Tam Kan Sayımı Parametrelerinin Çocuklarda Graves Hastalığı’nın Medikal Tedavi ile Remisyonu için Prognostik Belirteç Olarak Değerlendirilmesi

Yıl 2023, , 165 - 170, 30.06.2023

Diğdem Bezen , Eren Vurgun

https://doi.org/10.26650/jchild.2023.1270111

Öz

Amaç: Graves hastalığı (GH), hipertiroidizme neden olan otoimmün bir hastalıktır. Lökosit, nötrofil, lenfosit, trombosit sayıları ve nötrofil-lenfosit oranı (NLO) ve sistemik immün-enflamasyon indeksinin (SII) GH remisyonu ile bir ilişkisi olup olmadığını bulmayı amaçladık.
Gereç ve Yöntem: Çalışmaya GH olan otuz yedi çocuk dahil edildi. Hastaların antropometrik ölçümleri, fizik muayeneleri ve tıbbi öyküleri kaydedildi. Remisyonda olan (grup 1) ve remisyonda olmayan (grup 2) hastaların tanı anında ve medikal tedavi sonunda lökosit, nötrofil, lenfosit, trombosit sayıları, NLO ve SII değerleri karşılaştırıldı.
Bulgular: Remisyondaki hasta oranı %54 idi. Çarpıntı varlığı grup 2’de grup 1’e göre daha yüksekti (p=0,026). Tanı anında lökosit ve nötrofil sayıları grup 1’de daha yüksekti (sırasıyla p=0,001 ve p=0,014). Çarpıntı olmaması remisyon oranını 6,0 (%95 CI: 1,1-33,1) kat artırırken, nötrofil sayısı arttıkça remisyon oranı 2,4 (%95 CI: 1,1-5,2) kat artmış olarak bulundu (p=0,041 ve p= sırasıyla 0.031). Grup 2’de medikal tedavi sonrası lökosit ve nötrofil sayılarında, NLO ve SII’de tanı anına göre artış saptandı (sırasıyla, p=0,049, p=0,008, p=0,002 ve p=0,001).
Sonuç: Çocuklarda tanı anında çarpıntı olması ve nötrofil sayısının düşük olması, medikal tedavi sonrasında ise lökosit sayısı, nötrofil sayısı, NLO ve SII düzeylerinde artış olması GH’da medikal tedavi ile remisyona girmemeye ilişkin prognostik belirteçler olabilir

Anahtar Kelimeler

Graves Hastaliği, Çocuklar, Remisyon, Prognostik Belirteçler, Nötrofil-Lenfosit Orani, Sistemik Immün-Enflamasyon Indeksi

Evaluation of the Complete Blood Count Parameters as Prognostic Markers for Remission of Graves’ Disease with Medical Therapy in Children

Öz

Objective: Graves’ Disease (GD) is an autoimmune disease that causes hyperthyroidism. This study intended to find out whether leukocyte, neutrophil, lymphocyte, platelet counts, and neutrophil-to-lymphocyte ratio (NLR) and systemic immun-inflammation index (SII) have an association with the remission of GD.
Material and Methods: Thirty-seven children who have GD have been included in the study. Anthropometric measurements, physical examination and medical history of patients were recorded. Leukocyte, neutrophil, lymphocyte, platelet counts, NLR and SII at the time of diagnosis and at the end of medical therapy were compared between patients in remission (group 1) and patients not in remission (group 2).
Results: The rate of patients in remission was 54%. The presence of palpitation was higher in group 2 than group 1 (p=0.026). At the time of diagnosis, the leukocyte and neutrophil counts were higher in group 1 (p=0.001 and p=0.014, respectively). While the absence of palpitation increased the rate of remission 6.0 (95% CI: 1.1-33.1) times, the rate of remission increased 2.4 (95% CI: 1.1-5.2) times as the neutrophil count increased (p=0.041 and p=0.031, respectively). In group 2, there was an increase in leukocyte and neutrophil counts, NLR and SII after medical therapy compared to the levels at the time of diagnosis (p=0.049, p=0.008, p=0.002 and p=0.001, respectively).
Conclusion: Presence of palpitation and lower neutrophil count at the time of diagnosis and increase in leukocyte count, neutrophil count, NLR and SII levels after medical therapy could be prognostic markers for not achieving remission with medical therapy of GD in children.

