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The Relationship Between Platelet Indices, Hormonal Status, and Insulin Resistance in Adolescents with Polycystic Ovary Syndrome: A Retrospective Case-Control Study

Yıl 2024, Cilt: 8 Sayı: 2, 113 - 119, 30.08.2024
https://doi.org/10.29058/mjwbs.1485822

Öz

Aim: This study aimed to investigate the relationship between polycystic ovary syndrome in adolescents, a disease caused by inflammation and insulin resistance that is associated with metabolic disorders, and platelet indices, which provide information about platelet activity.
Materials and methods: Patients with oligoovulation, hyperandrogenemia, or clinical signs of hyperandrogenism (hirsutism, acne, etc.) and polycystic appearance with ≥ 20 small follicles ≥ 2∼ 9 mm in diameter in both ovaries on ultrasound according to the newly updated Rotterdam criteria were included in the study with a diagnosis of polycystic ovary syndrome and formed PCOS group. Patients with similar age groups and body mass index (BMI) values who presented to the clinic for non-PCOS symptoms (vaginitis, dysmenorrhea, cystitis), whose complete blood count was checked during hormone testing, and who did not meet the Rotterdam criteria were selected as the control group.
Platelet indices found in routine blood count parameters (platelet large cell ratio (P-LCR), platelet distribution width (PDW) and mean platelet volume (MPV)) were analyzed between the two groups. In addition, the relationship between these indices and hormone status and insulin resistance in PCOS patients was analyzed. Patients with diabetes mellitus, hypertension, malignant diseases, cardiovascular diseases, essential thrombocytopenia or other blood diseases and patients taking medication were excluded.
Results:
In the study of 123 patients, there was no statistically significant difference between the groups in terms of age and body mass index (p:>0.05). When hemogram parameters were compared between the groups, hemogram parameters such as P-LCR (p: 0.002), PDW (p: 0.011) and MPV (p: 0.007), which indicate platelet activity, were statistically significantly higher in the PCOS group. When the data of PCOS patients were analyzed, platelet indices were found to be higher in the group with high insulin resistance (p: <0.005). When analyzing the hormonal status, only the prolactin level in the blood correlates positively with the values of P-LCR (r:0.223, p: 0.017), PDW (r:0.214, p:0.022), and MPV (r: 0.213, p:0.023).
Conclusion:
Analyzing platelet indices in routine blood counts of patients with polycystic ovary syndrome, informing patients about their predisposition to metabolic diseases and making the necessary referrals will contribute to the treatment and follow-up of polycystic ovary syndrome. These tests, which can be easily performed in any center, should be used in common practice.

