İlyas TENLİK, Orhan COŞKUN, Mustafa ÇAPRAZ, Volkan GÖKBULUT, Ömer ÖZTÜRK

Ülseratif kolit aktivitesi ve şiddetinin invaziv olmayan biyobelirteçler ile değerlendirilmesi

Giriş ve Amaç: Bu çalışmamızda, ülseratif kolit hastalık aktivitesinin belirlenmesinde nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı ve C-reaktif protein/albümin oranının rolünü değerlendirdik. Gereç ve Yöntem: Ülseratif kolit tanısı ile takip ettiğimiz 18 yaş üstü hastalar retrospektif olarak tarandı. Yaş, cinsiyet, komorbid hastalıklar açısından farklılığı ortadan kaldırmak için aynı hastaların endoskopik remisyon ve aktivasyon dönemlerindeki laboratuvar ve tedavi verileri karşılaştırıldı. Bulgular: Çalışma kriterlerine uygun olan 87 hasta çalışmaya alındı. Hastaların %69’u erkek, %31’i kadındı. En sık sol tip (%48.3) tutulum saptandı ve aktif dönemde median endoskopik aktivite indeksi 8’di (6-12). Endoskopik olarak aktif hastalık döneminde istatistiksel açıdan lökosit, nötrofil, monosit, trombosit, sedimentasyon, C-reaktif protein düzeyi anlamlı olarak yüksekken, hemoglobin ve albümin düzeyleri anlamlı olarak düşüktü (p < 0.05). Median platelet/lenfosit oranı [152.4 (70.1 - 422.7) ve 137.5 (36 - 1212), p = 0.009)], monosit/lenfosit oranı [(0.06 (0.01 - 1.54) ve 0.04 (0.01 – 0.9), p = 0.03], nötrofil/lenfosit oranı [2.47 (0.73 - 9.92) ve 2.08 (0.55 - 6.54), p = 0.007] ve C-reaktif protein/albümin oranının [2.3 (0.1-80) ve 0.51 (0.04 - 8.48), p < 0.001] değerleri aktif hastalık döneminde hastalığın inaktif olduğu döneme göre anlamlı olarak daha yüksek saptandı. Yapılan ROC analizde nötrofil/lenfosit oranı ve C-reaktif protein/albümin oranının endoskopik aktif hastalığı tahmin etmede yararlı olduğu, platelet/lenfosit oranı ve monosit/lenfosit oranının ise aktif hastalığı göstermede faydalı olmadığı tespit edildi. Nötrofil/lenfosit oranı için eşik değer 2.35 alındığında aktif hastalık için sensitivite %59.8, spesifite %66.7, eğri altında kalan alan 0.619 saptandı (p = 0.007). C-reaktif protein/albümin oranı için eşik değer 0.87 alındığında aktif hastalık için sensitivite %74.7, spesifite %72.4, eğri altında kalan alan 0.806 saptandı (p < 0.001). Sonuç: Ülseratif kolit hastalarında nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı, C-reaktif protein/albümin oranı değerleri aktif hastalıkta anlamlı olarak yükselmekle birlikte, endoskopik aktif hastalığın tahmininde sadece nötrofil/lenfosit oranı ve C-reaktif protein/albümin oranı yeterli sensitivite ve spesifiteye sahiptir.

Anahtar Kelimeler:

Ülseratif kolit, endoskopik aktivite, nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı, C-reaktif protein/albümin oranı

Evaluation of ulcerative colitis activity and severity with non-invasive biomarkers

Background and Aims: In this study, we evaluated the role of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio and C-reactive protein/albumin ratio in determining ulcerative colitis endoscopic activity. Materials and Methods: Patients over the age of 18 who were followed up with the diagnosis of ulcerative colitis were retrospectively screened. In order to eliminate the difference in terms of age, gender, and comorbid diseases, the datas of the patients in the endoscopic remission periods compared with their own datas in the activation periods. Results: Eighty-seven patients who met the study criteria were included in the study, of which 69% were male and 31% were female. The most common localization was left-side (48.3%) and the median endoscopic activity index was 8 (6 - 12) in the active period. During the endoscopically active disease period, leukocyte, neutrophil, monocytes, thrombocyte, sedimentation, and C-reactive protein levels were significantly higher, while hemoglobin and albumin levels were significantly lower (p < 0.05). Median platelet/lymphocyte ratio [152.4 (70.1 - 422.7) and 137.5 (36 - 1212), p = 0.009)], monocyte/lymphocyte ratio [(0.06 (0.01 - 1.54) and 0.04 (0.01 - 0.9), p = 0.03], neutrophil/lymphocyte ratio [2.47 (0.73 - 9.92) and 2.08 (0.55 - 6.54), p = 0.007] and C-reactive protein/albumin ratio [2.3 (0.1 - 80) and 0.51 (0.04 - 8.48), p < 0.001] values were higher in the endoscopically active period compared to the inactive period. In the ROC analysis, only neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio were sensitive and specific enough to predict endoscopic active disease. When the cutoff value of neutrophil/lymphocyte ratio was taken as 2.35, sensitivity for active disease was 59.8%, specificity was 66.7%, and area under the curve was 0.619 (p = 0.007). And, when the cutoff value of C-reactive protein/albumin ratio was taken as 0.87, the sensitivity for active disease was 74.7%, the specificity was 72.4%, and the area under the curve was 0.806 (p < 0.001). Conclusions: Although neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and C-reactive protein/albumin ratio values increase significantly in active disease in ulcerative colitis, only neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio are useful in the estimation of endoscopic active disease and have sufficient sensitivity and specificity.

Keywords:

Ulcerative colitis, endoscopic activity, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, C-reactive protein/albumin ratio,

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