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Erken erişkinlik döneminde serum ferritin ve C-reaktif protein düzeylerinin polikistik over sendromu etyopatogenezine ve ilişkili klinik durumlara etkisi

Year 2018, , 151 - 156, 04.04.2018
https://doi.org/10.16948/zktipb.399436

Abstract

Amaç: Serum ferritin ve
C-reaktif protein (CRP) düzeylerinin polikistik over sendromu (PKOS)
etyopatogenezindeki yerini ve PKOS’un uzun dönem morbiditelerinden olan kardiyovaskuler
hastalık (KVH) ve insulin rezistansı (IR) gelişimi riskiyle ilişkisini
araştırmaktır.

Gereç ve Yöntem: Prospektif dizayn
edilen bu çalışmaya 68 PKOS ve 57 kontrol grubu olmak üzere toplam 125 hasta
dahil edildi. Tüm hastaların hormon değerleri, biyokimyasal parametreleri,
ferritin ve CRP düzeyleri ölçüldü. Vücut kitle indeksi (VKİ), bel çevresi (WC),
kalça çevresi (HC), bel kalça oranı (WHR) ve Ferriman-Gallway skorları (FGS)
kaydedildi.
VKİ≥25 kg/m2 olması
obezite, WHR
≥0.80 olması abdominal obezite olarak tanımlandı. Açlık kan şekeri
(AKŞ)(µmol/l)xAçlık insülin
(mU/ml)/22.5
formülüyle hesaplanan
‘Homeostasis model assessment of IR index’ (HOMA-IR)
düzeyinin >3.16 olması IR olarak tanımlandı.
Belirtilen kriterlerden en az ikisine sahip
olan hastalarda KVH gelişim riskininin arttığı kabul edildi: 1) VKİ>25 kg/m2; 2) WC≥80 cm; 3) IR; 4) Dislipidemi (En
az 1 kriterin varlığı: düşük dansiteli lipoprotein (LDL)≥110 mg/dl, yüksek
dansiteli lipoprotein (HDL)<35 mg/dl, trigliserid≥150 mg/dl, kolesterol>170
mg/dl). Serum ferritin ve CRP düzeyinin antropometrik, biyokimyasal ve hormonal
parametreler ile ilişkisine ve IR ve KVH gelişim riskindeki prediktif etkisine bakıldı.

Bulgular: Yaş, menarş yaşı ve bazal hormon değerleri açısından her iki
grup homojen dağılmıştı. VKİ, WHR, FGS,
dehidroepiandrostenodion-sülfat, AKŞ, insulin, HOMA-IR indeksi PKOS grubunda
daha yüksekti. HDL seviyesi PKOS grubunda daha düşükken; trigliserid, LDL ve
kolesterol seviyeleri gruplar arasında benzerdi. Serum ferritin ve CRP
düzeyleri açısından PKOS ve kontrol grubu arasında
anlamlı fark
izlenmedi. Ferritin düzeyinin yaş, VKİ, WHR ve FGS skorları
ile ilişkisi bulunmazken; CRP VKİ ile pozitif koreleydi. Araştırdığımız
parametrelerin biyokimyasal parametreler ve bazal hormon düzeyleriyle ilişkisi
bulunmadı. 
Ferritin düzeyinin KVH gelişim riski için
prediktif etkisi bulunmazken; CRP düzeyi KVH gelişim riskini öngörmede hem tüm
çalışma grubu içinde hem de PKOS grubu
içinde pozitif prediktif değere sahipti. IR gelişiminde ise serum CRP ve
ferritin düzeyi
ne tüm grupta ne de PKOS grubu içinde
prediktif değere sahipti. Obezitenin etkisi dahil edildiğinde ise IR
gelişiminde sadece abdominal obezite pozitif prediktif etkiye sahipti.













Sonuç: Erken erişkinlik döneminde serum ferritin ve CRP
düzeylerinin PKOS gelişiminde etkisi görünmemektedir. Artmış CRP düzeyleri hem
PKOS grubunda hem genel populasyonda KVH gelişim riskini öngörmede bir belirteç
olabilir.

