ARAŞTIRMA/ORIGINAL ARTICLE Gülhane Tıp Derg 2016;58:353-356 Date submitted: Oct 29, 2015 • Date accepted: Apr 08, 2016 • Online publication date: 30 Aralık 2016 Çölyak hastalığı ve nötrofl lenfosit oranı • 353 © Gülhane Tıp Fakültesi 2016 doi:10.5455/gulhane.206442 Introduction Celiac disease (CD) is a chronic, autoimmune and infam- matory disease with an incidence of 0.5 to 1% in the general population (1, 2). Patients usually present with gastrointesti- nal symptoms such as abdominal pain, diarrhea, nausea, and vomiting. However, extraintestinal manifestations such as iron deficiency anemia, vitamin B12 and folic acid deficiencies, os- teoporosis and neuropsychiatric symptoms are not rare (2, 3). CD is diagnosed by the evaluation of the segment of the upper intestine by histopathologically in terms of intraepithelial lymphocyte infiltration, crypt hyperplasia and villous atrophy (Marsh classification). The serological tests such as anti-en- domysium antibody (EMA), anti-tissue transglutaminase an- tibody (tTG) and anti-gliadin antibodies (AGA) support the di- agnosis (2, 4, 5). Neutrophil-lymphocyte ratio (NLR) can be obtained with a basic hemogram test. NLR is a simple and inexpensive mar- ker of systemic infammation. NLR has been associated with some conditions such as nonalcoholic fatty liver, ulcerative co- litis, Familial Mediterranean Fever, acute pancreatitis, and it has been suggested that NLR predicts systemic infammation in these disorders (6–10). Determining patient compliance to diet is very crucial for the success of treatment in CD. It saves the clinician from unne- cessary examinations. Apart from the patient’s statements, an objective marker is needed and we aimed to determine whet- her NLR might be used for this purpose. Materials and methods Thirty-seven patients with CD, diagnosed by the histopat- hological evaluation of the duodenum biopsy together with serological tests at the Gastroenterology Department of Cum- huriyet University (Sivas, Turkey) between January 2009 and June 2012, were evaluated by a retrospective review of pati- ent records. Thirty-seven age- and sex-matched participants were included as controls. The study was approved by the local Ethics Committees and was in accordance with the Dec- laration of Helsinki. Patients with diabetes mellitus, coronary heart diseases, malignacy, anemia, vitamin B12 and folic acid deficiencies, metabolic syndrome, acute/chronic infection, os- teoporosis/osteomalacia, thyroid dysfunction, and history of smoking were excluded. The Results of patients’ hemogram, biochemistry, and acu- te phase reactants [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] at diagnosis and after first year were obtained from laboratory archieve. And also, the transgressi- on status of the patients during the previous 12 months were Is there a link between neutrophil-lymphocyte ratio and patient compliance with gluten free diet in celiac disease? ÖZET Çölyak hastalığında nötrofil-lenfosit oranı glutensiz diyet uyumu ile ilişkili midir? Bu çalışmanın amacı, çölyak hastalığında (ÇH) diyet uyumu tespit edilmesi için objektif bir belirteç olarak nötrofil lenfosit oranının (NLO) etkisini belirlemektir. Otuz yedi ÇH hastası ve 37 sağlıklı gönüllü çalışmaya dahil edildi. Birinci yılın sonunda, hastalar diyet ile uyumu dikkate alınarak 2 gruba ayrıldı. Glutensiz diyet uyumu (GsDU) olmayan 7 hasta birinci grup içerisine (grup 1), GsDU olan 30 hasta ikinci grup (grup 2) içerisine ve 37 sağlıklı gönüllü kontrol grubu (grup 3) içerisine dahil edildi. NLO hasta grubunda kontrol grubuna kıyasla yüksek bulundu (p < 0.0001). Grup 2 hastalar içerisinde tanı anında ve tedavinin 1. yılındaki NLO değerleri arasında anlamlı farklıklar vardı (p < 0.0001). Grup 1 hastalar içerisinde tanı anında ve tedavinin 1. yılında NLO değerleri arasında anlamlı farklılık olmadığı görüldü (p > 0.05). NLO tedavinin 1. yılında grup 1 ve grup 2 hastaları arasında (p = 0.007), grup 1 ve grup 3 arasında (p = 0.005) anlamlı farklılık vardı. NLO’nun Receiver-operating characteristic curve analizi yöntemi ile GsD uyumsuzluğunu değerlendirmekteki perforrnansına bakıldığında kesme değeri 2.51, sensitivitesi % 85, spesifisitesi % 94 (area under curve : 0.819, 95 % confidence interval = 0.589-1.000, p = 0.009) olduğu görüldü. NLO, ÇH olan hastalarda hasta uyumunu öngörmede umut vaat eden bir belirteç olabilir. Anahtar Kelimeler: nötrofil lenfosit oranı, çölyak hastalığı, infamasyon, belirteç SUMMARY The aim of the present study is to determine the association of neutrophil- lymphocyte ratio (NLR) as an objective marker for detecting compliance to diet in celiac disease (CD). Thirty-seven patients with CD and 37 healthy volunteers were enrolled to the study. At the end of the first year, the patients were divided into 2 groups considering their compliance with diet. Seven patients, who are not comp- liant to gluten free diet (GFD), formed the first group (group 1). Thirty patients, who are compliant to GFD, formed the second group (group 2), and 37 healthy volunteers served as the control group (group 3). NLR was significantly higher in the patient group than the controls (p < 0.0001). There was a significant diference between the NLR values at the time of initial diagnosis and after a year of treat- ment in group 2 patients (p < 0.0001). However, we obtained no diference in terms of NLR between the initial and the first year of treatment in group 1 patients (P > 0.05). At the end of the first year, there were significant diferences between group 1 and group 2 (p = 0.007) and between group 1 and group 3 in terms of NLR (p = 0.005). Receiver-operating characteristic curve analysis suggested the optimum NLR cutof value for patients with GFD incompatible as 2.51, with a sensitivity and specificity of 85 % and 94 %, respectively (area under curve : 0.819, 95 % confiden- ce interval = 0.589-1.000, p = 0.009). NLR may be a promising marker in predicting the patient compliance in patients with CD. Key words: neutrophil-lymphocyte ratio, celiac disease, infammation, marker. Ali Ugur Uslu(*), Serdal Korkmaz(**), Ozlem Yonem(***), Bahattin Aydin(****), Tunahan Uncu(*****), Abdusselam Sekerci(*****), Firdevs Topal(******), Mehmet Sencan(*******) *Yunus Emre Public Hospital Eskisehir/Turkey **Kayseri Education and Research Hospital, Division of Hematology, Kayseri/ Turkey ***Cumhuriyet University Faculty of Medicine, Department of Gastroenterology, Sivas/Turkey ****Etimesgut Sait Ertürk Public Hospital, Department of Internal Medicine, Ankara/Turkey *****Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Sivas/Turkey ******Atatürk Education and Research Hospital, Department of Gastroenterology, İzmir/Turkey ******* Cumhuriyet University Faculty of Medicine, Department of Hematology, Sivas/Turkey Reprint request: Ali Ugur Uslu Etimesgut Sait Ertürk Public Hospital, Department of Internal Medicine Visnelik Mah., Atatürk Cd. 26020 Akarbası/Eskisehir/Turkey drauuslu@gmail.com