The Correlation of Systemic Immune Inflammation Index, Neutrophil to Lymphocyte Ratio, Derived Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio with Disease Severity in Recurrent Aphthous Stomatitis

The peripheral immune cell counts and mouth ulcers: A two-sample Mendelian randomization study

Objective

This study explored the causal association of peripheral immune cell counts with mouth ulcers (MUs) by two-sample Mendelian Randomization.

Design

The counts of 12 circulating immune cell types (leukocytes, lymphocytes, monocytes, eosinophils, neutrophils, basophils, CD4+ cells, CD8+ cells, unswitched memory B cells, NK cells, B cells and a derived ratio (CD4+/CD8+)) were determined as the exposure. MUs were the outcome. The analysis was conducted mostly using the inverse-variance weighted (IVW) approach. MR Egger, weighted median, weighted mode and simple mode were used to detect the horizontal pleiotropy.

Results

The IVW results for leukocytes and lymphocyte counts were OR = 0.93, 95 % CI = 0.88-0.98, p = 0.0115 and OR = 0.91, 95 % CI: 0.84-0.98, p = 0.0150, respectively. The Wald ratio result for CD4+ cell and CD8+ cell counts were OR = 0.70, 95 % CI: 0.65-0.75, p = 1.05 × 10-20 and OR = 1.25, 95 % CI: 1.19-1.31, p = 9.99 × 10-21, respectively.

Conclusions

This study supports a causal effect of peripheral immune cell counts on MUs. Higher leukocyte, lymphocyte and CD4+ cell counts can protect against MUs, but higher CD8+ cell counts enhance the risk of MUs. This finding confirms host immune factors play a crucial role in the aetiology of MUs.

Elevated serum fibrinogen levels in Chinese patients with minor recurrent aphthous stomatitis: An observational study

Fibrinogen is a protein that reflects systemic inflammation and regulates the immune response to disease. However, there is a scarcity of data on fibrinogen in recurrent aphthous stomatitis (RAS). We aimed to test the hypothesis that fibrinogen is involved in the aetiology of RAS. Between November 2016 and November 2018, we included 109 minor RAS patients and 29 age- and sex-matched controls in a single-center, observational study. Their clinical history and ulcer manifestations led to the diagnosis of minor RAS. The ulcer severity score (USS) was used to assess disease severity, and fibrinogen was also collected. We conducted three analyses: Analysis 1 (comparison of fibrinogen levels between patients and controls), Analysis 2 (comparison of fibrinogen levels between high and low USS patients) and Analysis 3 (comparison of fibrinogen levels between before and after anti-inflammatory treatment in patients). The fibrinogen levels in the 109 minor RAS patients were statistically higher than in the 29 controls (mean [SD], 2.6 [0.5] vs. 2.3 [0.3]; Student's t-test, p < 0.001). However, there were no significant differences in fibrinogen levels among the 43 patients with high USS and the 39 patients with low USS (mean [SD], 2.7 [0.5] vs. 2.6 [0.4]; Student's t-test, p = 0.278). Furthermore, fibrinogen levels were significantly higher before anti-inflammatory treatment in comparison to those after anti-inflammatory treatment in the 35 paired patients (mean [SD], 2.6 [0.4] vs. 2.5 [0.4]; Student's t-test, p = 0.026). Interestingly, fibrinogen levels were significantly higher in the 35 paired patients after anti-inflammatory treatment compared to the 29 control subjects (mean [SD], 2.5 [0.4] vs. 2.3 [0.3]; Student's t-test, p = 0.026]. Fibrinogen may play a role in the aetiology of RAS and may be a drug target for RAS treatment. Clinicians should be alert that high serum fibrinogen levels might be associated with the risk of RAS.

The interplay between oral microbes and immune responses

Oral microbes play a critical role in maintaining oral homeostasis. Microbial dysbiosis promotes disease pathogenesis through several mechanisms. Recent studies have revealed that microbial imbalance and sustained inflammation are involved in disease progression. The adverse interaction triggered by a host immune response to microorganisms can lead to oral and systemic diseases. Here, we reviewed how oral microbes communicate with hosts during the development of local and distant inflammation. Elucidation of these processes may reveal future directions in this field and the potential targets of novel biological therapies for oral and systemic diseases.

The SII reflects inflammation in acne vulgaris, but fails to determine categorical severity

BACKGROUND

Systemic Immune Inflammation Index (SII; calculated by multiplying neutrophil-lymphocyte ratio and platelet count) has been investigated as a marker of inflammation.

AIM

we aimed to investigate the relationship of SII with acne severity and whether it can be used as a practical method in determining categorical acne severity.

MATERIALS AND METHODS

All participants (aged 15-30 years, n = 212) were prospectively evaluated with acne severity scales, including the Global Acne-Grading System (GAGS), the Comprehensive Acne Severity Scale (CASS), and the Patient-centered Acne Severity Scale. Patients were grouped according to GAGS: healthy individuals (n = 53), patients with mild (n = 44), moderate (n = 86), and severe acne (n = 29). Patients' hemogram data obtained simultaneously with the physical examination were used in the analysis.

RESULTS

The groups were statistically similar in terms of age and gender, both according to acne severity and current lesion types. The neutrophil count was significantly higher in patients with nodulocystic acne than in acne patients with non-inflammatory lesions or healthy individuals (p: 0.022). SII was significantly higher in acne patients with nodulocystic lesions than in individuals with milder lesions, both non-inflammatory and inflammatory (p = 0.004). SII was weakly significantly correlated with GAGS, CASS, and the number of nodulocystic lesions (r = 0.164, p = 0.018; r = 0.147, p = 0.034; r = 0.222, p = 0.001). However, none of the hemogram parameters, including SII, differed in classifying acne severity according to GAGS (p > 0.05).

CONCLUSIONS

Systemic immune inflammation index may be a new and reliable inflammatory marker to reflect the severity of inflammation, especially in patients with nodulocystic acne, although it is not useful in categorizing acne severity.