Kaynakça

  • 1. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010;25(2):544 51. https://doi.org/10.1093/ humrep/dep399.
  • 2. HRIST, Jacob P.; CEDARS, Marcelle I. Current guidelines for diagnosing PCOS. Diagnostics 2023, 13.6: 1113. https://doi. org/10.3390/diagnostics13061113
  • 3. Wang, Y., Yang, Q., Wang, H., Zhu, J., Cong, L., Li, H., & Sun, Y. NAD+ deficiency and mitochondrial dysfunction in granulosa cells of women with polycystic ovary syndrome double dagger. Biol Reprod 2021;105(2):371–80.
  • 4. Mizgier M, Jarząbek-Bielecka G, Wendland N, Jodłowska- Siewert E, Nowicki M, Brożek A, Opydo-Szymaczek J. Relation between inflammation, oxidative stress, and macronutrient intakes in normal and excessive body weight adolescent girls with clinical features of polycystic ovary syndrome. Nutrients 2021, 13.3: 896. https://doi.org/10.3390/nu13030896
  • 5. Stener-Victorin E, Deng Q. Epigenetic inheritance of polycystic ovary syndrome- challenges and opportunities for treatment. Nat Rev Endocrinol 2021;17(9):521–33. https://doi. org/10.1038/s41574-021-00517-x.
  • 6. Rajkumar E, Ardra A, Prabhu G, Pandey V, Sundaramoorthy J, Manzoor R, Sooraj KV, Manikandaprabu M, Badiger T. Polycystic ovary syndrome: An exploration of unmarried women’s knowledge and attitudes. Heliyon 2022;8(7): e09835.
  • 7. Abraham Gnanadass S, Divakar Prabhu Y, Valsala Gopalakrishnan A. Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update. Arch Gynecol Obstet 2021;303(3):631–43.
  • 8. Kaur R, Kaur M and Singh J. Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies. Cardiovasc Diabetol 2018; 17: 121.
  • 9. Berg DD, Yeh RW, Mauri L, Morrow DA, Kereiakes DJ, Cutlip DE, Gao Q, Jarolim P, Michelson DA, Frelinger III AL, Cange AL, Sabatine MS, O’Donoghue M L. Biomarkers of platelet activation and cardiovascular risk in the DAPT trial. J Thromb Thrombolysis 2020. DOI: 10.1007/s11239-020-02221-5.
  • 10. Ji S, Zhang J, Fan X, Wang X, Ning X, Zhang B, Shi H, Yan H. The relationship between mean platelet volume and diabetic retinopathy: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019 Mar 12;11:25.
  • 11. Madan SA, John F, Pıtchumonı CS. Nonalcoholic fatty liver disease and mean platelet volume: a systemic review and meta- analysis. J Clin Gastroenterol 2016, 50.1: 69-74.
  • 12. Li L, Yu J, Zhou Z. Mean platelet volume and polycystic ovary syndrome: a systematic review and meta-analysis. J Int Med Res 2022, 50.1: 03000605211067316.
  • 13. Teede HJ, Tay CT, Laven JJ E, Dokras A, Moran LJ, Piltonen TT, Costello MF, Boivin J, Redman LM, Boyle JA, Norman RJ, Mousa A, Joham AE. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol 2023, 189.2: G43-G64. https://doi.org/10.1093/ejendo/lvad096
  • 14. Tehrani FR, Rashidi H, Khomami MB, Tohidi M, Azizi F. The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community-based study in Southwest of Iran. Reprod Biol Endocrinol 2014;12:89
  • 15. Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil steril 2011, 95.3: 1073-1079. e11. https://doi.org/10.1016/j. fertnstert.2010.12.027
  • 16. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010, 16.4: 347-363. https://doi. org/10.1093/humupd/dmq001
  • 17. Wang RT, Li Y, Zhu XY, Zhang YN. Increased mean platelet volume is associated with arterial stiffness. Platelets 2011, 22.6: 447-451. doi.org/10.3109/09537104.2011.565431
  • 18. Akgul O, Uyarel H, Pusuroglu H, Gul M, Isiksacan N, Turen S, Erturk M, Surgit O, Çetin M, Bulut U, Baycan O F, Uslu N. Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myocardial infarction. Acta Cardiol 2013, 68.3: 307-314. https://doi. org/10.1080/AC.68.3.2983426
  • 19. Kose C, Korpe B, Korkmaz V, Ustun YE. The role of systemic immune inflammation index in predicting treatment success in tuboovarian abscesses. Arch Gynecol Obstet 2023, 308.4: 1313-1319 doi: 10.1007/s00404-023-07107-4.
  • 20. Ke J, Lu N, Liu Y, Chen H. Association between platelet distribution width and peripheral arterial disease in elderly patients. Vasa 2022 https://doi.org/10.1024/0301-1526/a001022
  • 21. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010, 14.1: 28. PMID: 20411056
  • 22. Dogan BA, Arduc A, Tuna MM, Karakılıc E, Dagdelen I, Tutuncu Y, Berker D, Guler S. Association of mean platelet volume with androgens and insulin resistance in nonobese patients with polycystic ovary syndrome. Int J Endocrinol Metab. 2014;12(4):e18642.
  • 23. Yang XJ, Zhang LY, Ma QH, Sun HP, Xu Y, Chen X, Pan CW. Platelet parameters in Chinese older adults with metabolic syndrome. Endocr Connect. 2020 Jul;9(7):696-704.
  • 24. Gara HK, Vanamalı DR. Role of Platelet Indices for Cardiovascular Risk Assessment in Premenopausal Females with Metabolic Syndrome. Indian Journal of Cardiovascular Disease in Women| 2024, 9.2: 90. DOI: 10.25259/IJCDW_73_2023
  • 25. Buch A, Kaur S, Nair R, Jain A. Platelet volume indices as predictive biomarkers for diabetic complications in Type 2 diabetic patients. J Lab Physicians. 2017 Apr-Jun;9(2):84-88.
  • 26. Yilmaz O, Calan M, Kume T, Temur M, Yesil P, Senses MY. The effect of prolactin levels on MPV in women with PCOS. Clinical Endocrinology 2015, 82.5: 747-752. https://doi.org/10.1111/ cen.12647
  • 27. Ozay AC, Ozay OE. The importance of inflammation markers in polycystic ovary syndrome. Rev Assoc Med Bras 2021, 67.3: 411-417 https://doi.org/10.1590/1806-9282.20200860

