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

Öz

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.

Anahtar Kelimeler

• Ferritin
• C-reaktif protein
• Polikistik over sendromu

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

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.

Keywords

• Ferritin
• C-reactive protein
• polycystic ovary syndrome

Kaynakça

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