Obstruktif uyku apne sendromu cerrahisinden sonra nötrofil/lenfosit oranı, ortalama tombosit hacmi ve trombosit/ lenfosit oranlarının preoperatif ve postoperatif erken ve geç dönemdeki değişimi

Yıl 2018, Cilt: 2 Sayı: 2, 123 - 126, 01.05.2018

Hanife Kabukcu , Ülkü İnce Ela Kaplan

https://doi.org/10.28982/josam.404976

Öz

Amaç: Bu çalışmada Obstrüktif uyku apne sendromu (OUAS) şiddeti ile Nötrofil Lenfosit oranı (NLO), Trombosit Lenfosit oranı (TLO) ve Ortalama Trombosit Hacmi (OTH) arasındaki ilişki ve bu hastaların preoperatif ve postoperatif erken ve geç dönemdeki düzeyleri, cerrahiye bağlı değişimleri araştırıldı. 

Yöntemler: OUAS tanısı konmuş ve tedavi amacıyla cerrahi operasyon yapılmış toplam 148 hasta ( 22 kadın %14.9 ve 126 erkek %85.1 ) çalışmaya alındı. Hastalar apne hipoapne indeksine (AHİ) göre hafif-orta OUAS’lı hastalar ( 86 (%58.1 ) ), (AHİ:5-15 Hafif OUAS, AHİ:15-30 Orta OUAS ) ve Ağır OUAS’lı ( 62 (%41.9) ) hastalar olarak iki gruba ayrıldı. Retrospektif olarak hastaların kan sonuçları tarandı ve preoperatif, postopertif erken ve geç dönem tam kan sonuçları incelendi. 

Bulgular: Kilo ve BMI değerleri Ağır OUAS grubunda yüksek saptandı. Hafif-Orta OUAS ile Ağır OUAS grupları, NLO, TLO ve OTH değerleri preoperatif, erken ve geç postoperatif dönemler, gruplar arası karşılaştırıldığında anlamlı fark bulunmadı. Grup içi karşılaştırmada ise her iki grupta da NLO’da ve TLO’da postoperatif erken dönemde artış saptandı. OTH değerler arasında fark bulunmadı. Postoperatif geç dönemde NLO düzeyleri preoperatif değerlere düşerken, TLO düzeyleri preoperatif değerlere göre yükseklik devam etmekte idi.

Sonuç: Sistemik inflamasyonun belirteci olarak kullanılan NLO, TLO ve OTH değerlerinin Hafif-Orta ve Ağır OUAS grupları arasında benzer olması ve hava yolu tıkanıklığının giderilmesine rağmen değişmeyişi bu hastalıktaki oksidatif stres ve sistemik inflamasyonun hava yolu tıkanıklığının yanı sıra çok çeşitli faktörlere bağlı olduğunu düşündürmektedir.

Anahtar Kelimeler

Obstruktif uyku apne sendromu, Nötrofil lenfosit oranı, Trombosit lenfosit oranı, Ortalama trombosit hacmi

After obstructive sleep apnea syndrome surgery, preoperative, postoperative early and late change of neutrophil / lymphocyte ratio, platelet / lymphocyte ratio and mean platelet volume

Öz

Aim: The aim of this study was to investigate the relationship between the severity of obstructive sleep apnea syndrome (OSAS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and mean platelet volume (MPV), preoperative and postoperative early and late levels of these patients surgery related changes were investigated. Methods: A total of 148 patients (22 women, 14.9% and 126 men, 85.1%) who underwent OSA diagnosis and surgical treatment were included in the study. Patients with mild to moderate OSAS [86 (58.1%)], and severe OSAS [62 (41.9%)] patients with apnea hypoapnea index. (OSAS: 5-15 mild OSAS, AHI: 15-30, severe OSAS AHİ 30>) Patients were divided into two groups. Retrospectively, the blood results of these patients were investigated and preoperative, postoperative early and late full blood results were examined. Results: Weight and BMI values were found to be high in the heavy OSAS group. There was no significant difference between mild-moderate OSAS and severe OSAS groups, preoperative, early and late postoperative periods, and between NLR, PLR and MPV values. Intra-group comparison showed an increase in NLR and PLR in the early postoperative period in both groups. There was no difference between the other values. In late postoperative period, NLR levels decreased to preoperative values while PLR levels were higher than preoperative values. Conclusion: The similarity of NLR, PLR, and MPV values between the mild-moderate and severe OSAS groups as a marker of systemic inflammation and the fact that airway obstruction was remained unchanged suggests that oxidative stress and systemic inflammation in this disease are due to a variety of factors besides airway obstruction.

