hsCRP ,basophil count and MPV
Based on the scale of disease severity, 41 of 98 patients with CSU were
evaluated as severe, 57 as moderate and mild.
Patients with severe urticaria
displayed significantly higher levels of hsCRP and MPV than patients
with moderate and mild disease(p<0.0001; Fig 2 and Table 2).
Patients with severe urticaria displayed significantly lower levels of
basophil count than patients with moderate and mild disease(p=0.0008;Fig
2 and Table 2).
Relationship
among levels of whole blood hsCRP ,basophil count and MPV
HsCRP were
positively correlated with
MPV
(r=0.6733,p<0.0001),there
were significant negatively
correlations between basophil count and hsCRP concentrations
(r=-0.6720,p<0.0001;Fig 3),and MPV were negatively correlated
with basophil count (r=-0.6723,p<0.0001;Fig 3).
Discussion
In
this study, significant differences were found in hsCRP, basophil count
and MPV between CSU patients and the
controls,which supports the
assumption that chronic low-grade inflammation and platelet activation
are present in CSU15,16. One possible reason for the
reduced number of basophils in CSU is that these cells are actively
recruited into lesional skin. In the presence of IL-3,chemotaxis is
selectively enhanced in basophils by transendothelial
migration17.The presence of larger platelets in
patients might be a consequence of platelets’ consumption at the site of
the urticarial wheals and further compensatory
thrombopoiesis18.
Previous studies found a significant association between CSU severity
and blood levels of
CRP19.Ohtsuka T.
found that basopenia and high disease activity may be
interlinked.Besides a significant positive correlation between CU
severity score and MPV in ASST-positive patients was observed by Magen
et al. 18. The present findings are consistent with
previous studies.Based on large study it has been indicated that CRP,
basophil count and MPV may serve as biomarkers to monitor CSU severity.
In addition, We found a positive or negative correlation between these
markers, likely reflecting the potential interplay
between inflammatory process and
platelet activation in CSU.
It is known that CRP increased due to mast cell
activation accompanied by
inflammatory response20. MPV levels correlated with
hsCRP concentration, probably reflecting the same characteristic of the
inflammatory response in CSU.It suggests that there is an interrelation
between the platelets activation
and the inflammatory state in the pathogenesis of CSU. Prior studies
have consistently demonstrated that basophils play a crucial role in
IgE-dependent chronic allergic inflammation in the
skin21John A. Eckman et al. have
found altered basophil IgE
receptor function in CSU 22. Moreover,some other
studies pointed that platelet activation may occur during immunoglobulin
E antibody(1gE)-mediated reactions. Stimulated basophils release
preformed histamine, the major
mediator of urticaria, and newly synthesized factors, such as
leukotriene C4 and interleukin (IL)-4 and IL-1323.
Histamine potentiates platelet activity measured by the aggregation
induced by different agonists, acting through histamine
receptors16. Therefore, we suggest that the underlying
mechanism for this higher activity of platelets may result from local
and/or systemic inflammatory response in CSU.
On the other hand,platelets have been described as a source of
inflammatory mediators that are implicated in histamine release from
basophil and mast cells16.Some studies confirm that
platelet-derived supernatants (PDS) induce histamine release from human
mixed leukocytes containing basophils, one of the initial target cells
in IgE-mediated reactions. Platelets,
once activated,can produce a soluble substance or substances which can
initiate basophil-mediated reactions,further suggesting that platelet
activation can enhance inflammatory reactions24.
Interestingly, data from experimental studies prove that platelet
factor-4 (PF-4) fragment is able to induce rat mast cells to release
histamine in a dose-dependent manner.Moreover, it has been shown that
histamine is released by human platelets in response to aggregatory and
immunological stimuli.
Considering the fact that serum
histamine-releasing activity is an important determinant for urticarial
severity,it seems that CSU patients should be intensively treated to
ensure comprehensive control of their symptoms and to reduce
inflammatory process and platelet activation.So it is important to
perform repeated blood analyses after symptomatic treatment and CSU
remission. Sequential assessments of HsCRP, basophil and MPV
concentrations, related to severity of CSU might provide stronger
evidence of a causal relationship between platelet activation and
inflammation.Therefore, more
research is required to prove such hypothesis.The analysis of hsCRP,
basophil count and MPV is rapid and inexpensive, therefore combining
measurement may be a logical and practical tool to improve monitoring of
CSU severity in patients with low compliance.
To
the best of our knowledge, this study is the first prospective report of
the correlation among hsCRP,MPV and basophil
count.
However,
the limitation of the study was that biomarkers concentration all remain
within the normal range due to fewer cases. Some improvements may be
brought through increasing the number of patients.
In
conclusion,markers
of inflammatory process (CRP and basophil count) and of platelet
activation (MPV) are related to each other in CSU patients, suggesting
the possible interaction between these markers in the disease. There may
be an interplay between inflammatory process and platelet activation in
the pathogenesis of CSU.
The
correlation between hsCRP,basophil count and MPV would enable evaluation
of the effectiveness of medicines and comparing results of various
clinical or epidemiological studies.In addition,further study is needed
in order to verify the contribution of biomarkers to the pathological
etiology of CSU. Long-term prospective studies are
needed
to confirm whether this also correlates with disease course.