İdiyipatik huzursuz bacaklar sendromunda enflamasyonun nötrofil/lenfosit oranları ile incelenmesi

Öz

Amaç: Huzursuz bacaklar sendromu (HBS); ekstremitelerde öncelikle bacaklarda hareket ettirme dürtüsü ve anormal duyularla karakterize, kronik, ilerleyici sensorimotor bir bozukluktur. HBS’ nin patofizyolojisi net değildir. Son yıllarda birçok çalışmada patofizyoloji hakkında yorum yapabilmek ya da tanı ve tedavi takibi için farklı serum biyomarkerları kullanılmaktadır. HBS ve Nötrofil/Lenfosit (N/L) ilişkisini detaylı araştıran yeterli sayıda çalışma bulunmamaktadır. Bu nedenle çalışmamızda idiopatik HBS ile serum N/L arasında ilişkinin incelenmesi amaçlandı. 

Yöntemler: Olgu kontrol çalışması planlandı.  93 HBS tanılı hasta (çalışma grubu) ile yaş ve cinsiyet açısından eşleştirilen 50 sağlıklı gönüllü (kontrol grubu) çalışmaya dahil edildi. İki grubun N/L oranları restrospektif olarak incelendi.

Bulgular: N/L’nin ortanca değeri hasta grubunda 2.58 ve kontrol grubunda 2.72 idi. Hasta ve kontrol grubu arasında istatistiksel olarak anlamlı bir farklılık yoktu (p=0.891). Çalışmamızda hasta grubunda hastalık süresinin ortalama 3,2±1,37 yıl olduğu tespit edildi. Olguların %81,7’sinde (n=76) uyku bozukluğu, %34,4’ ünde (n=32) üst ekstremitelerde benzer yakınmaların olduğu görüldü. Hastalığın şiddet skalası Uluslarası Huzursuz Bacaklar Sendromu Çalışma Grubu (IRLSSG) ’na göre belirlendi. Semptomların şiddetinin dağılımı %6,3’ünde hafif, %15,2’sinde orta, %64,8’inde ciddi, %13,7’ sinde ağır şiddette olduğu izlendi. Hastalık süresi ile N/L arasında anlamlı korelasyon yoktu (r:-0.117 p= 0,281). Semptomların şiddeti ile N/L arasında istatistiksel olarak anlamlı korelasyon görülmedi (r:0.68, p= 0,413).

Sonuç: Bu çalışmada, HBS patofizyolojisinde enflamasyonun rolü N/L oranı ile birlikte değerlendirilmiş ve hasta grubunda enflamasyon lehine istatistiksel olarak anlamlı bir ilişki gözlenmemiştir.

Anahtar Kelimeler

• Enflamasyon,Huzursuz bacaklar sendromu,Nötrofil/lenfosit oranı

Investigation of inflammation with neutrophil/lymphocyte ratio in restless legs syndrome

Abstract

Aim: Restless Legs Syndrome (RLS) is a chronic, progressive, sensorimotor disorder characterized by the urge to move legs and abnormal sensations in the limbs. The pathophysiology of RLS is not clear. In recent years, many studies have used different serum biomarkers to discuss pathophysiology or to follow up the diagnosis and treatment. There are not enough studies that entirely investigating the relationship between RLS and serum neutrophil/lymphocytes (N/L). Therefore, in this study it was aimed to examine the relationship between idiopathic RLS and serum N/L.

Methods: A case control study was planned. After sample size analysis, 93 patients with diagnosed RLS (study group) and age- and gender matching 50 healthy volunteers (control group) were included in the study. N/L ratio were compared between two groups.

Results: The median of N/L ratio was 2.58 in the RLS group and 2.72 in the control group. There was no statistically significant difference between the groups (p=0.891). The mean duration of disease was 3.2±1.37 years in patients’ group. Sleep disorders were found in 81.7% (n=76) of the patients, and similar complaints were observed on the upper extremities in 34.4% (n=32) of the patients. Severity scale of disease was determined according to the International Restless Legs Syndrome Study Group (IRLSSG). It was observed to be low severity of the symptom in 6.3%, middle severity of the symptom in 15.2%, severe severity of the symptom in 64.8%, high severity of the symptom in 13.7% of the patients. There was no correlation neither between duration of disease and N/L ratio (r:-0.117, p=0.281) nor between severity of the symptoms and N/L (r:0.68, p=0.413). 

Conclusion: In this study, it was investigated the role of inflammation in the pathophysiology of RLS was evaluated with N/L ratio and it was not observed statistically significance on behalf of patients group.

