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Farklı Dört Polikistik Over Sendromu Fenotipinin Klinik Ve Laboratuvar Değerlerinin Karşılaştırılması

Yıl 2016, Cilt: 7 Sayı: 26, 0 - 0, 30.06.2016
https://doi.org/10.17944/mkutfd.81890

Öz

Amaç: Farklı Polikistik over sendromu (PKOS) fenotiplerinde klinik, biyokimyasal ve hormonal değerlerin karşılaştırılması.

Gereç ve Yöntem: Çalışmaya Dumlupınar Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum polikliniğimize Temmuz 2015- Ocak 2016 tarihleri arasında başvurarak PKOS tanısı almış 87 hasta ve yaş – vücut kitle endeksi uyumlu, 34 sağlıklı gönüllü olmak üzere toplam 121 olgu dahil edildi. PKOS tanısı için revize Rotterdam Kriterleri kullanıldı. Hastaların tanımlayıcı verileri, biyokimyasal ve hormonal değerleri karşılaştırıldı. İstatistiksel analizler için SPPS 21.0 programı kullanıldı. P değerinin 0.05’den küçük olması istatistiksel olarak anlamlı kabul edildi.

Bulgular: Çalışma grubunun 38’i fenotip 1 (%43.67), 6’sı fenotip 2 (%6.89), 22’si fenotip 3 (%25.28) ve 21’i fenotip 4 (%24.13) idi.  PKOS ve kontrol grubunun ortalama yaşları sırasıyla 23,09 ± 4.90 ve 23.15 ± 6.40 idi (p>0.05). Vücut kitle endeksi fenotip 1 ve 2’de daha yüksek olmasına rağmen gruplar arasındaki fark istatistiksel olarak anlamlı değildi. Bel kalça oranında fenotipler arasında fark izlenmedi (p>0.05). Hastaların % 63.2’sinde insülin direnci bulundu. İnsülin direnci en sık fenotip 2’de izlendi. Serum C reaktif protein (CRP) düzeyi incelendiğinde gruplar arasında istatistiksel açıdan anlamlı bir fark görülmedi (p>0.05). Grupların Ferriman Gallwey skorlarına (FGS) bakıldığında fenotip 2 ve 1’in en yüksek skorlara sahip olduğu görüldü. Fenotip 1, 2 ve 3’ün FGS’leri kontrol grubu ve fenotip 4’e göre ileri derecede anlamlı yüksekti (p<0.001). Luteinizan hormon (LH) değeri fenotip 1 ve 4’te kontrol grubu ve diğer fenotiplere göre anlamlı yüksekti (p<0.01). Serum testosteron seviyesi hasta grupta kontrol grubuna göre yüksek olmakla birlikte (p=0.03) fenotipler arasında anlamlı farklılık gözlenmedi (p>0.05).

Sonuç: Çalışmamızda farklı PKOS fenotiplerinde FGS ve serum LH seviyesi dışında gruplar arasında bir farklılığın olmadığı görüldü. Bununla birlikte, fenotip 2’de insülin direnci ve CRP düzeylerinin istatistiksel olarak anlamlı olmasa da belirgin şekilde yüksek olduğu gözlendi. Bu grubun uzun dönem kardiyovasküler morbidite açısından nisbeten riskli grup olduğu düşünülerek yakın takip yapılması uygun olacaktır. 

Anahtar kelimeler: Anovulasyon, Fenotip, Hiperandrojenizm, Polikistik over sendromu

