Nötrofil-lenfosit Oranının Hamile Kadınlarda Romatizmal Kalp Kapağı Hastalığını Öngörme Yeteneği

Year 2020, Volume: 10 Issue: 4, 642 - 649, 15.12.2020

Veciha Özlem Bozkaya Zeynep Asli Oskovi Kaplan Yaprak Ustun

https://doi.org/10.31832/smj.791258

Abstract

Amaç
Enflamatuar süreçlerin, romatizmal kalp kapağı hastalığı (RKKH) patofizyolojisi üzerinde bir rolü vardır. Enflamatuar bir belirteç olarak nötrofil-lenfosit oranı (NLO), gebelikte bazı klinik durumlarla ilişkilidir. Bu çalışmada, RKKH'li gebelerde NLO'nun prediktif rolünü araştırmayı amaçladık.
Gereç ve Yöntemler
Çalışmaya kardiyoloji polikliniğine sevk edilen ve RKKH tanısı alan (n = 24) birinci trimester gebeler alındı ve kontrol grubu olarak yaşları eşleşen sağlıklı gebeler (n = 24) alındı. İki grup klinik özellikler, ekokardiyografik bulgular ve NLO açısından karşılaştırıldı. NLO’nun RKKH’nı ön görmedeki rolü incelendi.
Bulgular
Gruplar demografik özellikler açısından benzerdi. NLO RKKH'lı kadınlarda kontrol grubuna göre daha yüksekti (3.68 ± 1.74 ve 2.68 ± 1.14, p = 0.00239). NLO (OR: 0,597, p= 0,037, 95% CI: 0,343-0,921) ve nötrofil sayısı (OR: 0,609, p= 0.013, 95% CI: 0,390-0,863) RKKH'nın olası bağımsız prediktörleriydi.
Sonuç
NLO RKKH olan gebe kadınlarda anlamlı olarak daha yüksekti. Tüm hamile kadınlara rutin kardiyak muayene sağlamak mümkün olmadığından; hamilelik sırasında kalp hastalıkları ile ilişkili riskleri azaltmak için spesifik risk grupları için belirteçlerin tanımlanması gerekir. Bu bulgulara göre, yüksek NLO'lı gebe kadınların RKKH gibi KVH açısından daha fazla dikkat göstermeleri gerekebilir. NLO'nın prediktif değerini tanımlamak için geniş hasta gruplarıyla daha ileri çalışmalara ihtiyaç vardır.

Keywords

gebelik, nötrofil-lenfosit oranı, romatizmal kalp kapak hastalığı

THE RELATIONSHIP BETWEEN NEUTROPHIL-LYMPHOCYTE RATIO AND RHEUMATIC HEART VALVE DISEASE IN PREGNANT WOMEN

Abstract

Objective
There is a role of inflammatory processes on the pathophysiology of rheumatic heart valve disease (RHVD). The neutrophil-lymphocyte ratio (NLR) as an inflammatory marker is associated with some clinical situations in pregnancy. In this study, we aimed to investigate the predictive role of NLR in pregnant women with NLR.
Materials and Methods
First-trimester pregnant women, who were referred to cardiology outpatient clinic and diagnosed with RHVD (n=24) were enrolled in this study and age-matched healthy pregnant women (n=24) were taken as control groups. The two groups were compared in terms of clinical characteristics, echocardiographic findings, and NLR. The role of NLO in predicting RKKH has been examined.
Results
Groups were similar in terms of demographic features. NLR was higher in pregnant women with RHVD than the control group (3.68 ±1.74 vs. 2.68±1.14, p=0.00239). NLR (OR: 0,597, p= 0,037, 95% CI: 0,343-0,921) and neutrophil count (OR: 0,609, p= 0.013, 95% CI: 0,390-0,863) were possible independent predictors of RHVD.
Conclusion
NLR was significantly higher among pregnant women with RHVD. As it is not possible to provide routine cardiac check-up to all pregnant women; markers for specific risk groups need to be defined to reduce the risks associated with heart diseases during pregnancy. According to these findings, pregnant women with high NLR may need extra attention in terms of CVD like RHVD. Further studies with large patient groups are needed to define the predictive value of NLR.

