Gestasyonel Diyabetes Mellituslu Gebelerde Serum YKL-40 Düzeyi

Year 2022, Volume: 12 Issue: 1, 92 - 97, 18.03.2022

Nevin Tüten Koray Gök Mine Kucur Abdullah Serdar Açıkgöz Mahmut Oncul Abdullah Tüten

https://doi.org/10.31832/smj.948949

Abstract

Amaç: GDM’lu ve sağlıklı gebelerde anne serumunda YKL-40 düzeyini ölçerek bu gebelerdeki insülin direnci üzerindeki rolünü açıklığa kavuşturmaktır.
Yöntem: Haziran 2012 ile Haziran 2013 tarihleri arasında Cerrahpaşa Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda takip edilen 40 GDM ve 40 sağlıklı term gebe çalışmaya dahil edildi. Gebelere ait demografik ve klinik parametreler hasta dosyalarından alındı. Bu gebelerde açlık glukoz, HbA1C, açlık insülin ve YKL-40 düzeyi ölçüldü. HOMA-IR değeri hesaplandı. GDM’li ve sağlıklı gebelerdeki parametreler karşılaştırıldı. Serum YKL-40 düzeyinin insülin direnci parametreleriyle ilişkisi araştırıldı.
Bulgular: GDM’lu ve sağlıklı gebeler arasında yaş, sistolik ve diyastolik kan basıncı, gebelik haftası, doğum ağırlığı, lökosit sayısı ve açlık glukoz düzeyi açısından istatistiksel bir fark saptanmadı (tümü için p > 0.05). GDM'lu gebelerin VKİ, HbA1c, açlık insülin düzeyi, HOMA-IR değeri ve YKL-40 düzeyi istatiksel açıdan anlamlı olacak şekilde yüksek saptandı ( sırasıyla, 31.8 ± 4.3, 28.1 ± 2.4, p:0,001; 5.86 ± 1.85, 5.11 ± 0.25, p:0,001; 12.74 ± 6.52, 7.44 ± 2.12, p:0,001, 3.12 ± 1.94, 1.81 ± 0.48, p:0,001). Serum YKL-40 düzeyi VKİ, HbaA1C, açlık insülin,ve HOMA-IR değeri ile pozitif korele saptandı(sırasıyla, r:0,507, p:0,001; r:0,668, p:0,001; r:0,556, p:0,001; r:0,379, p:0,009).
Sonuç: GDM’lu gebelerde serum YKL-40 düzeyinin arttığı ve bu düzeyin insülin direnci parametreleriyle pozitif korele olduğu tespit edilmiştir.

Keywords

GDM, İNSÜLİN DİRENCİ, HOMA-IR, YKL-40

Serum YKL-40 Level in Pregnant Women with Gestational Diabetes Mellitus

Abstract

Objective: To clarify its role on insulin resistance in pregnant women with GDM and by measuring the level of YKL-40 in maternal serum.
Materials and Methods: 40 GDM and 40 healthy term pregnant women followed in Cerrahpaşa Medical Faculty, Department of Obstetrics and Gynecology between June 2012 and June 2013 were included in the study. Demographic and clinical parameters of pregnant women were obtained from patient files. Fasting glucose, HbA1C, fasting insulin and YKL-40 levels were measured in these pregnant women. The HOMA-IR value was calculated. The parameters of GDM and healthy pregnant women were compared. The relationship between serum YKL-40 level and insulin resistance parameters was investigated.
Results: There was no statistical difference between GDM and healthy pregnant women in terms of age, systolic and diastolic blood pressure, gestational week, birth weight, leukocyte count and fasting glucose level (p > 0.05 for all). BMI, HbA1c, fasting insulin level, HOMA-IR value and YKL-40 level were found to be statistically significantly higher in pregnant women with GDM (31.8 ± 4.3, 28.1 ± 2.4, p:0.001; 5.86 ± 1.85, 5.11 ± 0.25, respectively). , p:0.001, 12.74 ± 6.52, 7.44 ± 2.12, p:0.001, 3.12 ± 1.94, 1.81 ± 0.48, p:0.001). Serum YKL-40 level was positively correlated with BMI, HbaA1C, fasting insulin, and HOMA-IR value (respectively, r:0.507, p:0.001; r:0.668, p:0.001; r:0.556, p:0.001; r: 0.379, p:0.009).
Conclusion: It was determined that serum YKL-40 level increased in pregnant women with GDM and this level was positively correlated with insulin resistance parameters.

