Ülseratif kolit aktivitesi ve şiddetinin invaziv olmayan biyobelirteçler ile değerlendirilmesi

Yıl 2023, Cilt: 22 Sayı: 2, 59 - 66, 31.08.2023

İlyas Tenlik Orhan Coşkun Mustafa Çapraz Volkan Gökbulut Ömer Öztürk

https://doi.org/10.17941/agd.1348965

Öz

Giriş ve Amaç: Bu çalışmamızda, ülseratif kolit hastalık aktivitesinin belirlenmesinde nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı ve C-reaktif protein/albümin oranının rolünü değerlendirdik. Gereç ve Yöntem: Ülseratif kolit tanısı ile takip ettiğimiz 18 yaş üstü hastalar retrospektif olarak tarandı. Yaş, cinsiyet, komorbid hastalıklar açısından farklılığı ortadan kaldırmak için aynı hastaların endoskopik remisyon ve aktivasyon dönemlerindeki laboratuvar ve tedavi verileri karşılaştırıldı. Bulgular: Çalışma kriterlerine uygun olan 87 hasta çalışmaya alındı. Hastaların %69’u erkek, %31’i kadındı. En sık sol tip (%48.3) tutulum saptandı ve aktif dönemde median endoskopik aktivite indeksi 8’di (6-12). Endoskopik olarak aktif hastalık döneminde istatistiksel açıdan lökosit, nötrofil, monosit, trombosit, sedimentasyon, C-reaktif protein düzeyi anlamlı olarak yüksekken, hemoglobin ve albümin düzeyleri anlamlı olarak düşüktü (p < 0.05). Median platelet/lenfosit oranı [152.4 (70.1 - 422.7) ve 137.5 (36 - 1212), p = 0.009)], monosit/lenfosit oranı [(0.06 (0.01 - 1.54) ve 0.04 (0.01 – 0.9), p = 0.03], nötrofil/lenfosit oranı [2.47 (0.73 - 9.92) ve 2.08 (0.55 - 6.54), p = 0.007] ve C-reaktif protein/albümin oranının [2.3 (0.1-80) ve 0.51 (0.04 - 8.48), p < 0.001] değerleri aktif hastalık döneminde hastalığın inaktif olduğu döneme göre anlamlı olarak daha yüksek saptandı. Yapılan ROC analizde nötrofil/lenfosit oranı ve C-reaktif protein/albümin oranının endoskopik aktif hastalığı tahmin etmede yararlı olduğu, platelet/lenfosit oranı ve monosit/lenfosit oranının ise aktif hastalığı göstermede faydalı olmadığı tespit edildi. Nötrofil/lenfosit oranı için eşik değer 2.35 alındığında aktif hastalık için sensitivite %59.8, spesifite %66.7, eğri altında kalan alan 0.619 saptandı (p = 0.007). C-reaktif protein/albümin oranı için eşik değer 0.87 alındığında aktif hastalık için sensitivite %74.7, spesifite %72.4, eğri altında kalan alan 0.806 saptandı (p < 0.001). Sonuç: Ülseratif kolit hastalarında nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı, C-reaktif protein/albümin oranı değerleri aktif hastalıkta anlamlı olarak yükselmekle birlikte, endoskopik aktif hastalığın tahmininde sadece nötrofil/lenfosit oranı ve C-reaktif protein/albümin oranı yeterli sensitivite ve spesifiteye sahiptir.

Anahtar Kelimeler

Ülseratif kolit, endoskopik aktivite, nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı, C-reaktif protein/albümin oranı

Evaluation of ulcerative colitis activity and severity with non-invasive biomarkers

Öz

Background and Aims: In this study, we evaluated the role of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio and C-reactive protein/albumin ratio in determining ulcerative colitis endoscopic activity. Materials and Methods: Patients over the age of 18 who were followed up with the diagnosis of ulcerative colitis were retrospectively screened. In order to eliminate the difference in terms of age, gender, and comorbid diseases, the datas of the patients in the endoscopic remission periods compared with their own datas in the activation periods. Results: Eighty-seven patients who met the study criteria were included in the study, of which 69% were male and 31% were female. The most common localization was left-side (48.3%) and the median endoscopic activity index was 8 (6 - 12) in the active period. During the endoscopically active disease period, leukocyte, neutrophil, monocytes, thrombocyte, sedimentation, and C-reactive protein levels were significantly higher, while hemoglobin and albumin levels were significantly lower (p < 0.05). Median platelet/lymphocyte ratio [152.4 (70.1 - 422.7) and 137.5 (36 - 1212), p = 0.009)], monocyte/lymphocyte ratio [(0.06 (0.01 - 1.54) and 0.04 (0.01 - 0.9), p = 0.03], neutrophil/lymphocyte ratio [2.47 (0.73 - 9.92) and 2.08 (0.55 - 6.54), p = 0.007] and C-reactive protein/albumin ratio [2.3 (0.1 - 80) and 0.51 (0.04 - 8.48), p < 0.001] values were higher in the endoscopically active period compared to the inactive period. In the ROC analysis, only neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio were sensitive and specific enough to predict endoscopic active disease. When the cutoff value of neutrophil/lymphocyte ratio was taken as 2.35, sensitivity for active disease was 59.8%, specificity was 66.7%, and area under the curve was 0.619 (p = 0.007). And, when the cutoff value of C-reactive protein/albumin ratio was taken as 0.87, the sensitivity for active disease was 74.7%, the specificity was 72.4%, and the area under the curve was 0.806 (p < 0.001). Conclusions: Although neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and C-reactive protein/albumin ratio values increase significantly in active disease in ulcerative colitis, only neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio are useful in the estimation of endoscopic active disease and have sufficient sensitivity and specificity.

