Bronşiolitli Çocuklarda Hastalık Aktivitesinin Değerlendirilmesinde Nötrofil / Lenfosit Oranı Yeni Bir Biyobelirteç Olabilir mi?

Year 2019, Volume: 7 Issue: 1, 13 - 18, 22.04.2019

Eda Çelik Güzel , Çiğdem Fidan , Savaş Güzel , Cem Paketçi Aliye Çelikkol

Abstract

Amaç:
Akut bronşiolit, inflamatuar bir hastalıktır.
Nötrofil/lenfosit oranı (NLO) çeşitli inflamatuar hastalıklarda arttığı bilinen
inflamatuar belirteçlerdir. Bu çalışmada amacımız bronşiolitli
çocuk hastalarda NLO değerlerini
incelemek ve hastalık şiddetiyle ilişkisini değerlendirmektir. 

Materyal
ve Metod: Çalışma akut bronşiolit tanısı alan 3 ay ile 5 yaş
arasında 77 hasta ve 34 sağlıklı çocuktan oluşturuldu. Hasta ve kontrol
grubunda C-reaktif protein (CRP), beyaz küre sayısı (BKS), ortalama trombosit
hacmi (OTH), nötrofil ve lenfosit değerleri ile birlikte NLO değerleri
incelendi. 

Bulgular: Akut bronşiolit
grubunda CRP, BKS, NLO ve nötrofil sayısı kontrol grubuna göre anlamlı olarak
yüksek saptandı (sırasıyla p<0.01, p<0.001, p<0.001, p<0.001 ). OTH
düzeyleri hasta grubunda anlamlı olarak düşük bulundu (p<0.05). Hastalık
şiddetine göre hasta grubu hafif, orta ve ağır olmak üzere üç gruba ayrıldı. Ağır
bronşiolitli hastalarda (n=21); nötrofil ve NLO değerleri hafif bronşiolitli
gruba (n=25) göre anlamlı olarak yüksek saptandı (Her ikisi de p<0.05).
Korelasyon analizinde; NLO ile OTH, BKS, CRP arasında pozitif korelasyon
saptandı (sırasıyla r=0.262–p<0.05; r=0.454–p<0.001; r=0.706–p<0.001).
Akut bronşiolitli hastaların hastaneye kabulde incelenen parametrelerden
yalnızca CRP için Receiver-operating characteristic (ROC) analizinde eğri
altında kalan alan (EAA) sonuçları tanısal olarak yeterli bulunurken (EAA=0.812),
BKS ve NLO için yeterlilik saptanamadı (sırasıyla EAA=0.692, EAA=0.583).

Sonuç: Çalışmamızda, hastaneye başvuruda saptanan
artmış CRP düzeylerinin; bronşiolit gelişecek hastaları predikte etmede ve
artmış NLO oranının hastalık şiddetinin belirlenmesinde iyi
bir belirteç olabileceğini göstermektedir.

