Značaj određivanja biomarkera zapaljenja u hroničnoj bubrežnoj slabosti
Sažetak
Uvod/Cilj. Zapaljenje ima ključnu ulogu u razvoju, progresiji i ishodu hronične bolesti bubrega (HBB). Cilj rada bio je da se ispita prediktivna vrednost biomarkera zapaljenja kod bolesnika sa HBB stadijuma I–V i njihova povezanost sa parametrima karakterističnim za HBB. Metode. Studijom preseka analizirano je 117 odraslih bolesnika sa HBB koji su na osnovu brzine glomerulske filtracije (glomerular filtration rate – GFR) podeljeni u dve grupe: Grupu 1, sa normalnom do slabo redukovanom bubrežnom funkcijom (GFR ≥ 60 mL/min/1,73 m2) stadijum I i II i Grupu 2, sa umerenim i teškim smanjenjem bubrežne funkcije (GFR < 60 mL/min/1,73 m2), stadijum III, IV i V koji nisu započeli lečenje dijalizom. Pored standardnih laboratorijskih analiza, kao markeri zapaljenja, određeni su izvedeni parametri: odnos neutrofila prema limfocitima (neutrophil-lymphocyte ratio – NLR), odnos trombocita prema limfocitima (platelet-lymphocyte ratio – PLR) i indeksi zapaljenja systemic immune-inflammation index – SII i system inflammation response index – SIRI. Rezultati. Utvrđena je statistički značajna razlika između Grupa 1 i 2 za indeks telesne mase (p < 0,003), za trombocite, hemoglobin, kreatinin, ureu, mokraćnu kiselinu, gvožđe, fosfor, paratiroidni hormon, kao i za 24-satnu proteinuriju (p < 0,001), zatim za kalcijum (p < 0,031) i leukocite (p < 0,030). Analiziranjem NLR, PLR, SII i SIRI kod bolesnika sa HBB uočena je statistički značajna razlika (p < 0,001) između grupa; povišene vrednosti ovih markera pokazane su kod bolesnika u Grupi 2. NLR, PLR i SII su pokazali statističku značajnost za važne parametre u HBB (C-reaktivni protein, kreatinin, GFR, hemoglobin, kalcijum, fosfor, paratiroidni hormon), a SIRI je pokazao statističku značajnost za fosfor u Grupi 2. Najsenzitivniji je bio NLR sa 87,7%, a najveću specifičnost imao je PLR – 81,7%, uz cut-off vrednosti za PLR – 151,75, NLR – 2,06, SII – 493,57 i SIRI – 0,739. Zaključak. Naši rezultati ukazuju da bi detekcija biomarkera NLR, PLR, SII i SIRI mogla imati značajnu ulogu u predviđanju zapaljenja u obolelih od HBB i doprineti blagovremenom prepoznavanju bolesnika sa rizikom od nastanka komplikacija.
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