Strok alt gruplarında lenfosit monosit oranındaki değişimin değerlendirilmesi
Öz
Özet
Amaç: Stroke dünya genelinde ciddi morbidite ve mortalite oluşturan hastalıkların başında gelmektedir. Stroke olgularında hematolojik inflamatuar belirteçlerde değişiklik geliştiğini gösteren bazı çalışmalar vardır. Lenfosit monosit oranı (LMO) ise son zamanlarda gündeme gelen özellikle düşük düzeyi ile birçok malignitede incelenmiş yeni bir hematolojik inflamatuar belirteç olarak kabul edilmektedir. Çalışmamızda acil servisimize nörolojik bulgular ile başvuran ve stroke tanısı alan hastalarda LMO düzeylerini ve klinik sınıflandırma olan Oxfordshire Community Stroke Project (OCSP) sınıflamasına göre subgruplarda LMO düzeylerini araştırmayı amaçladık.
Gereç ve Yöntemler: Bir üniversite hastanesinin acil servisine Ocak 2017 - Ocak 2019 tarihleri arasında nörolojik bozukluk semptomları ile başvuran ve iskemik inme tanısı alan hastalar geriye dönük olarak incelenmiştir. Stroke hastaları OCSP classificationa göre subgruplara ayrılmış ve klinik ile görüntüleme sonuçları korele edilmiştir. Tüm gruplarda hematolojik inflamatuar belirteçler incelenmiş, LMO’ daki değişimler tespit edilmiştir.
Bulgular: Çalışmamıza 109 (63 bayan, 46 erkek) iskemik stroke hastası, 110 (45 bayan, 65 erkek) kontrol hastası dahil edilmiştir. LMO değeri düşüklüğü strok olgularında kontrol grubuna göre istatistiksel olarak anlamlı bulundu (p<0.05). LMO değeri düşüklüğü her dört gruptada kontrol grubuna göre istatistiksel olarak anlamlı bulundu (p<0.05). TACI ve POCI gruplarında LMO’ da en düşük ortalamalar saptandı. Nötrofil lenfosit oranı ve gama glutamil transferaz (GGT) değerleri yüksekliği ise yine her dört grupta da kontrol grubuna göre istatistiksel olarak anlamlı bulundu (p<0.05).
Sonuç: Çalışmamızda stroke subgruplarında kısıtlı inceleme yapılan LMO değeri stroke ve subgruplarının tamamında düşük olarak tespit edilmiştir. Özellikle TACI ve POCI gibi geniş enfarkt alanına sahip klinik durumlarda en düşük seviyedeki ortalamalara ulaşılmıştır. LMO’ nın hem stroke hemde subgruplarda mortalite, morbidite ve prognoz belirleyicisi olarak kullanılabileceği düşünülmektedir.
Anahtar Kelimeler
Kaynakça
- Bennett DA, Krishnamurthi RV, Barker-Collo S, Forouzanfar MH, Naghavi M, Connor M, et al. The global burden of ischemic stroke: findings of the GBD 2010 study. Global heart. 2014;9(1):107-12.
- Tokgoz S, Kayrak M, Akpinar Z, Seyithanoğlu A, Güney F, Yürüten B. Neutrophil lymphocyte ratio as a predictor of stroke. Journal of Stroke and Cerebrovascular Diseases. 2013;22(7):1169-74.
- Nishijima TF, Muss HB, Shachar SS, Tamura K, Takamatsu Y. Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors: a systematic review and meta-analysis. Cancer treatment reviews. 2015;41(10):971-8.
- Ren H, Liu X, Wang L, Gao Y. Lymphocyte-to-monocyte ratio: A novel predictor of the prognosis of acute ischemic stroke. Journal of Stroke And Cerebrovascular Diseases. 2017;26(11):2595-602.
- Mead G, Lewis S, Wardlaw J, Dennis M, Warlow C. How well does the Oxfordshire Community Stroke Project classification predict the site and size of the infarct on brain imaging? Journal of Neurology, Neurosurgery & Psychiatry. 2000;68(5):558-62.
- Pittock SJ, Meldrum D, Hardiman O, Thornton J, Brennan P, Moroney JT. The Oxfordshire Community Stroke Project classification: correlation with imaging, associated complications, and prediction of outcome in acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2003;12(1):1-7.
- Kasapis C, Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. Journal of the american College of Cardiology. 2005;45(10):1563-9.
- Jean JC, Liu Y, Brown LA, Marc RE, Klings E, Joyce-Brady M. γ-Glutamyl transferase deficiency results in lung oxidant stress in normoxia. American Journal of Physiology-Lung Cellular and Molecular Physiology. 2002;283(4):L766-76.
- Maestrini I, Strbian D, Gautier S, Haapaniemi E, Moulin S, Sairanen T, et al. Higher neutrophil counts before thrombolysis for cerebral ischemia predict worse outcomes. Neurology. 2015;85(16):1408-16.
