Özgür BAYKAN, Tunay KARLIDERE, Hayriye BAYKAN, Emre Cem ESEN, Ayfer TIRAK, Serap AKDENİZ GÖRGÜLÜ

Nötrofil-lenfosit oranının majör depresif bozukluk, Parkinson hastalığı ve Alzheimer hastalığının ayırıcı tanısındaki potansiyel yeri

Amaç: Özellikle yaşlı popülasyonda görülen demans ile ilişkili semptomların en sık sebepleri arasında Alzheimer hastalığı, majör depresif bozukluk ve Parkinson hastalığı yer almaktadır. Ancak bu hastalıklar benzer klinik özelliklere sahip olduğu için sıklıkla yanlış tanı almakta ve uygun tedavi görememektedir. Biz araştırmamızda, bu hastalıkların ayırıcı tanısında, sistemik bir enflamatuvar belirteç olan nötrofil-lenfosit oranının potansiyel yerini araştırdık. Yöntem: Araştırmamıza Alzheimer hastalığı, majör depresif bozukluk veya Parkinson hastalığı bulunan toplam 95 hasta dahil edildi. Bu hastaların dosyalarından hemogram bilgileri alınarak nötrofil-lenfosit oranları hesaplandı. Gruplar nötrofil-lenfosit oranına ve yaşa göre düzeltilmiş nötrofil-lenfosit oranına göre karşılaştırıldı. Ayrıca alıcı işletim karakteristik eğrisi kullanılarak nötrofil-lenfosit oranının Alzheimer hastalığı ve majör depresif bozukluğun ayırıcı tanısındaki duyarlılığı ve özgüllüğü hesaplandı. Bulgular: Alzheimer hastalığı için ortalama nötrofil-lenfosit oranı 2.9±1.2 olarak, aynı değeri majör depresif bozukluk için 2.2±0.7 ve Parkinson hastalığı için 2.2±0.9 olarak bulundu. Nötrofil-lenfosit oranı değerleri açısından karşılaştırıldığında grupların arasında istatistiksel olarak anlamlı fark bulundu. Nötrofil-lenfosit oranını yaşa göre düzelttiğimizde değerleri sırasıyla 2.80±0.93, 2.20±0.97 ve 2.20±0.96 olarak hesaplandı (p=0.025). Alıcı işletim karakteristik eğrisi analizleri ile incelendiğinde nötrofil-lenfosit oranı için majör depresif bozukluk ve Alzheimer hastalığı arasındaki ayırıcı tanıda sensitivitesi %54.8 ve spesifisitesi %80.0 bulundu. Sonuç: Birbiri ile sıklıkla karışabilen bir kliniğe sahip olan Alzheimer Hastalığı, majör depresif bozukluk ve Parkinson hastalığı arasında ayırıcı tanıda temel olarak hikaye ve klinik muayene kullanılır. Ancak rutin kan tetkiklerinden elde edilen sonuçlarla hesaplanabilen nötrofil-lenfosit oranının, destekleyici veri olarak klinik rutine eklenmesi yanlış tanı sıklığını azaltacağını düşünüyoruz.

Neutrophil-to-Lymphocyte Ratio as a Potential Differential Diagnostic Marker for Alzheimer’s Disease, Major Depressive Disorder, and Parkinson’s Disease

Objective: Major depressive disorder, Alzheimer’s, and Parkinson’s diseases are among the leadingcauses of dementia in the elderly. These diseases are often misdiagnosed because of overlappingsymptoms. This study aimed to evaluate whether neutrophil-to-lymphocyte ratio, which has been usedas an indicator of systemic inflammation, can be used for the differential diagnosis of these diseases.Method: A total of 95 patients with major depressive disorder, Alzheimer’s, or Parkinson’s disease wereenrolled. Neutrophil-to-lymphocyte ratios of the participants were calculated using their past completeblood count results. We compared the three groups according to mean neutrophil-to-lymphocyteratio and mean neutrophil-to-lymphocyte ratio adjusted for age. We used the receiver operatingcharacteristics curve analysis to predict the sensitivity and specificity of this ratio for the differentialdiagnosis between depression and Alzheimer’s disease.Results: The mean neutrophil-to-lymphocyte ratios for the depression, Alzheimer’s, and Parkinson’sdisease groups were 2.2±0.7, 2.9±1.2, and 2.2±0.9, respectively (p=0.005). The age-adjusted meanneutrophil-to-lymphocyte ratios for the depression, Alzheimer’s, and Parkinson’s disease groups were2.20±0.93, 2.80±0.97, and 2.20±0.96, respectively (p=0.025). Receiver operating characteristics curveanalysis predicted that the sensitivity and specificity for the differential diagnosis between depressionand Alzheimer’s disease were 54.8% and 80.0%, respectively.Conclusion: This study suggests that a simple arithmetic calculation could help clinicians in thedifferential diagnosis between depression, Alzheimer’s, and Parkinson’s disease. Neutrophil-to-lymphocyte ratio can be used as a secondary line of evidence, along with the initial clinical assessment.

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