Gebelerde düşük molekül ağırlıklı heparin kullanımının sistemik immün-inflamasyon indeksi üzerine etkisi

Abstract

Amaç Gebelerde Düşük Molekül Ağırlıklı Heparin (DMAH) kullanımı sonrası inflamasyon belirteçlerinin değişiminin saptanması amaçlanmıştır. Gereç ve Yöntemler Gebeliğinde DMAH kullanan 57 hastanın DMAH kullanımı öncesi ve bir ay sonrası hemogram tetkikindeki parametreler kullanılarak hesaplanan, NLO (Nötrofil Lenfosit Oranı), TLO (Trombosit Lenfosit Oranı), LMO (Lenfosit Monosit Oranı) ve SII (Sistemik İmmün-inflamasyon İndeks) (Nötrofil x Trombosit / Lenfosit) karşılaştırıldı. Bulgular DMAH kullanımı sonrasında OEDG (Ortalama eritrosit dağılım genişliği), OTH (ortalama trombosit hacmi), OTDG (Ortalama trombosit dağılım genişliği), NLO ve SII anlamlı olarak artarken; platekrit, LMO anlamlı olarak azalmış olarak saptandı (p<0,05). Ayrıca TLO anlamlı olarak değişmemişti. Sonuç DMAH'nin anti inflamatuar sürece katkısını göstermek için teknik olarak ucuz ve uygulanabilir olan hemogram parameterlerinden OTH, OTDG ve platekrit kullanılabilir. Bu parametreler DMAH kullanan gebelerin takibinde klinisyenlere yardımcı olabilir. DMAH'nin gebelik sonuçlarını iyileştirmesinde antikoagülan etkisinin yanı sıra anti inflamatuar etkisinin olabileceği sonucuna varılmıştır.

Keywords

• Düşük molekül ağırlıklı heparin
• hemogram
• OTH
• OTDG
• platekrit
• Sistemik İmmün-inflamasyon İndeksi

The effect of low molecular weight heparin on the systemic immune-inflammation index in pregnancy

Abstract

Aim The aim of this study was to investigate the effect of low molecular weight heparin (LMWH) use on inflammatory markers. Material and Methods: Fifty-seven pregnant women were enrolled in this study. Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), and systemic immune-inflammation index (SII) (Neutrophil x Platelet / Lymphocyte) were calculated using complete blood count parameters. These parameters were compared before and after one month usage of LMWH. . Results After the usage of LMWH , mean erythrocyte distribution width (RDW), mean platelet volume (MPV), mean platelet distribution width (PDW) , NLR, and SII increased and platecrite, and LMR decreased significantly (p <0.05). Also, there was no change in TLR. Conclusion In order to see anti-inflammatory effect of LMWH easily and cost effectively MPV, PDW, platecrite may be used. These parameters might be helpful in LWMH prescribed patient follow-ups. LMWH might be associated with better pregnancy outcomes as a result of both anticoagulation and anti-inflammatory effects.

Keywords

• Low Molecular Weight Heparin
• Complete Blood Count
• MPV
• PDW
• Platecrite
• LMR
• Systemic Immune-inflammation Index

References

1. Kaynaklar Greer I, Hunt BJ. Low molecular weight heparin in pregnancy: current issues. British journal of haematology. 2005;128(5):593-601.
2. Yan Y, Ji Y, Su N, Mei X, Wang Y, Du S, et al. Non-anticoagulant effects of low molecular weight heparins in inflammatory disorders: A review. Carbohydrate polymers. 2017;160:71-81.
3. Hochart H, Vincent Jenkins P, Smith OP, White B. Low‐molecular weight and unfractionated heparins induce a downregulation of inflammation: decreased levels of proinflammatory cytokines and nuclear factor‐κB in LPS‐stimulated human monocytes. British journal of haematology. 2006;133(1):62-7.
4. Kirbas A, Biberoglu E, Daglar K, İskender C, Erkaya S, Dede H, et al. Neutrophil-to-lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;180:12-5.
5. Kurt RK, Güler A, Silfeler DB, Ozçil MD, Karateke A, Hakverdi AU. Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. Ginekol Pol. 2014;85(8):589-93.
6. Serin S, Avcı F, Ercan O, Köstü B, Bakacak M, Kıran H. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Pregnancy Hypertens. 2016;6(1):22-5.
7. Moffett A, Colucci F. Uterine NK cells: active regulators at the maternal-fetal interface. The Journal of clinical investigation. 2014;124(5):1872-9.
8. Tanacan A, Beksac MS, Orgul G, Duru S, Sener B, Karaagaoglu E. Impact of extractable nuclear antigen, anti-double stranded DNA, antiphospholipid antibody, and anticardiolipin antibody positivity on obstetrical complications and pregnancy outcomes. Human antibodies. 2019;27(2):135-41.

