C-Reactive Protein Levels in Women with Polycystic Ovarian Syndrome and Healthy Controls

Abstract

Aim/background: Although, pathophysiology of polycystic ovarian syndrome has not been fully understood, insulin resistance may have a pivotal role in this condition. It has been suggested that subclinical inflammation is strongly related to both insulin resistance and obesity associate metabolic disorders. In this study, we aimed to evaluate the serum levels of C-reactive protein which has been determined as an insulin resistance related inflammatory marker and investigate to its potential role the polycystic ovarian syndrome in our study population. Methods: Forty women with polycystic ovarian syndrome and forty age and body mass index matched healthy controls were retrospectively evaluated in this study. Serum fasting glucose, insulin, C-reactive protein and total testosterone concentrations were assessed. Results: Both serum C-reactive protein (1.14±1.86 mg/L vs. 3.56±4.69mg/L; p= 0.004) and total testosterone concentrations (p=0.011) were higher in polycystic ovarian syndrome group. C-reactive protein levels significantly and positive correlated with body weight, body mass index and waist circumference (p<0.05). In the linear regression model, polycystic ovarian syndrome was defined as a dependent variable and hs-CRP was determined as a independent variable. According to this analysis C-reactive protein associated with polycystic ovarian syndrome (β= 0.326, R² = 0.106 and p= 0.003) Conclusion: Several inflammatory molecules associate with both insulin resistance and obesity related cardio metabolic disorders. However, there are some conflicting results in relationship between polycystic ovarian syndrome and inflammatory molecules including C-reactive protein. Therefore, advanced studies need to explain the potential role of the C-reactive protein in polycystic ovarian syndrome.

 

Amaç/Giriş: Polikistik over sendromunun (PKOS) patogenezi tam olarak anlaşılamamış olmakla birlikte insülin direncinin bu hastalıkta önemli bir role sahip olabileceği bildirilmiştir. Subklinik inflamasyonun insulin direnci ve obezite ile ilişkili metabolik bozukluklarda önemli bir rol oynadığı düşünülmektedir. Bu çalışmada incelediğimiz populasyonda PKOS’lu ve sağlıklı kadınlar arasında bir inflamatuar belirteç olan C-reaktif protein serum düzeylerini değerlendirerek polikistik over sendromundaki yerini değerlendirmeyi amaçladık. Yöntem: Polikistik over sendromu olan 40 kadın ile vücut kitle indeksi ve yaş açısından eşleştirilmiş olan 40 sağlıklı kadın geriye dönük olarak incelendi. Serum açlık glukoz, insulin, C-reaktif protein (CRP) ve total testosteron düzeyleri değerlendirildi. Bulgular: Serum C-reaktif protein (1.14±1.86 mg/L’e karşın 3.56±4.69mg/L; p= 0.004) ve serum total testosteron konsantrasyonu (p=0.011) polikistik over sendromlu kadınlarda anlamlı olarak daha yüksekti. Serum C-reaktif protein ile vücut ağırlığı, vücut kitle indeksi ve bel çevresi arasında anlamlı pozitif korelasyon saptandı (p<0.05). Polikistik over sendromunun bağımlı değişken, C-reaktif proteinin ise bağımsız değişken olarak tasarlandığı lineer regresyon modeli’nin sonuçlarına göre C-reaktif proteinin polikistik over sendromu ile istatistiksel olarak anlamlı seviyede birliktelik gösterdiği saptandı (β= 0.326, R² = 0.106 ve p= 0.003) Sonuç: Pek çok inflamatuar molekül insulin direnci ve obezite ile ilişkili metabolik ve kardiyovasküler bozukluklar ile birliktelik gösterir. Ancak polikistik over sendromu ile C-reaktif proteini de içeren inflamatuar moleküller arasındaki ilişkiye ait veriler birbirleri ile tam olarak örtüşmemektedir.  Bundan dolayı ileri çalışmalarla C-reaktif proteinin polikistik over sendromundaki rolünün aydınlatılması gereklidir.

