|Year : 2020 | Volume
| Issue : 5 | Page : 427-431
Evaluation of serum lipid profile and complete hemogram in patients with oral submucous fibrosis: A case control study
Soundarya Ramesh, Poornima Govindaraju, Balaji Pachipalusu
Department of Oral Medicine and Radiology, RajaRajeswari Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Submission||21-Nov-2019|
|Date of Decision||11-Mar-2020|
|Date of Acceptance||14-Mar-2020|
|Date of Web Publication||21-Oct-2020|
Dr. Soundarya Ramesh
No. 14, Ramohalli Cross, Kumbalgodu, Bengaluru, Karnataka.
Source of Support: None, Conflict of Interest: None
Aim: Not many studies in the literature are found that include all the variables under complete blood picture along with lipid profile. The aim of study was to evaluate the serum lipid profile and complete blood picture in patients with oral submucous fibrosis (OSMF). Materials and Methods: It is a case control study with the sample size of 40 patients considered by random sampling, which includes 20 clinically diagnosed patients with OSMF as per the diagnostic criteria of Passi et al. and 20 sex-matched controls. Five milliliters of blood was collected from the most prominent vein of right cubital fossa and stored in test tubes. Centrifugation was carried out for about 4–5min at 2500rpm and the serum collected was stored at 4°C and subjected to auto analyzer for analyzing complete lipid profile and complete blood picture. Mann–Whitney U test was used to compare mean age, mean values of lipid profile parameters, and hematological parameters between OSMF and healthy group. Results: The serum lipid levels were significantly lower in patients with OSMF than in controls, and also patients with OSMF showed significantly lower levels of hemoglobin (Hb), red blood cells (RBCs), and platelets and increased levels of erythrocyte sedimentation rate (ESR) and white blood cell (WBC) than in controls. Conclusion: This study concluded that the lower serum lipid levels may serve as a diagnostic and prognostic indicator in the early diagnosis of oral premalignant lesions, and the findings in our study emphasize on the assessment of Hb, RBCs, WBCs, platelets, and ESR for patients with OSMF. So it is recommended to subject the patients with oral precancerous conditions to biochemical investigations as it may aid in early diagnosis and prognosis.
Keywords: Hemoglobin, Lipids, Oral Submucous Fibrosis, Platelets, RBCs, WBCs
|How to cite this article:|
Ramesh S, Govindaraju P, Pachipalusu B. Evaluation of serum lipid profile and complete hemogram in patients with oral submucous fibrosis: A case control study. J Int Oral Health 2020;12:427-31
|How to cite this URL:|
Ramesh S, Govindaraju P, Pachipalusu B. Evaluation of serum lipid profile and complete hemogram in patients with oral submucous fibrosis: A case control study. J Int Oral Health [serial online] 2020 [cited 2021 Jun 17];12:427-31. Available from: https://www.jioh.org/text.asp?2020/12/5/427/298792
| Introduction|| |
Use of tobacco products is a serious health issue and its usage has been established as risk factors for the development of potentially malignant lesions of the oral mucosa. It is associated with high levels of mortality and morbidity all over the world. Oral cancer is sometimes preceded by clinically visible lesions that are noncancerous to begin with and which have therefore been termed precancerous. Oral submucous fibrosis (OSMF) is a premalignant condition and molecular markers from body fluids, such as urine, blood, and saliva, play a role in detecting, predicting prognosis, and monitoring the progression of oral cancer. Various substances alter quantitatively in the serum during tumor development; these are called tumor markers and it can occur even before frank cancer has occurred. So we can predict even in oral precancerous lesions and condition whether a particular individual with the underlying biochemical defect would develop cancer or not at a later date. The changes in the lipid profile have long been associated with cancerous and precancerous condition because lipid plays a key role in maintenance of cell integrity. Estimation of hemoglobin (Hb) levels acts as an indicator for nutritional assessment as they can affect the integrity of oral mucosa.
