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

Yıl 2021, , 761 - 767, 20.11.2021

Barış Şensoy , Nur Ozer Sensoy

https://doi.org/10.16899/jcm.952003

Öz

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.

Anahtar Kelimeler

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

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

Öz

Amaç: Akut koroner sendromlarda (AKS) mideye hasar verebilen uzun
süreli güçlü-ikili antitrombotik tedavi kullanılmaktadır. Helicobacter
pylori (H. pylori) enfeksiyonuna bağlı şiddetli kronik gastrik mukozal
inflamasyonun, daha yüksek sayıda periferik kan lenfositleri ve daha
düşük kan ortalama trombosit hacmi (MPV) seviyeleri ile ilişkili olduğu
gösterilmiştir. Koroner arter hastalığı (KAH) olan hastalarda gerekli
ileri tanı testlerinden önce CagA pozitif H. pylori enfeksiyonu varlığını
belirlemede kan lenfosit/MPV oranının öncül belirteç olarak ayırt edici
yararlılığını araştırmayı amaçladık.
Gereç ve Yöntem: KAH nedeniyle elektif ve acil koroner anjiyografi
yapılan toplam 293 hasta çalışmaya dahil edildi. Serolojik H. pylori
enfeksiyon durumu ve hematolojik parametreler belirlendi. CagA
seroloji durumuna göre iki grup karşılaştırıldı. Etkin faktörler, eğilim
skoru eşleştirmesi ve çok değişkenli lojistik regresyon analizi ile
ayarlandı
Bulgular: AKS, erkek cinsiyet, diabetes mellitus, ailede KAH öyküsü,
halen sigara kullanımı ve lenfosit/MPV oranı seropozitif hastalarda
seronegatif hastalara göre daha yüksekti (p<0.05). ROC eğrisi analizi,
lenfosit/MPV oranının 165 kestirim noktası için pozitif H. pylori
serolojisi olan hastaları ayırt etmede %71 duyarlılığa ve %60 özgüllüğe
sahip olduğunu göstermiştir (AUC=0.71, p<0.0001). Lenfosit/MPV
oranı bağımsız olarak pozitif H. pylori serolojisi ile ilişkiliydi.
Sonuç: Lenfosit/MPV oranı, CagA pozitif H. pylori açısından İleri
yöntemler ile taranması gereken KAH hastalarını ayırt etmede yardımcı
olabilir.

Anahtar Kelimeler

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

Kaynakça

• 1. Murray LJ, Bamford KB, O'Reilly DP, McCrum EE, Evans AE. Helicobacter pylori infection: relation with cardiovascular risk factors, ischaemic heart disease, and social class. British heart journal. 1995;74(5):497-501.
• 2. Topal F, Karaman K, Akbulut S, Dincer N, Dölek Y, Cosgun Y, et al. The relationship between mean platelet volume levels and the inflammation in Helicobacter pylori gastritis. Journal of the National Medical Association. 2010;102(8):726-30.
• 3. Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut. 2012;61(5):646-64.
• 4. Marietti M, Gasbarrini A, Saracco G, Pellicano R. Helicobacter pylori infection and diabetes mellitus: the 2013 state of art. Panminerva medica. 2013;55(3):277-81.
• 5. Elizalde JI, Pérez-Pujol S, Heras M, Sionis A, Casanovas N, Martorell T, et al. Effects of Helicobacter pylori eradication on platelet activation and disease recurrence in patients with acute coronary syndromes. Helicobacter. 2004;9(6):681-9.
• 6. Sansanayudh N, Anothaisintawee T, Muntham D, McEvoy M, Attia J, Thakkinstian A. Mean platelet volume and coronary artery disease: a systematic review and meta-analysis. International journal of cardiology. 2014;175(3):433-40.
• 7. Borissoff JI, Spronk HM, ten Cate H. The hemostatic system as a modulator of atherosclerosis. The New England journal of medicine. 2011;364(18):1746-60.
• 8. Karttunen TJ, Niemela S, Kerola T. Blood leukocyte differential in Helicobacter pylori infection. Digestive diseases and sciences. 1996;41(7):1332-6.
• 9. Franceschi F, Niccoli G, Ferrante G, Gasbarrini A, Baldi A, Candelli M, et al. CagA antigen of Helicobacter pylori and coronary instability: insight from a clinico-pathological study and a meta-analysis of 4241 cases. Atherosclerosis. 2009;202(2):535-42.
• 10. Ikeda A, Iso H, Sasazuki S, Inoue M, Tsugane S, Group JS. The combination of Helicobacter pylori- and cytotoxin-associated gene-A seropositivity in relation to the risk of myocardial infarction in middle-aged Japanese: The Japan Public Health Center-based study. Atherosclerosis. 2013;230(1):67-72.
• 11. Singla S, Sachdeva R, Uretsky BF. The risk of adverse cardiac and bleeding events following noncardiac surgery relative to antiplatelet therapy in patients with prior percutaneous coronary intervention. Journal of the American College of Cardiology. 2012;60(20):2005-16.
• 12. Farah R, Khamisy-Farah R. Association of neutrophil to lymphocyte ratio with presence and severity of gastritis due to Helicobacter pylori infection. Journal of clinical laboratory analysis. 2014;28(3):219-23.
• 13. Jha HC, Prasad J, Mittal A. High immunoglobulin A seropositivity for combined Chlamydia pneumoniae, Helicobacter pylori infection, and high-sensitivity C-reactive protein in coronary artery disease patients in India can serve as atherosclerotic marker. Heart and vessels. 2008;23(6):390-6. 14. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020-35.
• 15. Matsukura N, Onda M, Tokunaga A, Kato S, Yamashita K, Ohbayashi M. Detection of Helicobacter pylori DNA in gastric juice by the polymerase chain reaction: comparison with findings in bacterial culture and the detection of tissue IgA and serum IgG antibodies against Helicobacter pylori. Journal of gastroenterology. 1995;30(6):689-95.
• 16. Rubin DB. The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials. Statistics in medicine. 2007;26(1):20-36.
• 17. Kowalski M. Helicobacter pylori (H. pylori) infection in coronary artery disease: influence of H. pylori eradication on coronary artery lumen after percutaneous transluminal coronary angioplasty. The detection of H. pylori specific DNA in human coronary atherosclerotic plaque. Journal of physiology and pharmacology : an official journal of the Polish Physiological Society. 2001;52(1 Suppl 1):3-31.
• 18. Haider AW, Wilson PW, Larson MG, Evans JC, Michelson EL, Wolf PA, et al. The association of seropositivity to Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus with risk of cardiovascular disease: a prospective study. Journal of the American College of Cardiology. 2002;40(8):1408-13.
• 19. Strachan DP, Mendall MA, Carrington D, Butland BK, Yarnell JW, Sweetnam PM, et al. Relation of Helicobacter pylori infection to 13-year mortality and incident ischemic heart disease in the caerphilly prospective heart disease study. Circulation. 1998;98(13):1286-90.
• 20. Niccoli G, Franceschi F, Cosentino N, Giupponi B, De Marco G, Merra G, et al. Coronary atherosclerotic burden in patients with infection by CagA-positive strains of Helicobacter pylori. Coronary artery disease. 2010;21(4):217-21.
• 21. Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Journal of the American College of Cardiology. 2010;56(24):2051-66.