Orta şiddette ve şiddetli psoriasis hastalarında ustekinumab tedavisi sonrası inflamatuar belirteçlerde azalma

Yıl 2021, Cilt: 14 Sayı: 2, 452 - 459, 01.04.2021

Banu Taşkın Bachar Memet Eren Vurgun Sibel Alper

https://doi.org/10.31362/patd.748871

Öz

Giriş: Psoriazis kronik, inflamatuar ve sistemik bir hastalıktır. Psoriaziste hastalık şiddetini ölçmek için Psoriazis Alan Şiddet İndeksi (PAŞİ) yanı sıra daha objektif laboratuar araçlarına ihtiyaç vardır. Nötrofil lenfosit oranı (NLO), trombosit lenfosit oranı (TLO), ve oratalama trombosit hacmi (OTH) çeşitli inflamatuar hastalıklarda arttığı bilinen belirteçlerdir. Bu çalışmada amacımız orta şiddette ve şiddetli psoriasis vulgarisi olan hastalarda NLO, TLO ve OTH değerlerinin ustekinumab tedavisi ile değişimlerini araştırmaktır.
Gereç ve yöntem: Çalışmada orta şiddette veya şiddetli psoriazis vulgarisi olup, ustekinumab tedavisi verilen kronik plak tipi psoriasis tanılı 25 hasta retrospektif olarak değerlendirilmiştir. Hastaların tedavi öncesi PASI, tam kan sayımı parametreleri, serum CRP seviyeleri ve PAŞİ 75 ve/veya üzeri başarı elde edildikleri kontrollerindeki değerleri kaydedilmiştir. Tam kan sayımı belirteçleri, OTH ve CRP değeri determine edilmiştir. Ek inflamatuar hastalığı ve eşlik eden enfeksiyonu olanlar çalışma dışı bırakılmıştır.
Bulgular: Hastaların PASI 75 başarı ve üzeri elde ettikleri incelemelerde NLO, TLO oranlarında istatistiksel olarak anlamlı düşme (p<0.05) saptanırken OTH ve CRP değerlerinde tedavi başarısı sonrası anlamlı değişiklik izlenmemiştir.
Tartışma: NLO ve TLO değerlerinde tedavi yanıtı alınmasıyla anlamlı düşme olduğu gösterdik. Bu göstergeler rutin pratikte kolay ölçülebilen ve maliyet açısından verimli belirteçlerdir.

Anahtar Kelimeler

Psoriazis, tedavi, nötrofil lenfosit oranı

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Decrease in inflammation markers with ustekinumab treatment in moderate-severe psoriasis

Öz

Purpose: Psoriasis is a chronic, inflammatory, and systemic disease. The disease activity is usually measured by Psoriasis Area and Severity Index (PASI), however, further objective laboratory tools are needed. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and mean platelet volume (MPV) are objectively calculated markers that increase in inflammation. This study aimed to investigate the utility of these markers for follow-up of systemic inflammation and response to treatment.
Material and methods: A total of 25 patients who had moderate or severe psoriasis vulgaris, who received ustekinumab treatment were retrospectively evaluated in the study. In patients, pre-treatment PASI, complete blood count parameters, serum CRP levels and NLR, PLR and MPV values in the follow up when they achieved PASI 75 and/or more improvement were recorded. Patients with an additional inflammatory disease or accompanying infection were excluded from the study.
Results: While a statistically significant decline was recorded in NLR and PLR (p<0.05), no significant change was observed in MPV and CRP after the therapy success where patients achieved an improvement greater than or equal to PASI 75.
Conclusion: We conclude that the correlation with the response to treatment and NLR and PLR levels show that these markers may be beneficial for assessment of disease severity either in combination with current scores or alone. These markers are cost effective predictors that can easily be measured in routine practice.

