al: The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets 2010;21:122–25.
  • Reference4. Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol.2016;36:94–9.
  • Reference5. Peng YF, Zhang Q, Cao L, et al. Red blood cell distribution width: a potential maker estimating disease activity of ankylosing spondylitis. Int J Clin Exp Med. 2014;7(12):5289–95.
  • Reference6. Gurm HS, Bhatt DL, Lincoff AM, , et al. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention:insights from the EPIC, EPILOG, and EPISTENT trials. Heart. 2003;89:1200–4.
  • Reference7. Yolbas S, Yildirim A, Gozel N, Uz B, Koca SS. Hematological Indices May Be Useful in the Diagnosis of Systemic Lupus Erythematosus and in Determining Disease Activity in Behcet’s Disease. Med Princ Pract.2016;25(6):510–516.
  • Reference8. Li L, Xia Y, Chen C, Cheng P, Peng C. Neutrophil-lymphocyte ratio in systemic lupus erythematosus disease: a retrospective study. Int J Clin Exp Med. 2015;8(7):11026–31.
  • Reference9. Mercan R, Bitik B, Tufan A, et al. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016;30(5):597–601.
  • Reference10. Van Der Loo B, Martin JF. A role for changes in platelet production in the cause of acute coronary syndromes. Arterioscler Thromb Vasc Biol 1999;19:672-9.
  • Reference11. Boyraz I, Koç B, Boyacı A, Tutoğlu A, Sarman H, Ozkan H. Ratio of neutrophil/lymphocyte and plate¬let/lymphocyte in patient with ankylosing spondylitis that are treating with anti-TNF. Int J Clin Exp Med 2014;7:2912-5.
  • Reference12. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010;14:28–32.
  • Reference13. Schweiger DJ. Red cell distribution width in sickle cell anemia. Am J Med Technol. 1981;47: 231–3.
  • Reference14. Sarican T, Ayabakan H, Turkmen S, Kalaslioglu V, Baran F, Yenice N. Homocysteine: an activity marker in Behçet’s disease? J Dermatol Sci. 2007;45:121-6.
  • Reference15. Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas KM, Kitas GD. Association of mean platelet volume with hypertension in rheumatoid arthritis. Inflamm Allergy Drug Targets 2010;9:45–50.
  • Reference16. Ozturk C, Balta S, Balta I, et al. Neutrophil-lymphocyte ratio and carotid-intima media thickness in patients with Behcet disease without cardiovascular involvement. Angiology 2015;66:291-6.
  • Reference17. Calamia KT, Wilson FC, Icen M, Crowson CS, Gabriel SE, Kremers HM. Epidemiology and clinical characteristics of Behçet’s disease in the US: a population-based study. Arthritis Rheum 2009;61:600-4.
  • Reference18. Direskeneli H. Behçet’s disease: infectious aetiology, new autoantigens, and HLA-B51. Ann Rheum Dis 2001;60:996-1002.
  • Reference19. Balkarli A, Kucuk A, Babur H, Erbasan F. Neutrophil/lymphocyte ratio and mean platelet volume in Behçet's disease. Eur Rev Med Pharmacol Sci. 2016;20(14):3045-50.
  • Reference20. Koiwa M, Goto S, Takahashi K et al (2016) Neutrophil/lymphocyte ratio in patients with rheumatoid arthritis treated with biological agents. J Nippon Med Sch 83(3):122–123
  • Reference21. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med. 2019;39:345-57.
  • Reference22. Jiang Y, Zang M, and Li S. Serum PLR and LMR in Behçet's disease Can they show the disease activity? Medicine (Baltimore). 2017;96(21): e6981.
  • Reference23. Hammad M, Shehata OZ, Abdel-Latif SM, El-Din AMM. Neutrophil /lymphocyte ratio and platelet/lymphocyte ratio in Behçet's disease: which and when to use? Clin Rheumatol. 2018;37:2811-7.
  • Reference24. Soydinc S, Turkbeyler IH, Pehlivan Y, et al. Mean platelet volume seems to be a valuable marker in patients with systemic sclerosis. Inflammation. 2014;37(1):100-6.
  • Reference25. Avci A, Avci D, Erden F, et al. Can we use the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume values for the diagnosis of anterior uveitis in patients with Behcet’s disease? Therapeutics and Clinical Risk Management 201;13:881-6.
  • Reference26. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Archives of Pathology & Laboratory Medicine. 2009;133:628-32.
  • Reference27. Aksoy ŞN, Savaş E, Sucu M, Kisacik B, Kul S, Zengin O. Association between red blood cell distribution width and disease activity in patients with Behçet's disease. J Int Med Res. 2015;43:765-73.
  • Reference28. Akturk S, Akturk E, Kurtoglu E, et al. Association between red cell distribution width and disease activity in patients with Behcet’s disease. Journal of Clinical & Experimental Cardiology. 2012;3:9.
  • Reference29. Kaito K, Otsubo H, Usui N, et al. Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia. Br J Haematol. 2005;128:698-702.
  • Reference30. Işık M, Şahin H, Hüseyin E. New platelet indices as inflammatory parameters for patients with rheumatoid arthritis. Eur J Rheumatol. 2014;1:144-6.
  • Reference31. Aktürk S, Büyükavcı R. Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clin Rheumatol. 2017;36:1885-9.