Keywords

GDM, INSULIN RESISTANCE, HOMA-IR, YKL-40

References

• 1. Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, et al. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med 2012; 29: 844– 54.
• 2. Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med 2009; 14: 77– 84.
• 3. Kirwan JP, Hauguel-De Mouzon S, Lepercq J, et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes. 2002;51(7):2207-2213. doi:10.2337/diabetes.51.7.2207
• 4. Wolf M, Sauk J, Shah A, et al. Inflammation and glucose intolerance: a prospective study of gestational diabetes mellitus. Diabetes Care. 2004;27(1):21-27. doi:10.2337/diacare.27.1.21
• 5. Bo S, Signorile A, Menato G, Gambino R, Bardelli C, Gallo ML et al. C-reactive protein and tumor necrosis factor-alpha in gestational hyperglycemia. J Endocrinol Invest 2005; 28: 779– 86.
• 6. Johansen JS, Williamson MK, Rice JS, Price PA. Identification of proteins secreted by human osteoblastic cells in culture. J Bone Miner Res 1992; 7: 501– 12.
• 7. Hakala BE, White C, Recklies AD. Human cartilage gp-39, a major secretory product of articular chondrocytes and synovial cells, is a mammalian member of a chitinase protein family. J Biol Chem 1993; 268: 25803– 10.
• 8. Rathcke CN, Vestergaard H. YKL-40, a new inflammatory marker with relation to insulin resistance and with a role in endothelial dysfunction and atherosclerosis. Inflamm Res 2006; 55: 221– 7.
• 9. Boot RG, Van Achterberg TA, Van Aken BE, Renkema GH, Jacobs MJ, Aerts JM et al. Strong induction of members of the chitinase family of proteins in atherosclerosis: chitotriosidase and human cartilage gp-39 expressed in lesion macrophages. Arterioscler Thromb Vasc Biol 1999; 19: 687– 94.
• 10. Wang Y, Ripa RS, Johansen JS, Gabrielsen A, Steinbrüchel DA, Friis T et al. YKL-40 a new biomarker in patients with acute coronary syndrome or stable coronary artery disease. Scand Cardiovasc J 2008; 42: 295– 302.
• 11. Luo W, Zhang L, Sheng L, Zhang Z, Yang Z. Increased levels of YKL-40 in patients with diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr. 2021;13(1):6. Published 2021 Jan 15. doi:10.1186/s13098-021-00624-9
• 12. Nielsen AR, Erikstrup C, Johansen JS, et al. Plasma YKL-40: a BMI-independent marker of type 2 diabetes. Diabetes. 2008;57(11):3078-3082. doi:10.2337/db08-0182
• 13. Schaller G, Brix JM, Placher-Sorko G, Höllerl F, Schernthaner GH, Schernthaner G. YKL-40 concentrations are not elevated in gestational diabetes. Eur J Clin Invest. 2010 Apr;40(4):339-43. doi: 10.1111/j.1365-2362.2010.02274.x. PMID: 20486995.
• 14. Rinnov AR, Rathcke CN, Bonde L, Vilsbøll T, Knop FK. Plasma YKL-40 during pregnancy and gestational diabetes mellitus. J Reprod Immunol. 2015 Nov;112:68-72. doi: 10.1016/j.jri.2015.06.092. Epub 2015 Jul 14. PMID: 26301577.
• 15. Li J, Niu G, Wang H, Wang K, Huang B, Li M. Serum YKL-40 levels in gestational diabetes mellitus. Gynecol Endocrinol. 2016;32(5):412-5. doi: 10.3109/09513590.2015.1126707. Epub 2015 Dec 24. PMID: 26698539.
• 16. Gybel-Brask D, Johansen JS, Christiansen IJ, Skibsted L, Høgdall EV. Serum YKL-40 and gestational diabetes - an observational cohort study. APMIS. 2016 Sep;124(9):770-5. doi: 10.1111/apm.12573. Epub 2016 Jul 25. PMID: 27457220.
• 17. Aktulay A, Engin-Ustun Y, Ozkan MS, et al. GESTATIONAL DIABETES MELLITUS SEEMS TO BE ASSOCIATED WITH INFLAMMATION. Acta Clin Croat. 2015;54(4):475-478.
• 18. Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144:768–773
• 19. Matthews DR, Hosker JP, Rudenski AS et al (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419
• 20. Deng Y, Li G, Chang D, Su X. YKL-40 as a novel biomarker in cardio-metabolic disorders and inflammatory diseases. Clin Chim Acta. 2020 Dec;511:40-46. doi: 10.1016/j.cca.2020.09.035. Epub 2020 Sep 28. PMID: 33002471.
• 21. Neels JG, Olefsky JM. Inflamed fat: what starts the fire? J Clin Investig. 2006;116:33–35. doi: 10.1172/JCI27280.
• 22. Lain KY, Catalano PM (2007) Metabolic changes in pregnancy. Clin Obstet Gynecol 50:938–948
• 23. Luo W, Zhang L, Sheng L, Zhang Z, Yang Z. Increased levels of YKL-40 in patients with diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr. 2021 Jan 15;13(1):6. doi: 10.1186/s13098-021-00624-9. PMID: 33446257; PMCID: PMC7809835.