Studies from various researchers have reported an inverse relationship between serum lipid profile and OSMF, and very few studies were found in the literature to assess the hematological variations in a single study in same patients. Hence this study was planned to evaluate the serum lipid profile and complete blood picture in patients with OSMF, and these values are compared with healthy subjects as they may have a diagnostic and prognostic role in the potentially malignant lesions.
| Materials and Methods|| |
The presented case control study was conducted among 20 clinically diagnosed patients of OSMF reporting to the Department of Oral Medicine and Radiology, RajaRajeswari Dental College and Hospital, Bengaluru, India, in the span of 3 months, after obtaining the institutional ethical committee clearance.
The presented case control study was performed with random sampling method on 20 patients diagnosed as having OSMF based on the criteria of Passi et al. Twenty healthy individuals were also taken as control with same age and sex groups. Patients with any previous treatment for OSMF, any systemic disease, or who are on corticosteroid therapy or on lipid-lowering agents were excluded from the study. Informed consent and detailed case history were taken before drawing the blood.
Five milliliters of blood was collected from the most prominent vein of right cubital fossa and stored in test tubes. Centrifugation was carried out for about 4–5min at 2500rpm and the serum collected was stored at 4°C and submitted for the estimation of lipid profile (total cholesterol [TC], high-density lipoprotein [HDL], low-density lipoprotein [LDL], very-low-density lipoprotein [VLDL], and triglycerides [TG]) and complete blood picture (Hb, red blood cell [RBC], white blood cell [WBC], neutrophils, lymphocytes, monocytes, eosinophil, platelets, packed cell volume [PCV], erythrocyte sedimentation rate [ESR], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration [MCHC]) using auto analyzer (Sysmex XN 1000; Beckman Coulter, Transasia).
Lipid profile parameters such as TC, HDL, LDL, VLDL, and TG and hematological parameters such as Hb, RBC, WBC, neutrophils, lymphocytes, monocytes, eosinophil, platelets, PCV, ESR, MCV, MCH, and MCHC were observed.
Mann Whitney U test was used to compare the mean values of lipid profile parameters and hematological parameters between the two groups. The level of significance was set at P < 0.05. All the variables from the study were statistically analyzed using SPSS (Statistical Package for Social Sciences for Windows, version 22.0, released 2013; IBM, Armonk, NY).
| Results|| |
This was a case control study conducted on 20 cases of OSMF and 20 age- and sex-matched healthy controls. Serum lipid levels and hematological variables were estimated and analyzed in cases and controls. The results were expressed as mean ± standard deviation.
The age distribution of cases and controls is depicted in [Table 1]. The mean age (in years) of cases was 34.65 years and that of controls was 31.10 years and was not significant (P > 0.05).
|Table 1: Comparison of mean age in years between OSMF and control groups using Mann–Whitney U test|
Click here to view
The mean values of lipid profile parameters such as TC, LDL, HDL, VLDL, and TG between OSMF and healthy groups were compared, and it revealed a statistically significant reduction in OSMF group than control group [Figure 1].
|Figure 1: Mean values of lipid profile parameters between OSMF and healthy groups were compared and it revealed a statistically significant reduction in OSMF than control group|
Click here to view
[Table 2] shows the mean serum cholesterol, serum HDL, serum LDL, serum VLDL, and serum TG levels in patients with OSMF and control group.
|Table 2: Comparison of mean values of lipid profile parameters between OSMF and healthy groups using Mann–Whitney U test|
Click here to view
The mean values of hematological parameters between OSMF and healthy groups are shown in [Table 3].
|Table 3: Comparison of mean values of hematological parameters between OSMF and healthy groups using Mann–Whitney U test|
Click here to view
The mean values of Hb, RBC, and platelets between OSMF and healthy groups showed a statistically significant reduction whereas the hematological parameters such as WBC, eosinophils, and ESR were slightly higher in patients with OSMF compared to controls [Figure 2] and [Figure 3].
