EFFECT OF DIABETES AND SYSTEMIC INFLAMMATION PARAMETERS ON THE PROGNOSIS OF BELL’S PALSY

Öz

Objective: This study aimed to evaluate the prognostic importance of diabetes mellitus, hematologic and biochemical test findings including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation response index and triglyceride-glucose index in patients with Bell’s palsy and to compare these results with healthy subjects.

Material and Methods: The study included 75 patients with incomplete Bell’s palsy.

and 24 healthy subjects as the control group. Patients were divided into two groups as diabetes mellitus and non- diabetes mellitus patients. Complete blood count, biochemical tests including glucose, liver and renal function tests and blood lipid profile were analyzed from all the subjects and neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation response index and triglyceride-glucose index values were calculated from these results.

Results: Neutrophil-to-lymphocyte ratio and systemic inflammation response index values were higher in patients with Bell’s palsy when compared with the control group. Triglyceride-glucose index was positively correlated with recovery time in all patients and the diabetes mellitus group. It was also positively correlated with prognosis in non- diabetes mellitus patients. High neutrophil-to-lymphocyte ratio was predictive for delayed recovery time only in non- diabetes mellitus patients.

Conclusion: Our results indicated that diabetes mellitus didn’t influence severity, recovery time and prognosis of Bell’s palsy. High triglyceride levels and triglyceride-glucose index values were associated with long recovery time in patients with Bell’s palsy. For both diabetes mellitus and non- diabetes mellitus patients, House-Brackmann facial nerve grading scale-initial was the best parameter to predict the prognosis. Neutrophil-to-lymphocyte ratio and systemic inflammation response index values were significantly higher in patients with Bell’s palsy.

Anahtar Kelimeler

• Bell's palsy
• Diabetes Mellitus
• inflammation
• prognosis

Diyabet ve Sistemik Enflamasyon Parametrelerinin Bell Palsisinin Prognozuna Etkisi

Öz

Amaç: Bell palsili hastalarda, diyabetin prognostik önemini, nötrofil-lenfosit oranı, trombosit-lenfosit oranı, sistemik inflamasyon yanıt indeksi dahil hematolojik ve biyokimyasal test bulgularını değerlendirmek, ayrıca Bell palsili hastalarda trigliserid-glikoz indeksini değerlendirmek ve bu sonuçları sağlıklı deneklerle karşılaştırmaktır.

Gereç ve Yöntemler: Çalışmaya, Bell palsisi komplet olmayan 75 hasta ve kontrol grubu olarak 24 sağlıklı birey dahil edildi. Hastalar diyabet olan ve diyabet olmayan olarak iki gruba ayrıldı. Tüm deneklerden tam kan sayımı, glikoz, karaciğer ve böbrek fonksiyon testleri gibi biyokimyasal testler ve kan lipid profili analiz edildi ve bu sonuçlardan nötrofil-lenfosit oranı, trombosit-lenfosit oranı, sistemik inflamasyon yanıt indeksi ve trigliserid-glikoz indeksi değerleri hesaplandı.

Bulgular: Nötrofil-lenfosit oranı ve sistemik inflamasyon yanıt indeksi değerleri Bell palsili hastalarda kontrol grubuna göre daha yüksekti. Trigliserid-glikoz indeksi, tüm hastalarda ve diyabet grubunda iyileşme süresi ile pozitif korelasyon gösterdi. Trigliserid-glikoz indeksi ayrıca diyabet olmayan hastalarda prognoz ile pozitif korelasyon gösterdi. Yüksek nötrofil-lenfosit oranı, sadece diyabet olmayan hastalarda gecikmiş iyileşme süresi için öngörücüydü.

Sonuç: Sonuçlarımız, diyabetin Bell palsinin şiddetini, iyileşme süresini ve prognozunu etkilemediğini gösterdi. Nötrofil-lenfosit oranı ve sistemik inflamasyon yanıt indeksi değerleri Bell palsili hastalarda anlamlı olarak yüksekti. Yüksek trigliserid seviyeleri ve trigliserid-glikoz indeksi değerleri Bell palsili hastalarda uzun iyileşme süresi ile ilişkilendirildi. Hem diyabet hem de diyabet olmayan hastalar için, the House-Brackmann facial nerve grading scale-initial prognozu tahmin etmek için en iyi parametreydi.

Anahtar Kelimeler

• Bell palsisi
• Diyabet
• inflamasyon
• prognoz

Kaynakça

1. 1. Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013;149(3 Suppl):S1-27.
2. 2. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002;(549):4-30.
3. 3. Eviston TJ, Croxson GR, Kennedy PG, Hadlock T, Krishnan AV. Bell's palsy: aetiology, clinical features and multidisciplinary care. J Neurol Neurosurg Psychiatry. 2015;86(12):1356-61.
4. 4. Greco A, Gallo A, Fusconi M, Marinelli C, Macri GF, de Vincentiis M. Bell's palsy and autoimmunity. Autoimmun Rev. 2012;12(2):323-8.
5. 5. Riga M, Kefalidis G, Danielides V. The role of diabetes mellitus in the clinical presentation and prognosis of Bell palsy. J Am Board Fam Med. 2012;25(6):819-26.
6. 6. Liou LS, Chang CY, Chen HJ, Tseng CH, Chen CY, Sung FC. Increased risk of peripheral arterial occlusive disease in patients with Bell's palsy using population data. PLoS One. 2017;12(12):e0188982.
7. 7. Zhang W, Xu L, Luo T, Wu F, Zhao B, Li X. The etiology of Bell's palsy: a review. J Neurol. 2020;267(7):1896-905.
8. 8. Chweya CM, Anzalone CL, Driscoll CLW, Lane JI, Carlson ML. For whom the Bell's toll: Recurrent facial nerve paralysis, a retrospective study and systematic review of the literature. Otol Neurotol. 2019;40(4):517-28.