Anahtar Kelimeler

Psoriasis, Treatment, Neutrophyl lymphocyte ratio

Proje Numarası

yok

Kaynakça

• 1. Boehncke WH, Schön MP. Psoriasis. Lancet 2015;386:983-994. https://doi.org/10.1016/S0140-6736(14)61909-7
• 2. Wiśniewski A, Matusiak Ł, Szczerkowska-Dobosz A, Nowak I, Łuszczek W, Kuśnierczyk P. The association of ERAP1 and ERAP2 single nucleotide polymorphisms and their haplotypes with psoriasis vulgaris is dependent on the presence or absence of the HLA-C*06:02 allele and age at disease onset. Hum Immunol 2018;79:109-116. https://doi.org/10.1016/j.humimm.2017.11.010
• 3. Paul C, Gourraud PA, Bronsard V et al. Evidence-based recommendations to assess psoriasis severity: systematic literature review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2010;24:2-9. https://doi.org/10.1111/j.1468-3083.2009.03561.x
• 4. Polat M, Bugdayci G, Kaya H, Oğuzman H. Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in Turkish patients with chronic plaque psoriasis. Acta Dermatovenerol Alp Pannonica Adriat 2017;26:97-100. https://doi.org/10.15570/actaapa.2017.28
• 5. Cho KH, Jeong MH, Ahmed K, et al. Value of early risk stratification using hemoglobin level and neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2011;107:849-856. https://doi.org/10.1016/j.amjcard.2010.10.067
• 6. Nunez J, Nunez E, Bodi V et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;101:747-752. https://doi.org/10.1016/j.amjcard.2007.11.004
• 7. Chandrashekara S, Rajendran A, Bai Jaganath A, Krishnamurthy R. Neutrophil-lymphocyte ratio, pain perception, and disease activity score may serve as important predictive markers for sustained remission in rheumatoid arthritis. Reumatismo 2015;67:109-115. https://doi.org/10.4081/reumatismo.2015.838
• 8. Nishida Y, Hosomi S, Yamagami H, et al. Neutrophil-to-Lymphocyte ratio for predicting loss of response to iInfliximab in ulcerative colitis. PLoS One.2017;12:e0169845. https://doi.org/10.1371/journal.pone.0169845
• 9. Gulcan AR, Karakaş MS, Akdemir B, Uçar M, Altekin RE, Yılmaz H. Relation between mean platelet volume and subclinical atherosclerosis in patients with metabolic syndrome. Turk Kardiyol Dern Ars 2014;42:22-28. https://doi.org/10.5543/tkda.2014.50708
• 10. Shah B, Sha D, Xie D, Mohler ER, Berger JS. The relationship between diabetes, metabolic syndrome, and platelet activity as measured by mean platelet volume: the National Health And Nutrition Examination Survey, 1999-2004. Diabetes Care 2012;35:1074-1078. https://doi.org/10.2337/dc11-1724
• 11. Korkmaz L, Korkmaz AA, Akyüz AR, et al. Association between mean platelet volume and coronary artery calcification in patients without overt cardiovascular disease: an observational study. Anadolu Kardiyol Derg 2012;12:35-39. https://doi.org/10.5152/akd.2012.007
• 12. Asahina A, Kubo N, Umezawa Y, Honda H, Yanaba K, Nakagawa H. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volume in Japanese patients with psoriasis and psoriatic arthritis: response to therapy with biologics. J Dermatol 2017;44:1112-1121. https://doi.org/10.1111/1346-8138.13875
• 13. Berrettini M, Parise P, Constantini V, Grasselli S, Nenci GG. Platelet activation in psoriasis. Thromb Haemost 1985;53:195-197. https://doi.org/10.1055/s-0038-1661271
• 14. Hayashi S, Shimizu I, Miyauchi H, Watanabe S. Increased platelet aggregation in psoriasis. Acta Derm Venereol 1985;65:258-262.
• 15. Leader A, Pereg D, Lishner M. Are platelet volume indices of clinical use? A multidisciplinary review. Ann Med 2012;44:805-816. https://doi.org/10.3109/07853890.2011.653391
• 16. Karabudak O, Ulusoy RE, Erikci AA, Solmazgul E, Dogan B, Harmanyeri Y. Inflammation and hypercoagulable state in adult psoriatic men. Acta Derm Venereol 2008;88:337-340. https://doi.org/10.2340/00015555-0456
• 17. Canpolat F, Akpinar H, Eskioğlu F. Mean platelet volume in psoriasis and psoriatic arthritis. Clin Rheumatol 2010;29:325-328. https://doi.org/10.1007/s10067-009-1323-8
