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Karpal Tünel Sendromunda İnflamasyonun Nötrofil-Lenfosit Oranı, Platelet-Lenfosit Oranı ve Ortalama Platelet Hacmi ile Değerlendirilmesi

Year 2020, Volume: 11 Issue: 41, 103 - 108, 01.12.2020

Erman Altunışık Ali Zeynel Abidin Tak

https://doi.org/10.17944/mkutfd.790592

Abstract

Amaç: Karpal tünel sendromu median sinirin karpal tünel seviyesinde sıkışmasından kaynaklanan ve en yaygın görülen mononöropati şeklidir. Büyük bir kısmı idiopatik olan bu tablonun fizyopatolojik mekanizması halen tam açıklanamamıştır. Biz bu çalışmada karpal tünel sendromun’da sistemik inflamasyonun olası rolünü nötrofil-lenfosit oranı, platelet-lenfosit oranı ve ortalama platelet hacmi değerleri ile incelemeyi amaçladık.

Gereç ve Yöntemler: Çalışmaya yaşları 20 ve 60 arasında değişen, elektofizyoloji labaratuvarımıza refere edilen ve American Academy of Neurology kriterlerine göre karpal tünel sendromu tanısı konulan toplam 55 hasta ve sağlıklı 36 kişi dahil edildi. Hastalar elektrofizyolojik bulgulara göre hafif, orta ve şiddetli olmak üzere üç alt gruba ayrıldı. Hastaların klinik açıdan fonksiyonel durumları ve hastalık şiddetleri Boston Questionnaire ile değerlendirildi.

Bulgular: Çalışmaya 71 kadın (%78,02) ve 20 erkek (%21,98) olmak üzere toplam 91 kişi alınmıştır. Hasta grubu yaş ortalaması 50,04±9,78 olan 43 kadın ve 12 erkekten oluşmaktadır. Kontrol grubu yaş ortalaması 49,92 ±7,59 olan 28 kadın ve 8 erkekten oluşmaktadır. Hasta ve kontrol grupları arasında karşılaştırıldığında nötrofil-lenfosit oranı, platelet-lenfosit oranı ve ortalama platelet hacmi değerleri arasında anlamlı fark saptanmadı. Ölçülen değerler hasta alt gruplarında karşılaştırıldığında hastalık şiddetiyle değerler arasında anlamlı fark saptanmamıştır.

Sonuç: Karpal tünel sendromu fizyopatolojisinde sistemik inflamasyonun rolünün belirsiz olduğu, bazı mekanik ve lokal patolojilerin etyopatogenezi aydınlatmakta daha ön planda düşünülmesi gerektiği akla yatkın görünmektedir. Konu ile ilgili hasta sayısının artırıldığı çok merkezli ve uzunlamasına çalışmalara ihtiyaç olduğu kanaatindeyiz.