Polikistik Over Sendromlu Adölesanlarda Trombosit İndeksleri, Hormonal Durum ve İnsülin Direnci Arasındaki İlişki: Retrospektif Bir Vaka-Kontrol Çalışması

Yıl 2024, Cilt: 8 Sayı: 2, 113 - 119, 30.08.2024
https://doi.org/10.29058/mjwbs.1485822

Öz

Amaç: Bu çalışmanın amacı, adölesanlarda metabolik bozukluklarla ilişkili, inflamasyon ve insülin direncinin neden olduğu bir hastalık olan polikistik over sendromu (PKOS) ile trombosit aktivitesi hakkında bilgi veren trombosit indeksleri arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntemler: Oligoovulasyon, hiperandrojenemi veya hiperandrojenizmin klinik bulguları (hirşutizm, akne vb.) ve yeni güncellenen Rotterdam kriterlerine göre ultrasonda her iki overde ≥ 20 küçük folikül ≥ 2∼ 9 mm çapında polikistik görünümü olan hastalar polikistik over sendromu tanısı ile çalışmaya dahil edildi ve PKOS grubunu oluşturdu. Kliniğe PKOS dışı nedenlerle (vajinit, dismenore, sistit) başvuran, hormon testi sırasında tam kan sayımına bakılan ve Rotterdam kriterlerini karşılamayan benzer yaş grupları ve vücut kitle indeksi (VKİ) değerlerine sahip hastalar kontrol grubu olarak seçildi.
Rutin kan sayımı parametrelerinde bulunan trombosit indeksleri (trombosit büyük hücre oranı (P-LCR), trombosit dağılım genişliği (PDW) ve ortalama trombosit hacmi (MPV)) iki grup arasında analiz edilmiştir. Ayrıca, PKOS hastalarında bu indeksler ile hormonal durum ve insülin direnci arasındaki ilişki analiz edilmiştir. Diabetes mellitus, hipertansiyon, malign hastalıklar, kardiyovasküler hastalıklar, esansiyel trombositopeni veya diğer kan hastalıkları olan hastalar ve ilaç kullanan hastalar çalışma dışı bırakıldı.
Bulgular:
Çalışmaya dahil edilmiş olan 123 hastadan 67 tanesi polikistik over sendromu tanısı alarak vaka grubunu, geri kalan 56 hasta kontrol grubunu oluşturmuştur. Gruplar arası yaş ve vücut kitle indeksi açısından istatistiksel anlamlı fark bulunmamaktadır (p: >0,05). Gruplar arasında tam kan sayımı parametreleri karşılaştırıldığında, trombosit aktivitesini gösteren trombosit büyük hücre oranı (p: 0,002), trombosit dağılım genişliği (p: 0,011) ve ortalama trombosit hacmi (p: 0,007) polikistik over sendromu grubunda istatistiksel anlamlı olarak daha fazla bulunmuştur. Polikistik over sendromu hastalarının verileri incelendiğinde insulin direnci yüksek olan grupta trombosit indeksleri daha yüksek bulunmuştur (p: <0,005). Hormonal durumu analiz ettiğimizde, sadece kandaki prolaktin seviyesi P-LCR (r:0.223, p: 0.017), PDW (r:0.214, p:0.022) ve MPV (r: 0.213, p:0.023) değerleri ile pozitif korelasyon göstermektedir.
Sonuç:
Polikistik over sendromu hastalarının rutin kan sayımlarında mevcut olan trombosit indekslerini inceleyip hastalara metabolik hastalıklara yatkınlık konusunda bilgi vermek ve gerekli yönlendirmeleri yapmak hastalığının tedavisi ve takibine katkı sağlayacaktır. Her merkezde bakılması kolay olan bu tetkikler güncel pratikte kullanım alanı almalıdır.