HEMATOLOJİK PARAMETRELER, BEHÇET HASTALIĞININ DEĞERLENDİRİLMESİNDE KULLANIŞLI MIDIR?

Year 2019, Volume: 52 Issue: 3, 245 - 250, 21.12.2019

Abstract

Giriş: Behçet
hastalığı (BH) otoinflamatuar bir hastalıktır. Hematolojik parametreler birçok
hastalıkta inflamasyon belirteci olarak araştırılmıştır. Bu çalışmanın amacı,
Behçet hastalarında hemogram parametrelerini (nötrofil-lenfosit oranı,
platelet-lenfosit oranı, ortalama trombosit hacmi, kırmızı kan hücresi dağılım
genişliği ve trombosit dağılım genişliği) hastalık aktivitesinin bir belirteci
olarak değerlendirmek ve farklı klinik bulgular ile ilişkisini tespit etmektir.

Yöntem: Bu tek
merkezli, kesitsel çalışmaya 141 (80 erkek, 61 kadın) Behçet hastası ve 96 (51
erkek, 45 kadın) sağlıklı kontrol grubu dahil edildi. Behçet hastası ve
sağlıklı kontrol gruplarında C-reaktif protein (CRP) ve eritrosit sedimentasyon
hızı (ESR) dahil olmak üzere hematolojik ve enflamatuar parametreler incelendi.
Behçet hastalarındaki hastalık aktivitesi, Behçet Hastalığı Anlık Aktivite
Formu (BDCAF) kullanılarak değerlendirildi.

Bulgular: Nötrofil-lenfosit
oranı ve kırmızı kan hücresi dağılım genişliği değerleri BH grubunda sağlıklı
kontrol gruplarına göre istatistiksel olarak daha yüksek bulundu. Ortalama
trombosit hacmi düzeyleri BH grubunda sağlıklı kontrol gruplarına göre düşüktü.
Bakılan hemogram parametreleri aktif ve inaktif hastalıkta benzerdi. Major
organ tutulumu olan behçet hastalarında Nötrofil-lenfosit oranı ve trombosit
dağılım genişliği mukokutanöz gruba kıyasla istatistiksel olarak daha yüksek
bulundu.


























Sonuçlar:
Bu
çalışma, inflamatuar göstergelerin Behçet hastalarında hastalık aktivitesi
hakkında yeterli bilgi sağlayamayacağını göstermiştir. Nötrofil-lenfosit oranı
ve trombosit dağılım genişliğinin ikisi de BH'da major organ tutulumu ile iyi
ilişki göstermiştir. Nötrofil-lenfosit oranı üveiti olanlarda, ortalama
trombosit hacmi eritema nodozumu olanlarda 
ve trombosit dağılım genişliği nörobehcet ve oral ülseri olan hastaları
takip etmek için kullanılabilir.

