Nötrofil Lenfosit Oranı ve Monosit Lenfosit Oranı Çocukluk Çağı Tuberkülozu Tanısında Kullanılabilir mi?

Öz

Amaç: Nötrofil-lenfosit oranı (NLO) ve monosit-lenfosit oranı (MLO) birçok hastalıkta bakteriyemi, hastalık aktivitesi, nüks oranı, sürveyans ve prognozu değerlendirmek için kullanılan yararlı inflamasyon biyobelirteçleridir. Bu çalışmada, enflamasyon belirteçleri olarak kullanılıp kullanılamayacaklarını göstermek için tüberkülozlu 92 çocuğun NLO ve MLO'sunu 45 sağlıklı çocukla karşılaştırarak değerlendirdik. Çalışmamızın amacı, çocukluk çağı TB tanısında NLO ve MLO'nun tanısal değerini göstermektir.

Materyal ve Metot: Bu retrospektif çalışmada, 92 tüberkülozlu çocuğun hastane kayıtları gözden geçirildi. Hastaların NLO ve MLO değerleri 45 sağlıklı çocuktan oluşan kontrol grubu ile karşılaştırıldı.

Bulgular: NLO ve MLO değerleri arasında tüberküloz hastaları ve kontrol grupları arasında anlamlı fark bulundu (p <0.001). Tüberküloz hastalarını kontrollerden ayırmak için NLO> 1.41 kesme değeri optimaldi (duyarlılık %75, özgüllük %82,2, pozitif öngörü değeri %89,6, negatif öngörü değeri %61,7). MLO> 0.22 kesme değeri, tüberküloz hastalarını kontrollerden ayırmak için optimaldi (duyarlılık %50, özgüllük %91,1, pozitif öngörü değeri %93,3, negatif öngörü değeri %53,2).

Sonuç: NLO ve MLO’nun her ikisi de çocukluk çağı tüberkülozunda inflamasyon belirteci olarak kullanılabilir. Daha net bir karar vermek için ileriye dönük ve daha kapsamlı çalışmalara ihtiyaç vardır.  

Anahtar Kelimeler

• İnflamasyon
• lenfosit
• nötrofil
• tüberküloz

Can Neutrophil to Lymphocyte Ratio and Monocyte to Lymphocyte Ratio Be Used in the Diagnosis of Childhood Tuberculosis?

Öz

Objective: Neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) are useful biomarkers of inflammation used to evaluate bacteremia, disease activity, recurrence rate, surveillance and prognosis in many diseases. In this study, we evaluated NLR and MLR of 92 children with tuberculosis versus 45 healthy children to show whether they can be used as inflammation markers. Aim of this study was to evaluate the diagnostic valure of NLR and MLR in childhood tuberculosis.

Materials and Methods: In this retrospective study, hospital records of 92 children with tuberculosis were reviewed. The NLR and MLR values of the patients were compared with the control group of 45 healthy children.

Results: A significant difference was found between NLO and MLO values between tuberculosis and control groups (p <0.001). A cut off value of NLR>1.41was optimal for discriminating patients with tuberculosis from controls (sensitivity 75%, specifity 82.2%, positive predictive value 89.6%, negative predictive value 61.7%). A cut off value of MLR>0.22 was optimal for discriminating patients with tuberculosis from controls (sensitivity 50%, specifity 91.1%, positive predictive value 93.3%, negative predictive value 53.2%).

Conclusions: NLR and MLR can both be used as inflammation biomarkers in the diagnosis of childhood tuberculosis. Prospective and more comprehensive studies are needed to make a clearer decision. 