References

  • KAYNAKLAR1. Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL, Cohen A, Hougaard DM, Nyboe Andersen A. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone. Hum Reprod. 2014;29(4):791-801.2. Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, Wei Z, Song X, Wang X, Fu S, Lin J, Zhu Y, Jiang Y, Feng HL, Qiao J. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013;28(9):2562-9.3. Hyderali BN, Mala K. Oxidative stress and cardiovascular complications in polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol. 2015;191:15-22.4. Turan V, Sezer ED, Zeybek B, Sendag F. Infertility and the presence of insulin resistance are associated with increased oxidative stress in young, non-obese Turkish women with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2015;28(2):119-23.5. Ong SY, Nicoll AJ, Delatycki MB. How should hyperferritinaemia be investigated and managed? Eur J Intern Med. 2016;33:21-7.6. Fernandez-Real JM, Lopez-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes. 2002;51(8):2348-54.7. Yang JH, Chou CH, Yang WS, Ho HN, Yang YS, Chen MJ. Iron stores and obesity are negatively associated with ovarian volume and anti-Mullerian hormone levels in women with polycystic ovary syndrome. Taiwan J Obstet Gynecol. 2015;54(6):686-92.8. Escobar-Morreale HF, Luque-Ramirez M, Alvarez-Blasco F, Botella-Carretero JI, Sancho J, San Millan JL. Body iron stores are increased in overweight and obese women with polycystic ovary syndrome. Diabetes Care. 2005;28(8):2042-4.9. Escobar-Morreale HF, Luque-Ramirez M, San Millan JL. The molecular-genetic basis of functional hyperandrogenism and the polycystic ovary syndrome. Endocr Rev. 2005;26(2):251-82.10. Fernandez-Real JM, Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev. 2003;24(3):278-301.11. Kim CH, Kim HK, Bae SJ, Park JY, Lee KU. Association of elevated serum ferritin concentration with insulin resistance and impaired glucose metabolism in Korean men and women. Metabolism. 2011;60(3):414-20.12. Martinez-Garcia MA, Luque-Ramirez M, San-Millan JL, Escobar-Morreale HF. Body iron stores and glucose intolerance in premenopausal women: role of hyperandrogenism, insulin resistance, and genomic variants related to inflammation, oxidative stress, and iron metabolism. Diabetes Care. 2009;32(8):1525-30.13. Escobar-Morreale HF, San Millan JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab. 2007;18(7):266-72.14. Festa A, D'Agostino R, Jr., Tracy RP, Haffner SM, Insulin Resistance Atherosclerosis S. Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes. 2002;51(4):1131-7.15. Morin-Papunen L, Rautio K, Ruokonen A, Hedberg P, Puukka M, Tapanainen JS. Metformin reduces serum C-reactive protein levels in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88(10):4649-54.16. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342(12):836-43.17. Fruzzetti F, Perini D, Lazzarini V, Parrini D, Genazzani AR. Hyperandrogenemia influences the prevalence of the metabolic syndrome abnormalities in adolescents with the polycystic ovary syndrome. Gynecol Endocrinol. 2009;25(5):335-43.18. NCEP. Expert Panel on Blood Cholesterol Levels in Children and Adolescents. National Cholesterol Education Program (NCEP): Highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992;89(3):495–501.19. Tola EN, Yalcin SE, Dugan N. The predictive effect of inflammatory markers and lipid accumulation product index on clinical symptoms associated with polycystic ovary syndrome in nonobese adolescents and younger aged women. Eur J Obstet Gynecol Reprod Biol. 2017;214:168-72.20. Agacayak E, Tunc SY, Sak S, Basaranoglu S, Yuksel H, Turgut A, et al. Levels of Neopterin and other Inflammatory Markers in Obese and Non-Obese Patients with Polycystic Ovary Syndrome. Med Sci Monit. 2015;21:2446-55.21. Ko PC, Huang SY, Hsieh CH, Hsu MI, Hsu CS. Serum ferritin levels and polycystic ovary syndrome in obese and nonobese women. Taiwan J Obstet Gynecol. 2015;54(4):403-7.22. Escobar-Morreale HF. Iron metabolism and the polycystic ovary syndrome. Trends Endocrinol Metab. 2012;23(10):509-15.23. Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for iron deficiency. Nutrients. 2014;6(9):3587-600.24. Behradmanesh S, Ranjbar Omrani GH, Ghazanfarpour F, Baradaran A. Effect of metformin on serum ferritin level in women with polycystic ovary syndrome. Iran Red Crescent Med J. 2011 Jul;13(7):487-92.25. Yoo KD, Ko SH, Park JE, Ahn YB, Yim HW, Lee WC, Park YM. High serum ferritin levels are associated with metabolic risk factors in non-obese Korean young adults: Korean National Health and Nutrition Examination Survey (KNHANES) IV. Clin Endocrinol (Oxf). 2012;77(2):233-40.