Keywords

Karpal tünel sendromu median sinir inflamasyon mononöropati

References

  • Michelsen H, Posner MA. Medical history of carpal tunnel syndrome. Hand Clin 2002; 18: 257 - 268. https://doi.org/10.1016/S0749-0712(01)00006-3
  • Altun Y, Tak AZA. Can serum C-Reactive Protein and Procalcitonin levels associate with Carpal Tunnel Syndrome? Medical Science and Discovery 2019; 6: 18-23 https://doi.org/10.17546/msd.510957
  • Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45: 373-6. https://doi.org/10.1016/0895-4356(92)90038-O
  • Keir PJ, Rempel DM. Pathomechanics of peripheral nerve loading. Evidence in carpal tunnel syndrome. J Hand Ther 2005; 18: 259-69. https://doi.org/10.1197/j.jht.2005.02.001
  • Tutoğlu A, Boyacı A, Kocatürk Ö, Sarıkaya S, Kul M, Karakaş EY, Yetişgin A. The relationship of carpal tunnel syndrome and mean platelet volume in geriatric patients Gaziantep Med J 2014; 20: 182-185 https://doi.org/10.5455/GMJ-30-153778
  • Bland JD. Carpal tunnel syndrome. Curr Opin Neurol 2005; 18: 581-5. https://doi.org/10.1097/01.wco.0000173142.58068.5a
  • Amirfeyz R, Gozzard C, Leslie IJ. Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br 2005; 30: 361-4. https://doi.org/10.1016/J.JHSB.2005.04.007
  • Hirata H, Nagakura T, Tsujii M, Morita A, Fujisawa K, Uchida A The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. Pathol 2004; 204: 605-12 https://doi.org/10.1002/path.1673
  • Neal NC, McManners J, Stirling GA. Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome. J Hand Surg [Br] 1987; 12: 229-232. https://doi.org/10.1016/0266-7681(87)90020-9
  • Varım C, Acar BA, Uyanık MS, Acar T, Alagoz N, Nalbant A, Kaya T, Ergenc H. Association between the neutrophil-to-lymphocyteratio, a new marker of systemic inflammation, and restless legs syndrome. SingaporeMed J 2016; 57: 514-516 https://doi.org/10.11622/smedj.2016154
  • Zhao QT, Zhang XP, Zhang H, Duan GC. Prognostic role of platelet to lymphocyte ratio in esophageal cancer: A meta-analysis. Oncotarget 2017; 20: 112085-112093. https://doi.org/10.18632/oncotarget.22557
  • Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996; 7: 157-61. https://doi.org/10.1097/00001721-199603000-00011
  • American Academy of Neurology Practice parameter for carpal tunnel syndrome (summary statement): report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology 1993; 43: 2406 - 2409. https://doi.org/10.1212/WNL.43.11.2406
  • Kurt S, Çevik B, Kaplan Y et al. The relationship between Boston Questionnaire and electrophysiological findings in Carpal Tunnel Syndrome. Archives of Neuropsychiatry 2010; 47: 237-40.
  • Levine DW, Simmons BP, Koris MJ, et al. A self- administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Surg (Am) 1993; 75: 1585-1592. https://doi.org/10.2106/00004623-199311000-00002
  • Stevens JC. The electrodiagnosis of carpal tunnel syndrome.American Association of Electrodiagnostic Medicine. Muscle Nerve 1997; 20: 1477 - 1486. https://doi.org/10.1002/(SICI)1097-4598(199712)20:12<1477::AID-MUS1>3.0.CO;2-5
  • Chikenji T, Gingery A, Zhao C, et al. Transforming growth factor-β (TGF-β) expression is increased in the subsynovial connective tissues of patients with idiopathic carpal tunnel syndrome. J Orthop Res 2014; 32: 116-122. https://doi.org/10.1002/jor.22485
  • Schuind F, Ventura M, Pasteels JL. Idiopathic carpal tunnel syndrome: Histologic study of flexor tendon synovium. J Hand Surg Am. 1990; 15: 497-503. https://doi.org/10.1016/0363-5023(90)90070-8
  • Kerr CD, Sybert DR, Albarracin NS. An analysis of the flexor synovium in idiopathic carpal tunnel syndrome: Report of 625 cases. J Hand Surg Am 1992; 17: 1028-1030. https://doi.org/10.1016/S0363-5023(09)91053-X
  • Scott KL, Conley CR, Renfree KJ Histopathologic Evaluation of Flexor Tenosynovium in Recurrent Carpal Tunnel Syndrome. Plast Reconstr Surg 2019; 143: 169-175 https://doi.org/10.1097/PRS.0000000000005090
  • Faithfull DK, Moir DH, Ireland J. The micropathology of the typical carpal tunnel syndrome. J Hand Surg Br 1986; 11: 131-132. https://doi.org/10.1016/0266-7681(86)90035-5
  • Joshi P, Lele V. Lighting the tunnel: FDG PET/CT findings leading to incidental diagnosis of carpal tunnel syndrome. Clin Nucl Med 2014; 39: 78-9. https://doi.org/10.1097/RLU.0b013e31827a276b
  • Freeland AE, Tucci MA, Barbieri RA, et al. Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome. Microsurgery 2002; 22: 378- 385. https://doi.org/10.1002/micr.10065
  • Takasu S, Takatsu S, Kunitomo K, Kokumai Y. Serum Hyaluronic Acid and Interleukin-6 as Possible Markers of Carpal Tunnel Syndrome in Chronic Hemodialysis Patients Artificial Organs 1994; 18: 420-42 https://doi.org/10.1111/j.1525-1594.1994.tb02227.x
  • Güneş M, Büyükgöl H. Correlation of neutrophil/lymphocyte and platelet/lymphocyte ratios with the severity of idiopathic carpal tunnel syndrome. Muscle Nerve 2020; 61: 369-374 https://doi.org/10.1002/mus.26791
  • Schrijver HM, Gerritsen AA, Strijers RL, et al. Correlating nerve conduction studies and clinical outcome measures on carpaltunnel syndrome: lessonsfrom a randomized controlled trial. J Clin Neurophysiol 2005; 22: 216-21.
  • Longstaff L, Milner RH, O'Sullivan S, Fawcett P. Carpaltunnel syndrome: the correlation between outcome, symptoms and nerve conduction study findings. J HandSurg [Br] 2001; 26: 475-80. https://doi.org/10.1054/jhsb.2001.0616
  • You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nevre conduction measures in carpal tunnel syndrome. Muscle Nerve 1999; 22: 497-501. https://doi.org/10.1002/(SICI)1097-4598(199904)22:4<497::AID-MUS11>3.0.CO;2-T
  • Dhong ES, Han SK, Lee BI, Kim WK. Correlation of electrodiagnostic Findings with subjective symptoms in carpal tunnel syndrome. AnnPlastSurg 2000; 45: 127-31. https://doi.org/10.1097/00000637-200045020-00005
  • Padua L, Padua R, Lo Monaco M, Aprile I, Tonali P. Multi perspective assessment of carpal tunnel syndrome: a multicenter study. Italian CTS Study Group. Neurology 1999; 53: 1654-9. https://doi.org/10.1212/WNL.53.8.1654
  • Dumitru D. Electrodiagnostic Medicine Philadelphia Hanley & Belfus 1994: 864-867
  • Becker J, Nora DB, Gomes I, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002; 113: 1429-1434. https://doi.org/10.1016/S1388-2457(02)00201-8
  • English JH, Gwynne-Jones DP. Incidence of carpal tunnel syndrome requiring surgical decompression. J Hand Surg Am 2015; 40: 2427-2434 https://doi.org/10.1016/j.jhsa.2015.07.029