|Figure 2: Mean values of differential count between OSMF and healthy groups showed a statistically significant reduction whereas the hematological parameters such as WBC, eosinophils, and ESR were slightly higher in patients with OSMF compared to controls|
Click here to view
|Figure 3: Mean ESR count (mm/h) between OSMF and healthy group showed a statistically significant reduction whereas the hematological parameters such as WBC, eosinophils, and ESR were slightly higher in patients with OSMF compared to controls|
Click here to view
| Discussion|| |
OSMF is a chronic disease of the oral cavity, which is characterized by an epithelial and subepithelial reaction followed by fibroelastic changes in the submucosa, and it was first described as “Atrophica idiopathica mucosae oris” by Schwartz in 1952.,
It is an insidious disease that affects the lamina propria of the oral mucosa, and as the disease advances it involves tissues deeper in the submucosa of the oral cavity with resulting loss of fibroelasticity. The disease commonly occurs in the southeast Asians, and Indian population has highest rate of incidence with the prevalence rate of 0.2%–0.5% and malignant transformation rate of 2.3–7.6%.
Lipids are the major cell membrane components essential for various biological functions including the cell growth and division of normal and malignant tissues. Lower level of lipids may indicate rapidly dividing cells of malignancy, and hence they play a role in carcinogenesis. Reduced lipid levels among patients with OSMF in our study could be due to rapidly dividing cells in malignancy. During the process of tumorigenesis, enormous amount of lipids are utilized and cells accomplish these needs from circulation either by synthesis through the metabolism or from degradation of major lipoprotein fraction such as VLDL, HDL, or LD. In our study, the decrease in lipid levels may be used as an indicator reflecting initial changes occurring in precancerous and neoplastic conditions.,,,,,,
The results in our study coincided with the studies conducted by Swamy and Ganiger Karthik et al., Anusha et al., Ajai et al., Kanthem et al., and Narang et al.,[18 in which they showed a significant reduction in TC],[ HDL],[ VLDL],[ LDL],[ and TG in patients with OSMF as compared to the controls.
A study that was conducted by Karthik et al. and the study by Narang et al. observed a significantly decreased Hb and RBC, and increased WBC and ESR in patients with OSMF, coinciding with the results of our study.
Utilization of the iron in collagen synthesis by the hydroxylation of proline and lysine leads to decreased serum iron levels in patients with OSMF. Low levels of Hb and serum RBC are suggestive of iron deficiency anemia. Iron deficiency anemia in patients with OSMF could be related to the precancerous nature of this condition. In this study, OSMF group showed significant lower levels of Hb and RBC on comparison with the values of the control group. Studies with similar results are reported by Karthik et al. and Narang et al.
In our study, an attempt was made to analyze serum lipid levels and complete hemogram in patients with OSMF in comparision with normal healthy individuals. It revealed that these variable acts as a marker and prognostic indicator in the early detection of oral cancer.
The findings in our study add to the evidence of an inverse relationship between serum lipid profile and OSMF. Evaluating the serum lipid profile and complete hemogram in OSMF is necessary as the change in lipid levels may have a diagnostic and prognostic role in premalignant lesion. Significant hematological variations are found in OSMF. So it is suggested that the biochemical assessment of oral precancerous lesions helps to evaluate the malignant potential in high-risk groups.
The authors would like to thank Department of Biochemistry and Department of Microbiology, Rajarajeswari Medical college and Hospital for conducting blood Investigations.
Financial support and sponsorship
Conflicts of interest
All the three Authors have contributed in the study and in the preparation of manuscript and finally all authors had given approval for publication.
Ethical clearance have been obtained from the institution with the institutional ethical clearance no RRDCHET/01OMR/2019.
Patient declaration of consent
Patient’s consent has been obtained.
