Kronik obstrüktif akciğer hastalığının akut alevlenmesi ile nötrofil-lenfosit oranı ve serum ürik asit düzeyleri arasındaki ilişki

Abstract

Amaç: Kronik inflamasyon, kronik obstrüktif akciğer hastalığında (KOAH) patojenik bir rol oynamaktadır. Dolaşımdaki nötrofil-lenfosit oranı (N / L oranı), serum ürik asit ve gama-glutamil transferaz (GGT) düzeylerindeki artış, sistemik bir iltihabın göstergesi olabilir.

Bu çalışmanın amaı KOAH'lı hastalarda biyolojik belirteç olarak kan nötrofil-lenfosit (N / L) oranı ile serum ürik asit ve gama-glutamil transferaz (GGT) düzeylerinin muhtemel rolü üzerindeki olası değerini değerlendirmektir.

Gereç ve Yöntemler: Retrospektif bir çalışma.Gereç ve Yöntem: Örneklem, KOAH'ın stabil ve akut alevlenmesi için göğüs hastalıkları bölümümüze başvuran 260 hastadan (stabil KOAH, n = 68, KOAH'ın akut alevlenişi, n = 192) oluşturuldu.

Bulgular: KOAH hastalarının akut alevlenmesinde yüksek N / L oranları ve serum ürik asit seviyeleri tespit edildi (p <0.01). Sigara (paket-yıllar) ile N / L oranı ve C-reaktif protein düzeyleri arasında pozitif korelasyon bulundu (sırasıyla p = 0.014; r = 0.153 ve p = 0.001; r = 0.252).

Sonuçlar: Çalışmamız, akut  KOAH alevlenmesi olan hastalarda N / L oranı ve serum ürik asit düzeylerinin belirgin olarak daha yüksek olduğunu göstermiştir. Kronik obstrüktif akciğer hastalığı ile bu parametreler arasındaki ilişkilerle ilgili olarak, rutin klinik uygulamada diğer risk faktörlerinin yanında hastalık yükünü belirlemek için kullanılabilirler. 

Keywords

• kronik obstriktif akciğer hastalığı,nötrofil lenfosit oranı inflamasyon,C reaktif protein,serum ürik asit,inflamasyon

The relationship between acute exacerbation of chronic obstructive pulmonary disease and neutrophile-to-lymphocyte ratio, serum uric acid and gamma-glutamyl transferase levels

Abstract

Aim: Chronic inflammation plays a pathogenic role in chronic obstructive  pulmonary disease. Increase in the ratio of circulating neutrophil to lymphocyte ratio (NLR), serum uric acid and gamma-glutamyl transferase (GGT) levels  may serve as a marker of systemic inflammation. The aim of this study is to evaluate the potential predictive value of blood neutrophil-to- lymphocyte NLR and possible role of serum uric acid and gamma-glutamyl transferase levels as biomarkers in chronic obstructive pulmonary disease patients.

Material and Methods: The sample was derived from a population of 276 patients admitted for acute exacerbation of chronic obstructive pulmonary disease to our respiratory medicine department.

Results: Higher N/L ratios, uric acid and GGT levels were detected in chronic obstructive pulmonary disease patients than in the controls (P < 0.001). Positive correlations between smoking (pack-years) and NLR, serum GGT, uric acid, and C- reactive protein levels were found (P < 0.001; r = 0.339, P < 0.001; r = 0.224, P < 0.001;r = 0.242,and P < 0.001; r = 0.563, respectively).

Conclusion: Our study demonstrated that NLR, serum GGT and uric acid levels are significantly higher in patients with chronic obstructive  pulmonary disease. With regard to the associations between chronic obstructive pulmonary disease and these parameters, they can be used to determine disease burden besides other risk factors in routine clinical practice.

