Ülseratif kolitte hastalık aktivitesini değerlendirmede ortalama trombosit hacmi ile nötrofil-lenfosit oranı ve platelet-lenfosit oranlarının değerlendirilmesi

Abstract

Amaç: Ülseratif kolit (ÜK) hastalarında hastalık aktivitesini değerlendirmek için serum ve gayta belirteçleri sıklıkla kullanılmaktadır. Ancak bu belirteçlerden hiçbiri hastalık aktivitesini göstermede yeterli spesifite ve sensitiviteye sahip değildir. Bu sebeple ÜK hastalarında hastalık aktivitesini belirlemede kullanılabilecek basit, maliyet-etkin ve kolay uygulanabilir laboratuvar testlerine olan ihtiyaç her geçen gün artmaktadır. Bu çalışma ÜK hastalarında aktiviteyi tahmin etmede ortalama trombosit hacmi (MPV), platelet lenfosit oranı (PLO) ve nötrofil-lenfosit oranının (NLO) kullanışlı olup olmadığını belirlemek için planlandı. Bununla birlikte MPV, PLO ve NLO’nun ÜK’daki diğer inflamatuar belirteçlerle olan ilişkisinin varlığı da araştırıldı. Gereç ve Yöntem: Bu çalışmaya 63 aktif ÜK, 68 remisyondaki ÜK hastası ve 34 sağlıklı birey kontrol grubu olarak dahil edildi. Hastalık aktivitesi Truelove-Witts kriterlerine uygun olarak belirlendi. Hasta yaşı, cinsiyeti, inflamatuar belirteçler ve tam kan sayımı değerleri her hasta için kaydedildi. Sonuçlar: Aktif ÜK grubunda NLO ve PLO değerleri remisyondaki ÜK ve kontrol grubu ile kıyaslandığında belirgin bir şekilde yüksek idi. Aktif ve remisyondaki ÜK grubunda NLO ortalamaları sırasıyla 2,8±1,7 ve 2,1±1,3, PLO ortalamaları ise sırasıyla 177,1±85,5 ve 137,9±64,0 idi. MPV düzeyleri aktif ÜK grubunda remisyondaki ÜK grubuna gore anlamlı bir şekilde düşük idi (p=0,044). Korelasyon analizinde NLO ve PLO hem CRP ve hem ESR ile korele olarak saptandı. Tartışma: Bu çalışmada aktif ÜK hastalarında artmış NLO ve PLO ile azalmış MPV düzeyleri saptandı. Periferik kanda kolaylıkla ölçülebilecek MPV, NLO ve PLO gibi ölçümlerle ÜK hastalarında hastalık aktivitesi saptanabilir ve bulgu intestinal inflamasyonu değerlendirmede ek katkılar sağlayabilir. Anahtar Kelimeler: Ortalama trombosit hacmi, platelet-lenfosit oranı, nötrofil-lenfosit oranı, ülseratif kolit

Keywords

• Ortalama trombosit hacmi,platelet-lenfosit oranı,nötrofil-lenfosit oranı,ülseatif kolit

References

1. 1. Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55(6):749‐753.
2. 2. Adams SM, Bornemann PH. Ulcerative colitis. Am Fam Physician. 2013;87(10):699‐705.
3. 3. Kapsoritakis AN, Koukourakis MI, Sfiridaki A, Potamianos P, Kosmadaki MG, Koutroubakis IE et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol. 2001;96(3):776‐781.
4. 4. Jaqua NT, Stratton A, Yaccobe L, Tahir U, Kenny P, Kerns T. A review of the literature on three extraintestinal complications of ulcerative colitis: an ulcerative colitis flare complicated by Budd-Chiari syndrome, cerebral venous thrombosis and idiopathic thrombocytopenia. Acta Gastroenterol Belg. 2013;76(3):311‐316.
5. 5. Tekelioglu Y, Uzun H, Sisman G. Activated platelets in patients suffering from inflammatory bowel disease. Bratisl Lek Listy. 2014;115(2):83‐85.
6. 6. Pamuk GE, Vural O, Turgut B, Demir M, Umit H, Tezel A. Increased circulating platelet-neutrophil, platelet-monocyte complexes, and platelet activation in patients with ulcerative colitis: a comparative study. Am J Hematol. 2006;81(10):753‐759.
7. 7. Martin JF, Trowbridge EA, Salmon G, Plumb J. The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res. 1983;32(5):443‐460. doi:10.1016/0049-3848(83)9025
8. 8. Kayahan H, Akarsu M, Ozcan MA, et al. Reticulated platelet levels in patients with ulcerative colitis. Int J Colorectal Dis. 2007;22(12):1429‐1435.

