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

Yıl 2018, , 151 - 156, 04.04.2018

Esra Nur Tola , Hilmi Baha Oral

https://doi.org/10.16948/zktipb.399436

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

Öz

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.

Anahtar Kelimeler

Ferritin, C-reactive protein, polycystic ovary syndrome

Kaynakça

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