Serum ferritin and C-reactive protein levels in the etiopathogenesis of polycystic ovary syndrome and its’ related conditions among early adulthood females

Year 2018, , 151 - 156, 04.04.2018
https://doi.org/10.16948/zktipb.399436

Abstract

Objective(s): We aimed to evaluate serum ferritin and C-reactive protein (CRP) levels
in early adulthood period with polycystic ovary
syndrome (PCOS) to determine their roles in the
etiopathogenesis
of PCOS and clinical implications, including cardiovascular disease (CVD) and
insulin resistance (IR), related to PCOS.

Material and Method: A
total of 125 participants, 68 PCOS and 57 control, were recruited
prospectively for our study. Basal hormone levels, biochemical parameters, and
serum ferritin and C-reactive protein levels were assessed. Body mass index
(BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio
(WHR) and
Ferriman-Gallway scores (FGS) were noted. BMI≥25 kg/m2 were accepted as obesity and WHR≥0.80 was
defined as abdominal obesity.
IR was
determined when the homeostasis model assessment of IR index (HOMA-IR) more
than 3.16 using the following formula: Fasting insulin
(mU/ml)xFasting glucose
(µmol/l)/22.5. CVD risk was accepted as the presence of at least two out of the
criteria: 1. BMI>25 kg/m2,
2. WC≥80 cm, 3. IR, and 4. Dyslipidemia (The presence of at least one of
the following criteria: Low density lipoprotein (LDL)≥110 mg/dl, high density
lipoprotein (HDL)<35 mg/dl,
trygliceride≥150 mg/dl, and
cholesterol>170 mg/dl). The correlation between serum ferritin and CRP
levels with antropometric, biochemical parameters and hormone levels and their
predictive effect for the
development of CVD risk and IR were assessed.

Results: Age, menarche age,
and basal hormone levels were similar between groups. BMI, WHR, FGS,
dehidroepiandrostendion
sulphat, glucose, and HDL was significantly decreased in PCOS group whereas trygliceride, LDL and cholesterol levels were distributed homogenously between groups.
We could not found any difference in terms of serum ferritin and CRP levels
between PCOS and control groups. 
Serum ferritin wasn’t correlated to age, BMI, WHR, and FGS, whereas, CRP
was positively correlated with BMI. There wasn’t any association between
investigated markers and biochemical parameters, and basal hormone levels. 
Any predictive effect of serum ferritin on the development of CVD
risk was found among PCOS group and whole group. Serum CRP levels had positive
predictive effect for the development of CVD among PCOS group and whole group.
None of investigated markers were predictive for IR among POCS group and whole
group even after adjustment for obesity and abdominal obesity.













Conclusion(s): It seems to be any
role of serum ferritin and CRP levels
in the etiopathogenesis of PCOS in early
adulthood period. Elevated CRP levels could be a predictive marker for the
development of CVD risk among PCOS patients and whole group.

