İdiopatik Pulmoner Fibroz ve Kronik Hipersensitivite Ayırıcı Tanısında Nötrofil-Lenfosit ve Platelet-Lenfosit Oranının Rolü
Öz
Amaç
İdiyopatik pulmoner fibrozis (IPF) ve kronik hipersensitivite pnömonisi (CHP), klinik ve radyolojik olarak benzer özellikler gösteren interstisyel akciğer hastalıklarıdır ve ayırıcı tanıları zorludur. Nötrofil-lenfosit oranı (NLR) ve trombosit-lenfosit oranı (PLR) gibi inflamatuar biyobelirteçler, çeşitli hastalıklarda araştırılmıştır. Bu çalışmanın amacı, NLR ve PLR’nin IPF ile CHP'yi ayırt etmedeki rolünü değerlendirmektir.
Gereç ve Yöntemler
Bu retrospektif çalışma, Ocak 2013 ile Aralık 2018 tarihleri arasında üçüncü basamak bir göğüs hastalıkları hastanesinde multidisipliner tartışma ile IPF ve CHP tanısı alan hastaları içermektedir. Hastaların tanı anında alınan kan örneklerinden nötrofil-lenfosit ve trombosit-lenfosit oranları hesaplandı. Hastane kayıtlarından demografik özellikler, laboratuvar parametreleri ve ek hastalıklar analiz edildi. Çalışma grupları ile sağlıklı kontrol grubu arasındaki NLR ve PLR değerlerini karşılaştırmak için istatistiksel analizler yapıldı.
Sonuç
Çalışmamızda hem IPF hem de CHP gruplarında NLR değerlerinin sağlıklı kontrol grubuna kıyasla anlamlı derecede yüksek olduğu gözlemlendi. Ancak, IPF ve CHP grupları arasında istatistiksel olarak anlamlı bir fark bulunamadı. Bu durum, NLR ve PLR’nin bu iki hastalığın ayırıcı tanısında güvenilir biyobelirteçler olmayabileceğini göstermektedir. IPF ve CHP’nin ayırıcı tanısı için alternatif biyobelirteçleri araştıran ileri çalışmalara ihtiyaç duyulmaktadır.
Anahtar Kelimeler
İdiyopatik pulmoner fibrozis, kronik hipersensitivite pnömonisi, nötrofil-lenfosit oranı, trombosit-lenfosit oranı, inflamatuar biyobelirteçler
Anahtar Kelimeler
İdiyopatik pulmoner fibrozis kronik hipersensitivite pnömonisi nötrofil-lenfosit oranı trombosit-lenfosit oranı inflamatuar biyobelirteçler
Kaynakça
- 1.Travis WD, Costabel U, Hansell DM, King TE,Lynch DA, Nicholson AG, et al. An officialAmerican Thoracic Society/EuropeanRespiratory Society statement: Update of theinternational multidisciplinary classification ofthe idiopathic interstitial pneumonias. Am JRespir Crit Care Med. 2013;188:733–48.
- 2.Raghu G, Remy-Jardin M, Myers JL, RicheldiL, Ryerson CJ, Lederer DJ, et al. Diagnosis ofidiopathic pulmonary fibrosis An OfficialATS/ERS/JRS/ALAT Clinical practiceguideline. Am J Respir Crit Care Med.2018;198:e44–68.
- 3.Raghu G, Wilson KC, Bargagli E, Bendstrup E,Chami HA, Chua AT, et al. Diagnosis ofhypersensitivity pneumonitis in adults: Anofficial ATS/JRS/ALAT clinical practiceguideline. Am J Respir Crit Care Med.2020;202:36–69.
- 4.Arai T, Takimoto T, Takeuchi N, Minomo S,Kagawa T, Inoue Y. Neutrophil-to-lymphocyteratio in acute exacerbation of idiopathicpulmonary fibrosis. J Clin Med. 2023;12:7446.
- 5.Liu J, Ao W, Zhou J, Luo P, Wang Q, Xiang D.The correlation between PLR-NLR andprognosis in acute myocardial infarction. Am JTransl Res. 2021;13:4892-99.
- 6.Bozan N, Alpaycı M, Aslan M, Cankaya H,Kıroglu AF, Turan M, et al. Mean plateletvolume, red cell distribution width, platelet-to-lymphocyte and neutrophil-to-lymphocyteratios in patients with ankylosing spondylitisand their relationships with high-frequencyhearing thresholds. Eur Arch Otorhinolaryngol.2016;273:3663-72.