Kaynakça

  • Abbot DH, Dumesic DA, Frank S. Developmental origin of polycystic ovary syndrome-a hypothesis. J Endoc-rinol 2002;174:1.
  • Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25.
  • Calan M, Yilmaz O, Kume T, Unal Kocabas G, Yesil Senses P, Senses YM, et al. Elevated circulating levels of betatrophin are associated with polycystic ovary syndrome. Endocrine. 2016 Feb 1. [Epub ahead of print]
  • Legro RS, Kunselman AR, Dodson WC, Dunaif A. Pre-valence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165–9.
  • Talbott EO, Zborwski JV, Rager JR, Boudreaux MY, Edmundowicz DA, Guzick DS. Evidence for an associa-tion between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004;89:5454–61.
  • Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, EscobarMorreale HF, Futterweit W, et al. The Andro-gen Excess and PCOS Society criteria for the polycys-tic ovary syndrome: the complete task force report. Fertil Steril 2009;91:456–88.
  • Wickenheisser JK, Nelson–DeGrave VL, McAllister JM. Human ovarian theca cells in culture. Trends Endocri-nol Metab 2006;17:65–71.
  • Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC, et al. Homeostasis model as-sessment: insulin resistance and beta cell function from fasting plasma glucose and insulin concentrati-ons in man. Diabetologia 1985; 28:412-9.
  • Joyce K. Polycystic ovary syndrome. J Midwifery Womens Health 2006;51:415–22.
  • Yilmaz M, Isaoglu U, Delibas IB, Kadanali S. Anthropo-metric, clinical and laboratory comparison of four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. J Obstet Gynaecol Res. 2011;37:1020-6.
  • Welt CK, Gudmundsson JA, Arason G, Adams J, Palsdottir H, Gudlaugsdottir G, et al. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: The impact of we-ight on phenotype andmatabolicfeatures.J Clin Endoc-rinol Metab2006;91:4842–8.
  • Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, Ku SY, Suh CS, et al. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod 2008;23:1924–31.
  • Panidis D, Tziomalos K, Misichronis G, Papadakis E, Betsas G, Katsikis I, et al. Insulin resistance and endoc-rine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod. 2012;27:541-9.
  • Poretsky L, Piper B. Insulin resistance, hypersecretion of LH, and a dual-defect hypothesis for the pathoge-nesis of polycystic ovary syndrome. Obstet Gynecol. 1994;84:613-21.
  • Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Pro-found peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989:38:1165-74.
  • Guastella E, Longo RA, Carmina E. Clinical and endoc-rine characteristics of the main polycystic ovary synd-rome phenotypes. Fertil Steril 2010; 94:2197–201.
  • Daan NM, Louwers YV, Koster MP, Eijkemans MJ, de Rijke YB, Lentjes EW, et al. Cardiovascular and meta-bolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertil Steril. 2014;102:1444-51.
  • Ladrón de Guevara A, Fux-Otta C, Crisosto N, Szafryk de Mereshian P, Echiburú B, Iraci G, et al. Metabolic profile of the different phenotypes of polycystic ovary syndrome in two Latin American populations. Fertil Steril. 2014 ;101:1732-9.
  • Diamanti-Kandarakis E, Christakou C, Marinakis E. Phenotypes and environmental factors: their influen-ce in PCOS. Curr Pharm Des 2012;18:270–82.
  • Zhang HY, Zhu FF, Xiong J, Shi XB, Fu SX. Characteris-tics of different phenotypes of polycystic ovary synd-rome based on the Rotterdam criteria in a large-scale Chinese population. BJOG. 2009;116:1633-9.
  • Goverde AJ, van Koert AJ, Eijkemans M.J, Knauff EA, Westerveld HE, Fauser BC, et al. Indicators for meta-bolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Hum Reprod. 2009;24:710-7.
Yıl 2016, Cilt: 7 Sayı: 26, 0 - 0, 30.06.2016
https://doi.org/10.17944/mkutfd.81890

