Polikistik Over Sendromu Olan Kadınlarda Artan Lökosit Sayısının Hyperandrojenizm ve Vücut Kitle İndeksi ile İlişkisi

Yıl 2016, Cilt: 16 Sayı: 4, 0 - 0, 12.12.2016

Şevin Demir Şule Temizkan

https://doi.org/10.17098/amj.40200

Öz

Amaç: Bu çalışmanın amacı, polikistik over sendromlu (PKOS) hastalarla kontrol grubunun lökosit (WBC) sayılarını karşılaştırmak ve lökosit sayısı ile metabolik belirteçler ve hormonal değerler arasındaki ilişkiyi değerlendirmektir.

Materyal ve Metot: Çalışma retrospektif olarak yapıldı. Yüz otuz polikistik over sendromlu ve düzenli adet gören 71 sağlıklı kadın çalışmaya alındı. Genel özellikleri ve antropometrik ölçümleri analiz edildi. Tüm katılımcıların hormonal, metabolik ve inflamatuar parametreleri adet döngüsünün foliküler fazında çalışıldı.

Bulgular: PCOS ve kontrol grubunun yaş ortalaması ve vücut kitle indeksi (VKİ) benzerdi (sırasıyla, P = 0.071 ve P = 0.063). Inflamatuar belirteçler, WBC [6.00 (4.51-7.17) karşı 7.20 (5.91-8.41); (P <0.001)] ve c-reaktif protein (CRP) [3.45 (3.30-3.61) karşı 3.48 (3.45-4.98); (P = 0.031)] PKOS grubunda anlamlı olarak yüksek bulundu. WBC’nin bağımlı değişken; total testosteron (TT), seks hormon bağlayıcı globulin (SHBG) ve insülin direncinin homeostatik model değerlendirmesinin (HOMA-IR) belirleyici olarak konduğu bir çoklu regresyon analizinde, WBC’yi, karıştırıcı faktörlerin de göz önüne alınmasından sonra TT ve BMI’nin anlamlı olarak belirlediği bulundu (P = 0.006; P = 0.039, sırasıyla).

Sonuç: Kardiyovasküler hastalıklar için bağımsız bir belirleyici olan WBC, PCOS’u olan kadınlarda yüksektir ve bu durum obezite ve hiperandrojenemi ile açıklanabilir.

 

The Association of Leukocyte Increase with Hyperandrogenism and Body Mass Index in Women with Polycystic Ovary Syndrome

Öz

Objectives: The aim of this study was to compare the white blood cells (WBC) count in patients with polycystic ovary syndrome (PCOS) with the controls and to assess its relationship between metabolic markers and hormonal measures.

Materials and Methods: The study was conducted retrospectively. One hundred-thirty women with PCOS and 71 healthy women with regular menses were included in the study. General characteristics and anthropometric measures were analyzed. Hormonal, metabolic and inflammatory parameters were studied in all subjects at the follicular phase of the menstrual cycle.

Results:  The average age and body mass index (BMI) of PCOS and the control groups were similar (P=0.071 and P=0.063, respectively). Inflammatory markers, WBC [6.00 (4.51-7.17) vs. 7.20 (5.91-8.41);(P<0.001)] and c-reactive protein (CRP) [3.45 (3.30-3.61) vs. 3.48 (3.45-4.98); (P=0.031)] were significantly higher in the PCOS group. In multiple regression analysis in a model when WBC is the dependent variable and total testosterone (TT), sex hormone binding globuline (SHBG), and homeostatic model assessment of insulin resistance (HOMA-IR) were the predictors, WBC was positively associated with TT levels and BMI even after adjustment for confounders (P=0.006; P=0.039, respectively).

Conclusion: WBC is an independent predictor of cardiovascular disease, is elevated in women with PCOS and is explained by both obesity and hyperandrogenemia. 