Keywords

pregnancy, neuthrophil-lymphocyte ratio, rheumatic heart valve disease

References

• 1. Rezk M, Gamal A (2016) Maternal and fetal outcome in women with rheumatic heart disease: a 3-year observational study. Archives of gynecology and obstetrics 294 (2):273-278. doi:10.1007/s00404-015-3990-9
• 2. Baysal E, Burak C, Cay S, Aksu T, Altintas B, Yaylak B, Sevuk U, Bilge O (2015) The neutrophil to lymphocyte ratio is associated with severity of rheumatic mitral valve stenosis. Journal of blood medicine 6:151-156. doi:10.2147/JBM.S82423
• 3. Olsson M, Thyberg J, Nilsson J (1999) Presence of oxidized low density lipoprotein in nonrheumatic stenotic aortic valves. Arteriosclerosis, thrombosis, and vascular biology 19 (5):1218-1222
• 4. Çiçek, G., Yayla, Ç., Açıkgoz, S. K. (2016). Predictive Value of Combination of NLR and PLR in the Absence of Medical Treatment. Angiology, 67(2), 197–197.
• 5. Yayla, Ç., Karanfil, M., Ertem, A. G., Açar, B., Unal, S., Akboğa, M. K. (2019). Inflammation Parameters in Aortic Aneurysm. Angiology, 70(3), 280–280.
• 6. Margolis KL, Manson JE, Greenland P, Rodabough RJ, Bray PF, Safford M, Grimm RH, Jr., Howard BV, Assaf AR, Prentice R, Women's Health Initiative Research G (2005) Leukocyte count as a predictor of cardiovascular events and mortality in postmenopausal women: the Women's Health Initiative Observational Study. Archives of internal medicine 165 (5):500-508. doi:10.1001/archinte.165.5.500
• 7. Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, Jeffrey RR, Buchan KG, Hillis GS (2010) Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. The American journal of cardiology 105 (2):186-191. doi:10.1016/j.amjcard.2009.09.007
• 8. Golbasi Z, Ucar O, Keles T, Sahin A, Cagli K, Camsari A, Diker E, Aydogdu S (2002) Increased levels of high sensitive C-reactive protein in patients with chronic rheumatic valve disease: evidence of ongoing inflammation. European journal of heart failure 4 (5):593-595. doi:10.1016/s1388-9842(02)00102-2
• 9. Kurt RK, Aras Z, Silfeler DB, Kunt C, Islimye M, Kosar O (2015) Relationship of red cell distribution width with the presence and severity of preeclampsia. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 21 (2):128-131. doi:10.1177/1076029613490827
• 10. Oylumlu M, Ozler A, Yildiz A, Oylumlu M, Acet H, Polat N, Soydinc HE, Yuksel M, Ertas F (2014) New inflammatory markers in pre-eclampsia: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio. Clinical and experimental hypertension 36 (7):503-507. doi:10.3109/10641963.2013.863324
• 11. Yilmaz H, Celik HT, Namuslu M, Inan O, Onaran Y, Karakurt F, Ayyildiz A, Bilgic MA, Bavbek N, Akcay A (2014) Benefits of the neutrophil-to-lymphocyte ratio for the prediction of gestational diabetes mellitus in pregnant women. Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association 122 (1):39-43. doi:10.1055/s-0033-1361087
• 12. Caglayan EK, Engin-Ustun Y, Gocmen AY, Sari N, Seckin L, Kara M, Polat MF (2016) Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? Journal of perinatal medicine 44 (3):315-320. doi:10.1515/jpm-2015-0178
• 13. Yıldız Ç, Karakuş S, Akkar ÖB, Topbaş T, Çetin M, Yanık A, Çetin A (2016) The Significance of Neutrophil-Lymphocyte Ratio and Mean Corpuscular Volume in Diagnosis of Preeclampsia. Gynecol Obstet Reprod Med 22 (2):75-79. doi:10.21613/gorm.2016.84
