Hidradenitis Suppurativalı Hastalarda İnflamatuar Belirteçlerin Değerlerdirilmesi: Tek Merkezli Vaka-Kontrol Çalışması

Year 2023, Volume: 7 Issue: 2, 128 - 136, 31.08.2023

Özge Kaya , Havva Yasemin Çinpolat

https://doi.org/10.29058/mjwbs.1278387

Abstract

Amaç: Hidradenitis suppurativa (HS), kronik inflamatuar bir deri hastalığıdır. Bu çalışmada hidradenitis
suppurativada yeni inflamatuar belirteçlerden olan monosit:HDL oranı (monosit:HDL ratio=MHR),
nötrofil:lenfosit oranı (nötrofil:lenfosit ratio=NLR), monosit:lenfosit oranının (monosit:lenfosit ratio=MLR)
değerlendirilmesi amaçlanmaktadır.
Gereç ve Yöntemler: Ocak 2012- Şubat 2023 tarihleri arasında HS tanısıyla takip edilen ve yaş-cinsiyet
açısından eşleşmiş sağlıklı kontrol grubu sosyodemografik bulgular (yaş, cinsiyet) ve laboratuvar
bulguları [yüksek yoğunluklu lipoprotein (high density lipoprotein=HDL), nötrofil sayısı, monosit sayısı,
eritrosit sedimantasyon hızı (ESH), C-reaktif protein (CRP), MHR, NLR, MLR] açısından retrospektif
olarak değerlendirildi. Elde edilen veriler hasta ve kontrol grubu arasında, ayrıca hasta grubunda
hastalık şiddeti açısından (Hurley evre 1, 2 ve 3) ve metabolik sendrom varlığına göre karşılaştırıldı.
Ayrıca hasta grubunda inflamatuar belirteçlerle korele olan bulgular değerlendirildi.
Bulgular: Çalışmaya 53 HS hastası (kadın:erkek oranı=0,6:1, yaş ort=33.32±11.37 ) ve 50 sağlıklı
kontrol (kadın:erkek oranı=0,47:1, yaş ort=36.74±11.95) dahil edildi. Hasta grubunda ortalama HDL
değeri istatistiksel olarak daha düşük saptanırken; ESH, nötrofil ve monosit sayıları, MHR ve NLR değerleri
daha yüksekti (p<0.05). Hastalar Hurley evrelemesi açısından karşılaştırıldığında; CRP, ESH
nötrofil ve monosit sayıları, MHR, NLR ve MLR değerleri evre ilerledikçe artmaktaydı, ancak bu artış
sadece ESH’nda istatistiksel olarak anlamlıydı (p=0.022). Anatomik lokalizasyon tutulum sayısı; nötrofil
sayısı, monosit sayısı, ESH, MHR, NLR, MLR ve Hurley evresiyle pozitif koreleydi. Hastalık süresi ise
MHR ile korelasyon göstermekteydi. Hastaların 11’inde (%20,8) metabolik sendrom mevcuttu. Metabolik
sendromu olan hastalarda MLR değeri daha düşük saptanırken, diğer parametrelerde istatistiksel
olarak anlamlı fark saptanmadı.
Sonuç: HS’te MHR, NLR ve MLR gibi maliyeti düşük ve kullanımı kolay olan yeni inflamatuar belirteçler
inflamatuar yükü yansıtması açısından günlük pratikte kullanılabilecek parametrelerdir.

Keywords

Hidradenitis suppurativa, inflamasyon, metabolik sendrom, monosit:HDL oranı, monosit:lenfosit oranı, nötrofil:lenfosit oranı

Thanks

Hasta verilerini toplama konusunda yardımlarından dolayı Doktor Öğretim üyesi Zeynep KESKİNKAYA ve Doktor Öğretim Üyesi Selda Işık MERMUTLU’ya; istatistiksel analizde yardımlarından dolayı Prof. Dr.Hakkı KAYA’ya teşekkürlerimi sunarım.

Evaluation of Inflammatory Markers in Patients with Hidraadenitis Suppurativa: A Single Center Case-Control Study

Abstract

Aim: In this study, it is aimed to evaluate monocyte: HDL ratio (MHR), neutrophil: lymphocyte ratio
(NLR), monocyte: lymphocyte ratio (MLR), which are new inflammatory markers, in HS.
Material and Methods: Patients followed up with the diagnosis of HS between January 2012 and
February 2023 and age-sex-matched healthy control group will be evaluated retrospectively in terms
of sociodemographic findings (age, gender), and laboratory findings [high-density lipoprotein (HDL),neutrophil count, monocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), MHR, NLR, MLR]. The obtained data
will be compared between the patient and control group. In addition, patients will be compared in terms of Hurley stage and the presence of
metabolic syndrome.
Results: 53 HS patients (female: male ratio=0.6:1, age mean=33.32±11.37) and 50 healthy controls (female: male ratio=0.47:1, age
mean=36.74±11.95) were included in the study. While the mean HDL value was statistically lower in the patient group; ESR, neutrophil and
monocyte counts, MHR, and NLR values were higher (p<0.05). When the patients were compared in terms of Hurley staging; neutrophil
count, CRP, ESR, MHR, NLR ve MLR values, increased as the stage progressed, but this increase was statistically significant only at ESR
(p=0.022). The number of anatomical localization involvement was positively correlated with the neutrophil count, monocyte count, ESR,
MHR, NLR, MLR, and Hurley stage. Disease duration was correlated with MHR. Metabolic syndrome was present in 11 (20.8 %) patients.
While the MLR value was found to be lower in patients with metabolic syndrome, no statistical difference was found in other parameters.
Conclusion: New inflammatory parameters such as MHR, NLR, and MLR can be used in daily practice in terms of reflecting the inflammatory
burden in HS patients.