Keywords

• Inflammation,Restless legs syndrome,Neutrophil/lymphocyte ratio

Kaynakça

1. 1. Wijemanne S, Jankovic J. Restless legs syndrome: clinical presentation diagnosis and treatment. J Sleep Medicine. 2015;16:678-90.
2. 2. Rye DB and Trotti LM. Restless legs syndrome and periodic leg movements of sleep. Neurologic Clinics. 2012;30(4):1137-66.
3. 3. Kompoliti K, Verhagen L. Encyclopedia of movement disorders: Academic Press; 2010.
4. 4. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance. J Sleep Medicine. 2014;15(8):860-73.
5. 5. Ceylan M, Aygül R, Yalçın A. Erzurum İli Huzursuz Bacak Sendromu Prevelansının Araştırılması ve Sosyodemografik Özelliklerin İncelenmesi. Journal of Contemporary Medicine. 2019;9(1):1.
6. 6. Dimitriadou E, Giannaki CD, Tsekoura M, Stefanidis I, Hadjigeorgiou GM, Lavdas E, et al. Restless legs syndrome/Willis-Ekbom disease prevalence in beta thalassemia patients. Sleep Breath. 2018 Mar;22(1):175-9. doi: 10.1007/s11325-017-1497-2.
7. 7. Dimitriadou E, Giannaki CD, Tsekoura M, Stefanidis I, Hadjigeorgiou GM, Lavdas E, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. J Sleep Medicine. 2003;4(2):101-19.
8. 8. Ondo W, Jankovic J. Restless legs syndrome: clinicoetiologic correlates. J Neurology. 1996;47(6):1435-41.

9. 9. Allen RP. Restless leg syndrome/Willis-Ekbom disease pathophysiology. J Sleep Medicine Clinics. 2015;10(3):207-14.
10. 10. Connor JR, Patton SM, Oexle K, Allen RP. Iron and restless legs syndrome: treatment, genetics and pathophysiology. J Sleep Medicine. 2017;3:61-70.
11. 11. Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. Journal of Clinical Sleep Medicine. 2015;11(03):259-70.
12. 12. Lin SW, Chen YL, Kao KC, Yang CT, Chuang LP, Chou YT, et al. Diseases in patients coming to a sleep center with symptoms related to restless legs syndrome. J PloS one. 2013;8(8): p.e71499.
13. 13. Shiohira S, Yoshida T, Sugiura H, Yoshida S, Mitobe M, Shimada K, et al. Effect of the antiplatelet agent cilostazol on endovascular inflammatory biochemical parameters and the clinical symptoms of peripheral artery disease and restless legs syndrome in hemodialysis patients. J Clinical Experimental Nephrology. 2011;15(6):893-9.
14. 14. Patton S, Ponnuru P, Snyder A, Podskalny G, Connor J. Hypoxia inducible factor pathway activation in restless legs syndrome patients. European Journal of Neurology. 2011; 18(11):1329-35.
15. 15. Bagheri R, Abedi P, Mousavi P, Azimi N. The prevalence of restless legs syndrome and its relationship with demographic characteristics and medical disorders in postmenopausal Iranian women. Health Care Women Int. 2018 Feb 8:1-9.
16. 16. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. J Bratislavske Lekarske Listy. 2001;102(1):5-14.
17. 17. de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Critical Care. 2010;14(5):R192.
18. 18. Ear T and McDonald PP. Cytokine generation, promoter activation, and oxidant-independent NF-κB activation in a transfectable human neutrophilic cellular model. J BMC Immunology. 2008;9(1):14.
19. 19. Robertson CM and Coopersmith CM. The systemic inflammatory response syndrome. J Microbes Infection and Immunity. 2006;8(5):1382-89.
20. 20. Gomez D, Farid S, Malik H, Young A, Toogood G, Lodge J, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. J World Journal of Surgery. 2008;32(8):1757-62.
21. 21. Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short-and long-term mortality in breast cancer patients. J Annals of Surgical Oncology. 2012;19(1):217-24.
22. 22. Tak A, Zeynal A, Şengül Y. Evaluation of Inflammation with Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio in Restless Legs Syndrome. Turkish journal of Neurology. 2018;24(3).
23. 23. Hening W, Walters AS, Allen RP, Montplaisir J, Myers A, Ferini-Strambi L. Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study. J Sleep Medicine. 2004;5(3):237-46.
24. 24. Bayazıt ZZ. Türkçe sözlü dilde emosyonel prozodi ve sözel bileşenlerin incelenmesine yönelik nörodilbilimsel bir inceleme. J Journal of Social Humanities Sciences Research. 2018;5(25):2081-97.
25. 25. Rye DB. Parkinson's disease and RLS: the dopaminergic bridge. Sleep Medicine. 2004;5(3):317-28.
26. 26. Weinstock LB, Walters AS, Mullin GE, Duntley SP. Celiac disease is associated with restless legs syndrome. Digestive Diseases and Sciences. 2010;55(6):1667-73.
27. 27. Happe S, Kundmüller L, Reichelt D, Husstedt I-W, Evers S. Comorbidity of restless legs syndrome and HIV infection. Journal of neurology. 2007;254(10):1401.
28. 28. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017; 8(34):57489.
29. 29. Bisgaard A, Pihl-Jensen G, Frederiksen J. The neutrophil-to-lymphocyte ratio as disease actvity marker in multiple sclerosis and optic neuritis. Multiple sclerosis and related disorders. 2017;18:213-17.
30. 30. Varım C, Acar BA, Uyanık MS, Acar T, Alagoz N, Nalbant A, et al. Association between the neutrophil-to-lymphocyte ratio, a new marker of systemic inflammation, and restless legs syndrome. Singapore Medical Journal. 2016;57(9):514.
31. 31. Allen RP. Controversies and challenges in defining the etiology and pathophysiology of restless legs syndrome. The American Journal of Medicine. 2007;120(1):S13-S21.