Evaluation of the response to nucleoside/nucleotide analogue treatment with neutrophil to lymphocyte ratio and mean platelet volume in patients with chronic hepatitis B infections

Kıvılcım Çiçek Çisem, Evaluation of the Response to Nucleoside/Nucleotide Analogue Treatment with Neutrophil to Lymphocyte Ratio and Mean Platelet Volume in Patients With Chronic Hepatitis B Infections, Zonguldak Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Zonguldak, 2019. Introduction: Chronic hepatitis B (CHB) virus infection is still one of the most common reasons for morbidity and mortality all over the world. Currently, it has been shown that the risk of developing hepatic fibrosis, cirrhosis, and hepatocellular carcinoma is reduced when patients are treated with effective treatment agents. However, methods measuring the success of treatment are limited. In this study, we aimed to investigate the usefulness of the changes in NLO, PLO and MPV parameters before and after nucleoside/nucleotide therapy in patients with CHB. Materıals and Methods: Between January 2013 and November 2017, a total of 136 out-clinic patients with CHB virus who underwent nucleoside/nucleotide analog treatment were enrolled to the study in the Department of Gastroenterology of Bülent Ecevit Univesity Medical Faculty. Basic demographic data of the patients (age, gender, comorbidities, medications, medication periods) were recorded. Neutrophil, leukocyte, platelet counts, Neutrophil/ lymphocyte rates, platelet/ lymphocyte rates, MPV, AST, ALT, GGT, Total Bilirubin, Albumin, INR, AFP, HBeAg, and HBV DNA levels analyzed before and after one year at least nucleoside/nucleotide therapy retrospectively. Results: Of 136 patients, while 38.97 % (fifty-three) were female and %61.03 (83) were male. Mean age of the patients were 43.21± 11.35 (female were 44.19±10.68 years, male were 42.59±11.79 years). 41.2 % (56) patients received Tenofovir, 7.35 % (10) Entecavir, 32.4 % (44) Lamivudine and 19.11 % (26)Telbivudine treatment. No statistically significant difference was calculated on pretreatment NLO (nlo1) and posttreatment NLO (nlo2) parameters (p=0.577). Patients were divided into subgroups according to their treatment agents and were analyzed (tenofovir p=0.12, entecavir p=0.646, lamivudine p=0.065, telbivudine p=0.286). Furthermore, patients were divided into subgroups according to HAI (Histologic Activity Index) scores. In both groups, pretreatment and posttreatment NLO was not statistically significant (HAI≤12 p=0.482, HAI>12 p=0.893). Also, no statistically significant difference was observed on pretreatment PLO (plo1) and posttreatment PLO (plo2) (p=0.337). Subgroup analyses showed that the value of PLO was found to be significantly elevated in patients with Telbivudine treatment (p=0.016). In low activity group (HAI≤12) and high activity group (HAI> 12), there was no difference in PLO levels after treatment (HAI≤12 p=0.429, HAI>12 p=1). Again, there was no significant difference in MPV values between patients before and after treatment (p=0.645). In subgroup analysis, a significant decrease in MPV levels was found in patients treated with Tenofovir (p=0.001). Conversely, it was found that MPV levels were significantly higher after treatment in patients who had entecavir (p=0.009). In addition, there was no significant difference according to MPV levels in groups of low activity (HAI≤12) and high activity (HAI> 12) (HAI≤12 p=0.589, HAI>12 p=0.715). Conclusion: As a result of our study, it is shown that the NLO, PLO, and MPV do not contribute to the evaluation of treatment responses of patients receiving nucleoside/nucleotide treatment. However, analysis on the basis of the drug used, we found that the decrease of MPV levels in patients treated with tenofovir and the increase of PLO levels in patients treated with Telbivudine may contribute to the evaluation of response to treatment. To use these parameters in clinical practice, studies with randomized, prospective, long follow-up period and larger patient numbers are needed. Keywords: Chronic hepatitis B, Nucleoside/Nucleotide Analogue, MPV, NLO, PLO.