Keywords

Hidradenitis suppurative, inflammation, metabolic syndrome, monocyte: HDL ratio, monocyte: lymphocyte ratio, neutrophil: lymphocyte ratio

References

• 1. Gulliver W, Zouboulis CC, Prens E, Jemec GB, Tzellos T. Evidence-based approach to the treatment of hidradenitis suppurative/acneinversa, based on the European guidelines for hidradenitis suppurativa. Rev Endocr Metab Disord 2016;17(3):343-351.
• 2. Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol 2020;82(5):1045-1058.
• 3. Vural S, Gündoğdu M, Akay BN, Boyvat A, Erdem C, Koçyiğit P, Bostancı S, Sanli H, Kundakci N. Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy. Dermatol Ther 2019;32(5):e13003.
• 4. Ganjali S, Gotto AM Jr, Ruscica M, Atkin SL, Butler AE, Banach M, Sahebkar A. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol 2018;233(12):9237-9246.
• 5. Demirbaş A, Elmas ÖF, Atasoy M, Türsen Ü, Lotti T. Can monocyte to HDL cholesterol ratio and monocyte to lymphocyte ratio be markers for inflammation and oxidative stress in patients with vitiligo? A preliminary study. Arch Dermatol Res 2021;313(6):491-498.
• 6. Aktaş Karabay E, Demir D, Aksu Çerman A. Evaluation of monocyte to high-density lipoprotein ratio, lymphocytes, monocytes, and platelets in psoriasis. An Bras Dermatol 2020;95(1):40-45.
• 7. Facchini F, Hollenbeck CB, Chen YN, Chen YD, Reaven GM. Demonstration of a relationship between white blood cell count, insulin resistance, and several risk factors for coronary heart disease in women. J Intern Med 1992;232:267-272.
• 8. Feng F, Tian Y, Liu S, Zheng G, Liu Z, Xu G. Combination of PLR, MLR MWR, and tumor size could significantly increase the prognostic value of for gastrointestinal stromalt umors. Medicine (Baltimore) 2016;95:e3248.
• 9. Zouboulis CC, del Marmol V, Mrowietz U, Prens EP, Tzellos T, Jemec GBE. Hidradenitis suppurativa/acne inversa: Criteria for diagnosis, severity assessment, classification and disease evaluation. Dermatology 2015;231(2):184-190.
• 10. Saklayen M.G. The global epidemic of the metabolic syndrome. Curr. Hypertens Rep 2018;20:1-8.
• 11. Babaoğlu AB, Tekindal M, Büyükuysal MÇ, Tözün M, Elmalı F, Bayraktaroğlu T, Tekindal MA. Epidemiyolojide gözlemsel çalışmaların raporlanması: STROBE Kriterlerinin Türkçe Uyarlaması. Batı Karadeniz Tıp Dergisi 2021;5(1):86-93.
• 12. Von Laffert M, Stadie V, Wohlrab J, Marsch WC. Hidradenitis suppurativa/acne inversa: Bilocated epithelial hyperplasia with very different sequelae. Br J Dermatol 2011;164:367-371.
• 13. Schmidt-Arras D, Rose-John S. IL-6 pathway in the liver: From physiopathology to therapy. J Hepatol 2016;64:1403-1415.
• 14. Kelly G, Hughes R, McGarry T, van den Born M, Adamzik K, Fitzgerald R, Lawlor C, Tobin AM, Sweeney CM, Kirby B. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol 2015;173:1431- 1439.
• 15. Melnik BC, John SM, Chen W, Plewig G. T helper 17 cell/ regulatoryT-cell imbalance in hidradenitis suppurativa/acne inversa: The link to hair follicle dissection, obesity, smoking and autoimmune comorbidities. Br J Dermatol 2018;179:260-272.
• 16. Scala E, Cacciapuoti S, Garzorz-Stark N, Megna M, Marasca C, Seiringer P, Volz T, Eyerich K, Fabbrocini G. Hidradenitis suppurativa: Where we are and where we are going. Cells 2021;10(8):2094.
• 17. Seow V, Lim J, Iyer A, Suen JY, Ariffin JK, Hohenhaus DM, Sweet MJ, Fairlie DP. Inflammatory responses induced by lipopolysaccharide are amplified in primary human monocytes but suppressed in macrophages by complement protein C5a. J Immunol 2013;191:4308-4316.
• 18. Grand D, Navrazhina K, Frew JW. Integrating complement into the molecular pathogenesis of hidradenitis suppurativa. Exp Dermatol 2020;29:86-92.
• 19. Kim DS, Shin D, Lee MS, Kim HJ, Kim DY, Kim SM, Lee MG. Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis. J Dermatol 2016;43:305-310.
• 20. Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol 2013;33:223-227.
