Stent Restenozunu Öngördürmede Eozinofil-Lenfosit Oranının Kullanışlılığı

Yıl 2016, Cilt: 43 Sayı: 2, 299 - 304, 01.06.2016

Mehmet Zihni Bilik Mehmet Ata Akıl Halit Acet Murat Yüksel Mustafa Oylumlu Nihat Polat Adem Aktan Sait Alan

Öz

Amaç: Stent içi restenoz (SR), perkütan koroner girişimin
(PKG) önemli komplikasyonlarından biridir. Eozinofil
ile SR arasındaki ilişkiyi ortaya çıkaran çok sayıda çalışma
olmasına rağmen, literatürde eozinofil-lenfosit oranı
(ELO)’nın SR gelişimi ile ilişkisi hakkında veri bulunmamaktadır.
Bu çalışmada, hastaların başvuru ELO değerlerinin
SR ile ilişkisini araştırmayı amaçladık.
Yöntemler: Çalışmaya, daha önce koroner stent takılmış
olup hastanemize stabil angina nedeniyle başvuran ve
tekrar koroner anjiyografisi yapılan 314 hasta dahil edildi.
Hastaların verileri retrospektif olarak incelendi. Anjiyografik
olarak SR tespit edilen 197 kişi hasta grubuna alındı,
stentleri açık olan 117 hasta ise kontrol grubuna dahil
edildi.
Bulgular: Yaş, cinsiyet, hipertansiyon, diabetes mellitus,
LDL-kolesterol, HDL-kolesterol, platelet sayısı, platelet-lenfosit
oranı (PLO), hemoglobin düzeyleri ve sol ventrikül
ejeksiyon fraksiyonu (LVEF) ölçümleri bakımından
gruplar arasında anlamlı bir fark yoktu. Başvuruda bakılmış
olan kan beyaz küre sayısı (WBC), nötrofil, eozinofil,
C-reaktif protein (CRP), ELO ve nötrofil-lenfosit oranı
(NLO) değerleri SR grubunda kontrol grubuna göre istatistiksel
olarak anlamlı şekilde daha yüksek lenfosit değerleri
daha düşüktü. Tüm hastalar ELO düzeylerine göre
iki gruba ayrıldığında, yüksek-ELO grubunda düşük-ELO
grubuna kıyasla daha sık SR görüldü. Başvuru ELO değerinin
≥0,745 olması durumunda, SR’u %64 sensitivite
ve %61 spesifite ile öngördürebildiği saptandı.
Sonuç: Bu çalışmada ELO değerleri kontrol grubuna kıyasla
SR grubunda anlamlı olarak daha yüksek bulundu.
Çalışmadan elde ettiğimiz bulgular ışığında kolay ve ucuz
bir yöntem olan ELO, SR açısından yüksek riskli hastaların
belirlenmesine yardımcı olabilir ve yüksek ELO, SR
için bir öngördürücü olarak kullanılabilir.

Anahtar Kelimeler

Koroner restenoz, stentler, eozinofiller, lenfositler

Usefulness of Eosinophil-Lymphocyte Ratio to Predict Stent Restenosis

Öz

Objective: Stent restenosis (SR) is an important compli­cation of percutaneous coronary intervention. There are many studies explored the relation of eosinophils with SR, however, there is no data about relationship between eo­sinophil-lymphocyte ratio (ELR) and SR. In this study we aimed to investigate the relationship between the value of ELR on admission and SR. Methods: The study was included 314 patients who had been applied a coronary stent implantation and they were admitted to cardiology clinic with stabile angina and un­derwent repeat coronary angiography. The data obtained from patients were analyzed retrospectively. The patient group was consisted of 197 patients who were diagnosed as SR, and the control group was consisted of 117 pa­tients whose stents were patent angiographically. Results: The groups were similar in terms of age, gender, hypertension, diabetes mellitus, LDL-C, HDL-C, platelet count, platelet-lymphocyte ratio (PLR), hemoglobin and left ventricle ejection fraction (LVEF). White blood cell (WBC), neutrophil, eosinophil, C-reactive protein (CRP), ELR and neutrophil-lymphocyte ratio (NLR) on admission were higher in the SR group compared to the controls. All patients were categorized into two groups according to ELR values and SR was more frequent in the high ELR group compared to low ELR group. An ELR value of ≥0.745 predicted SR with 64% sensitivity and 61% specif­ity. Conclusion: In this study ELR was found statistically higher in SR patients compared to the controls. Accord­ing to our data ELR as an inexpensive and easy method, may contribute to determination of high risk patients and increased ELR can be used as a predictor of SR.