Keywords

Bronşiolit, İnflamasyon, Nötrofil

References

• Marguet C, Bocquel N, Benichou J, Basuyau JP, Hellot MF, Couderc L, et al. Neutrophil but not eosinophil inflammation is related to the severity of a first acute epidemic bronchiolitis in young infants. Pediatr Allergy Immunol. 2008;19:157–165.
• Yasui K, Baba A, Iwasaki Y, Kubo T, Aoyama K, Mori T, et al. Neutrophil‐mediated inflammation in respiratory syncytial viral bronchiolitis. Pediatrics international. 2005;47(2):190-5.
• La Via W, Marks MI, Stutman HR. Respiratory syncytial virus puzzle: clinical features, pathophysiology, treatment, and prevention. J Pediatr. 1992;121:503–10.
• Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children. JAMA. 1999;282(15):1440-6.
• Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B. Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. Am. J. Respir. Crit. Care Med. 2000;161:1501–7.
• Lapin CD, Hiatt PW, Langston C, Mason E, Piedra PT. A lamb model of human respiratory syncytial virus infection. Pediatr. Pulmonol. 1993;15:151–6.
• Oppenshaw PJM. Immunity and immunopathology to respiratory syncytial virus. The mouse model. Am. J. Respir. Crit. Care Med. 1995;152:59–62.
• Olszewska-Pazdrak B, Casola A, Saito T, Alam R, Crowe SE, Mei F, et al. Cell-specific expression of RANTES, MCP-1, and MIP-1α by lower airway epithelial cells and eosinophils infected with respiratory syncytial virus. J Virol. 1998;72:4756–64.
• Van Schaik SM, Welliver RC, Kimpen JLL. Novelpathways in the pathogenesis of respiratory syncytialvirus disease. Pediatr Pulmonol 2000;30:131–8.
• Everard ML, Swarbrick A, Wrightham M, McIntyre J, Dunkley C, James PD, et al.Analysis of cells obtained by bronchial lavage of infantswith respiratory syncytial virus infection. Arch Dis Child 1994;71:428–32.
• Abu-Harb M, Bell F, Finn A, Rao WH, Nixon L, Shale D, et al. IL‐8 and neutrophil elastase levels in the respiratory tract of infants with RSV bronchiolitis. Eur Respir J 1999;14:139–43.
• Sheeran P , Jafri H , Carubelli C , Saavedra J , Johnson C , Krisher K ,et al. Elevated cytokine concentrations in the nasopharyngeal and tracheal secretions of children with respiratory syncytial virus disease. Pediatr Infect Dis J. 1999;18:115–22.
• 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.
• de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(5):R192.
• Counil FP, Lebel B, Segondy M, Peterson C, Voisin M, Bousquet J, et al. Cells and mediators from pharyngeal secretions in infants with acute wheezing episodes. Eur Respir J. 1997;10:2591–5.
• Costa S, Rocha R, Tavares M, Bonito-Vítor A, Guedes-Vaz L. C Reactive protein and disease severity in bronchiolitis. Rev Port Pneumol. 2009;15(1):55-65.
• Fang Q, Tong YW, Wang G, Zhang N, Chen WG, Li YF, et al. Neutrophil-to-lymphocyte ratio, obesity, and breast cancer risk in Chinese population. Medicine. 2018;97(30):e11692.
• Ding Y, Zhang S, Qiao J. Prognostic value of neutrophil-to-lymphocyte ratio in melanoma: Evidence from a PRISMA-compliant meta-analysis. Medicine. 2018;97(30):e11446.
• Wang J, Xiao W, Chen W, Hu Y. Prognostic significance of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with glioma. Excli J. 2018;17:505–12.
• Faria SS, Fernandes PC Jr, Silva MJ, Lima VC, Fontes W, Freitas-Junior R, et al. The neutrophil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience. 2016;10:702.
• Mallappa S, Sinha A, Gupta S, Chadwick SJ. Preoperative neutrophil to lymphocyte ratio > 5 is a prognostic factor for recurrent colorectal cancer. Colorectal Dis. 2013;15(3):323-8.
• Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009;58(1):15-23.
• An X, Ding PR, Li YH, Wang FH, Shi YX, Wang ZQ et al. Elevated neutrophil to lymphocyte ratio predicts survival in advanced pancreatic cancer. Biomarkers. 2010;15(6):516-22.
• Ohno Y, Nakashima J, Ohori M, Tanaka A, Hashimoto T, Gondo T, et al. Clinical variables for predicting metastatic renal cell carcinoma patients who might not benefit from cytoreductive nephrectomy: neutrophil-to-lymphocyte ratio and performance status. Int J Clin Oncol. 2014;19(1):139–45.
• Huang Y, Liu A, Liang L, Jiang J, Luo H, Deng W, et al. Diagnostic value of blood parameters for community-acquired pneumonia. Int Immunopharmacol. 2018;64:10-15.
• Lee JH, Song S, Yoon SY, Lim CS, Song JW, Kim HS. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic markers for pneumonia severity. Br J Biomed Sci. 2016;73(3):140-2.
• Derman BA, Macklis JN, Azeem MS, Sayidine S, Basu S, Batus M, et al. Relationships between longitudinal neutrophil to lymphocyte ratios, body weight changes, and overall survival in patients with non-small cell lung cancer. BMC Cancer. 2017;17(1):141.
• Gökçe Ş, Kurugöl Z, Suner A. The Role of Mean Platelet Volume in the Early Detection of Acute Bronchiolitis: A Prospective Study. Clin Respir J. 2018;12:2513–8.