Öz
Amaç: Çalışmamızda çölyak hastalığı tanılı çocuklarda tedavi öncesi ve sonrası inflamasyon temelli biyobelirteçlerin klinik önemi, tanısal yetenekleri, ilişkileri ve korelasyonlarını araştırmayı amaçladık.
Yöntemler: Bu çalışma, Ocak 2011- Ocak 2023 tarihleri arasında Selçuk Üniversitesi Çocuk Gastroenteroloji bölümünde tanı alan ve takip edilen hasta dosyalarının retrospektif olarak değerlendirilmesi ile gerçekleştirilmiştir. Avrupa Pediatrik Gastroenteroloji, Hepatoloji ve Beslenme topluluğunun kriterlerine göre tanı konulan 202 Çölyak hastası ve 160 sağlıklı kontrol grubu ile çalışma tamamlanmıştır. Hastaların tamamında klinik ve laboratuvar olarak şüphe duyulması halinde bakılan Doku Transglutaminaz Antikor (Anti-TTG) ve Anti Endomisyum (EMA) düzeyi gibi serolojik testlerinde pozitiflik olan ve endoskopik doku örneğinin histopatolojik incelemesinde ÇH ile uyumlu bulgular olma şartı arandı.
Bulgular: Hasta grubunda 122 (%56.7) kız, 80 (%54.4) erkek ve kontrol grubunda ise 93 kız (%43.3), 67 erkek (%45.6) idi. En sık karşılaşılan intestinal başvuru yakınması 49 (%22,3) idi. Hastalara tanı sonrası glutensiz diyet tedavisi başlandı. Hastaların tanı anı, diyet sonrası 6. ay kontrol değerleri ve sağlıklı kontrol hastaların değerleri karşılaştırıldı. Yapılan korelasyon analizinde NLO, RPO, RLO seviyeleri ile yaş, vücut ağırlığı ve boy arasında zayıf pozitif korelasyon tespit edildi. Çölyak hastalarının tanısal ek destek düzeyini değerlendirmek amacı ile Hematolojik biyobelirteçler için ROC eğrisi kullanılmıştır.
Sonuç: Glutensiz diyet sonrası semptomlar gerilemekte ve daha ciddi çölyak ilişkili hasarların gelişmesi önlenebilmektedir. Çölyak hastaların takipte diyet uyumunu belirlemek için birçok inflamatuar durumda kullanılan ve rutin hemogram parametrelerinden elde edilen NLO, RLO, PLO, Sİİ, HRO ve PNİ formüllerinin kullanılabileceğini düşündürmektedir.
Anahtar Kelimeler
Kaynakça
- Ciclitira PJ, King AL, Fraser JS. AGA technical review on Celiac Sprue. American Gastroenterological Association. Gastroenterology 2001; 120: 1526- 1540.
- Reilly NR, Fasano A, Green PH. Presentation of celiac disease. Gastrointest Endosc Clin N Am 2012; 22: 613–621.
- Lionetti E, Catassi C. New clues in celiac disease, epidemiyology, pathogenesis, clinical manifestations and treatment. Int Rev Immunol 2011; 30: 219-31.
- Dalgic B, Sari S, Basturk B, Ensari A, Egritas O, Bukulmez A, Baris Z; Turkish Celiac Study Group. Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol 2011; 106: 1512-7
- Al-Bawardy B, Codipilly DC, Rubio-Tapia A, Bruining DH, Hansel SL, Murray JA. Celiac disease: a clinical review. Abdom Radiol. 2017;42(2):351-360.
- Polanco I. Celiac disease. J Pediatr Gastroenterol Nutr 2008; 47: 283-7.
- Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999;11:1185–94.
- Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disaese. Gastroenterology 1999; 117: 297-303.
- Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: Diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108(5):656-676.
- Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Canc Res 2014;20:6212–22.