Evaluation of Inflammation in the Carpal Tunnel Syndrome by the Neutrophil-Lymphocyte Rate, Platelet- Lymphocyte Rate and Mena Platelet Volume

Year 2020, Volume: 11 Issue: 41, 103 - 108, 01.12.2020

Erman Altunışık Ali Zeynel Abidin Tak

https://doi.org/10.17944/mkutfd.790592

Abstract

Objective: Carpal tunnel syndrome is the most common form of mononeuropathy caused by compression of the median nerve at the carpal tunnel level. The physiopathological mechanism of this picture, which is mostly idiopathic, is still not fully explained. In this study, we aimed to examine the possible role of inflammation in carpal tunnel syndrome with neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volume values.

Materials and Methods: A total of 55 patients, aged between 20 and 60 years, referred to our electrophysiology laboratory and diagnosed with carpal tunnel syndrome according to the American Academy of Neurology criteria and 36 healthy participants were included in the study. Patients were divided into three subgroups as mild, moderate and severe according to electrophysiological findings. Clinical functional status and disease severity of patients were evaluated with Boston Questionnaire.

Results: A total of 91 people, 71 women (78.02%) and 20 men (21.98%), were included in the study. The patient group consists of 43 women and 12 men, with an average age of 50.04 ± 9.78. The control group consists of 28 women and 8 men with an average age of 49.92 ± 7.59. When compared between patient and control groups, no significant difference was found between neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volüme values. When the measured values were compared in the patient subgroups, there was no significant difference between disease severity and values.

Conclusions: The role of systemic inflammation in carpal tunnel syndrome physiopathology is uncertain, it seems plausible that some mechanical and local pathologies should be considered in the foreground to elucidate the etiopathogenesis. We believe that high number of patients, multicenter and longitudinal studies are needed.

