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Stabil KOAH’lılarda monosit-HDL oranı ile hastalık süreci ve solunum fonksiyonları arasındaki ilişki ve pulmoner hipertansiyon

Year 2023, Volume: 48 Issue: 3, 868 - 878, 30.09.2023
https://doi.org/10.17826/cumj.1315487

Abstract

Amaç: Monositler ve yüksek yoğunluklu lipoprotein-kolesterol (HDL-C) inflamasyonda görevi olan moleküllerdir ve inflamasyon kronik obstrüktif akciğer hastalığı (KOAH) patogenezinde önemli bir role sahiptir. Çalışmanın temel amacı, KOAH'ta monosit/HDL oranının (MHO) solunum fonksiyonları ve pulmoner hipertansiyon (PH) ile ilişkisini araştırmaktır.
Gereç ve Yöntem: Polikliniğe başvuran KOAH tanılı 40 yaş üstü 239 hastanın retrospektif verileri daha önce kayıt altına alınan anket formları ve hastane veri tabanından temin edilerek çalışma gerçekleştirildi. Verileri eksik hastalar çalışma dışı bırakıldı. Hastalar MHO yüksek olan ve olmayan şeklinde 2 gruba ayrıldı. MHO yüksekliğinin KOAH ve solunum fonksiyon testleri ile ilişkisi analiz edildi. İkinci aşamada KOAH’lılarda PH varlığı için analizler yapıldı.
Bulgular: Hastaların ortanca yaşı 62,22 ± 9,37 yaş ve %88,7'si erkekti. Yapılan analizlerde yüksek MHO ile KOAH arasında sigara dışında istatistiksel olarak anlamlılık bulunmamasına rağmen, bronkodilatasyon sonrası (post-BD) FEV1/FVC ile MHO arasında negatif bir korelasyon bulunmuştur. Ayrıca mutlak monosit değeri ile RV/TLC arasındaki negatif korelasyon da anlamlı bulunmuştur. Diğer yandan ileri yaşın (OR=0.949, 95% CI (0.915, 0.984)), üçten fazla komorbidite varlığının (OR=2.174, 95% CI (1.045, 4.521)) ve vücut kitle indeksi (VKİ) <25 olmasının (OR=0.419, 95% CI (0.219, 0.804)) KOAH hastalarında PH için risk faktörü olabileceği bulunmuştur.
Sonuç: Çalışmamızda MHO'nin KOAH ile ilişkisi net olarak kanıtlanamamış, ancak MHO’nin solunum fonksiyonları üzerine etkisi olabileceği bulunmuştur. Bunun yanında ileri yaş, çoklu komorbidite ve düşük vücut ağırlığının PH için önemli bir risk oluşturabileceği tespit edilmiştir. Ancak bu konuların çok merkezli daha geniş hasta gruplarında çalışılması ve doğrulanması gerekmektedir.