- Agus HZ, Kahraman S, Arslan C, Yildirim C, Erturk M, Kalkan AK, et al. Systemic immune-inflammation index predicts mortality in infective endocarditis. J Saudi Heart Assoc 2020;32: 58–64.
- Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C, et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. Journal of pediatric gastroenterology and nutrition. 2020;70(1):141-56.
- Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, et al. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. Journal of clinical research in pediatric endocrinology. 2015;7(4):280-93.
- Ludvigsson JF, Leffler DA, Bai JC. The Oslo definitions for coeliac disease and related terms. Gut 2013; 62: 43–52.
- Cataldo F, Marino V. Increased prevalence of autoimmune diseases in first degree relatives of patients with celiac disease. J Pediatr Gastroenterol Nutr 2003; 36: 470-3
- Margaritte-Jeannin P, Babron MC, Bourgey M, Louka AS, Clot F, Percopo S, et al. HLA-DQ relative risks for coeliac disease in European populations: A study of the European Genetics Cluster on Coeliac Disease. Tissue Antigens 2004; 63: 562-7
- Macdonald S (Editor). Gastroenterology. In: Shaw V, Lawson M. Clinical Paediatric Dietetics. 3rd ed. Oxford: Blackwell Publishing 2007: p. 100-3
- Wetterholm E, Linders J, Merza M, Regner S, Thorlacius H. Platelet-derived CXCL4 regulates neutrophil infiltration and tissue damage in severe acute pancreatitis. Transl Res 2016;176: 105–18.
- Kral JB, Schrottmaier WC, Salzmann M, Assinger A. Platelet interaction with innate immune cells. Transfus Med Hemotherapy 2016;43:78–88.
- Abdel SM, Edrees AM, Ajeeb AK, et al. Prognostic significance of platelet count in SLE patients. Platelets 2017;28:203-7.
- Forget P, Khalifa C, Defour JP, et al. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 2017 Jan 3;10(1):12.
- Lood C, Tydén H, Gullstrand B, et al. Decreased platelet size is associated with platelet activation and anti-phospholipid syndrome in systemic lupus erythematosus. Rheumatol Oxf Engl 2017;56:408-16.
- Uslu AU, Korkmaz S, Yonem O, Aydin B, Uncu T, Sekerci A, et al. Is there a link between neutrophil-lymphocyte ratio and patient compliance with gluten free diet in celiac disease? Gülhane Tip Dergisi 2016;58(4):353.
- Palmacci F, Toti E, Raguzzini A, Catasta G, Aiello P, Peluso I, et al. Neutrophil-to-Lymphocyte ratio, Mediterranean diet, and bone health in coeliac disease patients: a pilot study. Oxid Med Cell Longev 2019;2019:7384193.
- Sarikaya M, Dogan Z, Ergul B, Filik L. Neutrophil-to-lymphocyte ratio as a sensitive marker in diagnosis of celiac disease. Annals of gastroenterology. 2014;27(4):431-2.
- Karacaer C, Havva S, Tozlu M. Çölyak hastalarında glutensiz diyete uyumun öngörülmesinde nötrofil-lenfosit oranının önemi. akademik gastroenteroloji dergisi 2020;19(3):150-5.
- O’Grady JG, Harding B, Stevens FM, Egan EL, McCarthy CF. Influence of splenectomy and the functional hyposplenism of coeliac disease on platelet count and volume. Scand J Haematol 1985; 34: 425-8.
- Purnak T, Efe C, Yuksel O, Beyazit Y, Ozaslan E, Altiparmak E. Mean platelet volume could be a promising biomarker to monitor dietary compliance in celiac disease. Ups J Med Sci 2011; 116: 208-11.
- Demirezer Bolat A, Köseoğlu H, Akın FE, Yürekli ÖT, Tahtacı M, Başaran M, et al. Can serum mean platelet volume be used as an inflammatory marker in patients with celiac disease? The Turkish Journal of Academic Gastroenterology 2018; 17: 62-5.