Keywords

Carpal tunnel syndrome median nevre inflammation mononeuropathy

References

  • Michelsen H, Posner MA. Medical history of carpal tunnel syndrome. Hand Clin 2002; 18: 257 - 268. https://doi.org/10.1016/S0749-0712(01)00006-3
  • Altun Y, Tak AZA. Can serum C-Reactive Protein and Procalcitonin levels associate with Carpal Tunnel Syndrome? Medical Science and Discovery 2019; 6: 18-23 https://doi.org/10.17546/msd.510957
  • Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45: 373-6. https://doi.org/10.1016/0895-4356(92)90038-O
  • Keir PJ, Rempel DM. Pathomechanics of peripheral nerve loading. Evidence in carpal tunnel syndrome. J Hand Ther 2005; 18: 259-69. https://doi.org/10.1197/j.jht.2005.02.001
  • Tutoğlu A, Boyacı A, Kocatürk Ö, Sarıkaya S, Kul M, Karakaş EY, Yetişgin A. The relationship of carpal tunnel syndrome and mean platelet volume in geriatric patients Gaziantep Med J 2014; 20: 182-185 https://doi.org/10.5455/GMJ-30-153778
  • Bland JD. Carpal tunnel syndrome. Curr Opin Neurol 2005; 18: 581-5. https://doi.org/10.1097/01.wco.0000173142.58068.5a
  • Amirfeyz R, Gozzard C, Leslie IJ. Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br 2005; 30: 361-4. https://doi.org/10.1016/J.JHSB.2005.04.007
  • Hirata H, Nagakura T, Tsujii M, Morita A, Fujisawa K, Uchida A The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. Pathol 2004; 204: 605-12 https://doi.org/10.1002/path.1673
  • Neal NC, McManners J, Stirling GA. Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome. J Hand Surg [Br] 1987; 12: 229-232. https://doi.org/10.1016/0266-7681(87)90020-9
  • Varım C, Acar BA, Uyanık MS, Acar T, Alagoz N, Nalbant A, Kaya T, Ergenc H. Association between the neutrophil-to-lymphocyteratio, a new marker of systemic inflammation, and restless legs syndrome. SingaporeMed J 2016; 57: 514-516 https://doi.org/10.11622/smedj.2016154
  • Zhao QT, Zhang XP, Zhang H, Duan GC. Prognostic role of platelet to lymphocyte ratio in esophageal cancer: A meta-analysis. Oncotarget 2017; 20: 112085-112093. https://doi.org/10.18632/oncotarget.22557
  • Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996; 7: 157-61. https://doi.org/10.1097/00001721-199603000-00011
  • American Academy of Neurology Practice parameter for carpal tunnel syndrome (summary statement): report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology 1993; 43: 2406 - 2409. https://doi.org/10.1212/WNL.43.11.2406
  • Kurt S, Çevik B, Kaplan Y et al. The relationship between Boston Questionnaire and electrophysiological findings in Carpal Tunnel Syndrome. Archives of Neuropsychiatry 2010; 47: 237-40.
  • Levine DW, Simmons BP, Koris MJ, et al. A self- administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Surg (Am) 1993; 75: 1585-1592. https://doi.org/10.2106/00004623-199311000-00002
  • Stevens JC. The electrodiagnosis of carpal tunnel syndrome.American Association of Electrodiagnostic Medicine. Muscle Nerve 1997; 20: 1477 - 1486. https://doi.org/10.1002/(SICI)1097-4598(199712)20:12<1477::AID-MUS1>3.0.CO;2-5
  • Chikenji T, Gingery A, Zhao C, et al. Transforming growth factor-β (TGF-β) expression is increased in the subsynovial connective tissues of patients with idiopathic carpal tunnel syndrome. J Orthop Res 2014; 32: 116-122. https://doi.org/10.1002/jor.22485
  • Schuind F, Ventura M, Pasteels JL. Idiopathic carpal tunnel syndrome: Histologic study of flexor tendon synovium. J Hand Surg Am. 1990; 15: 497-503. https://doi.org/10.1016/0363-5023(90)90070-8