Anahtar Kelimeler

Obstructive sleep apnea syndrome, Neutrophil lymphocyte ratio, Platelet lymphocyte ratio, Mean platelet volume

Kaynakça

• 1. Young T, Patla M, Dempsey J, Skatrud J, Weber S, Badr S. The occurence of sleep disordered breathing among middle aged adults. N England J Med. 1993;328:1230-5.
• 2. Yamauchi M, Kimura H. Oxidative stress in obstructive sleep apnea: putative pathways to the cardiovascular complication. Antioxid Redox Signal. 2008;10:735e68.
• 3. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med. 2002;165:859–60.
• 4. Larkin EK, Rosen CL, Kirchner H, Storfer-Isser A, Emancipator JL, Johnson NL, et al. Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation. 2005;111:1978–84.
• 5. Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation. 2005;112:2660-7.
• 6. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratioand outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102:653–7.
• 7. Okyay GU, Inal S, Oneç K, Er RE, Paşaoğlu O, Paşaoğlu H, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail. 2013;35:29–36.
• 8. Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fi brillation after coronary artery bypass grafting. Am J Cardiol. 2010;105:186–91.
• 9. Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. 2014;36:217–21.
• 10. Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis. 1996;7:157-61.
• 11. Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;107:695-9.
• 12. Wang D, Yang JX, Cao DY, Wan XR, Feng FZ, Huang HF, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211-6.
• 13. Sharp DS, Benowitz NL, Bath PM, Martin JF, Beswick AD, Elwood PC. Cigarette smoking sensitizes and desensitizes impedance-measured ADP-induced platelet aggregation in whole blood. Thromb Haemost. 1995;74:730-5.
• 14. Tschoepe D, Roesen P, Esser J, Schwippert B, Nieuwenhuis HK, Kehrel B, et al. Large platelets circulate in an activated state in diabetes mellitus. Semin Thromb Hemost. 1991;17:433-8.
• 15. Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects. Singapore Med J. 2008;49:114-6.
• 16. Martin JF, Bath PM, Burr ML. Influence of platelet size on outcome after myocardial infarction. Lancet. 1991;338:1409-11.
• 17. Crawford VL, McNerlan SE, Stout RW. Seasonal changes in platelets, fibrinogen and factor VII in elderly people. Age Ageing. 2003;32:661-5.
• 18. Cameron HA, Phillips R, Ibbotson RM, Carson PH. Platelet size in myocardial infarction. Br Med J.1983;287:449-51.
• 19. Kario K, Matsuo T, Nakao K. Cigarette smoking increases the mean platelet volume in elderly patients with risk factors for atherosclerosis. Clin Lab Haematol. 1992;14:281-7.
• 20. Bath PM, Missouris CG, Buckenham T, MacGregor GA. Increased platelet volume and platelet mass in patients with atherosclerotic renal artery stenosis. Clin Sci (Lond). 1994;87:253-7.
• 21. Totani L, Evangelista V. Platelet-leukocyte interactions in cardiovascular disease and beyond. Arterioscler Thromb Vasc Biol. 2010;30:2357-61.
• 22. Sunbul M, Sunbul EA, Kanar B, Yanartas O, Aydin S, Bacak A, et al. The association of neutrophil to lymphocyte ratio with presence and severity of obstructive sleep apnea. Bratisl Lek Listy. 2015;116:654-8.
• 23. Uygur F, Tanriverdi H, Aktop Z, Erboy F, Altinsoy B, Damar M,et al. The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease. Heart Lung. 2016;45:121-5.
• 24. Song YJ, Kwon JH, Kim JY, Kim BY, Cho KI. The platelet-to-lymphocyte ratio reflects the severity of obstructive sleep apnea syndrome and concurrent hypertension. Clin Hypertens. 2016;4;22:1.
• 25. Varol E, Ozturk O, Gonca T, Has M, Ozaydin M, Erdogan D,et al. Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest. 2010;70:497-02.
• 26. Nena E, Papanas N, Steiropoulos P, Zikidou P, Zarogoulidis P, Pita E,et al. Mean Platelet Volume and Platelet Distribution Width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity? Platelets. 2012;23:447-54.
• 27. Kurt OK, Yildiz N. The importance of laboratory parameters in patients with obstructive sleep apnea syndrome. Blood Coagul Fibrinolysis. 2013;24:371-4.
• 28. Simsek G, Haytoglu S, Muluk NB, Arikan OK, Cortuk M, Kiraz K. Mean Platelet Volume Decreases in Adult Patients With Obstructive Sleep Apnea After Uvulopalatal Flap Surgery. J Craniofac Surg. 2015;26:2152-4.