Kolonun Divertiküler Hastalığında İnflamatuar Parametrelerin Tanısal ve Prognostik Önemi

Öz

Amaç Bu çalışmanın amacı, inflamatuar parametreleri kullanarak asemptomatik divertiküler hastalıkta inflamasyon varlığını belirlemek ve semptomatik divertiküler hastalıklarda inflamatuar parametreler ile komplikasyon derecesi arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntem Akut divertikülitli hastalar, divertikülozlu hastalar ve sağlıklı kontrol grubunun klinik ve dermografik bulguları karşılaştırıldı.Bulgular 31 kişilik sağlıklı kontrol grubu, 40 divertikülozisli hasta, 32 akut divertikülitli hasta çalışmaya dahil edildi. Hastaların 31’i (%43.11) kadın, 41’i (%56.9) erkekti. Asemptomatik divertikülozisli hastalarda RDW ve MLR, kontrol grubuna göre anlamlı derecede yüksekti (sırayla p=0.02, p=0.00). Hinchey grupları arasında NLR ve SII anlamlı derecede farklıydı (sırasıyla p<0.01, p<0.01). Sonuç Asemptomatik divertiküloz hastalarında ılımlı bir inflamasyon olabileceği, NLR ve SII’ ın akut divertikülitin derecesi hakkında bilgi verebileceği sonucuna vardık.

Anahtar Kelimeler

• divertikülozis
• inflamasyon
• akut divertikülit
• diverticulosis
• inflammation
• acute diverticulitis

Dİagnostİc and Prognostic Significance of Inflammatory Parameters in Diverticular Disease of the Colon

Öz

Aim The aim of this study was to determine the presence of inflammation in asymptomatic diverticular disease using inflammatory parameters and to evaluate the relationship between inflammatory parameters and the degree of complication in symptomatic diverticular diseases. Material and Method Clinical and dermographic findings of patients with acute diverticulitis, patients with diverticulosis and healthy volunteers were compared. Results A healthy control group of 31 people, 40 patients with diverticulosis and 32 patients with acute diverticulitis were included in the study. Thirty-one (43.11%) patients were female and 41 (56.9%) male. RDW and MLR were significantly higher in patients with asymptomatic diverticulosis compared to the control group (p=0.02, p=0.00, respectively). NLR and SII were significantly different among Hinchey groups (p<0.01, p<0.01, respectively).Conclusion We concluded that there may be a mild inflammation in asymptomatic diverticulosis patients, and NLR and SII can provide information about the degree of acute diverticulitis. Keywords diverticulosis, inflammation, acute diverticulitis

Anahtar Kelimeler

• diverticulosis
• inflammation
• acute diverticulitis

Kaynakça

1. 1. Thompson, A. E. Diverticulosis and Diverticulitis. JAMA 316, 1124 (2016).
2. 2. Everhart, J. E. & Ruhl, C. E. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 136, 741–754 (2009).
3. 3. Tursi, A. Advances in the management of colonic diverticulitis. CMAJ 184, 1470–1476 (2012).
4. 4. Walker, M. M. & Harris, A. K. Pathogenesis of diverticulosis and diverticular disease. Minerva Gastroenterol. Dietol. 63, 99–109 (2017).
5. 5. Humes, D. J. et al. Visceral hypersensitivity in symptomatic diverticular disease and the role of neuropeptides and low grade inflammation. Neurogastroenterol. Motil. 24, 318– e163 (2012).
6. 6. Spiller, R. How inflammation changes neuromuscular function and its relevance to symp- toms in diverticular disease. J. Clin. Gastroenterol. 40 Suppl 3, S117–20 (2006).
7. 7. Elli, L. et al. Absence of mucosal inflammation in uncomplicated diverticular disease. Dig. Dis. Sci. 56, 2098–2103 (2011).
8. 8. Tursi, A. et al. Musosal tumour necrosis factor α in diverticular disease of the colon is overexpressed with disease severity. Colorectal Dis. 14, e258–63 (2012).

9. 9. Kelly, M. E. et al. The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis, Length of Hospital Stay and Postoperative Complication Rates. Dig. Surg. 32, 459–463 (2015).
10. 10. Yamanaka, T. et al. The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology 73, 215–220 (2007).
11. 11. Gönüllü, E., Kucuk, F., Bayhan, Z., Harmantepe, A. T. & Capoglu, R. Akut Kolesistitte Kolesistektomi veya Kolesistostomi Yapılması Gerekecek Hastaların Ayırt Edilmesinde Biyolojik İndeksler Kullanılabilir mi? Sakarya Tıp Dergisi 12, 489–495.
12. 12. Nøst, T. H. et al. Systemic inflammation markers and cancer incidence in the UK Bio- bank. Eur. J. Epidemiol. 36, 841–848 (2021).
13. 13. Tursi, A. et al. Assessment and grading of mucosal inflammation in colonic diverticular disease. J. Clin. Gastroenterol. 42, 699–703 (2008).
14. 14. Tursi, A., Papa, A. & Danese, S. Review article: the pathophysiology and medical mana- gement of diverticulosis and diverticular disease of the colon. Aliment. Pharmacol. Ther. 42, 664–684 (2015).
15. 15. Painter, N. S. & Burkitt, D. P. Diverticular disease of the colon, a 20th century problem. Clin. Gastroenterol. 4, 3–21 (1975).
16. 16. Tursi, A. & Elisei, W. Role of Inflammation in the Pathogenesis of Diverticular Disease. Mediators Inflamm. 2019, 8328490 (2019).
17. 17. Peery, A. F. et al. Colonic Diverticula Are Not Associated With Mucosal Inflammation or Chronic Gastrointestinal Symptoms. Clin. Gastroenterol. Hepatol. 16, 884–891.e1 (2018).
18. 18. Gönüllü, E. et al. andisit Öngörme Başarısı Açısından Nötrofil/Lenfosit, Trombosit/ Lenfosit Oranı ile Sistemik İmmün İnflamatuar İndeksin Karşılaştırılması. Tek Merkez Deneyimi. Kocaeli Tıp Dergisi 11, 130–137 (2022).
19. 19. Hajibandeh, S., Hajibandeh, S., Hobbs, N. & Mansour, M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomp- licated appendicitis: A systematic review and meta-analysis. Am. J. Surg. 219, 154–163 (2020).
20. 20. Lee, W. S. & Kim, T.-Y. Is mean platelet volume a new predictor in confirming a diagnosis of acute appendicitis? Clinical and applied thrombosis/hemostasis: official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis vol. 17 E125–6 (2011).
21. 21. Absenger, G. et al. A derived neutrophil to lymphocyte ratio predicts clinical outcome in stage II and III colon cancer patients. Br. J. Cancer 109, 395–400 (2013).
22. 22. Reynolds, I. S. et al. The Utility of Neutrophil to Lymphocyte Ratio as a Predictor of Intervention in Acute Diverticulitis. Dig. Surg. 34, 227–232 (2017).
23. 23. Zager, Y. et al. Associations of novel inflammatory markers with long-term outcomes and recurrence of diverticulitis. ANZ J. Surg. 90, 2041–2045 (2020).
24. 24. Haghi, A. R., Pourmohammad, P. & Rabiee, M. A. S. Accuracy of Mean Platelet Volume (MPV) and Red Cell Distribution Width (RDW) for the Diagnosis of Acute Appendicitis: Evaluation of Possible New Biomarkers. Adv J Emerg Med 4, e20 (2020). 25. Anand, S. et al. Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomar- ker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases. Diagnostics (Basel) 12, (2022).