- 7.Jiang Y, Zang M, Li S. Serum PLR and LMRin Behçet's disease: can they show the diseaseactivity? Medicine (Baltimore).2017;96:e6981.
- 8.Wu Y, Chen Y, Yang X, Chen L, Yang Y.International immunopharmacologyneutrophil-to-lymphocyte ratio (NLR) andplatelet-to-lymphocyte ratio (PLR) wereassociated with disease activity in patients withsystemic lupus erythematosus. IntImmunopharmacol. 2016;36:94–9.
- 9.Gasparyan AY, Ayvazyan L, Mukanova U,Yessirkepov M, Kitas GD. The platelet-to-lymphocyte ratio as an inflammatory marker inrheumatic diseases. Ann Lab Med.2019;39:345-57.
- 10.Huang Z, Fu Z, Huang W, Huang K. Prognosticvalue of neutrophil-to-lymphocyte ratio insepsis: a meta-analysis. Am J Emerg Med.2020;38:641-47
- 11.Templeton AJ, Mcnamara MG, Šeruga B, Vera-badillo FE, Aneja P, Ocaña A, et al. Prognosticrole of neutrophil-to-lymphocyte ratio in solidtumors : a systematic review and meta-analysis.J Natl Cancer Inst. 2014;106:dju124.
- 12.Diem S, Schmid S, Krapf M, Flatz L, Born D,Jochum W, et al. Lung cancer neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic markersin patients with non-small cell lung cancer(NSCLC) treated with nivolumab. LungCancer. 2017;111:176–81.
- 13.Köse N, Yıldırım T, Akın F, Yıldırım SE, Altunİ. Prognostic role of NLR, PLR and LMR inpatients with pulmonary embolism. Bosn JBasic Med Sci. 2020;20:248-53.
- 14.Wang O, Ma J, Jiang Z, Ming L. Prognosticvalue of neutrophil-to-lymphocyte ratio andplatelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol. 2018;37:4-11.
- 15.El-Gazzar AG, Kamel MH, Elbahnasy OKM,El-Naggar ME. Prognostic value of platelet andneutrophil to lymphocyte ratio in COPDpatients. Expert Rev Respir Med.2020;14):111-16.
- 16.Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, BagciBA, Caglar E. Value of neutrophil/lymphocyteratio in the differential diagnosis of sarcoidosisand tuberculosis. Ann Thorac Med.2014;9:232-5.
- 17.Jeon Y, Lee WI, Kang SY, Kim MH.Neutrophil-to-monocyte-plus-lymphocyte ratioas a potential marker for discriminatingpulmonary tuberculosis from nontuberculosisinfectious lung diseases. Lab Med.2019;50:286-91.
- 18.Yang AP, Liu JP, Tao WQ, Li HM. Thediagnostic and predictive role of NLR, d-NLRand PLR in COVID-19 patients. IntImmunopharmacol. 2020;84:106504.
- 19.Forget P, Khalifa C, Defour JP, Latinne D, VanPel MC, De Kock M. What is the normal valueof the neutrophil-to-lymphocyte ratio? BMCRes Notes. 2017;10:1–4.
- 20.Moosazadeh M, Maleki I, Alizadeh-Navaei R,Kheradmand M, Hedayatizadeh-Omran A,Shamshirian A, et al. Normal values ofneutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratioamong Iranian population: results of Tabaricohort. Casp J Intern Med. 2019;10:320–5.
- 21.Zinellu A, Paliogiannis P, Sotgiu E, Mellino S,Mangoni AA, Zinellu E, et al. Blood cell countderived inflammation indexes in patients withidiopathic pulmonary fibrosis. Lung.2020;198:821–7.
- 22.Nathan SD, Mehta J, Stauffer J, Morgenthien E,Yang M, Limb SL, et al. Changes in neutrophil–lymphocyte or platelet–lymphocyte ratios andtheir associations with clinical outcomes inidiopathic pulmonary fibrosis. J Clin Med.2021;10:1427.
- 23.Ruta VM, Man AM, Alexescu TG, Motoc NS,Tarmure S, Ungur RA, et al. Neutrophil-to-lymphocyte ratio and systemic immune-inflammation index—biomarkers in interstitial lung disease. Med. 2020;56:1–9.
- 24.Fernandez IE, Eickelberg O. New cellular andmolecular mechanisms of lung injury andfibrosis in idiopathic pulmonary fibrosis.Lancet. 2012;380:680–8.
- 25.Nathan SD, Brown AW, Mogulkoc N, SoaresF, Collins AC, Cheng J, et al. The associationbetween white blood cell count and outcomes inpatients with idiopathic pulmonary fibrosis.Respir Med. 2020;170:106068.