References

  • KAYNAKLAR1. Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL, Cohen A, Hougaard DM, Nyboe Andersen A. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone. Hum Reprod. 2014;29(4):791-801.2. Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, Wei Z, Song X, Wang X, Fu S, Lin J, Zhu Y, Jiang Y, Feng HL, Qiao J. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013;28(9):2562-9.3. Hyderali BN, Mala K. Oxidative stress and cardiovascular complications in polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol. 2015;191:15-22.4. Turan V, Sezer ED, Zeybek B, Sendag F. Infertility and the presence of insulin resistance are associated with increased oxidative stress in young, non-obese Turkish women with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2015;28(2):119-23.5. Ong SY, Nicoll AJ, Delatycki MB. How should hyperferritinaemia be investigated and managed? Eur J Intern Med. 2016;33:21-7.6. Fernandez-Real JM, Lopez-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes. 2002;51(8):2348-54.7. Yang JH, Chou CH, Yang WS, Ho HN, Yang YS, Chen MJ. Iron stores and obesity are negatively associated with ovarian volume and anti-Mullerian hormone levels in women with polycystic ovary syndrome. Taiwan J Obstet Gynecol. 2015;54(6):686-92.8. Escobar-Morreale HF, Luque-Ramirez M, Alvarez-Blasco F, Botella-Carretero JI, Sancho J, San Millan JL. Body iron stores are increased in overweight and obese women with polycystic ovary syndrome. Diabetes Care. 2005;28(8):2042-4.9. Escobar-Morreale HF, Luque-Ramirez M, San Millan JL. The molecular-genetic basis of functional hyperandrogenism and the polycystic ovary syndrome. Endocr Rev. 2005;26(2):251-82.10. Fernandez-Real JM, Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev. 2003;24(3):278-301.11. Kim CH, Kim HK, Bae SJ, Park JY, Lee KU. Association of elevated serum ferritin concentration with insulin resistance and impaired glucose metabolism in Korean men and women. Metabolism. 2011;60(3):414-20.12. Martinez-Garcia MA, Luque-Ramirez M, San-Millan JL, Escobar-Morreale HF. Body iron stores and glucose intolerance in premenopausal women: role of hyperandrogenism, insulin resistance, and genomic variants related to inflammation, oxidative stress, and iron metabolism. Diabetes Care. 2009;32(8):1525-30.13. Escobar-Morreale HF, San Millan JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab. 2007;18(7):266-72.14. Festa A, D'Agostino R, Jr., Tracy RP, Haffner SM, Insulin Resistance Atherosclerosis S. Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes. 2002;51(4):1131-7.15. Morin-Papunen L, Rautio K, Ruokonen A, Hedberg P, Puukka M, Tapanainen JS. Metformin reduces serum C-reactive protein levels in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88(10):4649-54.16. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342(12):836-43.17. Fruzzetti F, Perini D, Lazzarini V, Parrini D, Genazzani AR. Hyperandrogenemia influences the prevalence of the metabolic syndrome abnormalities in adolescents with the polycystic ovary syndrome. Gynecol Endocrinol. 2009;25(5):335-43.18. NCEP. Expert Panel on Blood Cholesterol Levels in Children and Adolescents. National Cholesterol Education Program (NCEP): Highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992;89(3):495–501.19. Tola EN, Yalcin SE, Dugan N. The predictive effect of inflammatory markers and lipid accumulation product index on clinical symptoms associated with polycystic ovary syndrome in nonobese adolescents and younger aged women. Eur J Obstet Gynecol Reprod Biol. 2017;214:168-72.20. Agacayak E, Tunc SY, Sak S, Basaranoglu S, Yuksel H, Turgut A, et al. Levels of Neopterin and other Inflammatory Markers in Obese and Non-Obese Patients with Polycystic Ovary Syndrome. Med Sci Monit. 2015;21:2446-55.21. Ko PC, Huang SY, Hsieh CH, Hsu MI, Hsu CS. Serum ferritin levels and polycystic ovary syndrome in obese and nonobese women. Taiwan J Obstet Gynecol. 2015;54(4):403-7.22. Escobar-Morreale HF. Iron metabolism and the polycystic ovary syndrome. Trends Endocrinol Metab. 2012;23(10):509-15.23. Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for iron deficiency. Nutrients. 2014;6(9):3587-600.24. Behradmanesh S, Ranjbar Omrani GH, Ghazanfarpour F, Baradaran A. Effect of metformin on serum ferritin level in women with polycystic ovary syndrome. Iran Red Crescent Med J. 2011 Jul;13(7):487-92.25. Yoo KD, Ko SH, Park JE, Ahn YB, Yim HW, Lee WC, Park YM. High serum ferritin levels are associated with metabolic risk factors in non-obese Korean young adults: Korean National Health and Nutrition Examination Survey (KNHANES) IV. Clin Endocrinol (Oxf). 2012;77(2):233-40.
There are 1 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Esra Nur Tola