• 18. Kim DS, Lee J, Kim SH, Kim SM, Lee MG. Mean platelet volume is elevated in patients with psoriasis vulgaris. Yonsei Med J 2015;56:712-718. https://doi.org/10.3349/ymj.2015.56.3.712
• 19. Saleh HMA, Attia EAS, Onsy AM, Saad AA, Abd Ellah MMM. Platelet activation: a link between psoriasis per se and subclinical atherosclerosis - a case-control study. Br J Dermatol 2013;169:68-75. https://doi.org/10.1111/bjd.12285
• 20. Işik S, Kılıç S, Öğretmen Z, et al. The correlation between the psoriasis area severity index and ischemia-modified albumin, mean platelet volume levels in patients with psoriasis. Postepy Dermatol Alergol 2016;33:290-293. https://doi.org/10.5114/ada.2016.61606
• 21. Beyan C, Kaptan K, Ifran A. Platelet count, mean platelet volume, platelet distribution width, and plateletcrit do not correlate with optical platelet aggregation responses in healthy volunteers. J Thromb Thrombolysis 2006; 22:161-164. https://doi.org/10.1007/s11239-006-9014-7
• 22. Rocha-Pereira P, Santos-Silva A, Rebelo I, Figueiredo A, Quintanilha A, Teixeira F. The inflammatory response in mild and in severe psoriasis. Br J Dermatol 2004;150:917-928. https://doi.org/10.1111/j.1365-2133.2004.05984.x
• 23. Coimbra S, Oliveira H, Reis F, et al. C-reactive protein and leucocyte activation in psoriasis vulgaris according to severity and therapy. J Eur Acad Dermatol Venereol 2010;24:789-796. https://doi.org/10.1111/j.1468-3083.2009.03527.x
• 24. Kim DS, Shin D, Lee MS, et al. Assessment of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in korean patients with psoriasis vulgaris and psoriatic arthritis. J Dermatol 2016;43:305-310. https://doi.org/10.1111/1346-8138.13061
• 25. Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol 2014;33:223-227. https://doi.org/10.3109/15569527.2013.834498
• 26. Ünal M, Küçük A, Ünal GÜ, et al. Psoriasiste ortalama trombosit hacmi, nötrofil/lenfosit oranı ve trombosit/lenfosit oranı. Türkderm 2015;49:112-116. https://doi.org/10.4274/turkderm.57984
• 27. Ataseven A, Bilgin AU, Kurtipek GS. The importance of neutrophil lymphocyte ratio in patients with psoriasis. Mater Sociomed 2014;26:231-233. https://doi.org/10.5455/msm.2014.231-233
• 28. Boyraz I, Koc B, Boyaci A, Tutoğlu A, Sarman H, Ozkan H. Ratio of neutrophil/lymphocyte and platelet/lymphocyte in patient with ankylosing spondylitis that are treating with anti-TNF. Int J Clin Exp Med 2014;7:2912-2915. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211808/pdf/ijcem0007-2912.pdf. Accessed Sep 15, 2014
• 29. Turkmen K, Erdur FM, Ozcicek F, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int 2013;17:391-396. https://doi.org/10.1111/hdi.12040
• 30. Demir Pektaş S, Alataş ET, Yılmaz N. Plateletcrit is potential biomarker for presence and severity of psoriasis vulgaris. Acta Medica Mediterranea, 2016;32:1785. https://doi.org/10.19193/0393-6384_2016_6_164
• 31. Yurtdaş M, Yaylali YT, Kaya Y, Ozdemir M, Ozkan I, Aladağ N. Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis. Echocardiography 2014;31:1095-1104. https://doi.org/10.1111/echo.12511
• 32. Beygi S, Lajevardi V, Abedini R. C-reactive protein in psoriasis: a review of the literature. J Eur Acad Dermatol Venereol 2014;28:700-711. https://doi.org/10.1111/jdv.12257
• 33. Raghavan V, Radha RKN, Rao RK, Kuberan A. A correlative study between platelet count, mean platelet volume and red cell distribution width with the disease severity index in psoriasis patients. J Clin Diagn Res 2017;11:13-16. https://doi.org/10.7860/JCDR/2017/31172.10639
• 34. Hägg D, Sundström A, Eriksson M, Schmitt-Egenolf M. Severity of psoriasis differs between men and women: a study of the clinical outcome measure psoriasis area and severity index (PASI) in 5438 swedish register patients. Am J Clin Dermatol 2017;18: 583-590. https://doi.org/10.1007/s40257-017-0274-0