Anahtar Kelimeler

• Inflammation
• lymphocyte
• neutrophil
• tuberculosis

Kaynakça

1. World Health Organization. Global Tuberculosis Report 2018. https://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf?sequence=1&isAllowed=y. Accessed 12 November 2018.
2. Burki T. Neglecting childhood tuberculosis "a human rights violation". Lancet Infect Dis. 2018;18(7):723. doi:10.1016/S1473-3099(18)30365-7
3. Demir F, Karadeniz C, Özdemir R, et al. Usefulness of Neutrophil to Lymphocyte Ratio in Prediction of Coronary Artery Lesions in Patients with Kawasaki Disease. Balkan Med J. 2015;32(4):371-376. doi:10.5152/balkanmedj.2015.151108
4. Uygur F, Tanriverdi H, Aktop Z, et al. The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease. Heart Lung. 2016;45(2):121-125. doi:10.1016/j.hrtlng.2016.01.002
5. Kucuk A, Erol MF, Senel S, et al. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis. Korean J Intern Med. 2016;31(2):386-391. doi:10.3904/kjim.2015.039
6. Gokcen K, Dundar G, Gulbahar H, Gokce G, Gultekin EY. Can routine peripheral blood counts like neutrophil-to-lymphocyte ratio be beneficial in prediagnosis of testicular cancer and its stages? J Res Med Sci. 2018;23:64. doi:10.4103/jrms.JRMS_1009_16
7. Bozdemir ŞE, Altıntop YA, Uytun S, Aslaner H, Torun YA. Diagnostic role of mean platelet volume and neutrophil to lymphocyte ratio in childhood brucellosis. Korean J Intern Med. 2017;32(6):1075-1081. doi:10.3904/kjim.2016.092
8. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med. 2013;33(2):105-110. doi:10.3343/alm.2013.33.2.105

9. Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med. 2014;9(4):232-235. doi:10.4103/1817-1737.140135
10. Wyllie DH, Bowler IC, Peto TE. Relation between lymphopenia and bacteraemia in UK adults with medical emergencies. J Clin Pathol. 2004;57(9):950-955. doi:10.1136/jcp.2004.017335
11. Naranbhai V, Hill AV, Abdool Karim SS, et al. Ratio of monocytes to lymphocytes in peripheral blood identifies adults at risk of incident tuberculosis among HIV-infected adults initiating antiretroviral therapy. J Infect Dis. 2014;209(4):500-509. doi:10.1093/infdis/jit494
12. Beneri CA, Aaron L, Kim S, et al. Understanding NIH clinical case definitions for pediatric intrathoracic TB by applying them to a clinical trial. Int J Tuberc Lung Dis. 2016;20(1):93-100. doi:10.5588/ijtld.14.0848
13. Jilma B, Blann A, Pernerstorfer T, et al. Regulation of adhesion molecules during human endotoxemia. No acute effects of aspirin. Am J Respir Crit Care Med. 1999;159(3):857-863.
14. Kiran B, Cagatay T, Clark P, et al. Can immune parameters be used as predictors to distinguish between pulmonary multidrug-resistant and drug-sensitive tuberculosis? Arch Med Sci. 2010;6(1):77-82. doi:10.5114/aoms.2010.13511
15. Abakay O, Abakay A, Sen HS, Tanrikulu AC. The relationship between inflammatory marker levels and pulmonary tuberculosis severity. Inflammation. 2015;38(2):691-696. doi:10.1007/s10753-014-9978-y
16. Leem AY, Song JH, Lee EH, et al. Changes in cytokine responses to TB antigens ESAT-6, CFP-10 and TB 7.7 and inflammatory markers in peripheral blood during therapy. Sci Rep. 2018;8(1):1159. doi:10.1038/s41598-018-19523-7
17. Wang J, Yin Y, Wang X, et al. Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis. Braz J Infect Dis. 2015;19(2):125-131. doi:10.1016/j.bjid.2014.10.008
18. Rakotosamimanana N, Richard V, Raharimanga V, et al. Biomarkers for risk of developing active tuberculosis in contacts of TB patients: a prospective cohort study. Eur Respir J. 2015;46(4):1095-1103. doi:10.1183/13993003.00263-2015
19. Choudhary RK, Wall KM, Njuguna I, et al. Monocyte-to-Lymphocyte Ratio Is Associated With Tuberculosis Disease and Declines With Anti-TB Treatment in HIV-Infected Children. J Acquir Immune Defic Syndr. 2019;80(2):174-181. doi:10.1097/QAI.0000000000001893
20. Jain R, Mukherjee A, Singla M, et al. Predictors of Microbiologically Confirmed Intrathoracic Tuberculosis. Indian J Pediatr. 2017;84(11):843-847. doi:10.1007/s12098-017-2467-1