Koroner Aterosklerozda CagA Pozitif Helicobacter pylori Enfeksiyonu: Lenfosit Sayısının Ortalama Trombosit Hacmine Oranının Tanısal Değeri

Amaç: Akut koroner sendromlarda (AKS) mideye hasar verebilen uzunsüreli güçlü-ikili antitrombotik tedavi kullanılmaktadır. Helicobacterpylori (H. pylori) enfeksiyonuna bağlı şiddetli kronik gastrik mukozalinflamasyonun, daha yüksek sayıda periferik kan lenfositleri ve dahadüşük kan ortalama trombosit hacmi (MPV) seviyeleri ile ilişkili olduğugösterilmiştir. Koroner arter hastalığı (KAH) olan hastalarda gerekliileri tanı testlerinden önce CagA pozitif H. pylori enfeksiyonu varlığınıbelirlemede kan lenfosit/MPV oranının öncül belirteç olarak ayırt ediciyararlılığını araştırmayı amaçladık.Gereç ve Yöntem: KAH nedeniyle elektif ve acil koroner anjiyografiyapılan toplam 293 hasta çalışmaya dahil edildi. Serolojik H. pylorienfeksiyon durumu ve hematolojik parametreler belirlendi. CagAseroloji durumuna göre iki grup karşılaştırıldı. Etkin faktörler, eğilimskoru eşleştirmesi ve çok değişkenli lojistik regresyon analizi ileayarlandıBulgular: AKS, erkek cinsiyet, diabetes mellitus, ailede KAH öyküsü,halen sigara kullanımı ve lenfosit/MPV oranı seropozitif hastalardaseronegatif hastalara göre daha yüksekti (p<0.05). ROC eğrisi analizi,lenfosit/MPV oranının 165 kestirim noktası için pozitif H. pyloriserolojisi olan hastaları ayırt etmede %71 duyarlılığa ve %60 özgüllüğesahip olduğunu göstermiştir (AUC=0.71, p<0.0001). Lenfosit/MPVoranı bağımsız olarak pozitif H. pylori serolojisi ile ilişkiliydi.Sonuç: Lenfosit/MPV oranı, CagA pozitif H. pylori açısından İleriyöntemler ile taranması gereken KAH hastalarını ayırt etmede yardımcıolabilir.

Anahtar Kelimeler:

CagA, Koroner Arter Hastalığı, H. Pylori, lenfositler, ortalama trombosit hacmi

CagA Positive Helicobacter Pylori Infection in Coronary Atherosclerosis: Discriminative value of lymphocyte to mean platelet volume ratio.

Aim: Potent combined and long-term antithrombotic therapies that predispose to gastric injury are the mainstay of treatment in acute coronary syndromes (ACS). Severe chronic gastric mucosal inflammation due to the Helicobacter Pylori (H. pylori) infection was shown to be associated with higher peripheral blood lymphocytes and lower blood mean platelet volume (MPV) levels. We aimed to investigate the discriminative usefulness of blood lymphocyte to MPV ratio as a simple premise marker for CagA positive H. Pylori infection before the required advanced diagnostic tests in patients with coronary arterial disease (CAD). Materials and Methods: A total of 293 patients’ who had undergone elective and urgent coronary angiography due to CAD were included in the study. Serologic H. pylori infection status and hematological parameters were determined. Two groups were compared according to CagA serology status. Confounding factors were adjusted by propensity score matching and multivariate logistic regression analysis. Results: Rates of ACS, male gender, diabetes mellitus, family history of CAD, current smoking and lymphocyte to MPV ratio were higher in seropositive patients according to seronegative patients (p < 0.05). The ROC curve analysis showed that the lymphocyte to MPV ratio at a cut-off point of 165 had 71% sensitivity and 60% specificity for discriminating patients with positive H. pylori serology (AUC = 0.71, p < 0.0001). Lymphocyte to MPV ratio was independently associated with positive H. Pylori serology. Conclusion: Lymphocyte to MPV ratio can be helpful for discriminating CagA positive H pylori infected CAD patients requiring advanced confirmatory tests.

Keywords:

coronary arterial disease, H.Pylori, CagA, lymphocytes, mean platelet volume.,

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