- Yavaşi Ö, Gündoğdu ÖL. Clinical Evaluation of Young Adult Patients With Ischemic Stroke Applying To Emergency Department. Bozok Tıp Dergisi. 2019;9(3):70-5.
- Goldstein LB, Jones MR, Matchar DB, Edwards LJ, Hoff J, Chilukuri V, et al. Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. STROKE-DALLAS-. 2001;32(5):1091-5.
- Öztekin Ü, Caniklioğlu M, Sarı S, Selmi V, Gürel A, Gürtan E, et al. Is It Possible to Use Neutrofil/Lymphocyte and Platelet/Lymphocyte Ratio as a Predictive Marker for Azoospermia and Abnormal Semen Parameters? Bozok Tıp Dergisi.2019;9(3):102-7.
- Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Modern rheumatology. 2016;26(3):372-6.
- Aksakal C, Katar M. Çocuklardaki Bell’s Palsy de Nötrofil/Lenfosit Oranı, Platelet/Lenfosit Oranı ve Ortalama Trombosit Hacminin Değerlendirilmesi. Bozok Tıp Dergisi. 2019;9(3):39-44
- Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. Journal of clinical laboratory analysis. 2014;28(1):27-31.
- Altintas O, Altintas MO, Tasal A, Kucukdagli OT, Asil T. The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy. Neurological research. 2016;38(9):759-65.
- İnanç Y, İnanç Y. Relationship between hematologic parameters and carotid intima media thickness in patients wıth acute stroke. Turkish Journal of Cerebrovascular Diseases. 2018;24(2):71-7.
- Wang Q, Ma J, Jiang Z, Wu F, Ping J, Ming L. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine. 2017;96(34):e7897.
- Ren H, Han L, Liu H, Wang L, Liu X, Gao Y. Decreased lymphocyte-to-monocyte ratio predicts poor prognosis of acute ischemic stroke treated with thrombolysis. Medical science monitor: international medical journal of experimental and clinical research. 2017;23:5826.
- Ertem AG, Yayla C, Acar B, Kirbas O, Unal S, Uzel Sener M, et al. Relation between lymphocyte to monocyte ratio and short‐term mortality in patients with acute pulmonary embolism. The clinical respiratory journal. 2018;12(2):580-6.
- Zhang XW, Li M, Hou WS, Li K, Zhou JR, Tang ZY. Association between Gamma-Glutamyltransferase Level and Risk of Stroke: A Systematic Review and Meta-analysis of Prospective Studies. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2015;24(12):2816-23.
- Ulus T, Yildirir A, Sade LE, Temiz A, Polat E, Bozbas H, et al. Serum gamma-glutamyl transferase activity: new high-risk criteria in acute coronary syndrome patients? Coronary artery disease. 2008;19(7):489-95.
- Gurbuzer N, Gozke E, Ayhan Basturk Z. Gamma-glutamyl transferase levels in patients with acute ischemic stroke. Cardiovascular psychiatry and neurology. 2014;2014:170626.
Evaluation of changes in lymphocyte to monocyte ratio in stroke subgroups
Öz
Abstract
Backround: Stroke is one of the most important disease causing serious morbidity and mortality worldwide. There are some studies showing the change in hematological inflammatory markers in stroke patients. Lymphocyte to monocyte ratio (LMR) is considered to be a new hematological inflammatory marker that has been recently investigated in many malignancies with its particularly low level. In this study, we aimed to evaluate the levels of LMR in patients presented to our emergency department with neurological findings, diagnosed as ischemic stroke and also we aimed to evaluate the levels of LMR in subgroups according to the Oxfordshire Community Stroke Project (OCSP) classification which is a clinical classification.
Material and Methods: The patients admitted to the emergency department of a university hospital with symptoms of neurological disorders and diagnosed with ischemic stroke between January 2017 and January 2019 were retrospectively analyzed. Stroke patients were divided into subgroups according to OCSP classification and clinical and imaging results were correlated. Hematologic inflammatory markers were examined in all groups and changes in LMR were detected.
Results: 109 (63 female, 46 male) ischemic stroke patients and 110 (45 female, 65 male) control patients were included in the study. The low LMR values were found to be statistically significant in stroke cases compared to the control group (p <0.05). The low LMR values were found to be statistically significant in all four subgroups compared to the control group (p <0.05). TACI and POCI groups showed the lowest mean in LMR values. Higher NLR and GGT values were found to be statistically significant in all four groups compared to the control group (p <0.05).
Conclusion: In our study, the LMR value, which was limited investigated in stroke subgroups, was found to be low in all stroke and subgroups. Especially in clinical situations with large infarct sizes such as TACI and POCI groups, the lowest means were reached. It is thought that LMR can be used as a predictor of mortality, morbidity, and prognosis in both stroke and its subgroups.
Anahtar Kelimeler
Emergency department ischemic stroke lymphocyte to monocyte ratio
Kaynakça
- Bennett DA, Krishnamurthi RV, Barker-Collo S, Forouzanfar MH, Naghavi M, Connor M, et al. The global burden of ischemic stroke: findings of the GBD 2010 study. Global heart. 2014;9(1):107-12.