References

  • Safiri S, Carson-Chahhoud K, Noori M, Nejadghaderi SA, Sullman MJM, Ahmadian Heris J et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ. 2022;378:e069679.
  • Brusselle GG, Joos GF, Bracke KR. New insights into the immunology of chronic obstructive pulmonary disease. Lancet. 2011;378:1015-26.
  • Auffray C, Sieweke MH, Geissmann F. Blood monocytes: development, heterogeneity, and relationship with dendritic cells. Annu Rev Immunol. 2009;27:669-92.
  • Kotlyarov S. High-Density Lipoproteins: A role in inflammation in COPD. Int J Mol Sci. 2022;23:8128.
  • Murphy AJ, Woollard KJ, Hoang A, Mukhamedova N, Stirzaker RA, McCormick SP et al. High-density lipoprotein reduces the human monocyte inflammatory response. Arterioscler Thromb Vasc Biol. 2008;28:2071-7.
  • Takata K, Imaizumi S, Kawachi E, Suematsu Y, Shimizu T, Abe S et al. Impact of cigarette smoking cessation on high-density lipoprotein functionality. Circ J. 2014;78:2955-62.
  • He BM, Zhao SP, Peng ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013;114:2431-6.
  • Vaisberg M, Bachi AL, Latrilha C, Dioguardi GS, Bydlowski SP, Maranhão RC. Lipid transfer to HDL is higher in marathon runners than in sedentary subjects, but is acutely inhibited during the run. Lipids. 2012;47:679-86.
  • Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32:2045-51.
  • Canpolat U, Çetin EH, Cetin S, Aydin S, Akboga MK, Yayla C et al. Association of Monocyte-to-HDL cholesterol ratio with slow coronary flow is linked to systemic inflammation. Clin Appl Thromb Hemost. 2016;22:476-82.
  • Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014;46:1619-25.
  • Kundi H, Kiziltunc E, Cetin M, Cicekcioglu H, Cetin ZG, Cicek G et al. Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease. Herz. 2016;41:523-9.
  • Carlin BW. COPD and associated comorbidities: a review of current diagnosis and treatment. Postgrad Med. 2012;124:225-40.
  • Blanco I, Tura-Ceide O, Peinado VI, Barberà JA. Updated perspectives on pulmonary hypertension in COPD. Int J Chron Obstruct Pulmon Dis. 2020;15:1315-24.
  • Zhang L, Liu Y, Zhao S, Wang Z, Zhang M, Zhang S et al. The Incidence and prevalence of pulmonary hypertension in the COPD population: A systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2022;17:1365-79.
  • Torres-Castro R, Gimeno-Santos E, Vilaró J, Roqué-Figuls M, Moisés J, Vasconcello-Castillo L et al. Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis. Eur Respir Rev. 2021;30:200321.
  • Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159:158-64.
  • Cuttica MJ, Kalhan R, Shlobin OA, Ahmad S, Gladwin M, Machado RF et al. Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med. 2010;104:1877-82.
  • Andersen KH, Iversen M, Kjaergaard J, Mortensen J, Nielsen-Kudsk JE, Bendstrup E et al. Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease. J Heart Lung Transplant. 2012;31:373-80.
  • Ferrera MC, Labaki WW, Han MK. Advances in chronic obstructive pulmonary disease. Annu Rev Med. 2021;72:119-34.
  • GBD 2015 chronic respiratory disease collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet Respir Med. 2017;5:691-706.
  • Turkish statistical institute (TUIK) news bulletin. Death and cause of death statistics, 2022. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2022-49679 (accessed august 2023).
  • Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P et al. Global initiative for chronic obstructive lung disease 2023 Report: GOLD executive summary. Eur Respir J. 2023;61:2300239.
  • Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL et al. Standardization of spirometry 2019 update. An official american thoracic society and european respiratory society technical statement. Am J Respir Crit Care Med. 2019;200:e70-e88.
  • Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M et al; ESC/ERS scientific document group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43:3618-731.
  • Yakar HI, Kanbay A. Could monocyte level/HDL cholesterol ratio predict cardiovascular diseases in patients with COPD? Niger J Clin Pract. 2020;23:450-5.
  • Jiang M, Yang J, Zou H, Li M, Sun W, Kong X. Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and the risk of all-cause and cardiovascular mortality: a nationwide cohort study in the United States. Lipids Health Dis. 2022;21:30.
  • Seckin D, Nurtac O, Yasemin K, Ahmet K, Osman B, Mustafa Y et al. The monocyte to high-density lipoprotein cholesterol ratio predicts the mortality in patients with reduced ejection fraction heart failure. Dicle Med J. 2020;47:812-9.
  • Oelsner E, Balte P, Schwartz JE, Burkart KM, Cassano P, Jacobs DR et al. LATE-BREAKING ABSTRACT: High density lipoprotein cholesterol (HDL-C) and longitudinal lung function in six United States (US) cohorts. Eur. Respir. J. 2016;48:OA2001.
  • Park JH, Mun S, Choi DP, Lee JY, Kim HC. Association between high-density lipoprotein cholesterol level and pulmonary function in healthy Korean adolescents: the JS high school study. BMC Pulm Med. 2017;17:190.
  • Huerta-Ramírez S, Paniagua-Pérez A, Castro-Serna D, Ledesma-Velázquez A, Rubio-Guerra A, Vargas-Ayala G. Effect of the components of the metabolic syndrome on pulmonary function. The unexpected role of high-density lipoprotein cholesterol. Cir Cir. 2018;86:175-181.
  • Huang Y, Jiang B, Miao X, Ma J, Wang J, Ding K et al. The relationship of lymphocyte to high-density lipoprotein ratio with pulmonary function in COPD. Int J Chron Obstruct Pulmon Dis. 2020;15:3159-69.
  • Opitz I, Ulrich S. Pulmonary hypertension in chronic obstructive pulmonary disease and emphysema patients: prevalence, therapeutic options and pulmonary circulatory effects of lung volume reduction surgery. J Thorac Dis. 2018;10:S2763-74.
  • Chaouat A, Bugnet AS, Kadaoui N, Schott R, Enache I, Ducoloné A et al. Severe pulmonary hypertension and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172:189-94.
  • Scharf SM, Iqbal M, Keller C, Criner G, Lee S, Fessler HE; national emphysema treatment trial (NETT) group. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med. 2002;166:314-22.
  • Thabut G, Dauriat G, Stern JB, Logeart D, Lévy A, Marrash-Chahla R et al. Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest. 2005;127:1531-6.
  • Oswald-Mammosser M, Apprill M, Bachez P, Ehrhart M, Weitzenblum E. Pulmonary hemodynamics in chronic obstructive pulmonary disease of the emphysematous type. Respiration. 1991;58:304-10.
  • Vizza CD, Hoeper MM, Huscher D, Pittrow D, Benjamin N, Olsson KM et al. Pulmonary hypertension in patients with COPD: results from the comparative, prospective registry of newly ınitiated therapies for pulmonary hypertension (COMPERA). Chest. 2021;160:678-89.
  • Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3:631-9.
  • Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009;11:130-9.
  • Seeger W, Adir Y, Barberà JA, Champion H, Coghlan JG, Cottin V et al. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013;62:D109-16.