Anahtar Kelimeler

PCOS, WBC, CRP, Free androgen index

Kaynakça

• Azziz R, Adashi EY. Stein and Leventhal: 80 years on. Am J Obstet Gynecol 2016;214(2):247.
• Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81(1):19-25.
• Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89(6):2745-9.
• Bassuk SS, Rifai N, Ridker PM. High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol 2004;29(8):439-93.
• Tardif JC, Heinonen T, Orloff D, Libby P. Vascular biomarkers and surrogates in cardiovascular disease. Circulation 2006;113(25):2936-42.
• Libby P, Theroux P. Pathophysiology of coronary artery disease. Circulation 2005;111(25):3481-8.
• Kannel WB, Anderson K, Wilson PW. White blood cell count and cardiovascular disease. Insights from the Framingham Study. JAMA 1992;267(9):1253-6.
• Corbould A. Chronic testosterone treatment induces selective insulin resistance in subcutaneous adipocytes of women. J Endocrinol 2007;192(3):585-94.
• Bhasin S. Regulation of body composition by androgens. J Endocrinol Invest 2003;26(9):814-22.
• Spritzer PM, Lecke SB, Satler F, Morsch DM. Adipose tissue dysfunction, adipokines, and low-grade chronic inflammation in polycystic ovary syndrome. Reproduction 2015;149(5):R219-27.
• Phelan N, O'Connor A, Kyaw Tun T, et al. Leucocytosis in women with polycystic ovary syndrome (PCOS) is incompletely explained by obesity and insulin resistance. Clin Endocrinol (Oxf) 2013;78(1):107-13.
• Keskin Kurt R, Okyay AG, Hakverdi AU, et al. The effect of obesity on inflammatory markers in patients with PCOS: a BMI-matched case-control study. Arch Gynecol Obstet 2014;290(2):315-9.
• Herlihy AC, Kelly RE, Hogan JL, O'Connor N, Farah N, Turner MJ. Polycystic ovary syndrome and the peripheral blood white cell count. J Obstet Gynaecol 2011;31(3):242-4.
• Xiong YL, Liang XY, Yang X, Li Y, Wei LN. Low-grade chronic inflammation in the peripheral blood and ovaries of women with polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol 2011;159(1):148-50.
• Shi Y, Han T, Cui L, et al. White blood cell differential counts in patients with polycystic ovary syndrome: a pilot study on Chinese women. Eur J Obstet Gynecol Reprod Biol 2013;170(1):162-4.
• Papalou O, Livadas S, Karachalios A, et al. White blood cells levels and PCOS: direct and indirect relationship with obesity and insulin resistance, but not with hyperandogenemia. Hormones (Athens) 2015;14(1):91-100.
• Toscani M, Migliavacca R, Sisson de Castro JA, Spritzer PM. Estimation of truncal adiposity using waist circumference or the sum of trunk skinfolds: a pilot study for insulin resistance screening in hirsute patients with or without polycystic ovary syndrome. Metabolism 2007;56(7):992-7.
• Wiltgen D, Spritzer PM. Variation in metabolic and cardiovascular risk in women with different polycystic ovary syndrome phenotypes. Fertil Steril 2010;94(6):2493-6.
• Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrınology, and Androgen Excess and PCOS Society Disease State Clinical Review: guıde to the best practıces ın the evaluatıon and treatment of polycystıc ovary syndrome - part 2. Endocr Pract 2015;21(12):1415-26.
• González F, Sia CL, Stanczyk FZ, Blair HE, Krupa ME. Hyperandrogenism exerts an anti-inflammatory effect in obese women with polycystic ovary syndrome. Endocrine 2012;42(3):726-35.
• González F, Sia CL, Shepard MK, Rote NS, Minium J. Inflammation in response to glucose ingestion is independent of excess abdominal adiposity in normal-weight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2012;97(11):4071-9.
• Ignacak A, Kasztelnik M, Sliwa T, Korbut RA, Rajda K, Guzik TJ. Prolactin not only lactotrophin. A "new" view of the "old" hormone. J Physiol Pharmacol. 2012;63(5):435-43.
• Alipour A, van Oostrom AJ, Izraeljan A, et al. Leukocyte activation by triglyceride-rich lipoproteins. Arterioscler Thromb Vasc Biol 2008;28(4):792-7.