Anahtar Kelimeler

Ulcerative colitis, endoscopic activity, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, C-reactive protein/albumin ratio

Kaynakça

• 1-Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19:5A-36A.
• 2-Lindholm CR, Siegel CA. Are We Ready to Include Prognostic Factors in Inflammatory Bowel Disease Trials? Curr Pharm Des 2019;25:64-8.
• 3-Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol 2019;114:384-413.
• 4-Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology 2011;140:1817-26.
• 5-Tenlik I, Ozturk O, Kaplan M, et al. Relationship between histological stage and neutrophil to lymphocyte ratio in chronic hepatitis C. Ann Med Res 2022;29:1360-5.
• 6-Zhou Y, Tian N, Li P, et al. The correlation between neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio with nonalcoholic fatty liver disease: a crosssectional study. Eur J Gastroenterol Hepatol 2022;34:1158-64.
• 7-Wang J, Su J, Yuan Y, et al. The role of lymphocyte-monocyte ratio on axial spondyloarthritis diagnosis and sacroiliitis staging. BMC Musculoskelet Disord 2021;22:86.
• 8-Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med 2019;39:345-57.
• 9- Tarar MY, Khalid A, Choo XY, et al. Use of the C-Reactive Protein (CRP)/Albumin Ratio as a Severity Tool in Acute Pancreatitis: Systematic Review. Cureus 2022;14:e29243.
• 10-Pamukcu M, Duran TI. Could C-Reactive Protein/Albumin Ratio be an Indicator of Activation in Axial Spondyloarthritis? J Coll Physicians Surg Pak 2021;30:537-41.
• 11-Okba AM, Amin MM, Abdelmoaty AS, et al. Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity. Auto Immun Highlights 2019;10:4.
• 12-Feng W, Liu Y, Zhu L, Xu L, Shen H. Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential markers for ulcerative colitis: a retrospective study. BMC Gastroenterol 2022;22:485.
• 13-Sayar S, Kurbuz K, Kahraman R, et al. A practical marker to determining acute severe ulcerative colitis: CRP/albumin ratio. North Clin Istanb 2019;7:49-55.
• 14-Furukawa S, Yagi S, Shiraishi K, et al. Effect of disease duration on the association between C-reactive protein-albumin ratio and endoscopic activity in ulcerative colitis. BMC Gastroenterol 2022;22:39.
• 15-Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006;55:749-53.
• 16-Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. BMJ 1989;298:82-6.
• 17 - Avanzas P, Quiles J, Lopez de Sa E, et al. Neutrophil count and infarct size in patients with acute myocardial infarction. Int J Cardiol 2004;97:155-6.
• 18-Chen YH, Wang L, Feng SY, et al. The Relationship between C-Reactive Protein/Albumin Ratio and Disease Activity in Patients with Inflammatory Bowel Disease. Gastroenterol Res Pract 2020;2020:3467419.
• 19-Cherfane CE, Gessel L, Cirillo D, Zimmerman MB, Polyak S. Monocytosis and a Low Lymphocyte to Monocyte Ratio Are Effective Biomarkers of Ulcerative Colitis Disease Activity. Inflamm Bowel Dis 2015;21:1769-75.
• 20-Xu M, Cen M, Chen X, et al. Correlation Between Serological Biomarkers and Disease Activity in Patients with Inflammatory Bowel Disease. Biomed Res Int 2019;2019:6517549.
• 21-Fu W, Fu H, Ye W, et al. Peripheral blood neutrophil-to-lymphocyte ratio in inflammatory bowel disease and disease activity: A meta-analysis. Int Immunopharmacol 2021;101:108235.
• 22-Ma L, Pang X, Ji G, et al. Application of the neutrophil to lymphocyte ratio in the diagnosis and activity determination of ulcerative colitis: A meta-analysis and systematic review. Medicine (Baltimore) 2021;100:e27551.
• 23- Bertani L, Rossari F, Barberio B, et al. Novel Prognostic Biomarkers of Mucosal Healing in Ulcerative Colitis Patients Treated With Anti-TNF: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio. Inflamm Bowel Dis 2020;26:1579-87.
• 24-Akpinar MY, Ozin YO, Kaplan M, et al. Platelet-to-lymphocyte Ratio and Neutrophil-to-lymphocyte Ratio Predict Mucosal Disease Severity in Ulcerative Colitis. J Med Biochem 2018;37:155-62.
• 25-Cifci S, Ekmen N. Prediction of Mucosal Health by NLR, CRP x NLR and MPV in Ulcerative Colitis: Can Their Availability Change According to Treatment Options? Cureus 2021;13:e19942.
• 26-Jeong Y, Jeon SR, Kim HG, et al. The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis. Intest Res 2021;19:62-70.
• 27-Cui J, Li X, Zhang Z, Gao H, Li J. Common laboratory blood test immune panel markers are useful for grading ulcerative colitis endoscopic severity. BMC Gastroenterol 2022;22:540.
• 28- Zhang MH, Wang H, Wang HG, Wen X, Yang XZ. Effective immune-inflammation index for ulcerative colitis and activity assessments. World J Clin Cases 2021;9:334-43.
• 29- Yalçın MS, Yalaki S, Ölmez Ş, Taş A. Monocyte/High-Density Lipoprotein Ratio Is an Indicator of Activity in Patients with Ulcerative Colitis. Turk J Gastroenterol 2022;33:329-35.
• 30- Coillard A, Segura E. In vivo Differentiation of Human Monocytes. Front Immunol 2019;10:1907.
• 31- Walsh AJ, Bryant RV, Travis SP. Current best practice for disease activity assessment in IBD. Nat Rev Gastroenterol Hepatol 2016;13:567-79.
• 32- Chojkier M. Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol 2005;39(4 Suppl 2):S143-6.