- Tokgoz S, Kayrak M, Akpinar Z, Seyithanoğlu A, Güney F, Yürüten B. Neutrophil lymphocyte ratio as a predictor of stroke. Journal of Stroke and Cerebrovascular Diseases. 2013;22(7):1169-74.
- Nishijima TF, Muss HB, Shachar SS, Tamura K, Takamatsu Y. Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors: a systematic review and meta-analysis. Cancer treatment reviews. 2015;41(10):971-8.
- Ren H, Liu X, Wang L, Gao Y. Lymphocyte-to-monocyte ratio: A novel predictor of the prognosis of acute ischemic stroke. Journal of Stroke And Cerebrovascular Diseases. 2017;26(11):2595-602.
- Mead G, Lewis S, Wardlaw J, Dennis M, Warlow C. How well does the Oxfordshire Community Stroke Project classification predict the site and size of the infarct on brain imaging? Journal of Neurology, Neurosurgery & Psychiatry. 2000;68(5):558-62.
- Pittock SJ, Meldrum D, Hardiman O, Thornton J, Brennan P, Moroney JT. The Oxfordshire Community Stroke Project classification: correlation with imaging, associated complications, and prediction of outcome in acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2003;12(1):1-7.
- Kasapis C, Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. Journal of the american College of Cardiology. 2005;45(10):1563-9.
- Jean JC, Liu Y, Brown LA, Marc RE, Klings E, Joyce-Brady M. γ-Glutamyl transferase deficiency results in lung oxidant stress in normoxia. American Journal of Physiology-Lung Cellular and Molecular Physiology. 2002;283(4):L766-76.
- Maestrini I, Strbian D, Gautier S, Haapaniemi E, Moulin S, Sairanen T, et al. Higher neutrophil counts before thrombolysis for cerebral ischemia predict worse outcomes. Neurology. 2015;85(16):1408-16.
- Yavaşi Ö, Gündoğdu ÖL. Clinical Evaluation of Young Adult Patients With Ischemic Stroke Applying To Emergency Department. Bozok Tıp Dergisi. 2019;9(3):70-5.
- Goldstein LB, Jones MR, Matchar DB, Edwards LJ, Hoff J, Chilukuri V, et al. Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. STROKE-DALLAS-. 2001;32(5):1091-5.
- Öztekin Ü, Caniklioğlu M, Sarı S, Selmi V, Gürel A, Gürtan E, et al. Is It Possible to Use Neutrofil/Lymphocyte and Platelet/Lymphocyte Ratio as a Predictive Marker for Azoospermia and Abnormal Semen Parameters? Bozok Tıp Dergisi.2019;9(3):102-7.
- Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Modern rheumatology. 2016;26(3):372-6.
- Aksakal C, Katar M. Çocuklardaki Bell’s Palsy de Nötrofil/Lenfosit Oranı, Platelet/Lenfosit Oranı ve Ortalama Trombosit Hacminin Değerlendirilmesi. Bozok Tıp Dergisi. 2019;9(3):39-44
- Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. Journal of clinical laboratory analysis. 2014;28(1):27-31.
- Altintas O, Altintas MO, Tasal A, Kucukdagli OT, Asil T. The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy. Neurological research. 2016;38(9):759-65.
- İnanç Y, İnanç Y. Relationship between hematologic parameters and carotid intima media thickness in patients wıth acute stroke. Turkish Journal of Cerebrovascular Diseases. 2018;24(2):71-7.
- Wang Q, Ma J, Jiang Z, Wu F, Ping J, Ming L. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine. 2017;96(34):e7897.
- Ren H, Han L, Liu H, Wang L, Liu X, Gao Y. Decreased lymphocyte-to-monocyte ratio predicts poor prognosis of acute ischemic stroke treated with thrombolysis. Medical science monitor: international medical journal of experimental and clinical research. 2017;23:5826.
- Ertem AG, Yayla C, Acar B, Kirbas O, Unal S, Uzel Sener M, et al. Relation between lymphocyte to monocyte ratio and short‐term mortality in patients with acute pulmonary embolism. The clinical respiratory journal. 2018;12(2):580-6.
- Zhang XW, Li M, Hou WS, Li K, Zhou JR, Tang ZY. Association between Gamma-Glutamyltransferase Level and Risk of Stroke: A Systematic Review and Meta-analysis of Prospective Studies. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2015;24(12):2816-23.
- Ulus T, Yildirir A, Sade LE, Temiz A, Polat E, Bozbas H, et al. Serum gamma-glutamyl transferase activity: new high-risk criteria in acute coronary syndrome patients? Coronary artery disease. 2008;19(7):489-95.
- Gurbuzer N, Gozke E, Ayhan Basturk Z. Gamma-glutamyl transferase levels in patients with acute ischemic stroke. Cardiovascular psychiatry and neurology. 2014;2014:170626.