- Balaban DV, Popp A, Beata A, Vasilescu F, Jinga M. Diagnostic accuracy of red blood cell distribution width-to-lymphocyte ratio for celiac disease. Rev Română de Medicină de Lab 2018; 26; 45-50.
Öz
Aim: In the present study, the purpose was to investigate the clinical significance, diagnostic capabilities, relationships, and correlations of inflammation-based biomarkers before and after treatment in children with Celiac Disease.
Methods: The study was conducted by retrospectively evaluating the files of patients who were diagnosed and followed up in the Department of Pediatric Gastroenterology of Selçuk University between January 2011 and January 2023. The study was completed with 202 Celiac Disease patients who were diagnosed according to the criteria of the European Pediatric Gastroenterology, Hepatology, and Nutrition Community and 160 healthy follow-ups. In case of clinical or laboratory suspicion, serological tests such as positive Tissue Transglutaminase Antibody and Anti-Endomysium values and the histopathological examination of the endoscopic tissue sample findings consistent with Celiac Disease were evaluated.
Results: There were 122 (56.7%) girls and 80 (54.4%) boys in the patient group and 93 (43.3%) girls and 67 (45.6%) boys in the control group. The most common intestinal complaint was abdominal pain in 49 (22.3%) patients. Gluten-free diet treatment was started after the diagnosis. The values of the patients at the time of diagnosis, in the 6th month after the diet, and the values of healthy control patients were compared. A weak and positive correlation was found between NLR, RPO, RLO levels, and age, body weight, and height in the correlation analysis. The ROC curve for hematological biomarkers was used to evaluate the level of additional diagnostic support in Celiac Disease patients.
Conclusion: After a gluten-free diet, symptoms regress, and the development of more serious celiac-related damage can be prevented. This suggests that NLR, RLR, PLO, SII, HRO, and PNI formulas, which are used in many inflammatory conditions and obtained from routine hemogram parameters, can be used to determine dietary compliance in Celiac Disease patients during their follow-ups.
Anahtar Kelimeler
Kaynakça
- Ciclitira PJ, King AL, Fraser JS. AGA technical review on Celiac Sprue. American Gastroenterological Association. Gastroenterology 2001; 120: 1526- 1540.
- Reilly NR, Fasano A, Green PH. Presentation of celiac disease. Gastrointest Endosc Clin N Am 2012; 22: 613–621.
- Lionetti E, Catassi C. New clues in celiac disease, epidemiyology, pathogenesis, clinical manifestations and treatment. Int Rev Immunol 2011; 30: 219-31.
- Dalgic B, Sari S, Basturk B, Ensari A, Egritas O, Bukulmez A, Baris Z; Turkish Celiac Study Group. Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol 2011; 106: 1512-7
- Al-Bawardy B, Codipilly DC, Rubio-Tapia A, Bruining DH, Hansel SL, Murray JA. Celiac disease: a clinical review. Abdom Radiol. 2017;42(2):351-360.
- Polanco I. Celiac disease. J Pediatr Gastroenterol Nutr 2008; 47: 283-7.
- Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999;11:1185–94.
- Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disaese. Gastroenterology 1999; 117: 297-303.
- Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: Diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108(5):656-676.
- Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Canc Res 2014;20:6212–22.
- Agus HZ, Kahraman S, Arslan C, Yildirim C, Erturk M, Kalkan AK, et al. Systemic immune-inflammation index predicts mortality in infective endocarditis. J Saudi Heart Assoc 2020;32: 58–64.
- Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C, et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. Journal of pediatric gastroenterology and nutrition. 2020;70(1):141-56.
- Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, et al. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. Journal of clinical research in pediatric endocrinology. 2015;7(4):280-93.
- Ludvigsson JF, Leffler DA, Bai JC. The Oslo definitions for coeliac disease and related terms. Gut 2013; 62: 43–52.