Data availability statement
Data can be available on valid request on contacting to corresponding author mail.
| References|| |
Al-Attas SA, Ibrahim SS, Amer HA, Darwish Z, Hassan MH Prevalence of potentially malignant oral mucosal lesions among tobacco users in Jeddah, Saudi Arabia. Asian Pac J Cancer Prev 2014;15:757-62.
Kumar S, Debnath N, Ismail MB, Kumar A, Kumar A, Badiyani BK, et al
. Prevalence and risk factors for oral potentially malignant disorders in Indian population. Adv Prev Med 2015;2015:208519.
Santosh AB, Jones T, Harvey J A review on oral cancer biomarkers: Understanding the past and learning from the present. J Cancer Res Ther 2016;12:486-92.
Swamy KM, Ganiger A Alterations of serum lipid profile in oral submucous fibrosis. Int J Otorhinolaryngol Head Neck Surg 2017;3:1064-7.
Karthik H, Nair P, Gharote HP, Agarwal K, Ramamurthy Bhat G, Kalyanpur Rajaram D Role of hemoglobin and serum iron in oral submucous fibrosis: A clinical study. ScientificWorldJournal 2012;2012:254013.
Passi D, Bhanot P, Kacker D, Chahal D, Atri M, Panwar Y Oral submucous fibrosis: Newer proposed classification with critical updates in pathogenesis and management strategies. Natl J Maxillofac Surg 2017;8:89-94.
Ahmad MS, Ali SA, Ali AS, Chaubey KK Epidemiological and etiological study of oral submucous fibrosis among gutkha chewers of Patna, Bihar, India. J Indian Soc Pedod Prev Dent 2006;24:84-9.
Anusha , Pratap M, Sinha A, Srivastav S, Mishra A, Iqbal H Estimation of serum lipid profile in patients with OSMF. J Indian Acad Oral Med Radiol 2018;30:102‐6. doi:10.4103/jiaomr.JIAOMR_21_17.
Ajai K, Panat SR, Aggarwal A, Agarwal N, Upadhyay N, Joshi A Estimation of serum lipids in patients with oral submucous fibrosis in India. J Clin Exp Dent 2014;6:e237-42.
Subbulakshmi AC, Mohan N, Thiruneervannan R, Naveen S Comparative evaluation of serum lipid profile in patients with oral submucous fibrosis and oral squamous cell carcinoma with that of control subjects: A case control study. J Pharm Bioallied Sci 2017;9:191-6.
Yashveer JK, Pankaj D Alteration of serum lipid in oral sub mucous fibrosis in central India. Indian J Otolaryngol Head Neck Surg 2018;70:421-4.
Mehta R, Gurudath S, Dayansoor S, Pai A, Ganapathy KS Serum lipid profile in patients with oral cancer and oral precancerous conditions. Dent Res J (Isfahan) 2014;11:345-50.
Garg D, Sunil MK, Singh PP, Singla N, Rani SR, Kaur B Serum lipid profile in oral precancer and cancer: A diagnostic or prognostic marker? J Int Oral Health 2014;6:33-9.
Kumar P, Singh A, Sankhla B, Naraniya A Alteration in plasma lipid profile in oral submucous fibrosis patients: A case control study. South Asian J Cancer 2013;2:147-9.
Pantvaidya GH, Katna R Oral submucous fibrosis and plasma lipid profile. South Asian J Cancer 2013;2:145-6.
Mehrotra R, Pandya S, Chaudhary AK, Singh HP, Jaiswal RK, Singh M, et al
. Lipid profile in oral submucous fibrosis. Lipids Health Dis 2009;8:29.
Kanthem RK, Guttikonda VR Serum lipid profile in oral submucous fibrosis: A clinico pathological study. J Oral Maxillofac Pathol 2015;19:139-44.
Narang D, Shishodiya S, Sur J, Khan NF White blood cells count: As a pathological diagnostic marker for oral pre-cancerous lesions and conditions: A randomized blind trial. J Carcinog Mutagen 2014;5:188.doi:10.4172/2157–2518.1000188.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]