Çölyak hastalığı ile ilişkili sistemik enflamasyonun değerlendirilmesi

Öz

Amaç: Çalışmanın nihai amacı, çölyak hastalığında sistemik inflamasyonu ölçmek ve ilişkili parametreleri belirlemek, böylece Çölyak Hastalığı'nda (ÇH) sistemik inflamasyonla mücadele ederek sistemik yan etkileri önlemektir. Gereç ve Yöntemler: 2015-2025 yılları arasında merkezlerimizin Dahiliye Kliniklerine başvuran ÇH tanılı hastalar ve başka nedenlerle değerlendirilen ÇH tanısı olmayan, sağlıklı bireylerde Sistemik İnflamatuar İndeks (Sİİ) “trombosit sayısı × nötrofil sayısı/lenfosit sayısı” olarak hesaplandı. Demografik özellikler, Anti-doku transglutaminaz (Anti-TTG), anti-gliadin, insan lökosit antijenleri olan HLADQB102, HLADQA103, HLADQA105, hemogram, eritrosit sedimentasyon hızı (ESR), C-reaktif protein (CRP) değerleri hastane kayıt sisteminden alınmıştır Bulgular: 102 CD hastası ve 98 kontrol grubu olarak toplam 200 katılımcı çalışmaya dahil edilmiştir. Kohortun %60,1'ini kadınlar oluşturmuştur. Ortalama Sİİ değeri ÇH hastalarında 636,06 ve kontrol grubunda 466,48 olup istatistiksel olarak anlamlı bir fark bulunmamıştır (p = 0,037). Sİİ ile otoantikor veya genetik belirteçler arasında korelasyon gözlenmemiştir. Hemoglobin ve trombosit düzeyleri gruplar arasında anlamlı farklılık göstermiştir (p = 0,011 ve p = 0,001). Sİİ, ESR ve hemoglobin ile güçlü bir pozitif korelasyon ve CRP ile zayıf bir korelasyon gösterdi. Sonuçlar: Sİİ, CD hastalarında daha yüksek bulunmuş olmasına rağmen, serolojik veya genetik belirteçlerle anlamlı bir ilişki göstermemiştir. Sİİ, geleneksel belirteçlerin ötesinde ÇH'deki sistemik inflamasyonu yansıtıyor olabilir. Tanı ve izlemdeki rolünü netleştirmek için daha ileri prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Çölyak hastalığı
• inflamasyon
• sistemik inflamatuvar indeks

Evaluation of Systemic Inflammation Associated with Celiac Disease

Öz

Aim: The ultimate goal of the study is to measure systemic inflammation in celiac disease and identify associated parameters, thus preventing systemic side effects by combating systemic inflammation in Celiac Disease (CD). Material and Methods: The Systemic Inflammatory Index (SII) was calculated as “platelet count × neutrophil count/lymphocyte count” in patients with CD and healthy individuals without a diagnosis of CD who were evaluated for other reasons, who applied to the Internal Medicine Clinics of our centers between 2015-2025. Demographic characteristics, Anti-tissue transglutaminase (Anti-TTG), anti-gliadin, Human leucocyte antigenes HLADQB102, HLADQA103, HLADQA105, hemogram, ESR, CRP, and routine biochemical markers were extracted from medical records. Results: A total of 200 participants were included: 102 CD patients and 98 controls. Females constituted 60.1% of the cohort. The mean SII was 636.06 in CD patients and 466.48 in controls, with no statistically significant difference (p = 0.037). No correlation was observed between SII and autoantibody or genetic markers. Hemoglobin and platelet levels differed significantly between groups (p = 0.011 and p = 0.001). SII showed a strong positive correlation with ESR and hemoglobin, and a weak correlation with CRP. Conclusion: Although SII was higher in CD patients, it was not significantly associated with serological or genetic markers. SII may reflect systemic inflammation in CD beyond traditional markers. Further prospective studies are needed to clarify its role in diagnosis and monitoring.