9. 9. Pitsavos C, Tampourlou M, Panagiotakos DB, et al. Association between low-grade systemic inflammation and type 2 diabetes mellitus among men and women from the ATTICA Study. Rev Diabet Stud. 2007;4(2):98-104.
10. 10. Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S et al. The Role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol. 2019;14(1):50-59.
11. 11. Schmidt MI, Duncan BB, Sharrett AR, Lindberg G, Savage PJ, Offenbacher S et al. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet. 1999;353(9165):1649-52.
12. 12. Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest. 2006;116(7):1793-801.
13. 13. Şevik ES, Erdem D. Does type 2 diabetes mellitus affect the healing of bell's palsy in adults? Can J Diabetes. 2018;42(4):433-6.
14. 14. Cai Z, Li H, Wang X, Niu X, Ni P, Zhang W et al. Prognostic factors of Bell's palsy and Ramsay Hunt syndrome. Medicine (Baltimore). 2017;96(2):e5898.
15. 15. Lee HY, Byun JY, Park MS, Yeo SG. Effect of aging on the prognosis of Bell's palsy. Otol Neurotol. 2013;34(4):766-70.
16. 16. Fujiwara T, Hato N, Gyo K, Yanagihara N. Prognostic factors of Bell's palsy: prospective patient collected observational study. Eur Arch Otorhinolaryngol. 2014;271(7):1891-5.
17. 17. Kanazawa A, Haginomori S, Takamaki A, Nonaka R, Araki M, Takenaka H. Prognosis for Bell's palsy: a comparison of diabetic and nondiabetic patients. Acta Otolaryngol. 2007;127(8):888-91.
18. 18. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández-González SO et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347-51.
19. 19. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299-304.
20. 20. Simental-Mendía LE, Hernández-Ronquillo G, Gómez-Díaz R, Rodríguez-Morán M, Guerrero-Romero F. The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents. Pediatr Res. 2017;82(6):920-5.
21. 21. Unger G, Benozzi SF, Perruzza F, Pennacchiotti GL. Triglycerides and glucose index: a useful indicator of insulin resistance. Endocrinol Nutr. 2014;61(10):533-40.
22. 22. Horibe Y, Tanigawa T, Shibata R, Nonoyama H, Kano F, Yamaguchi S et al. Efficacy of the red blood cell distribution width for predicting the prognosis of Bell palsy: a pilot study. Eur Arch Otorhinolaryngol. 2017;274(5):2303-6.
23. 23. Kim HS, Jung J, Dong SH, Kim SH, Jung SY, Yeo SG. Association between high neutrophil to lymphocyte ratio and delayed recovery from Bell's Palsy. Clin Exp Otorhinolaryngol. 2019;12(3):261-6.
24. 24. Oya R, Takenaka Y, Imai T, Sato T, Oshima K, Ohta Y et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognostic hematologic markers of Bell's palsy: A Meta-analysis. Otol Neurotol. 2019;40(5):681-7.
25. 25. Bucak A, Ulu S, Oruc S, Yucedag F, Tekin MS, Karakaya F et al. Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy. Laryngoscope. 2014;124(7):1678-81.
26. 26. Wasano K, Kawasaki T, Yamamoto S, Tomisato S, Shinden S, Ishikawa T et al. Pretreatment hematologic findings as novel predictive markers for facial Palsy prognosis. Otolaryngol Head Neck Surg. 2016;155(4):581-7.
27. 27. Eryilmaz A, Basal Y, Tosun A, Kurt Omurlu I, Basak S. The neutrophil to lymphocyte ratios of our pediatric patients with Bell's palsy. Int J Pediatr Otorhinolaryngol. 2015;79(12):2374-7.
28. 28. Geng Y, Zhu D, Wu C, Wu J, Wang Q, Li R et al. A novel systemic inflammation response index (SIRI) for predicting postoperative survival of patients with esophageal squamous cell carcinoma. Int Immunopharmacol. 2018;65:503-10.
29. 29. Wasano K, Ishikawa T, Kawasaki T, Yamamoto S, Tomisato S, Shinden S et al. Novel pre-therapeutic scoring system using patient and haematological data to predict facial palsy prognosis. Clin Otolaryngol. 2017;42(6):1224-8.
30. 30. Engström M, Jonsson L, Grindlund M, Stålberg E. House-Brackmann and Yanagihara grading scores in relation to electroneurographic results in the time course of Bell's palsy. Acta Otolaryngol. 1998;118(6):783-9.
31. 31. Devriese PP, Schumacher T, Scheide A, de Jongh RH, Houtkooper JM. Incidence, prognosis and recovery of Bell's palsy. A survey of about 1000 patients (1974-1983). Clin Otolaryngol Allied Sci. 1990;15(1):15-27.
32. 32. Jung SY, Jung J, Byun JY, Park MS, Kim SH, Yeo SG. The effect of metabolic syndrome on Bell's palsy recovery rate. Acta Otolaryngol. 2018;138(7):670-4.
33. 33. Liu W, Fan Z, Han Y, Xu L, Wang M, Zhang D et al. Activation of NF-κB signaling pathway in HSV-1-induced mouse facial palsy: Possible relation to therapeutic effect of glucocorticoids. Neuroscience. 2015;289:251-61.
34. 34. Qi Q, Zhuang L, Shen Y, Geng Y, Yu S, Chen H et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer. 2016;122(14):2158-67.