- 26.Kolahian S, Fernandez IE, Eickelberg O, HartlD.Immune mechanisms in pulmonary fibrosis.Am J Respir Cell Mol Biol. 2016;55:309–22.
- 27.Zinellu A, Collu C, Nasser M, Paliogiannis P,Mellino S, Zinellu E, et al. The aggregate indexof systemic inflammation (AISI): a novelprognostic biomarker in idiopathic pulmonaryfibrosis. J Clin Med. 2021;10:4134.
- 28.Üçsular F, Polat G, Karadeniz G, Ayrancı A,Keskin M, Büyükşirin M, et al. Predictive valueof platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients withhypersensitivity pneumonia. Vasc Diffus LungDis. 2020;37:1–7.
- 29.Sugiyama Y, Kasahara T, Mukaida N,Matsushima K, Kitamura S. Chemokines inbronchoalveolar lavage fluid in summer-typehypersensitivity pneumonitis. Eur Respir J.1995;8:1084-90.
- 30.Inoue Y, Ishizuka M, Furusawa H, Honda T,Kawahara T, Tateishi T, Miyazaki Y. Acuteinflammatory and immunologic responsesagainst antigen in chronic bird-relatedhypersensitivity pneumonitis. Allergol Int.2019l;68:321-28.
- 31.Denis M. Proinflammatory cytokines inhypersensitivity pneumonitis. Am J Respir CritCare Med. 1995;51:164-9.
- 32.Ishizuka M, Miyazaki Y, Tateishi T, Tsutsui T,Tsuchiya K, Inase N. Validation of inhalationprovocation test in chronic bird-relatedhypersensitivity pneumonitis and newprediction score. Ann Am Thorac Soc.2015;12:167-73.
- 33.Nathan SD, Reffett T, Brown AW, Fischer CP,Shlobin OA, Ahmad S, et al. The red celldistribution width as a prognostic indicator inidiopathic pulmonary fibrosis. Chest.2013;143:1692–8.
- 34.Gürün Kaya A, Özyürek BA, Şahin ÖzdemirelT, Öz M, Erdoǧan Y. Prognostic significance ofred cell distribution width in idiopathicpulmonary fibrosis and combined pulmonary fibrosis emphysema. Med Princ Pract. 2021;30:154–9.
- 35.Achaiah A, Yadav R, Jacob J, Chaudhuri N.Blood leucocyte indices in idiopathicpulmonary fibrosis and fibrotic hypersensitivitypneumonitis. BMJ Open Resp Res.2022;9:e001202.
The Role of Neutrophile-Lymphocyte and Platelet- Lymphocyte Ratios in the Differential Diagnosis of Idiopathic Pulmonary Fibrosis and Chronic Hypersensitivity Pneumonia
Öz
Abstract
Aim
Idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis (CHP) are interstitial lung diseases with overlapping clinical and radiological features, making differential diagnosis challenging. Inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been investigated in various diseases. This study aims to evaluate the role of NLR and PLR in distinguishing IPF from CHP.
Materials and Methods
This retrospective study included patients diagnosed with IPF and CHP based on multidisciplinary discussion between January 2013 and December 2018 at a tertiary chest diseases hospital. The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were calculated from blood samples obtained at the time of diagnosis. Demographic characteristics, laboratory parameters, and comorbidities were extracted from hospital records. Statistical analyses were performed to compare NLR and PLR values between the study groups and a healthy control group.
Conclusion
Our results indicate that NLR values were significantly higher in both IPF and CHP groups compared to the healthy control group. However, there was no statistically significant difference between IPF and CHP groups, suggesting that NLR and PLR are not reliable markers for differentiating these diseases. Further studies are needed to explore alternative biomarkers for the differential diagnosis of IPF and CHP.
Keywords
Idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonitis, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, inflammatory biomarkers
Anahtar Kelimeler
Idiopathic pulmonary fibrosis chronic hypersensitivity pneumonitis neutrophil-to-lymphocyte ratio platelet-to-lymphocyte ratio inflammatory biomarkers
Etik Beyan
The study was conducted in accordance with ethical principles and received ethical approval. Details are provided in the methodology section.
Destekleyen Kurum
None
Teşekkür
None
Kaynakça
- 1.Travis WD, Costabel U, Hansell DM, King TE,Lynch DA, Nicholson AG, et al. An officialAmerican Thoracic Society/EuropeanRespiratory Society statement: Update of theinternational multidisciplinary classification ofthe idiopathic interstitial pneumonias. Am JRespir Crit Care Med. 2013;188:733–48.