9. 9. Demir AK, Demirtas A, Kaya SU, et al. The relationship between the neutrophil-lymphocyte ratio and disease activity in patients with ulcerative colitis. Kaohsiung J Med Sci. 2015;31(11):585‐590.
10. 10. Murray NP, Fuentealba C, Reyes E, Lopez MA, Salazar A, Minzer S et al. Predictive Value of Neutrophil to Lymphocyte Ratio in the Diagnosis of Significant Prostate Cancer at Initial Biopsy: A Comparison with Free Percent Prostate Specific Antigen, Prostate Specific Antigen Density and Primary Circulating Prostate Cells. Asian Pac J Cancer Prev. 2019;20(11):3385‐3389.
11. 11. Eto S, Kawahara H, Matsumoto T, Hirabayashi T, Omura N, Yanaga K. Preoperative Neutrophil-Lymphocyte Ratio Is a Predictor of Bowel Obstruction Due to Colorectal Cancer Growth. Anticancer Res. 2019;39(6):3185‐3189.
12. 12. Wong L, Bozhilov K, Hernandez B, Kwee S, Chan O, Ellis L, et al. Underlying liver disease and advanced stage liver cancer are associated with elevated neutrophil-lymphocyte ratio. Clin Mol Hepatol. 2019;25(3):305‐316
13. 13. Wu S, Zhao X, Wang Y, Zhong Z, Zhang L, Cao J et al. Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies. Cell Physiol Biochem. 2018;46(4):1352‐1364.
14. 14. Chandrashekara S, Mukhtar Ahmad M, Renuka P, Anupama KR, Renuka K. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis. 2017;20(10):1457‐1467.
15. 15. Akpinar MY, Ozin YO, Kaplan M, Ates I, Kalkan IH, Kilic ZMY et al. Platelet-to-lymphocyte Ratio and Neutrophil-to-lymphocyte Ratio Predict Mucosal Disease Severity in Ulcerative Colitis. J Med Biochem. 2018;37(2):155‐162.
16. 16. Bou Jaoude J, Bakouny Z, Hallit R, Honein K, Ghorra C, El Rassy E. Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in Crohn's disease: The controversy remains. Clin Res Hepatol Gastroenterol. 2018;42(1):e16‐e18.
17. 17. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041‐1048.
18. 18. Passos MAT, Chaves FC, Chaves-Junior N. The importance of colonoscopy in inflammatory bowel diseases. Arq Bras Cir Dig. 2018;31(2):e1374
19. 19. Mak WY, Buisson A, Andersen MJ Jr, Lei D, Pekow J, Cohen RD et al. Fecal Calprotectin in Assessing Endoscopic and Histological Remission in Patients with Ulcerative Colitis. Dig Dis Sci. 2018;63(5):1294‐1301.
20. 20. Bertani L, Rossari F, Barberio B, et al. Novel Prognostic Biomarkers of Mucosal Healing in Ulcerative Colitis Patients Treated With Anti-TNF: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio [published online ahead of print, 2020 Mar 31]. Inflamm Bowel Dis. 2020;izaa062.
21. 21. Okba AM, Amin MM, Abdelmoaty AS, Ebada HE, Kamel AH, Allam AS et al. Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity. Auto Immun Highlights. 2019;10(1):4.
22. 22. van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;341:c3369
23. 23. Torun S, Tunc BD, Suvak B, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36(5):491‐497.
24. 24. Celikbilek M, Dogan S, Ozbakır O, Zararsız G, Küçük H, Gürsoy S et al. Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal. 2013;27(1):72‐76.
25. 25. Cherfane CE, Gessel L, Cirillo D, Zimmerman MB, Polyak S. Monocytosis and a Low Lymphocyte to Monocyte Ratio Are Effective Biomarkers of Ulcerative Colitis Disease Activity. Inflamm Bowel Dis. 2015;21(8):1769‐1775.
26. 26. Gao SQ, Huang LD, Dai RJ, Chen DD, Hu WJ, Shan YF. Neutrophil-lymphocyte ratio: a controversial marker in predicting Crohn's disease severity. Int J Clin Exp Pathol. 2015;8(11):14779‐14785.
27. 27. Argeny S, Stift A, Bergmann M, et al. Prognostic value of preoperative neutrophil-to-lymphocyte ratio in Crohn's disease. Wien Klin Wochenschr. 2018;130(11-12):398‐403.
28. 28. Alexandrakis MG, Passam FH, Moschandrea IA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol. 2003;26(2):135‐140.
29. 29. Fidan K, Kocak MZ. Assessment of Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio in Ulcerative Colitis: A Retrospective Study. EJMO 2017;1(4):224–227
30. 30. Dogan M, Algin E, Guven ZT, Baykara M, Kos TF, Bal O et al. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, neutrophil-platelet score and prognostic nutritional index: do they have prognostic significance in metastatic pancreas cancer?. Curr Med Res Opin. 2018;34(5):857‐863
31. 31. Smith RA, Bosonnet L, Raraty M, Sutton R, Neoptolemos JP, Campbell F et al. Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg. 2009;197(4):466‐472.
32. 32. Kwon HC, Kim SH, Oh SY, Lee S, Choi HJ, Park K et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17(3):216‐222.
33. 33. Mazzi S, Lordier L, Debili N, Raslova H, Vainchenker W. Megakaryocyte and polyploidization. Exp Hematol. 2018;57:1‐13.
34. 34. Yüksel O, Helvaci K, Başar O, Köklü S, Caner S, Helvaci N et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets. 2009;20(4):277‐281.
35. 35. Voudoukis E, Karmiris K, Oustamanolakis P, Theodoropoulou A, Sfiridaki A, Paspatis GA et al. Association between thrombocytosis and iron deficiency anemia in inflammatory bowel disease. Eur J Gastroenterol Hepatol. 2013;25(10):1212‐1216.