Ankilozan Spondilit Hastalarında Hastalık Aktivitesi ve Anti-Tümör Nekroz Faktörü Alfa Ajanlar ile Tedavi Yanıtını Değerlendirmede Hematolojik Endekslerin Klinik Yararlılığı

Yıl 2024, , 37 - 45, 31.01.2024

Dilek Tezcan , Muslu Kazım Körez , Selda Hakbilen , Mustafa Emin Kaygısız , Semral Gülcemal , Sema Yilmaz

https://doi.org/10.16899/jcm.1415761

Öz

Amaç: Ankilozan spondilit (AS), yüksek morbititeye sahip kronik inflamatuar bir hastalıktır. AS'nin patogenezinde TNF-α önemlidir ve TNF inhibitörleri AS hastaları için etkili tedavi ajanlarıdır.AS patogenezinde tümör nekroz faktör alfa (TNF-α) esastır ve TNF inhibitörleri AS hastaları için en etkili tedavi yöntemidir. Son yıllarda rutin kan parametrelerinin, çok sayıda malignite ve kronik inflamatuar hastalığın tanı ve prognozu ile ilişkili sistemik inflamasyon belirteçleri olduğu rapor edilmiştir. Bu çalışmada TNF inhibitörleri ile tedavi edilen AS hastalarında hematolojik parametreler ile klinik parametreler, hastalık şiddeti ve tedaviye yanıt arasındaki ilişkinin araştırılması amaçlandı.
Yöntemler: Bu çalışmaya romatoloji bölümünden toplam 326 katılımcı dahil edildi. Katılımcılar sağlıklı kontroller (n = 178) ve AS (n = 148) olarak ikiye ayrıldı. Nötrofil, lenfosit, monosit ve trombosit sayıları, ortalama trombosit hacmi (MPV), plateletkrit (PTC), nötrofil lenfosit oranı (NLO), nötrofil platelet oranı (PLO), monosit lenfosit oranı (MLO), eritrosit dağılım genişliği (RDW), sistemik inflamatuar indeks (SII), sistemik inflamatuar yanıt indeksi (SIRI), sistemik inflamasyon agregat indeksi (AISI) ve RPR düzeyleri her katılımcı için analiz edildi. Sağlıklı kontrol ile AS hastalarının tedaviden önceki ve tedaviden üç ay sonraki paremetreleri karşılaştırıldı.
Bulgular: RDW, PLR, NLR, MLR, SIRI, AISI ve SII sağlıklı kontrollerden yüksekti ve SIRI dışındakiler tedavilerle azaldı. HLA-B27 pozitif hastalarda tedavi sonrası AISI ve SII'deki azalma anlamlıydı. MPV sağlıklı kontrollerden düşüktü ve tedaviyle arttı. Aktif AS hastalarında SII, SIRI ve AISI, aktif olmayan hastalara göre anlamlı derecede yüksekti. Ayrıca eritrosit sedimantasyon hızı (ESH), C-reaktif protein (CRP) ve BASDAI ile koreleydi.
Sonuç: SII, AISI ve SIRI, hastalık aktivasyonunu göstermede ve anti-TNF-α tedavisinin etkinliğini değerlendirmede değerli belirteçler olabilir.

Anahtar Kelimeler

Ankilozan spondilit, anti tümor nekroz faktör alfa, sistemik inflamasyon agregat indeksi, sistemik inflamatuar indeks, sistemik inflamatuar yanıt indeksi

Clinical Usefulness of Hematologic Indices in Evaluating Response to Treatment with Anti-Tumor Necrosis Factor-Alfa Agents and Disease Activity in Patients with Ankylosing Spondylitis

Öz

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease which influences the proportion of immune cells. Tumor necrosis factor alpha (TNF-α) is essential in the pathogenesis of AS, and TNF inhibitors are the most effective treatment for AS patients. In recent years, routine blood parameters were reported as markers of systemic inflammation associated with the diagnosis and prognosis of numerous malignancies and chronic inflammatory diseases. This study aimed to investigate the relationship between haematological parameters and clinical parameters, disease severity and treatment response in AS patients treated with TNF inhibitors.
Methods: A total of 326 participants were recruited from the rheumatology department in this study. Participants were divided into healthy controls (n = 178) and AS (n = 148). Neutrophil, lymphocyte, monocyte and platelet counts, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), platelet crit (PCT), mean platelet volume (MPV), red cell distribution width (RDW), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), cluster systemic inflammation index (AISI) and RPR levels were analyzed for each participant. They were compared between healthy control, AS patients during the pre-treatment phase and three months after the treatment.
Results: RDW, PLR, NLR, MLR, SIRI, AISI and SII were higher than healthy controls and decreased with treatment except SIRI. The decrease in AISI and SII after treatment was significant in HLA-B27 positive patients. MPV was lower than healthy controls and increased with treatment. SII, SIRI and AISI were significantly higher in the active AS patients than in the inactive patient. Also, they were correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).
Conclusion: SII, AISI, and SIRI may be valuable markers for demonstrating disease activation and evaluating the effectiveness of anti‐TNF‐α therapy.

