Çölyak hastalığının tanısında inflamatuvar ve nütrisyonel biyobelirteçlerin rolünün değerlendirilmesi

Abstract

Arka Plan: Çölyak hastalığı (ÇH), çoklu sistemleri etkileyen ve klinik belirtilerin değişkenliği nedeniyle sıklıkla tanı konulamayan, immün aracılı bir enteropatidir. Güvenilir, erişilebilir ve invaziv olmayan biyobelirteçlerin tanımlanması, özellikle kaynakların kısıtlı olduğu ortamlarda zamanında tanı koymak için kritik öneme sahiptir. Amaç: Bu çalışmanın amacı, rutin laboratuvar testlerinden hesaplanan inflamasyon ve beslenme ile ilişkili indeks ve skorların çölyak hastalığını öngörmedeki tanısal değerini değerlendirmektir. Yöntemler: Bu kesitsel çalışmaya biyopsi ile doğrulanmış 79 çölyak hastası ve 60 sağlıklı kontrol dahil edilmiştir. Demografik, hematolojik ve biyokimyasal veriler toplanmıştır. Trombosit-lenfosit oranı (PLR), trigliserid-glukoz indeksi (TyG), hemoglobin, albümin, lenfosit ve trombosit (HALP) skoru ile diğer inflamasyonla ilişkili indeksler doğrulanmış formüllerle hesaplanmıştır. ÇH için bağımsız prediktörleri belirlemek amacıyla lojistik regresyon analizi yapılmıştır. Tanısal performansı değerlendirmek için ROC (alıcı işletim karakteristikleri) eğrileri kullanılmıştır. Bulgular: Kontrollerle karşılaştırıldığında, çölyak hastalarında PLR anlamlı derecede yüksek, TyG indeksi ve HALP skoru ise anlamlı derecede düşük bulunmuştur (tümünde p<0.05). Lojistik regresyon analizinde TyG indeksi (OR: 0.297; %95 GA: 0.112–0.791) ve HALP skoru (OR: 0.052; %95 GA: 0.009–0.283) çölyak hastalığı için bağımsız risk faktörleri olarak saptanmıştır. ROC analizi, PLR (EAA: 0.641), TyG skoru (EAA: 0.643) ve HALP skoru (EAA: 0.697) ile çölyak hastalarının sağlıklı bireylerden ayırt edilebileceğini göstermiştir. Optimal eşik değerler PLR için 138, TyG için 8.21 ve HALP için 0.47 olarak bulunmuş; bunlara karşılık gelen duyarlılık ve özgüllük değerleri %53 ile %68 arasında değişmiştir. Sonuç: TyG indeksi ve HALP skoru, çölyak hastalığı için bağımsız prediktörlerdir ve PLR ile birlikte risk sınıflandırması için faydalı invaziv olmayan belirteçler olarak hizmet edebilir.

Keywords

• Çölyak hastalığı
• PLR
• TyG indeksi
• HALP skoru
• biyobelirteçler
• inflamasyon
• beslenme

Assessing the role of inflammatory and nutritional biomarkers in the diagnosis of celiac disease

Abstract

Aims: Celiac disease (CeD) is an immune-mediated enteropathy with multisystem involvement that is often underdiagnosed due to variable clinical manifestations. Identifying reliable, accessible, and noninvasive biomarkers is essential for timely diagnosis, particularly in resource-limited settings. This study aims to evaluate the diagnostic utility of inflammation and nutrition-related indices and scores calculated from routine laboratory tests in predicting CeD. Methods: This retrospective cross-sectional study included 79 biopsy-confirmed celiac patients and 60 healthy controls. Demographic, hematological, and biochemical data were collected. The platelet-to-lymphocyte ratio (PLR), triglycerideglucose index (TyG), hemoglobin, albumin, lymphocyte, and platelet (HALP) score, and other inflammation-related indices were calculated via validated formulas. Logistic regression analysis was performed to identify independent predictors of CeD. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results: Compared with controls, patients with CeD had significantly greater PLRs and lower TyG indices and HALP scores (p<0.05 for all). In logistic regression analysis, both the TyG index (OR: 0.248, 95% CI [0.090, 0.685]) and the HALP score (OR: 0.013, 95% CI [0.001, 0.108]) were identified as independent risk factors for CeD. ROC analysis demonstrated that the PLR (AUC: 0.641), TyG score (AUC: 0.643), and HALP score (AUC: 0.697) could distinguish celiac patients from healthy individuals. The optimal cut-off values were 138 for PLR, 8.21 for TyG, and 0.47 for HALP, with corresponding sensitivities and specificities ranging from 53% to 68%. Conclusion: The TyG index and HALP score are independent predictors of CeD and, may serve as useful noninvasive markers for risk stratification.

Keywords

• Celiac disease
• PLR
• TyG index
• HALP score
• biomarkers
• inflammation
• nutrition

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