• 14. Zuhlke LJ, Beaton A, Engel ME, Hugo-Hamman CT, Karthikeyan G, Katzenellenbogen JM, Ntusi N, Ralph AP, Saxena A, Smeesters PR, Watkins D, Zilla P, Carapetis J (2017) Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations. Current treatment options in cardiovascular medicine 19 (2):15. doi:10.1007/s11936-017-0513-y
• 15. Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J, Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zuhlke L, Carapetis J (2012) World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline. Nature reviews Cardiology 9 (5):297-309. doi:10.1038/nrcardio.2012.7
• 16. ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease (2019). Obstetrics and gynecology 133 (5):e320-e356. doi:10.1097/AOG.0000000000003243
• 17. Seeland U, Bauersachs J, Roos-Hesselink J, Regitz-Zagrosek V (2018) [Update of the ESC guidelines 2018 on cardiovascular diseases during pregnancy : Most important facts]. Herz 43 (8):710-718. doi:10.1007/s00059-018-4765-4
• 18. van Hagen IM, Thorne SA, Taha N, Youssef G, Elnagar A, Gabriel H, ElRakshy Y, Iung B, Johnson MR, Hall R, Roos-Hesselink JW, Investigators R, Team E (2018) Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease: Results From the Registry of Pregnancy and Cardiac Disease. Circulation 137 (8):806-816. doi:10.1161/CIRCULATIONAHA.117.032561
• 19. Hameed AB, Lawton ES, McCain CL, Morton CH, Mitchell C, Main EK, Foster E (2015) Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. American journal of obstetrics and gynecology 213 (3):379 e371-310. doi:10.1016/j.ajog.2015.05.008
• 20. Roos-Hesselink J, Baris L, Johnson M, De Backer J, Otto C, Marelli A, Jondeau G, Budts W, Grewal J, Sliwa K, Parsonage W, Maggioni AP, van Hagen I, Vahanian A, Tavazzi L, Elkayam U, Boersma E, Hall R (2019) Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). European heart journal. doi:10.1093/eurheartj/ehz136
• 21. Davutoglu V, Celik A, Aksoy M (2005) Contribution of selected serum inflammatory mediators to the progression of chronic rheumatic valve disease, subsequent valve calcification and NYHA functional class. The Journal of heart valve disease 14 (2):251-256
• 22. Song J, Zheng Q, Ma X, Zhang Q, Xu Z, Zou C, Wang Z (2019) Predictive Roles of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Calcific Aortic Valve Disease. International heart journal 60 (2):345-351. doi:10.1536/ihj.18-196
• 23. Kucukseymen S CG, Guven R, Arslan S (2017) Is neutrophyl to lymphocyte ratio really a useful marker for all grades of degenerative aortic stenosis? Turk Kardiyoloji Dernegi arsivi 25 (6):506-513
• 24. Varol E, Aksoy F, Ozaydin M, Erdogan D, Dogan A (2014) Association between neutrophil-lymphocyte ratio and mitral annular calcification. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis 25 (6):557-560. doi:10.1097/MBC.0000000000000094
• 25. Avci A, Elnur A, Goksel A, Serdar F, Servet I, Atilla K, Mustafa TM, Cuneyt T, Yeliz G, Mustafa B, Metin EA (2014) The relationship between neutrophil/lymphocyte ratio and calcific aortic stenosis. Echocardiography 31 (9):1031-1035. doi:10.1111/echo.12534
• 26. Akboga MK, Akyel A, Sahinarslan A, Yayla C, Alsancak Y, Gokalp G, Nurkoc S, Abaci A (2015) Neutrophil-to-lymphocyte ratio is increased in patients with rheumatic mitral valve stenosis? Anatolian journal of cardiology 15 (5):380-384. doi:10.5152/akd.2014.5399