- Cataldo F, Marino V. Increased prevalence of autoimmune diseases in first degree relatives of patients with celiac disease. J Pediatr Gastroenterol Nutr 2003; 36: 470-3
- Margaritte-Jeannin P, Babron MC, Bourgey M, Louka AS, Clot F, Percopo S, et al. HLA-DQ relative risks for coeliac disease in European populations: A study of the European Genetics Cluster on Coeliac Disease. Tissue Antigens 2004; 63: 562-7
- Macdonald S (Editor). Gastroenterology. In: Shaw V, Lawson M. Clinical Paediatric Dietetics. 3rd ed. Oxford: Blackwell Publishing 2007: p. 100-3
- Wetterholm E, Linders J, Merza M, Regner S, Thorlacius H. Platelet-derived CXCL4 regulates neutrophil infiltration and tissue damage in severe acute pancreatitis. Transl Res 2016;176: 105–18.
- Kral JB, Schrottmaier WC, Salzmann M, Assinger A. Platelet interaction with innate immune cells. Transfus Med Hemotherapy 2016;43:78–88.
- Abdel SM, Edrees AM, Ajeeb AK, et al. Prognostic significance of platelet count in SLE patients. Platelets 2017;28:203-7.
- Forget P, Khalifa C, Defour JP, et al. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 2017 Jan 3;10(1):12.
- Lood C, Tydén H, Gullstrand B, et al. Decreased platelet size is associated with platelet activation and anti-phospholipid syndrome in systemic lupus erythematosus. Rheumatol Oxf Engl 2017;56:408-16.
- Uslu AU, Korkmaz S, Yonem O, Aydin B, Uncu T, Sekerci A, et al. Is there a link between neutrophil-lymphocyte ratio and patient compliance with gluten free diet in celiac disease? Gülhane Tip Dergisi 2016;58(4):353.
- Palmacci F, Toti E, Raguzzini A, Catasta G, Aiello P, Peluso I, et al. Neutrophil-to-Lymphocyte ratio, Mediterranean diet, and bone health in coeliac disease patients: a pilot study. Oxid Med Cell Longev 2019;2019:7384193.
- Sarikaya M, Dogan Z, Ergul B, Filik L. Neutrophil-to-lymphocyte ratio as a sensitive marker in diagnosis of celiac disease. Annals of gastroenterology. 2014;27(4):431-2.
- Karacaer C, Havva S, Tozlu M. Çölyak hastalarında glutensiz diyete uyumun öngörülmesinde nötrofil-lenfosit oranının önemi. akademik gastroenteroloji dergisi 2020;19(3):150-5.
- O’Grady JG, Harding B, Stevens FM, Egan EL, McCarthy CF. Influence of splenectomy and the functional hyposplenism of coeliac disease on platelet count and volume. Scand J Haematol 1985; 34: 425-8.
- Purnak T, Efe C, Yuksel O, Beyazit Y, Ozaslan E, Altiparmak E. Mean platelet volume could be a promising biomarker to monitor dietary compliance in celiac disease. Ups J Med Sci 2011; 116: 208-11.
- Demirezer Bolat A, Köseoğlu H, Akın FE, Yürekli ÖT, Tahtacı M, Başaran M, et al. Can serum mean platelet volume be used as an inflammatory marker in patients with celiac disease? The Turkish Journal of Academic Gastroenterology 2018; 17: 62-5.
- Balaban DV, Popp A, Beata A, Vasilescu F, Jinga M. Diagnostic accuracy of red blood cell distribution width-to-lymphocyte ratio for celiac disease. Rev Română de Medicină de Lab 2018; 26; 45-50.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Gastroenteroloji ve Hepatoloji |
| Bölüm | Original Article |
| Yazarlar | |
| Erken Görünüm Tarihi | 23 Ekim 2023 |
| Yayımlanma Tarihi | 25 Ekim 2023 |
| Gönderilme Tarihi | 9 Haziran 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 33 Sayı: 5 |
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