Anahtar Kelimeler

Coronary restenosis, stents, eosinophils, lymphocytes

Kaynakça

• 1. Li JJ, Nie SP, Zhang CY, et al. Is inflammation a contributor for coronary stent restenosis? Med Hypotheses 2007;68:945-951.
• 2. Jukema JW, Verschuren JJ, Ahmed TA, Quax PH. Restenosis after pci. Part 1: Pathophysiology and risk factors. Nat Rev Cardiol 2012;9:53-62.
• 3. Kornowski R, Hong MK, Tio FO, et al. In-stent restenosis: Contributions of inflammatory responses and arterial injury to neointimal hyperplasia. J Am Coll Cardiol 1998;31:224- 230.
• 4. Niccoli G, Montone RA, Ferrante G, Crea F. The evolving role of inflammatory biomarkers in risk assessment after stent implantation. J Am Coll Cardiol 2010;56:1783-1793.
• 5. Niccoli G, Sgueglia GA, Conte M, et al. Eosinophil cationic protein and clinical outcome after bare metal stent implantation. Atherosclerosis 2011;215:166-169.
• 6. Oylumlu M, Yıldız A, Yüksel M, et al. Usefulness of platelet-lymphocyte ratio to predict stent thrombosis in patients with st elevation myocardial infarction. Kosuyolu Heart J 2014;17:81-85.
• 7. Turak O, Ozcan F, Isleyen A, et al. Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis. Am J Cardiol 2012;110:1405-1410.
• 8. Polat N, Elbey MA, Akıl E, et al. Karotis artere stent yerleştirme: Tek merkez deneyimi ve klinik sonuçları. Dicle Med J 2014;41
• 9. Ridker PM, Rifai N, Rose L, et al. Comparison of c-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Eng J Med 2002;347:1557-1565.
• 10. Ferrante G, Niccoli G, Biasucci LM, et al. Association between c-reactive protein and angiographic restenosis after bare metal stents: An updated and comprehensive meta-analysis of 2747 patients. Cardiovasc Revasc Med 2008;9:156-165.
• 11. Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-1643.
• 12. Yarnell JW, Patterson CC, Sweetnam PM, Lowe GD. Haemostatic/inflammatory markers predict 10-year risk of ihd at least as well as lipids: The caerphilly collaborative studies. Eur Heart J 2004;25:1049-1056.
• 13. Meyer-Sabellek W, Brasch H: Atherosclerosis, inflammation, leukocyte function and the effect of statins. J Hypertens 2006;24:2349-2351.
• 14. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. J Am Coll Cardiol 1997;79:812-814.
• 15. Bian C, Wu Y, Shi Y, et al.Predictive value of the relative lymphocyte count in coronary heart disease. Heart Vessels 2010;25:469-473.
• 16. Acet H, Ertas F, Akil MA, et al. Novel predictors of infarctrelated artery patency for st-segment elevation myocardial infarction: Platelet-to-lymphocyte ratio, uric acid, and neutrophil-to-lymphocyte ratio. Anatol J Cardiol 2015;15:648- 656.
• 17. Yuksel M, Yildiz A, Oylumlu M, et al. The association between platelet/lymphocyte ratio and coronary artery disease severity. Anatol J Cardiol 2015;15:640-647.
• 18. Murat SN, Yarlioglues M, Celik IE, et al. The relationship between lymphocyte-to-monocyte ratio and baremetal stent in-stent restenosis in patients with stable coronary artery disease. Clin Appl Thromb Hemost 2016. pii: 1076029615627340
• 19. Fauci AS, Harley JB, Roberts WC, et al. The idiopathic hypereosinophilic syndrome. Clinical, pathophysiologic, and therapeutic considerations. Ann Intern Med 1982;97:78-92.
• 20. Chihara J, Yamamoto T, Kurachi D, et al. Possible release of eosinophil granule proteins in response to signaling from intercellular adhesion molecule-1 and its ligands. Int Arch Allergy Immunol 1995;108 Suppl 1:52-54.
• 21. Toor IS, Jaumdally R, Lip GY, et al. Eosinophil count predicts mortality following percutaneous coronary intervention. Thromb Res 2012;130:607-611.
• 22. Budinger L, Hertl M: Immunologic mechanisms in hypersensitivity reactions to metal ions: An overview. Allergy 2000;55:108-115.
• 23. Nakatani M, Takeyama Y, Shibata M, et al. Mechanisms of restenosis after coronary intervention: Difference between plain old balloon angioplasty and stenting. Cardiovasc Pathol 2003;12:40-48.
• 24. Rittersma SZ, Meuwissen M, van der Loos CM, et al. Eosinophilic infiltration in restenotic tissue following coronary stent implantation. Atherosclerosis 2006;184:157-162.
• 25. Koster R, Vieluf D, Kiehn M, et al. Nickel and molybdenum contact allergies in patients with coronary in-stent restenosis. Lancet 2000;356:1895-1897.
• 26. Kawano H, Koide Y, Baba T, et al. Granulation tissue with eosinophil infiltration in the restenotic lesion after coronary stent implantation. Circ J 2004;68:722-723.