Relationship between monocyte-HDL ratio and disease process and pulmonary functions and pulmonary hypertension in stable COPD patients

Year 2023, Volume: 48 Issue: 3, 868 - 878, 30.09.2023
https://doi.org/10.17826/cumj.1315487

Abstract

Purpose: Inflammation is a major factor in the pathophysiology of chronic obstructive pulmonary disease (COPD), and molecules implicated in inflammation include monocytes and high-density lipoprotein-cholesterol (HDL-C). The primary goal of the study was to look at the relationship between pulmonary function and pulmonary hypertension (PH) in COPD and the monocyte to HDL ratio (MHR).
Materials and Methodsː The study was conducted by acquiring retrospective data from previously recorded questionnaires and hospital databases for 239 individuals over the age of 40 with a diagnosis of COPD who admitted to the outpatient clinic. Patients whose data were missing were not included in the analysis. Two groups of patients were created: those with high MHO levels and those without. Analysis was done on the correlation between high MHO and COPD and pulmonary function tests. The presence of PH in COPD patients was analyzed in the second stage.
Resultsː The median age of the patients was 62.22 ± 9.37 year and 88.7% of them were male. With the exception of smoking, there was no statistically significant link between high MHR and COPD in the analyses, however there was a negative connection between post-bronchodilation (post-BD) FEV1/FVC and MHR. Additionally, the statistically significant negative association was found between the absolute monocyte value and RV/TLC. However, older age (OR=0.949, 95% CI (0.915, 0.984)), having more than three comorbidities (OR=2.174, 95% CI (1.045, 4.521)), and having a body mass index (BMI) below 25 have all been linked to an increased risk of PH in COPD patients.
Conclusionː Although the link between MHR and COPD was not conclusively established, it was linked to pulmonary functions. The study that was presented also came to the conclusion that PH may be significantly increased by advanced age, numerous comorbidities, and low body weight. These problems must be investigated and validated in larger, multicenter patient populations.