Anahtar Kelimeler

Graves’ Disease, Children, Remission, Prognostic Markers, Neutrophil-To-Lymphocyte Ratio, Systemic Immun-Inflammation Index

Kaynakça

• Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism. Eur Thyroid J 2018;7(4):167-86. google scholar
• Kaguelidou F, Carel JC, Leger J. Graves’ disease in childhood: advances in management with antithyroid Drug therapy. Horm Res 2009;71(6):310-7. google scholar
• Hung W, Sarlis NJ. Autoimmune and non-autoimmune hyperthyroidism in pediatric patients: a review and personal commentary on management. Pediatr Endocrinol Rev 2004;2(1):21-38. google scholar
• Okawa ER, Grant FD, Smith JR. Pediatric Graves’ disease: decisions regarding therapy. Curr Opin Pediatr 2015;27(4):442-7. google scholar
• Leger J, Oliver I, Rodrigue D, Lambert AS, Coutant R. Graves’ disease in children. Ann Endocrinol 2018;79(6):647-55. google scholar
• Gastaldi R, Poggi E, Mussa A, Weber G, Vigone MG, Salerno M et al. Graves disease in children: thyroid-stimulating hormone receptor antibodies as remission markers. J Pediatr 2014;164(5):1189-94. google scholar
• Niang B, Thiam L, Ly F, Ly ID, Boiro D, Sow A et al. Evolutionary profile of Graves’ disease in children at Albert Royer National Children Hospital in Dakar. Open J Pediatr 2019;9(2):119-25. google scholar
• Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res 2014;20(23):6212-22. google scholar
• Liu CL, Lee JJ, Liu TP, Chang YC, Hsu YC, Cheng SP. Blood neutrophil-to-lymphocyte ratio correlates with tumor size in patients with differentiated thyroid cancer. J Surg Oncol 2013;107(5):493-7. google scholar
• Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol 2016;36:94-9. google scholar
• Gallo D, Piantanida E, Gallazzi M, Bartalena L, Tanda ML, Bruno A et al. Immunological Drivers in Graves’ Disease: NK Cells as a Master Switcher. Front Endocrinol 2020;11:406. google scholar
• Demir K, Konakçı E, Özkaya G, Kasap Demir B, Özen S, Aydın M et al. New Features for Child Metrics: Further Growth References and Blood Pressure Calculations. J Clin Res Pediatr Endocrinol 2020;12(2):125-129. google scholar
• Tunç S, Köprülü Ö, Ortaç H, Nalbantoğlu Ö, Dizdarer C, Demir K et al. Long-term monitoring of Graves’ disease in children and adolescents: a single-center experience. Turk J Med Sci 2019;49(2):464-71. google scholar
• Suzuki N, Noh JY, Yoshimura R, Mikura K, Kinoshita A, Suzuki A et al. Does Age or Sex Relate to Severity or Treatment Prognosis in Graves’ Disease? Thyroid 2021;31(9):1409-15. google scholar
• Allahabadia A, Daykin J, Holder RL, Sheppard MC, Gough SCL, Franklyn JA. Age and Gender Predict the Outcome of Treatment for Graves’ Hyperthyroidism. J Clin Endocrinol Metab 2000;85(3):1038-42. google scholar
• Bayramoğlu E, Elmaogulları S, Sagsak E, Aycan Z. Evaluation of long-term follow-up and methimazole therapy outcomes of pediatric Graves’ disease: a single-center experience. J Pediatr Endocr Met 2019;32(4):341-46. google scholar
• Wemeau JI, Klein M, Sadoul JL, Briet C, Velayoudom-Cephise FL. Graves’ disease: Introduction, epidemiology, endogenous and environmental pathogenic factors. Ann Endocrinol 2018;79(6):599-607. google scholar
• Esen İ, Bayramoğlu E, Yıldız M, Aydın M, Özturhan EK, Aycan Z et al. Management of Thyrotoxicosis in Children and Adolescents: A Turkish Multi-center Experience. J Clin Res Pediatr Endocrinol 2019;11(2):164-72. google scholar
• Gasparyan AR, 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(4):345-57. google scholar
• Yeter V, Koçak N, Arslan MT, Kan EK. Blood Count-derived Immunoinflammatory Markers in Thyroid associated Ophtalmopathy. Korean J Ophthalmol 2021;35(3):198-206. google scholar
• Kawa MP, Grymuta K, Paczkowska E, Baskiewicz-Masiuk M, Dqbkowska E, Koziotek M et al. Clinical relevance of thyroid dysfunction in human haematopoiesis: biochemical and molecular studies. Eur J Endocrinol 2010;162(2):295-305. google scholar
• Kim M, Kim BH, Jang MH, Kim JM, Kim EH, Jeon YK et al. High neutrophil-to-lymphocyte ratio is associated with relapse in Graves’ disease after antithyroid drug therapy. Endocrine 2020;67(2):406-11. google scholar
• Çetin E, Kamış F, Karakılıç E, Arslan M, Beyazıt Y. Evaluation of the hematologic indices in patients with thyrotoxicosis with distinct etiologies: a case-control study. J Health Sci Med 2021;4(2):198-202. google scholar
• Taşkaldıran I, Omma T, Önder ÇE, Fırat SN, Koç G. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-tolymphocyte ratio in different etiological causes of thyrotoxicosis. Turk J Med Sci 2019;49(6):1687-92. google scholar
• Klatka M, Grywalska E, Surdacka A, Tarach J, Klatka J, Rolinski J. Peripheral blood lymphocyte apoptosis and its relationship with thyroid function tests in adolescents with hyperthyroidism due to Graves’ disease. Arch Med Sci 2012;8(5):865-73. google scholar