Omjer neutrofila i limfocita u bolesnika s reumatoidnim artritisom i sustavnim eritemskim lupusom

master's thesis

• Title (english): Neutrophil to lymphocyte ratio (NLR) in patients with rheumatoid arthritis and systemic lupus erythematosus
• Author: Antica Pasarić
• Mentor: Jadranka Morović-Vergles (mentor)
• Committee member: Branimir Anić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Jadranka Morović-Vergles (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Clinical Immunology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

UVOD: Omjer neutrofila i limfocita (NLR) prepoznat je unatrag nekoliko godina kao mogući marker sustavne upale u mnogim malignim, kardiovaskularnim, autoimunim i drugim bolestima. Prema dosadašnjim istraživanjima NLR pozitivno korelira s aktivnosti bolesti u reumatoidnom artritisu (RA), dok su nalazi o NLR u sustavnom eritemskom lupusu (SLE) kontradiktorni. Koliko nam je poznato, nema istraživanja o promjenama broja neutrofila i limfocita u perifernoj krvi bolesnika s RA i SLE i
njihovom utjecaju na promjenu NLR. ----- CILJ RADA: Istražiti mehanizam promjene NLR u RA i SLE vezan uz aktivnost bolesti. ----- ISPITANICI I METODE: Ispitivanje je povijesno, a ispitanici su bolesnici s RA (n=181) i bolesnici sa SLE (n=146). Bolesnici su podijeljeni u dvije skupine, u remisiji i s aktivnom bolesti, prema iznosu DAS28CRP (granična vrijednost = 2.6) za RA i iznosu SLEDAI (granična vrijednost = 3) za SLE. Bolesnici s RA podijeljeni su i u dvije skupine prema tome jesu li liječeni glukokortikoidima ili nisu. ----- REZULTATI: NLR i broj neutrofila u perifernoj krvi bolesnika s RA pozitivno koreliraju s iznosom DAS28CRP-a (NLR: r=0.254, p<0.001; broj neutofila: r=0.328, p<0.001) i plazmatskom koncentracijom CRP-a (NLR: r=0.716, p<0.001; broj neutrofila: r=0.417, p<0.001), dok se broj limfocita beznačajno mijenja. NLR u bolesnika sa SLE pozitivno, a broj limfocita u perifernoj krvi negativno korelira s iznosom SLEDAI (NLR: r=0.165, p=0.046; broj limfocita: r=-0.173, p=0.037) i plazmatskom koncentracijom CRP-a (NLR: r=0.233, p=0.005; broj limfocita: r=-0.287, p=0.001), dok se broj neutrofila beznačajno mijenja. ----- ZAKLJUČAK: NLR je dobar pokazatelj sustavne upale u RA i SLE, ali dva različita mehanizma dovode do njegove promjene. S porastom upalne aktivnosti NLR u RA postaje veći zbog porasta broja neutrofila uz beznačajne promjene broja limfocita, dok NLR u SLE postaje veći zbog pada broja limfocita uz beznačajne promjene broja neutrofila u perifernoj krvi.

Abstract (english)

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) has in recent years emerged as a potential marker of systemic inflammation in numerous malignant, cardiovascular, autoimmune and other diseases. Previous studies have found positive correlation between NLR and disease activity in RA, while findings in SLE are contradictory. To our knowledge there is no study of the neutrophil and lymphocyte count changes in peripheral blood of patients with RA and SLE and their impact on the NLR. ----- AIM: Examine the mechanisms behind the NLR change in RA and SLE, associated with disease
activity. ----- SUBJECTS AND METHODS: This is a historical study. Subjects are patients with RA (n=181) and patients with SLE (n=146). Patients were divided in two groups, group in remission and group with active disease, with cut-off value of DAS28CRP = 2.6 for RA and SLEDAI = 3 for SLE. Also, patients with RA were divided in two groups according to whether they were treated with glucocorticoids or not. ----- RESULTS: NLR and neutrophil count in peripheral blood of patients with RA are in positive correlation with DAS28CRP (NLR: r=0.254, p<0.001; neutrophil count: r=0.328, p<0.001) and plasma concentration of CRP (NLR: r=0.716, p<0.001; neutrophil count: r=0.417, p<0.001), while change in lymphocyte count is insignificant. In patients with SLE, NLR is in positive, and lymphocyte count in peripheral blood in negative correlation with SLEDAI (NLR: r=0.165, p=0.046; lymphocyte count: r=-0.173, p=0.037) and plasma concentration of CRP (NLR: r=0.233, p=0.005; lymphocyte count: r=-0.287, p=0.001), while change in neutrophil count is insignificant. ----- CONCLUSION: NLR is a good marker of systemic inflammation in RA and SLE, but two different mechanisms are responsible for the change in NLR. In response to increased disease activity, in RA NLR increases due to elevated neutrophil count in peripheral blood with insignificant change in lymphocyte count, while in SLE NLR increases due to elevated lymphocyte count with insignificant change in neutrophil count.

• Keywords: omjer neutrofila i limfocita (NLR); sustavna upala; reumatoidni artritis; sustavni eritemski lupus
• Keywords (english): neutrophil to lymphocyte ratio; systemic inflammation; rheumatoid arthritis; systemic lupus erythematosus
• Language: croatian
• URN:NBN: urn:nbn:hr:105:880582
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-03-15 13:31:45