9. Beksac MS, Tanacan A, Ozten G, Cakar AN. Low-dose low-molecular-weight heparin prophylaxis against obstetrical complications in pregnancies with metabolic and immunological disorder-associated placental inflammation. The Journal of Maternal-Fetal & Neonatal Medicine. 2020:1-8.
10. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clinical chemistry and laboratory medicine. 2012;50(4):635-41.
11. Artaza JR, Carbia C, Ceballo M, Diaz N. Red cell distribution width (RDW): its use in the characterization of microcytic and hypochromic anemias. Medicina. 1999;59(1):17-22.
12. Yilmaz ZV, Turkmen GG, Daglar K, Yılmaz E, Kara O, Uygur D. Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy. Ginekologia polska. 2017;88(2):75-80.
13. Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008;75(3):291-4.
14. Seçkin KD, Karslı MF, Yücel B, Özköse B, Yıldırım D, Çetin BA, et al. Neutrophil lymphocyte ratio, platelet lymphocyte ratio and mean platelet volume; which one is more predictive in the diagnosis of pelvic inflammatory disease? Gynecology Obstetrics & Reproductive Medicine. 2015;21(3):150-4.
15. Albayrak Y, Albayrak A, Albayrak F, Yildirim R, Aylu B, Uyanik A, et al. Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis. Clinical and Applied Thrombosis/Hemostasis. 2011;17(4):362-6.
16. Sayit AT, Gunbey PH, Terzi Y. Is the mean platelet volume in patients with acute cholecystitis an inflammatory marker? Journal of clinical and diagnostic research: JCDR. 2015;9(6):TC05.
17. Öztürk Z, Dag M, Kuyumcu M, Cam H, Yesil Y, Yilmaz N, et al. Could platelet indices be new biomarkers for inflammatory bowel diseases. Eur Rev Med Pharmacol Sci. 2013;17(3):334-41.
18. Lurie S, Rahamim E, Piper I, Golan A, Sadan O. Total and differential leukocyte counts percentiles in normal pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2008;136(1):16-9.
19. Naccasha N, Gervasi M-T, Chaiworapongsa T, Berman S, Yoon BH, Maymon E, et al. Phenotypic and metabolic characteristics of monocytes and granulocytes in normal pregnancy and maternal infection. American journal of obstetrics and gynecology. 2001;185(5):1118-23.
20. Galliazzo S, Nigro O, Bertù L, Guasti L, Grandi AM, Ageno W, et al. Prognostic role of neutrophils to lymphocytes ratio in patients with acute pulmonary embolism: a systematic review and meta-analysis of the literature. Internal and emergency medicine. 2018;13(4):603-8.
21. Jeon Y, Lee W-I, Kang SY, Kim MH. Modified Complete Blood Count Indices as Predicting Markers of Preeclampsia from Gestational Hypertension: Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and. Clinical laboratory. 2017;63(11):1897-902.
22. Cakmak HA, Dincgez Cakmak B, Abide Yayla C, Inci Coskun E, Erturk M, Keles I. Assessment of relationships between novel inflammatory markers and presence and severity of preeclampsia: Epicardial fat thickness, pentraxin-3, and neutrophil-to-lymphocyte ratio. Hypertension in pregnancy. 2017;36(3):233-9.
23. Kang Q, Li W, Yu N, Fan L, Zhang Y, Sha M, et al. Predictive role of neutrophil-to-lymphocyte ratio in preeclampsia: A meta-analysis including 3982 patients. Pregnancy hypertension. 2020;20:111-8.
24. Gezer C, Ekin A, Solmaz U, Sahingoz Yildirim AG, Dogan A, Ozeren M. Identification of preterm birth in women with threatened preterm labour between 34 and 37 weeks of gestation. Journal of Obstetrics and Gynaecology. 2018;38(5):652-7.
25. İlhan M, İlhan G, Gök AFK, Bademler S, Verit Atmaca F, Ertekin C. Evaluation of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine. 2016;29(9):1476-80.
26. Sargın MA, Yassa M, Taymur BD, Celik A, Ergun E, Tug N. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag. 2016;12:657-65.
27. Nikolsky E, Grines CL, Cox DA, Garcia E, Tcheng JE, Sadeghi M, et al. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). The American journal of cardiology. 2007;99(8):1055-61.
28. Cintesun E, Çintesun FNI, Ezveci H, Akyürek F, Celik C. Systemic inflammatory response markers in preeclampsia. Journal of laboratory physicians. 2018;10(3):316.
29. Toprak E, Bozkurt M, Çakmak BD, Özçimen EE, Silahlı M, Yumru AE, et al. Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes. Journal of the Turkish German Gynecological Association. 2017;18(3):122.
30. Gong S, Gao X, Xu F, Shang Z, Li S, Chen W, et al. Association of lymphocyte to monocyte ratio with severity of coronary artery disease. Medicine. 2018;97(43).
31. Hu B, Yang X-R, Xu Y, Sun Y-F, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clinical Cancer Research. 2014;20(23):6212-22.
32. Tanacan A, Uyanik E, Unal C, Beksac MS. A cut‐off value for systemic immune‐inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes. Journal of Obstetrics and Gynaecology Research. 2020;46(8):1333-41.