• 21. Polat M, Bugdaycı G, Kaya H, O guzman H. Evaluation of neutrophilto-lymphocyte ratio and platelet-to-lymphocyte ratio in Turkish patients with chronic plaque psoriasis. Acta Dermatovenerol Alp Pannonica Adriat 2017;26(4):97-100.
• 22. Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-tolymphocyte ratio (NLR) and plate- let-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol 2016;36:94-99.
• 23. Rifaioglu EN, Bülbül Şen B, Ekiz Ö, Cigdem DA. Neutrophil to lymphocyte ratio in Behçet’s disease as a marker of disease activity. Acta Dermatovenerol Alp Pannonica Adriat 2014;23:65-67.
• 24. Alan S, Tuna S, Türkoglu EB. The relation of neutrophil-tolymphocyte ratio, and mean platelet volume with the presence and severity of Behçet’s syndrome. Kaohsiung J Med Sci 2015;31(12):626-631.
• 25. Jiang Y, Ma W. Assessment of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in atopic dermatitis patients. Med Sci Monit 2017;17(23):1340-1346.
• 26. Kolkhir P, Andre F, Church MK, Maurer M, Metz M. Potential blood biomarkers in chronic spontaneous urticaria. Clin Exp Allergy 2017;47(1):19-36.
• 27. Wang WM, Jin HZ. Role of Neutrophils in Psoriasis. J Immunol Res 2020;2020:3709749.
• 28. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: An emerging marker of the relationships between the immune system and diseases. Int J Mol Sci 2022;23(7):3636.
• 29. Song M, Graubard BI, Rabkin CS, Engels EA. Neutrophil-tolymphocyte ratio and mortality in the United States general population. Sci Rep 2021;11:464.
• 30. Turfan M, Erdoğan E, Tasal A, Vatankulu MA, Jafarov P, Sönmez O, Ertaş G, Bacaksız A, Göktekin O. Neutrophil-tolymphocyte ratio and in-hospital mortality in patients with acute heart failure. Clinics (Sao Paulo) 2014;69(3):190-193.
• 31. Jiang J, Liu R, Yu X, Yang R, Xu H, Mao Z, Wang Y. The neutrophil-lymphocyte count ratio as a diagnostic marker for bacteraemia: A systematic review and meta-analysis. Am J Emerg Med 2019;37:1482-1489.
• 32. Liu HT, Jiang ZH, Yang ZB, Quan XQ. Monocyte to highdensity lipoprotein ratio predict long-term clinical outcomes in patients with coronary heart disease: A meta-analysis of 9 studies. Medicine (Baltimore) 2022;101(33):e30109.
• 33. Riis PT, Søeby K, Saunte DM, Jemec GB. Patients with hidradenitis suppurativa carry a higher systemic inflammatory load than other dermatological patients. Arch Dermatol Res 2015;307(10):885-889.
• 34. Miller IM, Ring HC, Prens EP, Rytgaard H, Mogensen UB, Ellervik C, Jemec GB. Leukocyte profile in peripheral blood and neutrophil-lymphocyte ratio in hidradenitis suppurativa: A comparative cross-sectional study of 462 cases. Dermatology 2016;232(4):511-519.
• 35. Çetinarslan T, Türel Ermertcan A, Özyurt B, Gündüz K. Evaluation of the laboratory parameters in hidradenitis suppurativa: Can we use new inflammatory biomarkers? Dermatol Ther 2021;34(2):e14835.
• 36. Gambichler T, Hessam S, Cramer P, Abu Rached N, Bechara FG. Complete blood collection-based systemic inflammation biomarkers for patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2022;36(9):1593-1596.
• 37. Mintoff D, Benhadou F, Pace NP, Frew JW. Metabolic syndrome and hidradenitis suppurativa: Epidemiological, molecular, and therapeutic aspects. Int J Dermatol 2022;61(10):1175-1186.
• 38. Abacı A, Kılıçkap M, Göksülük H, Karaaslan D, Barçın C, Kayıkçıoğlu M, Özer N, Yılmaz MB, Şahin M, Tokgözoğlu L. Türkiye’de metabolik sendrom sıklığı verileri: Kardiyovasküler risk faktörlerine yönelik epidemiyolojik çalışmaların sistematik derleme, meta-analiz ve meta-regresyonu [Data on prevalence of metabolic syndrome in Turkey: Systematic review, metaanalysis and meta-regression of epidemiological studies on cardiovascular risk factors]. Turk Kardiyol Dern Ars 2018;46(7):591-601.
• 39. Alavi A, Anooshirvani N, Kim WB, Coutts P, Sibbald RG. Qualityof- life impairment in patients with hidradenitis suppurativa: A Canadian study. Am J Clin Dermatol 2015;16:61-65.
• 40. Matusiak L, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol 2010;90:264-268.