Anahtar Kelimeler

Ankylosing spondylitis, anti tumor necrosis factor alpha, cluster systemic inflammation index, systemic inflammatory index, systemic inflammatory response index

Etik Beyan

The present study was designed as a prospective study and was approved by the ethics committee of Selçuk University Faculty of Medicine Hospital (decision no. 2021/118) and conducted according to the principles of the Declaration of Helsinki.

Destekleyen Kurum

Selçuk University Faculty of Medicine Hospital

Teşekkür

We acknowledge our patients for the consent to publish this research to teach medical professionals to help their patients better.

Kaynakça

• 1. Fiorillo MT, Haroon N, Ciccia F, et al. Ankylosing Spondylitis and Related Immune-Mediated Disorders. Front Immunol. 2019; 10:1232. 2. Rudwaleit M, Braun J, Sieper J. Assessment of SpondyloArthritis international S. [ASASclassification criteria for axial spondyloarthritis] Z Rheumatol.2009; 68(7):591–593.
• 3. Hao X, Li D, Wu D, et al. The Relationship between Hematological Indices and Autoimmune Rheumatic Diseases (ARDs), a Meta-Analysis. Sci Rep.2017; 7(1):10833.
• 4. Taha SI, Samaan SF, Ibrahim RA, et al. Can Complete Blood Count Picture Tell Us More About the Activity of Rheumatological Diseases? Clin Med Insights Arthritis Musculoskelet Disord. 2022;15:11795441221089182.
• 5. Qian H, Chen R, Wang B, et al. Associations of platelet count with inflammation and response to anti‐TNF‐α therapy in patients with ankylosing spondylitis. Front Pharmacol. 2020;11:559593.
• 6. Satis S. New Inflammatory Marker Associated with Disease Activity in Rheumatoid Arthritis: The Systemic ImmuneInflammation Index. Curr Health Sci J. 2021;47(4):553-557.
• 7. Peng YF, Zhang Q, Cao L, et al. Red blood cell distribution width: a potential maker estimating disease activity of ankylosing spondylitis. Int J Clin Exp Med. 2014;7:5289-5295.
• 8. Targońska-Stępniak B, Zwolak R, Piotrowski M et al. The Relationship between Hematological Markers of Systemic Inflammation (Neutrophil-To Lymphocyte, Platelet-To-Lymphocyte, Lymphocyte-To-Monocyte Ratios) and Ultrasound Disease Activity Parameters in Patients with Rheumatoid Arthritis. J Clin Med. 2020;9(9):2760.
• 9. Yolbas S, Yildirim A, Gozel N, et al. Hematological indices may be useful in the diagnosis of systemic lupus erythematosus and in determining disease activity in Behçet's disease. Med Princ Pract. 2016;25:510-516.
• 10. Uslu AU, Deveci K, Korkmaz S, et al. Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever? Biomed Res Int. 2013:185317.
• 11. Lee HN, Kim YK, Kim GT, et al. Neutrophil-to-lymphocyteand platelet-to-lymphocyte ratio as predictors of 12-week treatment response and drug persistence of anti-tumor necrosis factor-α agents in patients with rheumatoid arthritis: a retrospective chart review analysis. Rheumatol Int. 2019;39(5):859-868.
• 12. Chen W, Xin S, Xu B. Value Research of NLR, PLR, and RDW in Prognostic Assessment of Patients with Colorectal Cancer. J Healthc Eng. 2022;7971415.
• 13. Chen L, Liu C, Liang T, et al. Monocyte-to-Lymphocyte Ratio Was an Independent Factor of the Severity of Spinal Tuberculosis. Oxid Med Cell Longev. 2022:7340330.
• 14. Özaslan M, Erdoğan B, Gül Erdoğan A, et al. The Relationship Between Disease Activity and Platelet Indices in Pemphigus: An Observational Preliminary Study. Acta Dermatovenerol Croat.2022;30(1):18-24.
• 15. Liang T, Chen J, Xu G, et al. Platelet-to-Lymphocyte Ratio as an Independent Factor Was Associated With the Severity of Ankylosing Spondylitis. Front Immunol.2021;12:760214.