Keywords

• inflammation,C- reactive protein,Chronic obstructive pulmonary disease,neutrophil/lymphocyte ratio,serum uric acid

References

1. 1. Rodriguez-Roisin R: Toward a consensus definition for COPD exacerbations. Chest 2000; 117: 398S-401S.
2. 2. Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007; 29: 1224-1238.
3. 3. Dentener MA, Creutzberg EC, Schols AM, et al. Systemic anti-inflammatory mediators in COPD: increase in soluble inteleukin 1 receptor II during treatment of exacerbations. Thorax 2001; 56: 721-726.
4. 4. Agusti A, Sin DD. Biomarkers in COPD. Clin Chest Med 2014; 35:131-41.
5. 5. Casaburi R, celli B, Crapo J, et al. The COPD Biomarker Qualification Consortium (CBQC). COPD 2013; 10:367-77.
6. 6. Bartziokas K, Papaioannou A.I, Loukides S, et al. Papadopoulos A, Haniotou A, Papiris S, Kostikas K. Serum uric asid as a predictor of mortality and future exacerbations of COPD. Eur Respir J 2014; 43:43-53.
7. 7. Ermis H, Celik M.R, Gulbas G, Tavli D, Aytemur Z.A. Relationship between serum γ-glutamyltransferase levels and acute exacerbation of chronic obstructive pulmonary disease. Pol Arch Med Wewn 2013; 123: 85-90.
8. 8. The Global Initiative for Chronic Obstructive Lung Diseas (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2014.