References

  • Reference1. Emmi G, Silvestri E, Squatrito D, et al. Behcet’s syndrome pathophysiology and potential therapeutic targets. Int Emerg Med 2014;9:257e65.
  • Reference2. Kisacik B, Tufan A, Kalyoncu U, et al: Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75: 291–94.
  • Reference3. Yazici S, Yazici M, Erer B, et al: The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets 2010;21:122–25.
  • Reference4. Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol.2016;36:94–9.
  • Reference5. Peng YF, Zhang Q, Cao L, et al. Red blood cell distribution width: a potential maker estimating disease activity of ankylosing spondylitis. Int J Clin Exp Med. 2014;7(12):5289–95.
  • Reference6. Gurm HS, Bhatt DL, Lincoff AM, , et al. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention:insights from the EPIC, EPILOG, and EPISTENT trials. Heart. 2003;89:1200–4.
  • Reference7. Yolbas S, Yildirim A, Gozel N, Uz B, Koca SS. Hematological Indices May Be Useful in the Diagnosis of Systemic Lupus Erythematosus and in Determining Disease Activity in Behcet’s Disease. Med Princ Pract.2016;25(6):510–516.
  • Reference8. Li L, Xia Y, Chen C, Cheng P, Peng C. Neutrophil-lymphocyte ratio in systemic lupus erythematosus disease: a retrospective study. Int J Clin Exp Med. 2015;8(7):11026–31.
  • Reference9. Mercan R, Bitik B, Tufan A, et al. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016;30(5):597–601.
  • Reference10. Van Der Loo B, Martin JF. A role for changes in platelet production in the cause of acute coronary syndromes. Arterioscler Thromb Vasc Biol 1999;19:672-9.
  • Reference11. Boyraz I, Koç B, Boyacı A, Tutoğlu A, Sarman H, Ozkan H. Ratio of neutrophil/lymphocyte and plate¬let/lymphocyte in patient with ankylosing spondylitis that are treating with anti-TNF. Int J Clin Exp Med 2014;7:2912-5.
  • Reference12. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010;14:28–32.
  • Reference13. Schweiger DJ. Red cell distribution width in sickle cell anemia. Am J Med Technol. 1981;47: 231–3.
  • Reference14. Sarican T, Ayabakan H, Turkmen S, Kalaslioglu V, Baran F, Yenice N. Homocysteine: an activity marker in Behçet’s disease? J Dermatol Sci. 2007;45:121-6.
  • Reference15. Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas KM, Kitas GD. Association of mean platelet volume with hypertension in rheumatoid arthritis. Inflamm Allergy Drug Targets 2010;9:45–50.
  • Reference16. Ozturk C, Balta S, Balta I, et al. Neutrophil-lymphocyte ratio and carotid-intima media thickness in patients with Behcet disease without cardiovascular involvement. Angiology 2015;66:291-6.
  • Reference17. Calamia KT, Wilson FC, Icen M, Crowson CS, Gabriel SE, Kremers HM. Epidemiology and clinical characteristics of Behçet’s disease in the US: a population-based study. Arthritis Rheum 2009;61:600-4.
  • Reference18. Direskeneli H. Behçet’s disease: infectious aetiology, new autoantigens, and HLA-B51. Ann Rheum Dis 2001;60:996-1002.
  • Reference19. Balkarli A, Kucuk A, Babur H, Erbasan F. Neutrophil/lymphocyte ratio and mean platelet volume in Behçet's disease. Eur Rev Med Pharmacol Sci. 2016;20(14):3045-50.
  • Reference20. Koiwa M, Goto S, Takahashi K et al (2016) Neutrophil/lymphocyte ratio in patients with rheumatoid arthritis treated with biological agents. J Nippon Med Sch 83(3):122–123
  • Reference21. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med. 2019;39:345-57.
  • Reference22. Jiang Y, Zang M, and Li S. Serum PLR and LMR in Behçet's disease Can they show the disease activity? Medicine (Baltimore). 2017;96(21): e6981.
  • Reference23. Hammad M, Shehata OZ, Abdel-Latif SM, El-Din AMM. Neutrophil /lymphocyte ratio and platelet/lymphocyte ratio in Behçet's disease: which and when to use? Clin Rheumatol. 2018;37:2811-7.
  • Reference24. Soydinc S, Turkbeyler IH, Pehlivan Y, et al. Mean platelet volume seems to be a valuable marker in patients with systemic sclerosis. Inflammation. 2014;37(1):100-6.
  • Reference25. Avci A, Avci D, Erden F, et al. Can we use the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume values for the diagnosis of anterior uveitis in patients with Behcet’s disease? Therapeutics and Clinical Risk Management 201;13:881-6.
  • Reference26. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Archives of Pathology & Laboratory Medicine. 2009;133:628-32.
  • Reference27. Aksoy ŞN, Savaş E, Sucu M, Kisacik B, Kul S, Zengin O. Association between red blood cell distribution width and disease activity in patients with Behçet's disease. J Int Med Res. 2015;43:765-73.
  • Reference28. Akturk S, Akturk E, Kurtoglu E, et al. Association between red cell distribution width and disease activity in patients with Behcet’s disease. Journal of Clinical & Experimental Cardiology. 2012;3:9.
  • Reference29. Kaito K, Otsubo H, Usui N, et al. Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia. Br J Haematol. 2005;128:698-702.
  • Reference30. Işık M, Şahin H, Hüseyin E. New platelet indices as inflammatory parameters for patients with rheumatoid arthritis. Eur J Rheumatol. 2014;1:144-6.
  • Reference31. Aktürk S, Büyükavcı R. Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clin Rheumatol. 2017;36:1885-9.
There are 31 citations in total.

Details

Primary Language English
Journal Section Original research article
Authors

Sevinç Can Sandıkçı 0000-0001-5921-8029

Ahmet Omma This is me 0000-0003-2582-7445

Publication Date December 21, 2019
Submission Date July 8, 2019
Published in Issue Year 2019 Volume: 52 Issue: 3

Cite

AMA Can Sandıkçı S, Omma A. Are Hematological Parameters Useful In The Evaluation Of Behçet’s Disease?. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. December 2019;52(3):245-250.