Hilmi Baha Oral

Publication Date April 4, 2018
Published in Issue Year 2018

Cite

APA Tola, E. N., & Oral, H. B. (2018). Erken erişkinlik döneminde serum ferritin ve C-reaktif protein düzeylerinin polikistik over sendromu etyopatogenezine ve ilişkili klinik durumlara etkisi. Zeynep Kamil Tıp Bülteni, 49(1), 151-156. https://doi.org/10.16948/zktipb.399436
AMA Tola EN, Oral HB. Erken erişkinlik döneminde serum ferritin ve C-reaktif protein düzeylerinin polikistik over sendromu etyopatogenezine ve ilişkili klinik durumlara etkisi. Zeynep Kamil Tıp Bülteni. April 2018;49(1):151-156. doi:10.16948/zktipb.399436
Chicago Tola, Esra Nur, and Hilmi Baha Oral. “Erken erişkinlik döneminde Serum Ferritin Ve C-Reaktif Protein düzeylerinin Polikistik over Sendromu Etyopatogenezine Ve ilişkili Klinik Durumlara Etkisi”. Zeynep Kamil Tıp Bülteni 49, no. 1 (April 2018): 151-56. https://doi.org/10.16948/zktipb.399436.
EndNote Tola EN, Oral HB (April 1, 2018) Erken erişkinlik döneminde serum ferritin ve C-reaktif protein düzeylerinin polikistik over sendromu etyopatogenezine ve ilişkili klinik durumlara etkisi. Zeynep Kamil Tıp Bülteni 49 1 151–156.
IEEE E. N. Tola and H. B. Oral, “Erken erişkinlik döneminde serum ferritin ve C-reaktif protein düzeylerinin polikistik over sendromu etyopatogenezine ve ilişkili klinik durumlara etkisi”, Zeynep Kamil Tıp Bülteni, vol. 49, no. 1, pp. 151–156, 2018, doi: 10.16948/zktipb.399436.
ISNAD Tola, Esra Nur - Oral, Hilmi Baha. “Erken erişkinlik döneminde Serum Ferritin Ve C-Reaktif Protein düzeylerinin Polikistik over Sendromu Etyopatogenezine Ve ilişkili Klinik Durumlara Etkisi”. Zeynep Kamil Tıp Bülteni 49/1 (April 2018), 151-156. https://doi.org/10.16948/zktipb.399436.
JAMA Tola EN, Oral HB. Erken erişkinlik döneminde serum ferritin ve C-reaktif protein düzeylerinin polikistik over sendromu etyopatogenezine ve ilişkili klinik durumlara etkisi. Zeynep Kamil Tıp Bülteni. 2018;49:151–156.
MLA Tola, Esra Nur and Hilmi Baha Oral. “Erken erişkinlik döneminde Serum Ferritin Ve C-Reaktif Protein düzeylerinin Polikistik over Sendromu Etyopatogenezine Ve ilişkili Klinik Durumlara Etkisi”. Zeynep Kamil Tıp Bülteni, vol. 49, no. 1, 2018, pp. 151-6, doi:10.16948/zktipb.399436.
Vancouver Tola EN, Oral HB. Erken erişkinlik döneminde serum ferritin ve C-reaktif protein düzeylerinin polikistik over sendromu etyopatogenezine ve ilişkili klinik durumlara etkisi. Zeynep Kamil Tıp Bülteni. 2018;49(1):151-6.