 

Keywords

• Polycystic ovarian syndrome,C-reactive protein,inflammation

References

1. 1. Mukherjee S, Maitra A. Molecular & genetic factors contributing to insulin resistance in polycystic ovary syndrome. Indian J Med Res. 2010; 131:743-60.
2. 2. Majumdar A, Singh TA. Comparison of clinical features and health manifestations in lean vs. obese Indian women with polycystic ovarian syndrome. J Hum Reprod Sci. 2009; 2:12-17.
3. 3. Sathyapalan T, Atkin SL. Mediators of inflammation in polycystic ovary syndrome in relation to adiposity. Mediators Inflamm. 2010; 2010:758656
4. 4. Diamanti-Kandarakis E, Christakou CD, Kandaraki E, Economou FN. Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome.Eur J Endocrinol. 2010; 162:193-212.
5. 5. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003; 107:363-369.
6. 6. Oemrawsingh RM, Cheng JM, Akkerhuis KM, Kardys I, Degertekin M, van Geuns RJ et al. High-sensitivity C-reactive protein predicts 10-year cardiovascular outcome after percutaneous coronary intervention. EuroIntervention. 2016 Jun 20;12(3):345-51
7. 7. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2013;12: 4565–4592
8. 8. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28:412–419

9. 9. El-Mesallamy HO, Abd El-Razek RS, El-Refaie. TA.Circulating high-sensitivity C-reactive protein and soluble CD40 ligand are inter-related in a cohort of women with polycystic ovary syndrome.Eur J Obstet Gynecol Reprod Biol. 2013; 168:178-182.
10. 10. Sumithra NU, Lakshmi RL, Leela Menon N, Subhakumari KN, Sheejamol VS. Evaluation of oxidative stress and hsCRP in polycystic ovarian syndrome in a tertiary care hospital.Indian J Clin Biochem. 2015; 30:161-166.
11. 11. Puder JJ, Varga S, Kraenzlin M, De Geyter C, Keller U, Müller B. Central fat excess in polycystic ovary syndrome: relation to low-grade inflammation and insulin resistance.J Clin Endocrinol Metab. 2005; 90:6014-6019
12. 12. Ganie MA, Hassan S, Nisar S, Shamas N, Rashid A, Ahmed I, et al. High-sensitivity C-reactive protein (hs-CRP) levels and its relationship with components of polycystic ovary syndrome in Indian adolescent women with polycystic ovary syndrome (PCOS). Gynecol Endocrinol. 2014; 30:781-784.
13. 13. Kelly CC, Lyall H, Petrie JR, Gould GW, Connell JM, Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome. J Clin Endocrinol Metab. 2001; 86:2453-2455.
14. 14. Amato G, Conte M, Mazziotti G, Lalli E, Vitolo G, Tucker AT, et al. Serum and follicular fluid cytokines in polycystic ovary syndrome during stimulated cycles.Obstet Gynecol. 2003;101:1177-1182
15. 15. Gonzalez F, Thusu K, Abdel-Rahman E, Prabhala A, Tomani M, Dandona P. Elevated serum levels of tumor necrosis factor alpha in normal-weight women with polycystic ovary syndrome. Metabolism. 1999; 48:437-441.
16. 16. Escobar-Morreale HF, Villuendas G, Botella-Carretero JI, Sancho J, San Millán JL. Obesity, and not insulin resistance, is the major determinant of serum inflammatory cardiovascular risk markers in pre-menopausal women. Diabetologia. 2003; 46:625-633
17. 17. Chen MJ, Yang WS, Yang JH, Chen CL, Ho HN, Yang YS. Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome. Hypertension. 2007; 49:1442-1447
18. 18. Luque-Ramírez M, Martí D, Fernández-Durán E, Alpañés M, Álvarez-Blasco F, Escobar-Morreale HF. Office blood pressure, ambulatory blood pressure monitoring, and echocardiographic abnormalities in women with polycystic ovary syndrome: role of obesity and androgen excess. Hypertension 2014;63:624-629.
19. 19. Kim MJ, Lim NK, Choi YM, Kim JJ, Hwang KR, Chae SJ, et al. Prevalence of metabolic syndrome is higher among non-obese PCOS women with hyperandrogenism and menstrual irregularity in Korea. PLoS One. 2014 Jun 5;9(6):e99252.