References

  • Safiri S, Carson-Chahhoud K, Noori M, Nejadghaderi SA, Sullman MJM, Ahmadian Heris J et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ. 2022;378:e069679.
  • Brusselle GG, Joos GF, Bracke KR. New insights into the immunology of chronic obstructive pulmonary disease. Lancet. 2011;378:1015-26.
  • Auffray C, Sieweke MH, Geissmann F. Blood monocytes: development, heterogeneity, and relationship with dendritic cells. Annu Rev Immunol. 2009;27:669-92.
  • Kotlyarov S. High-Density Lipoproteins: A role in inflammation in COPD. Int J Mol Sci. 2022;23:8128.
  • Murphy AJ, Woollard KJ, Hoang A, Mukhamedova N, Stirzaker RA, McCormick SP et al. High-density lipoprotein reduces the human monocyte inflammatory response. Arterioscler Thromb Vasc Biol. 2008;28:2071-7.
  • Takata K, Imaizumi S, Kawachi E, Suematsu Y, Shimizu T, Abe S et al. Impact of cigarette smoking cessation on high-density lipoprotein functionality. Circ J. 2014;78:2955-62.
  • He BM, Zhao SP, Peng ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013;114:2431-6.
  • Vaisberg M, Bachi AL, Latrilha C, Dioguardi GS, Bydlowski SP, Maranhão RC. Lipid transfer to HDL is higher in marathon runners than in sedentary subjects, but is acutely inhibited during the run. Lipids. 2012;47:679-86.
  • Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32:2045-51.
  • Canpolat U, Çetin EH, Cetin S, Aydin S, Akboga MK, Yayla C et al. Association of Monocyte-to-HDL cholesterol ratio with slow coronary flow is linked to systemic inflammation. Clin Appl Thromb Hemost. 2016;22:476-82.
  • Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014;46:1619-25.
  • Kundi H, Kiziltunc E, Cetin M, Cicekcioglu H, Cetin ZG, Cicek G et al. Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease. Herz. 2016;41:523-9.
  • Carlin BW. COPD and associated comorbidities: a review of current diagnosis and treatment. Postgrad Med. 2012;124:225-40.
  • Blanco I, Tura-Ceide O, Peinado VI, Barberà JA. Updated perspectives on pulmonary hypertension in COPD. Int J Chron Obstruct Pulmon Dis. 2020;15:1315-24.
  • Zhang L, Liu Y, Zhao S, Wang Z, Zhang M, Zhang S et al. The Incidence and prevalence of pulmonary hypertension in the COPD population: A systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2022;17:1365-79.
  • Torres-Castro R, Gimeno-Santos E, Vilaró J, Roqué-Figuls M, Moisés J, Vasconcello-Castillo L et al. Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis. Eur Respir Rev. 2021;30:200321.
  • Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159:158-64.
  • Cuttica MJ, Kalhan R, Shlobin OA, Ahmad S, Gladwin M, Machado RF et al. Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med. 2010;104:1877-82.
  • Andersen KH, Iversen M, Kjaergaard J, Mortensen J, Nielsen-Kudsk JE, Bendstrup E et al. Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease. J Heart Lung Transplant. 2012;31:373-80.
  • Ferrera MC, Labaki WW, Han MK. Advances in chronic obstructive pulmonary disease. Annu Rev Med. 2021;72:119-34.
  • GBD 2015 chronic respiratory disease collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet Respir Med. 2017;5:691-706.
  • Turkish statistical institute (TUIK) news bulletin. Death and cause of death statistics, 2022. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2022-49679 (accessed august 2023).
  • Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P et al. Global initiative for chronic obstructive lung disease 2023 Report: GOLD executive summary. Eur Respir J. 2023;61:2300239.
  • Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL et al. Standardization of spirometry 2019 update. An official american thoracic society and european respiratory society technical statement. Am J Respir Crit Care Med. 2019;200:e70-e88.
  • Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M et al; ESC/ERS scientific document group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43:3618-731.