  • Kerr CD, Sybert DR, Albarracin NS. An analysis of the flexor synovium in idiopathic carpal tunnel syndrome: Report of 625 cases. J Hand Surg Am 1992; 17: 1028-1030. https://doi.org/10.1016/S0363-5023(09)91053-X
  • Scott KL, Conley CR, Renfree KJ Histopathologic Evaluation of Flexor Tenosynovium in Recurrent Carpal Tunnel Syndrome. Plast Reconstr Surg 2019; 143: 169-175 https://doi.org/10.1097/PRS.0000000000005090
  • Faithfull DK, Moir DH, Ireland J. The micropathology of the typical carpal tunnel syndrome. J Hand Surg Br 1986; 11: 131-132. https://doi.org/10.1016/0266-7681(86)90035-5
  • Joshi P, Lele V. Lighting the tunnel: FDG PET/CT findings leading to incidental diagnosis of carpal tunnel syndrome. Clin Nucl Med 2014; 39: 78-9. https://doi.org/10.1097/RLU.0b013e31827a276b
  • Freeland AE, Tucci MA, Barbieri RA, et al. Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome. Microsurgery 2002; 22: 378- 385. https://doi.org/10.1002/micr.10065
  • Takasu S, Takatsu S, Kunitomo K, Kokumai Y. Serum Hyaluronic Acid and Interleukin-6 as Possible Markers of Carpal Tunnel Syndrome in Chronic Hemodialysis Patients Artificial Organs 1994; 18: 420-42 https://doi.org/10.1111/j.1525-1594.1994.tb02227.x
  • Güneş M, Büyükgöl H. Correlation of neutrophil/lymphocyte and platelet/lymphocyte ratios with the severity of idiopathic carpal tunnel syndrome. Muscle Nerve 2020; 61: 369-374 https://doi.org/10.1002/mus.26791
  • Schrijver HM, Gerritsen AA, Strijers RL, et al. Correlating nerve conduction studies and clinical outcome measures on carpaltunnel syndrome: lessonsfrom a randomized controlled trial. J Clin Neurophysiol 2005; 22: 216-21.
  • Longstaff L, Milner RH, O'Sullivan S, Fawcett P. Carpaltunnel syndrome: the correlation between outcome, symptoms and nerve conduction study findings. J HandSurg [Br] 2001; 26: 475-80. https://doi.org/10.1054/jhsb.2001.0616
  • You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nevre conduction measures in carpal tunnel syndrome. Muscle Nerve 1999; 22: 497-501. https://doi.org/10.1002/(SICI)1097-4598(199904)22:4<497::AID-MUS11>3.0.CO;2-T
  • Dhong ES, Han SK, Lee BI, Kim WK. Correlation of electrodiagnostic Findings with subjective symptoms in carpal tunnel syndrome. AnnPlastSurg 2000; 45: 127-31. https://doi.org/10.1097/00000637-200045020-00005
  • Padua L, Padua R, Lo Monaco M, Aprile I, Tonali P. Multi perspective assessment of carpal tunnel syndrome: a multicenter study. Italian CTS Study Group. Neurology 1999; 53: 1654-9. https://doi.org/10.1212/WNL.53.8.1654
  • Dumitru D. Electrodiagnostic Medicine Philadelphia Hanley & Belfus 1994: 864-867
  • Becker J, Nora DB, Gomes I, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002; 113: 1429-1434. https://doi.org/10.1016/S1388-2457(02)00201-8
  • English JH, Gwynne-Jones DP. Incidence of carpal tunnel syndrome requiring surgical decompression. J Hand Surg Am 2015; 40: 2427-2434 https://doi.org/10.1016/j.jhsa.2015.07.029
There are 33 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Articles
Authors

Erman Altunışık 0000-0002-5996-2090

Ali Zeynel Abidin Tak 0000-0002-3783-184X

Publication Date December 1, 2020
Submission Date September 4, 2020
Acceptance Date September 8, 2020
Published in Issue Year 2020 Volume: 11 Issue: 41

Cite

Vancouver Altunışık E, Abidin Tak AZ. Karpal Tünel Sendromunda İnflamasyonun Nötrofil-Lenfosit Oranı, Platelet-Lenfosit Oranı ve Ortalama Platelet Hacmi ile Değerlendirilmesi. mkutfd. 2020;11(41):103-8.
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