Etik Beyan

Çalışmanın yerel hastanenin tıbbi araştırmalar etik kurulu tarafından etik onayı alındıktan sonra (AESH-BADEK-2024-340), tıbbi kayıtlar retrospektif olarak incelendi.

Destekleyen Kurum

ankara etlik şehir haatanesi

Kaynakça

  • 1. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010;25(2):544 51. https://doi.org/10.1093/ humrep/dep399.
  • 2. HRIST, Jacob P.; CEDARS, Marcelle I. Current guidelines for diagnosing PCOS. Diagnostics 2023, 13.6: 1113. https://doi. org/10.3390/diagnostics13061113
  • 3. Wang, Y., Yang, Q., Wang, H., Zhu, J., Cong, L., Li, H., & Sun, Y. NAD+ deficiency and mitochondrial dysfunction in granulosa cells of women with polycystic ovary syndrome double dagger. Biol Reprod 2021;105(2):371–80.
  • 4. Mizgier M, Jarząbek-Bielecka G, Wendland N, Jodłowska- Siewert E, Nowicki M, Brożek A, Opydo-Szymaczek J. Relation between inflammation, oxidative stress, and macronutrient intakes in normal and excessive body weight adolescent girls with clinical features of polycystic ovary syndrome. Nutrients 2021, 13.3: 896. https://doi.org/10.3390/nu13030896
  • 5. Stener-Victorin E, Deng Q. Epigenetic inheritance of polycystic ovary syndrome- challenges and opportunities for treatment. Nat Rev Endocrinol 2021;17(9):521–33. https://doi. org/10.1038/s41574-021-00517-x.
  • 6. Rajkumar E, Ardra A, Prabhu G, Pandey V, Sundaramoorthy J, Manzoor R, Sooraj KV, Manikandaprabu M, Badiger T. Polycystic ovary syndrome: An exploration of unmarried women’s knowledge and attitudes. Heliyon 2022;8(7): e09835.
  • 7. Abraham Gnanadass S, Divakar Prabhu Y, Valsala Gopalakrishnan A. Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update. Arch Gynecol Obstet 2021;303(3):631–43.
  • 8. Kaur R, Kaur M and Singh J. Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies. Cardiovasc Diabetol 2018; 17: 121.
  • 9. Berg DD, Yeh RW, Mauri L, Morrow DA, Kereiakes DJ, Cutlip DE, Gao Q, Jarolim P, Michelson DA, Frelinger III AL, Cange AL, Sabatine MS, O’Donoghue M L. Biomarkers of platelet activation and cardiovascular risk in the DAPT trial. J Thromb Thrombolysis 2020. DOI: 10.1007/s11239-020-02221-5.
  • 10. Ji S, Zhang J, Fan X, Wang X, Ning X, Zhang B, Shi H, Yan H. The relationship between mean platelet volume and diabetic retinopathy: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019 Mar 12;11:25.
  • 11. Madan SA, John F, Pıtchumonı CS. Nonalcoholic fatty liver disease and mean platelet volume: a systemic review and meta- analysis. J Clin Gastroenterol 2016, 50.1: 69-74.
  • 12. Li L, Yu J, Zhou Z. Mean platelet volume and polycystic ovary syndrome: a systematic review and meta-analysis. J Int Med Res 2022, 50.1: 03000605211067316.
  • 13. Teede HJ, Tay CT, Laven JJ E, Dokras A, Moran LJ, Piltonen TT, Costello MF, Boivin J, Redman LM, Boyle JA, Norman RJ, Mousa A, Joham AE. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol 2023, 189.2: G43-G64. https://doi.org/10.1093/ejendo/lvad096
  • 14. Tehrani FR, Rashidi H, Khomami MB, Tohidi M, Azizi F. The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community-based study in Southwest of Iran. Reprod Biol Endocrinol 2014;12:89
