STROK ALT GRUPLARINDA LENFOSİT MONOSİT ORANI VE İNFLAMATUAR BELİRTEÇLERDEKİ DEĞİŞİMİN DEĞERLENDİRİLMESİ Evaluation of Changes in Lymphocyte to Monocyte Ratio and İnflammatory Markers in Stroke Subgroups

Yıl 2020, Cilt: 10 Sayı: 1, 190 - 195, 25.03.2020

İbrahim Çaltekin Emre Gökçen

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: Acil servis; İskemik inme; Lenfosit monosit oranı
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.
Keywords: Emergency department; Ischemic stroke; Lymphocyte to monocyte ratio

Anahtar Kelimeler

STROK ALT GRUPLARINDA LENFOSİT MONOSİT ORANI VE İNFLAMATUAR BELİRTEÇLERDEKİ DEĞİŞİMİN DEĞERLENDİRİLMESİ Evaluation of Changes in Lymphocyte to Monocyte Ratio and İnflammatory Markers in Stroke Subgroups

Kaynakça

• 1. 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. 2. 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. 3. 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. 4. 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. 5. 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. 6. 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. 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. 8. 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. 9. 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. 10. 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.