Öz

Kaynakça

  • Abbot DH, Dumesic DA, Frank S. Developmental origin of polycystic ovary syndrome-a hypothesis. J Endoc-rinol 2002;174:1.
  • Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25.
  • Calan M, Yilmaz O, Kume T, Unal Kocabas G, Yesil Senses P, Senses YM, et al. Elevated circulating levels of betatrophin are associated with polycystic ovary syndrome. Endocrine. 2016 Feb 1. [Epub ahead of print]
  • Legro RS, Kunselman AR, Dodson WC, Dunaif A. Pre-valence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165–9.
  • Talbott EO, Zborwski JV, Rager JR, Boudreaux MY, Edmundowicz DA, Guzick DS. Evidence for an associa-tion between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004;89:5454–61.
  • Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, EscobarMorreale HF, Futterweit W, et al. The Andro-gen Excess and PCOS Society criteria for the polycys-tic ovary syndrome: the complete task force report. Fertil Steril 2009;91:456–88.
  • Wickenheisser JK, Nelson–DeGrave VL, McAllister JM. Human ovarian theca cells in culture. Trends Endocri-nol Metab 2006;17:65–71.
  • Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC, et al. Homeostasis model as-sessment: insulin resistance and beta cell function from fasting plasma glucose and insulin concentrati-ons in man. Diabetologia 1985; 28:412-9.
  • Joyce K. Polycystic ovary syndrome. J Midwifery Womens Health 2006;51:415–22.
  • Yilmaz M, Isaoglu U, Delibas IB, Kadanali S. Anthropo-metric, clinical and laboratory comparison of four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. J Obstet Gynaecol Res. 2011;37:1020-6.
  • Welt CK, Gudmundsson JA, Arason G, Adams J, Palsdottir H, Gudlaugsdottir G, et al. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: The impact of we-ight on phenotype andmatabolicfeatures.J Clin Endoc-rinol Metab2006;91:4842–8.
  • Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, Ku SY, Suh CS, et al. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod 2008;23:1924–31.
  • Panidis D, Tziomalos K, Misichronis G, Papadakis E, Betsas G, Katsikis I, et al. Insulin resistance and endoc-rine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod. 2012;27:541-9.
  • Poretsky L, Piper B. Insulin resistance, hypersecretion of LH, and a dual-defect hypothesis for the pathoge-nesis of polycystic ovary syndrome. Obstet Gynecol. 1994;84:613-21.
  • Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Pro-found peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989:38:1165-74.
  • Guastella E, Longo RA, Carmina E. Clinical and endoc-rine characteristics of the main polycystic ovary synd-rome phenotypes. Fertil Steril 2010; 94:2197–201.
  • Daan NM, Louwers YV, Koster MP, Eijkemans MJ, de Rijke YB, Lentjes EW, et al. Cardiovascular and meta-bolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertil Steril. 2014;102:1444-51.
  • Ladrón de Guevara A, Fux-Otta C, Crisosto N, Szafryk de Mereshian P, Echiburú B, Iraci G, et al. Metabolic profile of the different phenotypes of polycystic ovary syndrome in two Latin American populations. Fertil Steril. 2014 ;101:1732-9.
  • Diamanti-Kandarakis E, Christakou C, Marinakis E. Phenotypes and environmental factors: their influen-ce in PCOS. Curr Pharm Des 2012;18:270–82.
  • Zhang HY, Zhu FF, Xiong J, Shi XB, Fu SX. Characteris-tics of different phenotypes of polycystic ovary synd-rome based on the Rotterdam criteria in a large-scale Chinese population. BJOG. 2009;116:1633-9.
  • Goverde AJ, van Koert AJ, Eijkemans M.J, Knauff EA, Westerveld HE, Fauser BC, et al. Indicators for meta-bolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Hum Reprod. 2009;24:710-7.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Bölüm Original Articles
Yazarlar

Suna Kabil Kucur

Beril Yüksel

Ali Seven Bu kişi benim

Murat Polat

Nadi Keskin Bu kişi benim

Ayşe Nur Aksoy

Yayımlanma Tarihi 30 Haziran 2016
Gönderilme Tarihi 27 Mart 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 7 Sayı: 26

Kaynak Göster

Vancouver Kabil Kucur S, Yüksel B, Seven A, Polat M, Keskin N, Aksoy AN. Farklı Dört Polikistik Over Sendromu Fenotipinin Klinik Ve Laboratuvar Değerlerinin Karşılaştırılması. mkutfd. 2016;7(26).