Ankilozan Spondilit Hastalarında Hastalık Aktivitesi ve Anti-Tümör Nekroz Faktörü Alfa Ajanlar ile Tedavi Yanıtını Değerlendirmede Hematolojik Endekslerin Klinik Yararlılığı

Year 2024, Volume: 14 Issue: 1, 37 - 45, 31.01.2024

Dilek Tezcan , Muslu Kazım Körez , Selda Hakbilen , Mustafa Emin Kaygısız , Semral Gülcemal , Sema Yilmaz

https://doi.org/10.16899/jcm.1415761

Abstract

Amaç: Ankilozan spondilit (AS), yüksek morbititeye sahip kronik inflamatuar bir hastalıktır. AS'nin patogenezinde TNF-α önemlidir ve TNF inhibitörleri AS hastaları için etkili tedavi ajanlarıdır.AS patogenezinde tümör nekroz faktör alfa (TNF-α) esastır ve TNF inhibitörleri AS hastaları için en etkili tedavi yöntemidir. Son yıllarda rutin kan parametrelerinin, çok sayıda malignite ve kronik inflamatuar hastalığın tanı ve prognozu ile ilişkili sistemik inflamasyon belirteçleri olduğu rapor edilmiştir. Bu çalışmada TNF inhibitörleri ile tedavi edilen AS hastalarında hematolojik parametreler ile klinik parametreler, hastalık şiddeti ve tedaviye yanıt arasındaki ilişkinin araştırılması amaçlandı.
Yöntemler: Bu çalışmaya romatoloji bölümünden toplam 326 katılımcı dahil edildi. Katılımcılar sağlıklı kontroller (n = 178) ve AS (n = 148) olarak ikiye ayrıldı. Nötrofil, lenfosit, monosit ve trombosit sayıları, ortalama trombosit hacmi (MPV), plateletkrit (PTC), nötrofil lenfosit oranı (NLO), nötrofil platelet oranı (PLO), monosit lenfosit oranı (MLO), eritrosit dağılım genişliği (RDW), sistemik inflamatuar indeks (SII), sistemik inflamatuar yanıt indeksi (SIRI), sistemik inflamasyon agregat indeksi (AISI) ve RPR düzeyleri her katılımcı için analiz edildi. Sağlıklı kontrol ile AS hastalarının tedaviden önceki ve tedaviden üç ay sonraki paremetreleri karşılaştırıldı.
Bulgular: RDW, PLR, NLR, MLR, SIRI, AISI ve SII sağlıklı kontrollerden yüksekti ve SIRI dışındakiler tedavilerle azaldı. HLA-B27 pozitif hastalarda tedavi sonrası AISI ve SII'deki azalma anlamlıydı. MPV sağlıklı kontrollerden düşüktü ve tedaviyle arttı. Aktif AS hastalarında SII, SIRI ve AISI, aktif olmayan hastalara göre anlamlı derecede yüksekti. Ayrıca eritrosit sedimantasyon hızı (ESH), C-reaktif protein (CRP) ve BASDAI ile koreleydi.
Sonuç: SII, AISI ve SIRI, hastalık aktivasyonunu göstermede ve anti-TNF-α tedavisinin etkinliğini değerlendirmede değerli belirteçler olabilir.

Keywords

Ankilozan spondilit, anti tümor nekroz faktör alfa, sistemik inflamasyon agregat indeksi, sistemik inflamatuar indeks, sistemik inflamatuar yanıt indeksi

Clinical Usefulness of Hematologic Indices in Evaluating Response to Treatment with Anti-Tumor Necrosis Factor-Alfa Agents and Disease Activity in Patients with Ankylosing Spondylitis

Abstract

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease which influences the proportion of immune cells. Tumor necrosis factor alpha (TNF-α) is essential in the pathogenesis of AS, and TNF inhibitors are the most effective treatment for AS patients. In recent years, routine blood parameters were reported as markers of systemic inflammation associated with the diagnosis and prognosis of numerous malignancies and chronic inflammatory diseases. This study aimed to investigate the relationship between haematological parameters and clinical parameters, disease severity and treatment response in AS patients treated with TNF inhibitors.
Methods: A total of 326 participants were recruited from the rheumatology department in this study. Participants were divided into healthy controls (n = 178) and AS (n = 148). Neutrophil, lymphocyte, monocyte and platelet counts, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), platelet crit (PCT), mean platelet volume (MPV), red cell distribution width (RDW), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), cluster systemic inflammation index (AISI) and RPR levels were analyzed for each participant. They were compared between healthy control, AS patients during the pre-treatment phase and three months after the treatment.
Results: RDW, PLR, NLR, MLR, SIRI, AISI and SII were higher than healthy controls and decreased with treatment except SIRI. The decrease in AISI and SII after treatment was significant in HLA-B27 positive patients. MPV was lower than healthy controls and increased with treatment. SII, SIRI and AISI were significantly higher in the active AS patients than in the inactive patient. Also, they were correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).
Conclusion: SII, AISI, and SIRI may be valuable markers for demonstrating disease activation and evaluating the effectiveness of anti‐TNF‐α therapy.

Keywords

Ankylosing spondylitis, anti tumor necrosis factor alpha, cluster systemic inflammation index, systemic inflammatory index, systemic inflammatory response index

Ethical Statement

The present study was designed as a prospective study and was approved by the ethics committee of Selçuk University Faculty of Medicine Hospital (decision no. 2021/118) and conducted according to the principles of the Declaration of Helsinki.

Supporting Institution

Selçuk University Faculty of Medicine Hospital

Thanks

We acknowledge our patients for the consent to publish this research to teach medical professionals to help their patients better.

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