9. 9. Jones PW, Harding G, Berry P, et al.Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J 2009; 34: 648-54.
10. 10. Bathoorn E, Liesker JJ, Postma DS, et al. Change in inflammation in out-patient COPD patients from stable phase to a subsequent excerbation. Int J Chron Obstruct Pulmon Dis 2009; 4:101-109.
11. 11. Stolz D, Christ-Crain M, Morgenthaler NG, et al. Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 2007; 131:1058-1067.
12. 12. Dahl M, Vestbo J, Lange P, et al. C-reactive protein as a predictor of pronosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007; 175:250-255.
13. 13. Hurst JR, Vestbo J, Anzueto A, et al; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010; 363:1128-1138.
14. 14. Lebowitz MD, Postma DS. Adverse effects of smoking on the natural history of newly diagnosed chronic bronchitis. Chest 1995; 108: 55–61.
15. 15. Segal AW. How neutrophils kill microbes. Annu Rev Immunol 2005; 23: 197-223.
16. 16. Chan-Yeung M, Dybuncio A. Leucocyte count, smoking and lung function. Am J Med 1984; 76: 31–37.
17. 17. Van Antwerpen VL, Theron AJ, Richards GA, et al. Vitamin E, pulmonary functions, and phagocytemediatedoxidative stress in smokers and nonsmokers.Free Radic Biol Med 1995; 18: 935–943.
18. 18. Brown DM, Drost E, Donaldson K, MacNee W. Deformability and CD11/CD18 expression of sequesteredneutrophils in normal and inflamed lungs. Am J Respir Cell Mol Biol1995; 13: 5531-9.
19. 19. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the giagnosis, management and prevention of chronic obstructive pulmonary disease, GOLD executive summary. Am J Respir Crit Care Med 2013; 187:347-365.
20. 20. Osaka D, Shibata Y, Abe S, et al. Relationship between habit of cigarette smoking and airflow limitation in healthy Japanese individuals: The Takahata Study. Intern Med 2010; 49: 1489-1499.5; 13: 531–539.
21. 21. Okyay G.U, Inal S, Onec K, et al; Neutrophil to Lymphocyte Ratio in Evaluation of Inflammation in Patients with Chronic Kidney Disease. Renal Failure 2013; 35: 29-36.
22. 22. Solak Y, Yilmaz M.I, Sonmez A, et al. Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease. Clin Exp Nephrol 2013; 17: 532-40.
23. 23. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 1: 5-14.
24. 24. Ertas G, Sonmez O, Turfan M, et al ; Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation. Journal of the Neurological Sciences 2013; 324: 49-52.
25. 25. Celikbilek M, Dogan S, Ozbakır O, et al; Neutrophil-Lymphocit Ratio as a Predictor of Disease Severity in Ulcerative Colitis. J Clin Lab Anal 2013; 27: 72-6.
26. 26. Azab B, Bhatt VR, Phookan J, et al; Usefulness of the neutrophil-to-lymphocyteratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012; 19:217-24.
27. 27. Jung MR, Park YK, Jeong O, et al. Elevated preoperative neutrophil to lymphocyte ratio predictspoor survival following resection in late stage gastric cancer.J Surg Oncol 2011;104: 504–10.
28. 28. Tanrıverdi H, Örnek T, Erboy F et al. Comparison of diagnosticvalues of procalcitonin, C-reactive protein and bloodneutrophil/lymphocyte ratio levels in predicting bacterial infection in hospitalized patients with acute exacerbations of COPD. Wien Klin Wochenschr 2015;127: 756-63.
29. 29. Kurtipek E, Bekci TT, Kesli R, Sami SS, Terzi Y. The role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease. J Pak Med Assoc 2015; 65:1283-7.
30. 30. Taylan M, Demir M, Kaya H, et al ; Alterations of the neutrophil-lymphocyte ratio during the period of stable and acute exacerbation of chronic obstructive pulmonary disease patients. Clin Respir J 2017;11: 311-7.
31. 31. Gürol G, Ciftci IH, Terzi HA, et al. Are there standardized cutoff values for neutrophil-lymphocyte ratios in bacteremia or sepsis? J Microbiol Biotechnol 2015; 25: 521–5.
32. 32. Gunay E, Ulaslı S.S, Akar O, et al ;Neutrophil to Lymphocyte Ratio in Chronic Obstructive Pulmonary Disease: A Retrospective Study. Inflammation 2014; 37: 374-380.
33. 33. Mannino DM, Ford ES, Redd SC. Obstructive and restrictive lung disease and markers of inflammation; data from the Third National Health and Nutrition Examination. Am J Med 2003; 114: 758-762.
34. 34. Forman HJ, Dickinson DA. Oxidative signaling and glutathione synthesis. Biofactors 2003; 17: 1–12.
35. 35. Holme J, Dawkins PA, Stockley, et al. Studies of gamma-glutamyl transferase in alpha-1 antitrypsin deficiency. COPD 2010; 7: 126-132.
36. 36. Ji-Seun Lim, Jin-Hoon Yang, Byung-Yeol Chun, et al.Is serum γ-glutamyltransferase inversely associated with serum antioxidants as a marker of oxidative stress?. Free Radical Biology and Medicine. 2004; 37: 1018-1023
37. 37. Lee HD, Jacobs DR Jr. Association between serum gamma-glutamyltransferase and C-reactive protein. Atherosclerosis 2005; 178: 327-330.
38. 38. Elsayed NM, Nakashima JM, Postlethwait EM. Measurement of uric acid as a marker of oxygen tension in the lung. Arch Bio-chem Biophys 1993; 302: 228-232.
39. 39. Shimizu Y, Nagaya N, Satoh T, et al. Serum uric acid level increases in proportion to the severity of pulmonary throm-boembolism. Circ J 2002; 66: 571-575.
40. 40. So A, Thorens B. Uric acid transport and disease. J Clin Invest, 2010; 120: 1791-1799.
41. 41. Sjodin B, Hellsten Westing Y, Apple FS. Biochemical mecha-nisms for oxygen free radical formation during exercise. Sports Med 1990; 10: 236-254.
42. 42. Garcia-Pachon E, Padilla-Navas I, Shum C. Serum uric acid to creatinine ratio in patients with chronic obstructive pulmonary disease. Lung 2007; 185: 21-24.
43. 43. Obermayr RP, Temml C, Gutjahr G, et al. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol 2008; 19: 2407-2413.
44. 44. Ruggiero C, Cherubini A, Miller E 3rd, et al. Usefulness of uric acid to predict changes in C-reactive protein and interleukin-6 in 3-year period in Italians aged 21 to 98 years. Am J Cardiol 2007; 100: 115-121.
45. 45. Koçak ND, Sasak G, Aktürk ÜA, et al. Serum Uric Acid Levels and Uric Acid/Creatinine Ratios in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients: Are These Parameters Efficient Predictors of Patients at Risk for Exacerbation and/or Severity of Disease?. Med Sci Monit 2016; 22: 4169-4176.
46. 46. Aida Y, Shibata Y, Osaka D, et al. The relationship between serum uric asid and spirometric values in participants in a health check: The Takahata study. Int J Med Sci 2011; 8:470-478.