  • Yakar HI, Kanbay A. Could monocyte level/HDL cholesterol ratio predict cardiovascular diseases in patients with COPD? Niger J Clin Pract. 2020;23:450-5.
  • Jiang M, Yang J, Zou H, Li M, Sun W, Kong X. Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and the risk of all-cause and cardiovascular mortality: a nationwide cohort study in the United States. Lipids Health Dis. 2022;21:30.
  • Seckin D, Nurtac O, Yasemin K, Ahmet K, Osman B, Mustafa Y et al. The monocyte to high-density lipoprotein cholesterol ratio predicts the mortality in patients with reduced ejection fraction heart failure. Dicle Med J. 2020;47:812-9.
  • Oelsner E, Balte P, Schwartz JE, Burkart KM, Cassano P, Jacobs DR et al. LATE-BREAKING ABSTRACT: High density lipoprotein cholesterol (HDL-C) and longitudinal lung function in six United States (US) cohorts. Eur. Respir. J. 2016;48:OA2001.
  • Park JH, Mun S, Choi DP, Lee JY, Kim HC. Association between high-density lipoprotein cholesterol level and pulmonary function in healthy Korean adolescents: the JS high school study. BMC Pulm Med. 2017;17:190.
  • Huerta-Ramírez S, Paniagua-Pérez A, Castro-Serna D, Ledesma-Velázquez A, Rubio-Guerra A, Vargas-Ayala G. Effect of the components of the metabolic syndrome on pulmonary function. The unexpected role of high-density lipoprotein cholesterol. Cir Cir. 2018;86:175-181.
  • Huang Y, Jiang B, Miao X, Ma J, Wang J, Ding K et al. The relationship of lymphocyte to high-density lipoprotein ratio with pulmonary function in COPD. Int J Chron Obstruct Pulmon Dis. 2020;15:3159-69.
  • Opitz I, Ulrich S. Pulmonary hypertension in chronic obstructive pulmonary disease and emphysema patients: prevalence, therapeutic options and pulmonary circulatory effects of lung volume reduction surgery. J Thorac Dis. 2018;10:S2763-74.
  • Chaouat A, Bugnet AS, Kadaoui N, Schott R, Enache I, Ducoloné A et al. Severe pulmonary hypertension and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172:189-94.
  • Scharf SM, Iqbal M, Keller C, Criner G, Lee S, Fessler HE; national emphysema treatment trial (NETT) group. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med. 2002;166:314-22.
  • Thabut G, Dauriat G, Stern JB, Logeart D, Lévy A, Marrash-Chahla R et al. Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest. 2005;127:1531-6.
  • Oswald-Mammosser M, Apprill M, Bachez P, Ehrhart M, Weitzenblum E. Pulmonary hemodynamics in chronic obstructive pulmonary disease of the emphysematous type. Respiration. 1991;58:304-10.
  • Vizza CD, Hoeper MM, Huscher D, Pittrow D, Benjamin N, Olsson KM et al. Pulmonary hypertension in patients with COPD: results from the comparative, prospective registry of newly ınitiated therapies for pulmonary hypertension (COMPERA). Chest. 2021;160:678-89.
  • Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3:631-9.
  • Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009;11:130-9.
  • Seeger W, Adir Y, Barberà JA, Champion H, Coghlan JG, Cottin V et al. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013;62:D109-16.
There are 41 citations in total.

Details

Primary Language English
Subjects Chest Diseases, ​Internal Diseases
Journal Section Research
Authors

Efraim Güzel 0000-0001-6677-9254

Burak Mete 0000-0002-0780-6176

Sedat Kuleci 0000-0002-6464-3270

Yasemin Saygideger 0000-0003-3293-373X

Oya Baydar Toprak 0000-0001-7320-976X

Early Pub Date September 25, 2023
Publication Date September 30, 2023
Acceptance Date September 1, 2023
Published in Issue Year 2023 Volume: 48 Issue: 3

Cite

MLA Güzel, Efraim et al. “Relationship Between Monocyte-HDL Ratio and Disease Process and Pulmonary Functions and Pulmonary Hypertension in Stable COPD Patients”. Cukurova Medical Journal, vol. 48, no. 3, 2023, pp. 868-7, doi:10.17826/cumj.1315487.