• 16. Al-Osami MH, Awadh NI, Khalid KB, et al. Neutrophil/lymphocyte and platelet/lymphocyte ratios as potential markers of disease activity in patients with Ankylosing spondylitis: a case-control study. Adv Rheumatol.2020;60(1):13.
• 17. Gökmen F, Akbal A, Reşorlu H, et al. Neutrophil/lymphocyte ratio connected to treatment options and inflammation markers of ankylosing spondylitis. J Clin Lab Anal.2015;29:294‐298.
• 18. Seng JJB, Kwan YH, Low LL, et al. Role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV) in assessing disease control in Asian patients with axial spondyloarthritis. Biomarkers. 2018;23:335‐338.
• 19. Song GG, Lee YH. Red cell distribution width, platelet-to-lymphocyte ratio, and mean platelet volume in ankylosing spondylitis and their correlations with inflammation: a meta-analysis. Mod Rheumatol. 2020;30:894-899.
• 20. Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine.2008;75(3):291-4.
• 21. Fest J, Ruiter R, Mulder M, et al. The systemic immune‐inflammation index is associated with an increased risk of incident cancer‐a population‐based cohort study. Int J Cancer. 2020;146:692‐698.
• 22. Gao YB, Guo W, Cai S, et al. Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients with surgically resected esophageal squamous cell carcinoma. J. Cancer. 2019;10:3188–3196.
• 23. Xia Y, Xia C, Wu L, et al. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J Clin Med. 2023;12(3):1128.
• 24.Zinellu A, Paliogiannis P, Sotgiu E, et al. Blood cell count derived inflammation indexes in patients with idiopathic pulmonary fibrosis. Lung. 2020; 198:821–827.
• 25. Li LH, Chen CT, Chang YC, et al. Prognostic Role of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immune Inflammation Index in Acute Ischemic Stroke: A STROBE-Compliant Retrospective Study. Medicine.2021;100(25):e26354.
• 26. Putzu C, Cortinovis D, Colonese F, et al. Blood cell count indexes as predictors of outcomes in advanced non-small-cell lung cancer patients treated with Nivolumab. Cancer Immunol. Immunother. 2018;67:1349–1353.
• 27: Yorulmaz A, Hayran Y, Akpinar U, et al. Systemic Immune-Inflammation Index (SII) Predicts Increased Severity in Psoriasis and Psoriatic Arthritis. Curr Health Sci J. 2020;46(4):352-357.
• 28.Hamad DA, Aly MM, Abdelhameid MA, et al. Combined Blood Indexes of Systemic Inflammation as a Mirror to Admission to Intensive Care Unit in COVID-19 Patients: A Multicentric Study. J Epidemiol Glob Health. 2022;12(1):64-73.
• 29. Fois AG, Paliogiannis P, Scano V, et al. The Sytemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. Molecules. 2020; 25:5725.
• 30. Peirovy A, Malek Mahdavi A, Khabbazi A, et al. Clinical Usefulness of Hematologic Indices as Predictive Parameters for Systemic Lupus Erythematosus. Lab Med. 2020;51:519-528.
• 31. Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021;35(9):e23964.
• 32. Tanacan E, Dincer D, Erdogan FG, et al. A cutoff value for the systemic immune‐inflammation index in determining activity of Behçet disease. Clin Exp Dermatol. 2021;46(2):286‐291.
• 33. Kim Y, Choi H, Jung SM, et al. Systemic immune‐inflammation index could estimate the cross‐sectional high activity and the poor outcomes in immunosuppressive drug‐naïve patients with antineutrophil cytoplasmic antibody‐associated vasculitis. Nephrol (Carlton). 2019;24:711‐717.
• 34. Kim JW, Jung JY, Suh CH, et al. Systemic immune‐inflammation index combined with ferritin can serve as a reliable assessment score for adult‐onset still's disease. Clin Rheumatol. 2021;40:661‐668.
• 35. Fang H, Zhang H, Wang Z, et al. Systemic immune-inflammation index acts as a novel diagnostic biomarker for postmenopausal osteoporosis and could predict risk of osteoporotic fracture. J Clin Lab Anal.2020;34(1)