溃疡性结肠炎患者疾病活动的新趋势

Tahir Buran, Sanem Gökçen Merve Kılınç, Mustafa Sahin
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引用次数: 0

摘要

背景/目的:溃疡性结肠炎(UC)的严重程度和范围可指导我们确定每个病例的治疗方法。有文献认为,中性粒细胞-淋巴细胞和血小板-淋巴细胞的高比率可作为活动性溃疡性结肠炎的标志物。本研究回顾性分析了中性粒细胞-淋巴细胞比率和血小板-淋巴细胞比率与临床活动指数和内镜活动指数之间的关系,以预测溃疡性结肠炎患者的疾病严重程度。关于血小板-淋巴细胞比值(PLR)与溃疡性结肠炎疾病活动性之间关系的文献研究很少。这项研究有助于对这些患者的随访和预后进行研究,因为在我国和世界范围内都缺乏对确诊为溃疡性结肠炎患者的血小板/淋巴细胞比值的回顾性研究:本研究是一项基于人群的单中心病例对照研究。方法:本研究是一项基于人群的单中心病例对照研究,通过回顾性分析医院信息系统中记录的 2014 年 1 月至 2021 年 12 月期间塞拉勒巴亚尔大学医学院消化内科对溃疡性结肠炎患者进行常规诊断和治疗的数据。研究共纳入 135 名溃疡性结肠炎患者。根据临床活动指数和内镜活动指数,将患者分为两组:活动期和缓解期。在对溃疡性结肠炎患者进行常规随访时,检查了红细胞沉降率(ESR)、C反应蛋白(CRP)、血红蛋白(Hb)、白细胞(WBC)、中性粒细胞-淋巴细胞比值(NLR)和血小板-淋巴细胞比值(PLR)水平。结果:结果:113 名溃疡性结肠炎缓解期患者在就诊时的化验值与治疗三个月后的化验值进行了比较:NLR(5.529(3.485)和4.374(2.335),[P<0.001])、红细胞沉降率(26.81(20.42)和21.78(19.32),[P=0.015])、C反应蛋白(4.087(6.729)和 1.696(3.525),[P<0.001])以及白细胞计数(9,864(3,514)和 8,067(1,927),[P<0.001])均低于基线值。正如预期的那样,缓解期患者的炎症指标有所下降。在一组 22 名活动期患者中,将发病时的数值与治疗第三个月时的数值进行比较:发现中性粒细胞计数(8 508(2 908)和 9 646(3 265),[P=0.037])和血小板计数(289 591(95 123)和 323 364(127 647),[P=0.010])偏高。同样,血沉(19.63(15.43)和 27.89(21.11),[P=0.036])也偏高。与入院时相比,这些数值在疾病活动期更高:在我们的研究中,活动性溃疡性结肠炎患者的中性粒细胞-淋巴细胞比率和血小板-淋巴细胞比率明显较高。溃疡性结肠炎患者在确诊时和疾病早期的炎症标志物水平有助于预测疾病的进程,这与临床、内窥镜和实验室指标有关。这些炎症指标可以单独或联合预测疾病的活动性。然而,由于患者人数不足,无法计算出阈值,因此需要进行更全面的前瞻性研究。
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New trends associated with disease activity in patients with ulcerative colitis
Background/Aim: The severity and extent of ulcerative colitis (UC) guide us in determining the treatment method for each case. It has been suggested in the literature that high neutrophil-lymphocyte and platelet-lymphocyte ratios can serve as markers of active ulcerative colitis. This study retrospectively analyzes the relationship between neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with clinical activity indices and endoscopic activity indices in predicting disease severity in patients with ulcerative colitis. There are few studies in the literature regarding the relationship between platelet-lymphocyte ratio (PLR) and disease activation in ulcerative colitis. This study contributes to the follow-up and outcomes of these patients, as there is a lack of sufficient retrospective studies on the platelet/lymphocyte ratio in patients diagnosed with UC in our country and worldwide. Methods: This study is a population-based, single-center, case-controlled study. It was conducted by retrospectively analyzing the hospital information system for data recorded during the routine diagnosis and treatment of ulcerative colitis patients followed and treated at Celal Bayar University Medical Faculty Gastroenterology Division between January 2014 and December 2021. A total of 135 patients with ulcerative colitis were included in the study. The patients were divided into 2 groups, active disease and disease in remission, based on clinical activity indices and endoscopic activity indices. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin (Hb), white blood cell (WBC), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) levels were checked during routine follow-up of patients with ulcerative colitis. These values were recorded at the first presentation to the hospital and 3 months after treatment. Results: Laboratory values at presentation were compared with those at the third month of treatment in a group of 113 patients with UC in remission: NLR (5.529 (3.485) and 4.374 (2.335), [P<0.001]), erythrocyte sedimentation rate (26.81 (20.42) and 21.78 (19.32), [P=0.015]), C-reactive protein (4.087 (6.729) and 1.696 (3.525), [P<0.001]), and white blood cell count (9,864 (3,514) and 8,067 (1,927), [P<0.001]) were found to be lower than the baseline values. As expected, decreases in inflammatory markers were observed in patients in remission. In a group of 22 patients with active disease, values at presentation were compared with those at the third month of treatment: neutrophil count (8,508 (2,908) and 9,646 (3,265), [P=0.037]) and platelet count (289,591 (95,123) and 323,364 (127,647), [P=0.010]) were found to be high. Similarly, ESR (19.63 (15.43) and 27.89 (21.11), [P=0.036]) was found to be high. These values were higher in active disease compared to the time of admission. Conclusion: In our study, neutrophil-lymphocyte ratios and platelet-lymphocyte ratios were significantly higher in patients with active ulcerative colitis. The level of inflammatory markers in ulcerative colitis patients at the time of diagnosis and in the early stages of the disease is helpful in predicting the course of the disease, and this was shown to be related to clinical, endoscopic, and laboratory indices. These inflammatory markers can predict disease activity alone or in combination. However, a threshold value could not be calculated due to the insufficient number of patients, and thus, more comprehensive prospective studies are needed.
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