- 2.Raghu G, Remy-Jardin M, Myers JL, RicheldiL, Ryerson CJ, Lederer DJ, et al. Diagnosis ofidiopathic pulmonary fibrosis An OfficialATS/ERS/JRS/ALAT Clinical practiceguideline. Am J Respir Crit Care Med.2018;198:e44–68.
- 3.Raghu G, Wilson KC, Bargagli E, Bendstrup E,Chami HA, Chua AT, et al. Diagnosis ofhypersensitivity pneumonitis in adults: Anofficial ATS/JRS/ALAT clinical practiceguideline. Am J Respir Crit Care Med.2020;202:36–69.
- 4.Arai T, Takimoto T, Takeuchi N, Minomo S,Kagawa T, Inoue Y. Neutrophil-to-lymphocyteratio in acute exacerbation of idiopathicpulmonary fibrosis. J Clin Med. 2023;12:7446.
- 5.Liu J, Ao W, Zhou J, Luo P, Wang Q, Xiang D.The correlation between PLR-NLR andprognosis in acute myocardial infarction. Am JTransl Res. 2021;13:4892-99.
- 6.Bozan N, Alpaycı M, Aslan M, Cankaya H,Kıroglu AF, Turan M, et al. Mean plateletvolume, red cell distribution width, platelet-to-lymphocyte and neutrophil-to-lymphocyteratios in patients with ankylosing spondylitisand their relationships with high-frequencyhearing thresholds. Eur Arch Otorhinolaryngol.2016;273:3663-72.
- 7.Jiang Y, Zang M, Li S. Serum PLR and LMRin Behçet's disease: can they show the diseaseactivity? Medicine (Baltimore).2017;96:e6981.
- 8.Wu Y, Chen Y, Yang X, Chen L, Yang Y.International immunopharmacologyneutrophil-to-lymphocyte ratio (NLR) andplatelet-to-lymphocyte ratio (PLR) wereassociated with disease activity in patients withsystemic lupus erythematosus. IntImmunopharmacol. 2016;36:94–9.
- 9.Gasparyan AY, Ayvazyan L, Mukanova U,Yessirkepov M, Kitas GD. The platelet-to-lymphocyte ratio as an inflammatory marker inrheumatic diseases. Ann Lab Med.2019;39:345-57.
- 10.Huang Z, Fu Z, Huang W, Huang K. Prognosticvalue of neutrophil-to-lymphocyte ratio insepsis: a meta-analysis. Am J Emerg Med.2020;38:641-47
- 11.Templeton AJ, Mcnamara MG, Šeruga B, Vera-badillo FE, Aneja P, Ocaña A, et al. Prognosticrole of neutrophil-to-lymphocyte ratio in solidtumors : a systematic review and meta-analysis.J Natl Cancer Inst. 2014;106:dju124.
- 12.Diem S, Schmid S, Krapf M, Flatz L, Born D,Jochum W, et al. Lung cancer neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic markersin patients with non-small cell lung cancer(NSCLC) treated with nivolumab. LungCancer. 2017;111:176–81.
- 13.Köse N, Yıldırım T, Akın F, Yıldırım SE, Altunİ. Prognostic role of NLR, PLR and LMR inpatients with pulmonary embolism. Bosn JBasic Med Sci. 2020;20:248-53.
- 14.Wang O, Ma J, Jiang Z, Ming L. Prognosticvalue of neutrophil-to-lymphocyte ratio andplatelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol. 2018;37:4-11.
- 15.El-Gazzar AG, Kamel MH, Elbahnasy OKM,El-Naggar ME. Prognostic value of platelet andneutrophil to lymphocyte ratio in COPDpatients. Expert Rev Respir Med.2020;14):111-16.
- 16.Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, BagciBA, Caglar E. Value of neutrophil/lymphocyteratio in the differential diagnosis of sarcoidosisand tuberculosis. Ann Thorac Med.2014;9:232-5.
- 17.Jeon Y, Lee WI, Kang SY, Kim MH.Neutrophil-to-monocyte-plus-lymphocyte ratioas a potential marker for discriminatingpulmonary tuberculosis from nontuberculosisinfectious lung diseases. Lab Med.2019;50:286-91.
- 18.Yang AP, Liu JP, Tao WQ, Li HM. Thediagnostic and predictive role of NLR, d-NLRand PLR in COVID-19 patients. IntImmunopharmacol. 2020;84:106504.