  • 15. Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil steril 2011, 95.3: 1073-1079. e11. https://doi.org/10.1016/j. fertnstert.2010.12.027
  • 16. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010, 16.4: 347-363. https://doi. org/10.1093/humupd/dmq001
  • 17. Wang RT, Li Y, Zhu XY, Zhang YN. Increased mean platelet volume is associated with arterial stiffness. Platelets 2011, 22.6: 447-451. doi.org/10.3109/09537104.2011.565431
  • 18. Akgul O, Uyarel H, Pusuroglu H, Gul M, Isiksacan N, Turen S, Erturk M, Surgit O, Çetin M, Bulut U, Baycan O F, Uslu N. Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myocardial infarction. Acta Cardiol 2013, 68.3: 307-314. https://doi. org/10.1080/AC.68.3.2983426
  • 19. Kose C, Korpe B, Korkmaz V, Ustun YE. The role of systemic immune inflammation index in predicting treatment success in tuboovarian abscesses. Arch Gynecol Obstet 2023, 308.4: 1313-1319 doi: 10.1007/s00404-023-07107-4.
  • 20. Ke J, Lu N, Liu Y, Chen H. Association between platelet distribution width and peripheral arterial disease in elderly patients. Vasa 2022 https://doi.org/10.1024/0301-1526/a001022
  • 21. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010, 14.1: 28. PMID: 20411056
  • 22. Dogan BA, Arduc A, Tuna MM, Karakılıc E, Dagdelen I, Tutuncu Y, Berker D, Guler S. Association of mean platelet volume with androgens and insulin resistance in nonobese patients with polycystic ovary syndrome. Int J Endocrinol Metab. 2014;12(4):e18642.
  • 23. Yang XJ, Zhang LY, Ma QH, Sun HP, Xu Y, Chen X, Pan CW. Platelet parameters in Chinese older adults with metabolic syndrome. Endocr Connect. 2020 Jul;9(7):696-704.
  • 24. Gara HK, Vanamalı DR. Role of Platelet Indices for Cardiovascular Risk Assessment in Premenopausal Females with Metabolic Syndrome. Indian Journal of Cardiovascular Disease in Women| 2024, 9.2: 90. DOI: 10.25259/IJCDW_73_2023
  • 25. Buch A, Kaur S, Nair R, Jain A. Platelet volume indices as predictive biomarkers for diabetic complications in Type 2 diabetic patients. J Lab Physicians. 2017 Apr-Jun;9(2):84-88.
  • 26. Yilmaz O, Calan M, Kume T, Temur M, Yesil P, Senses MY. The effect of prolactin levels on MPV in women with PCOS. Clinical Endocrinology 2015, 82.5: 747-752. https://doi.org/10.1111/ cen.12647
  • 27. Ozay AC, Ozay OE. The importance of inflammation markers in polycystic ovary syndrome. Rev Assoc Med Bras 2021, 67.3: 411-417 https://doi.org/10.1590/1806-9282.20200860
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri (Diğer)
Bölüm Araştırma Makalesi
Yazarlar

Serap Topkara Sucu 0000-0002-9187-2941

Hüseyin Levent Keskin 0000-0002-2268-3821

Yayımlanma Tarihi 30 Ağustos 2024
Gönderilme Tarihi 17 Mayıs 2024
Kabul Tarihi 11 Ağustos 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 8 Sayı: 2

Kaynak Göster

Vancouver Topkara Sucu S, Keskin HL. The Relationship Between Platelet Indices, Hormonal Status, and Insulin Resistance in Adolescents with Polycystic Ovary Syndrome: A Retrospective Case-Control Study. Med J West Black Sea. 2024;8(2):113-9.

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