Anahtar Kelimeler

• Celiac Disease
• inflammation
• systemic inflammatory index

Kaynakça

1. Daley SF, Haseeb M. Celiac disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025
2. Dunne MR, Byrne G, Chirdo FG, Feighery C. Coeliac disease pathogenesis: the uncertainties of a well-known immune mediated disorder. Front Immunol. 2020; 11: 1374.
3. Domsa EM, Berindan-Neagoe I, Para I, Cozma A, Vacariuc A, Achimas-Cadariu A, et al. Celiac disease: a multi-faceted medical condition. J Physiol Pharmacol. 2020; 71: 5-14.
4. Holtmeier W, Caspary WF. Celiac disease. Orphanet J Rare Dis. 2006; 1: 3.
5. Urgancı N, Usta M. Çölyak hastalığına eşlik eden hastalıklar. Turkiye Klin Pediatr Gastroenterol-Spec Top. 2022; 3: 76–83.
6. Kalkan EA. Yeni tanı çölyak hastalarında Marsh sınıflamasının belirlenmesinde trombosit indeksleri. J Ankara Univ Fac Med. 2022; 75: 199–203.
7. Palmacci F, Toti E, Raguzzini A, Lintas C, Luchinat C, Capuani G, et al. Neutrophil-to-lymphocyte ratio, Mediterranean diet, and bone health in coeliac disease patients: a pilot study. Oxid Med Cell Longev. 2019; 2019: 7384193.
8. Cakir I, Dogan S. Association between systemic immune inflammation index and newly diagnosed adult celiac disease. Turk J Biochem. 2022; 47: 59–64.

9. Barone MV, Auricchio R, Nanayakkara M, Greco L, Troncone R, Auricchio S. Pivotal role of inflammation in celiac disease. Int J Mol Sci. 2022; 23: 7177.
10. Porpora M, Conte M, Lania G, Salvati VM, Parente A, Zamparella M, et al. Inflammation is present, persistent and more sensitive to proinflammatory triggers in celiac disease enterocytes. Int J Mol Sci. 2022; 23: 1973.
11. Palumbo CS, Wyse J. Markers of systemic and gut-specific inflammation in celiac disease. Turk J Gastroenterol. 2020; 31: 187–9.
12. Hindryckx P, Levesque BG, Holvoet T, Colombel JF, Vermeire S, Sandborn WJ, et al. Disease activity indices in coeliac disease: systematic review and recommendations for clinical trials. Gut. 2018; 67: 61–9.
13. Gerceker E, Baykan AR, Cerrah S, Yuceyar H. Mean platelet volume can indicate dietary adherence and disease severity of celiac disease. North Clin Istanb. 2022; 9: 41–6.
14. Sarikaya M, Dogan Z, Ergul B, Filik L. Neutrophil-to-lymphocyte ratio as a sensitive marker in diagnosis of celiac disease. Ann Gastroenterol. 2014; 27: 431.
15. Eroğlu N, Evirgen Şahin G, Özbay Hoşnut F, Şahin G. Çölyak hastalığı diyet uyumunda yeni bir belirteç: delta nötrofil indeksi?. Kocatepe Med J. 2021; 22: 294–9.
16. Hu B, Yang XR, Xu Y, Sun HC, Zhang W, Kong LQ, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014; 20: 6212–22.
17. Muhammad S, Fischer I, Naderi S, Schmidbauer ML, Rehman S, Görtz GE, et al. Systemic inflammatory index is a novel predictor of intubation requirement and mortality after SARS-CoV-2 infection. Pathogens. 2021; 10: 58.
18. Dziedzic EA, Gąsior JS, Tuzimek A, Wilczynska M, Rzymski P, Pinkas J, et al. Investigation of the associations of novel inflammatory biomarkers - systemic inflammatory index (SII) and systemic inflammatory response index (SIRI) - with the severity of coronary artery disease and acute coronary syndrome occurrence. Int J Mol Sci. 2022; 23: 9553.
19. Barbaro MR, Cremon C, Stanghellini V, Barbara G. Recent advances in understanding non-celiac gluten sensitivity. F1000Res. 2018; 7: F1000 Faculty Rev–1631.
20. Gümüş M, Yorulmaz A, Kilim E, Gümüştekin R, Ergani AC, Emiroğlu H. The importance of biomarkers in the diagnosis and follow-up of the celiac disease. Gen Med J. 2023; 33: 548–57.
21. Mangoni AA, Zinellu A. The diagnostic role of the systemic inflammation index in patients with immunological diseases: a systematic review and meta-analysis. Clin Exp Med. 2024; 24: 27.
22. Murray JA, Moore SB, Van Dyke CT, Lahr BD, Dierkhising RA, Zinsmeister AR, et al. HLA DQ gene dosage and risk and severity of celiac disease. Clin Gastroenterol Hepatol. 2007; 5: 1406–12.
23. Dahlbom I, Korponay-Szabó IR, Kovács JB, Szalai Z, Mäki M, Hansson T. Prediction of clinical and mucosal severity of coeliac disease and dermatitis herpetiformis by quantification of IgA/IgG serum antibodies to tissue transglutaminase. J Pediatr Gastroenterol Nutr. 2010; 50: 140–6.
24. Midhagen G, Aberg AK, Olcén P, Dahlbom I, Hansson T, Högberg L, et al. Antibody levels in adult patients with coeliac disease during gluten-free diet: a rapid initial decrease of clinical importance. J Intern Med. 2004; 256: 519–24.