- 19.Forget P, Khalifa C, Defour JP, Latinne D, VanPel MC, De Kock M. What is the normal valueof the neutrophil-to-lymphocyte ratio? BMCRes Notes. 2017;10:1–4.
- 20.Moosazadeh M, Maleki I, Alizadeh-Navaei R,Kheradmand M, Hedayatizadeh-Omran A,Shamshirian A, et al. Normal values ofneutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratioamong Iranian population: results of Tabaricohort. Casp J Intern Med. 2019;10:320–5.
- 21.Zinellu A, Paliogiannis P, Sotgiu E, Mellino S,Mangoni AA, Zinellu E, et al. Blood cell countderived inflammation indexes in patients withidiopathic pulmonary fibrosis. Lung.2020;198:821–7.
- 22.Nathan SD, Mehta J, Stauffer J, Morgenthien E,Yang M, Limb SL, et al. Changes in neutrophil–lymphocyte or platelet–lymphocyte ratios andtheir associations with clinical outcomes inidiopathic pulmonary fibrosis. J Clin Med.2021;10:1427.
- 23.Ruta VM, Man AM, Alexescu TG, Motoc NS,Tarmure S, Ungur RA, et al. Neutrophil-to-lymphocyte ratio and systemic immune-inflammation index—biomarkers in interstitial lung disease. Med. 2020;56:1–9.
- 24.Fernandez IE, Eickelberg O. New cellular andmolecular mechanisms of lung injury andfibrosis in idiopathic pulmonary fibrosis.Lancet. 2012;380:680–8.
- 25.Nathan SD, Brown AW, Mogulkoc N, SoaresF, Collins AC, Cheng J, et al. The associationbetween white blood cell count and outcomes inpatients with idiopathic pulmonary fibrosis.Respir Med. 2020;170:106068.
- 26.Kolahian S, Fernandez IE, Eickelberg O, HartlD.Immune mechanisms in pulmonary fibrosis.Am J Respir Cell Mol Biol. 2016;55:309–22.
- 27.Zinellu A, Collu C, Nasser M, Paliogiannis P,Mellino S, Zinellu E, et al. The aggregate indexof systemic inflammation (AISI): a novelprognostic biomarker in idiopathic pulmonaryfibrosis. J Clin Med. 2021;10:4134.
- 28.Üçsular F, Polat G, Karadeniz G, Ayrancı A,Keskin M, Büyükşirin M, et al. Predictive valueof platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients withhypersensitivity pneumonia. Vasc Diffus LungDis. 2020;37:1–7.
- 29.Sugiyama Y, Kasahara T, Mukaida N,Matsushima K, Kitamura S. Chemokines inbronchoalveolar lavage fluid in summer-typehypersensitivity pneumonitis. Eur Respir J.1995;8:1084-90.
- 30.Inoue Y, Ishizuka M, Furusawa H, Honda T,Kawahara T, Tateishi T, Miyazaki Y. Acuteinflammatory and immunologic responsesagainst antigen in chronic bird-relatedhypersensitivity pneumonitis. Allergol Int.2019l;68:321-28.
- 31.Denis M. Proinflammatory cytokines inhypersensitivity pneumonitis. Am J Respir CritCare Med. 1995;51:164-9.
- 32.Ishizuka M, Miyazaki Y, Tateishi T, Tsutsui T,Tsuchiya K, Inase N. Validation of inhalationprovocation test in chronic bird-relatedhypersensitivity pneumonitis and newprediction score. Ann Am Thorac Soc.2015;12:167-73.
- 33.Nathan SD, Reffett T, Brown AW, Fischer CP,Shlobin OA, Ahmad S, et al. The red celldistribution width as a prognostic indicator inidiopathic pulmonary fibrosis. Chest.2013;143:1692–8.
- 34.Gürün Kaya A, Özyürek BA, Şahin ÖzdemirelT, Öz M, Erdoǧan Y. Prognostic significance ofred cell distribution width in idiopathicpulmonary fibrosis and combined pulmonary fibrosis emphysema. Med Princ Pract. 2021;30:154–9.
- 35.Achaiah A, Yadav R, Jacob J, Chaudhuri N.Blood leucocyte indices in idiopathicpulmonary fibrosis and fibrotic hypersensitivitypneumonitis. BMJ Open Resp Res.2022;9:e001202.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Göğüs Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Haziran 2025 |
| Gönderilme Tarihi | 16 Mart 2025 |
| Kabul Tarihi | 1 Haziran 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 4 Sayı: 2 |
Kaynak Göster
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.