Yeni Tanı Çölyak Hastalarında Marsh Sınıflamasının Belirlenmesinde Trombosit İndeksleri

Amaç: Çölyak hastalığı, genetik olarak duyarlı bireylerde, diyetteki gluten tarafından uyarılan otoimmün ve enflamatuvar bir hastalıktır. Çölyak hastalığı tanısında en önemli tanı yöntemi histopatolojik inceleme ve Marsh sınıflamasıdır. Bazı enflamatuvar hastalıklarda ortalama trombosit hacmi (OTH), plateletkrit (PCT) ve trombosit/lenfosit oranı (TLO) ve nötrofil/lenfosit oranı (NLO) gibi sistemik enflamatuvar yanıt belirteçlerinin tanısal önemi olduğu bilinmektedir. Bu araştırmada amacımız, sistemik enflamatuvar yanıt belirteçlerinin Marsh sınıflamasını belirlemekteki önemini araştırmaktır. Gereç ve Yöntem: Gluten sensitif enteropatisi olan 250 hasta OTH, PCT, TLO ve NLO kullanılarak değerlendirildi. Hastalar 5 gruba sınıflandırıldı. Grup I: Marsh tip 1, Grup II: Marsh tip 2, Grup III: Marsh tip 3, Grup IV: artmış intraepitelial lenfosit, ayrıca bir grup kontrol grubu olarak belirlendi (Grup: V). Bulgular: Yeni tanı almış 250 çölyak hastası Marsh sınıflandırmasına göre Grup I (Marsh tip 1, n=109), Grup II (tip 2, n=11) ve Grup III (tip 3, n=130) olmak üzere 3 gruba ayrıldı. Ayrıca intraepitelyal lenfosit artışı olan 50 hasta (Grup IV) ile duodenum biyopsisi normal olan 150 hasta kontrol grubu olarak alındı (Grup V). Hastalar ve kontrol grubu OTH, PCT, TLO ve NLO değerleri yönünden karşılaştırıldı. Sonuç: OTH (8,7±1,07 vs 8,7±1,2 fL, p=0,922), PCT (0,24±0,06 vs 0,22±0,07, p=0,145) ve TLO (144,28±61,54 vs 148,59±89,71, p=0,711) değerleri, kontrol grubu ile karşılaştırıldığında farklılık göstermemektedir. Bu araştırmanın sonuçlarına göre, OTH, PCT, TLO, NLO’nun Marsh sınıflandırmasının belirlenmesinde kullanılması uygun değildir.

Platelet Indices in Determination of Marsh Classification in New Diagnosed Celiac Patients

Objectives: Celiac disease is an autoimmune and inflammatory disease induced by dietary gluten in genetically susceptible individuals. The most important diagnostic method in celiac disease is histopathological examination, and Marsh classification. It is known that in some inflammatory diseases, systemic inflammatory response markers such as mean platelet volume (MPV), plateletcrit (PCT) and platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) are of diagnostic importance. Our aim in this study is to investigate the importance of systemic inflammatory response markers in determining the Marsh classification Materials and Methods: Two hundred and fifty patients with gluten sensitive enteropathy were investigated by using MPV, PCT, PLR, and NLR. Patients were stratified into five groups; Group I: Marsh type 1, Group II: Marsh type 2, Group III: Marsh type 3, Group IV: increased intraepithelial lymphocytes, and also one group involving control group (Group V). Results: 250 newly diagnosed celiac patients were divided into 3 groups as Group I (Marsh type 1, n=109), Group II (type 2, n=11) and Group III (type 3, n=130) according to the Marsh classification. Fifty patients with increased intraepithelial lymphocytes (Group IV) and 150 patients with normal duodenal biopsy were taken as the control group (Group V). Patients and control groups were compared in terms of MPV, PCT, PLR, and NLR values. Conclusion: MPV (8.7±1.07 vs 8.7±1.2 fL, p=0.922), PCT (0.24±0.06 vs 0.22±0.07, p=0.145) and PLR (144.28±61.54 vs 148.59±89.71, p=0.711) values did not differ compared to the controls. As a result, it is not appropriate to use MPV, PCT, PLR, and NLR in determining the Marsh classification.

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