18-28 YAŞ ARASI POLİKİSTİK OVER SENDROMLU HASTALARDA KANDA İRİSİN SEVİYESİNİN DEĞERLENDİRİLMESİ

Amaç: Son yıllarda polikistik over sendromu (PKOS) etiyopatogenezinde insülin direncinin rolünün ortaya konmuş ve obezite, tip 2 diabetes mellitus, hipertansiyon, dislipidemi, iskemik kalp hastalıkları, obstruktif uyku apnesi, endometrium kanseri ve mood bozuklukları gibi uzun dönem sağlık riskleriyle ilişkisi gösterilmiştir. İrisin ise yeni tanımlanmış bir myokin olup, insülin direnci ve metabolik sendromla ilişkili bulunmuştur. Biz bu çalışmamızda 18-28 yaş arası PKOS’lu olan ve olmayan gruplarda klinik, biyokimyasal, hormonal parametrelerle serum irisin düzeylerini karşılaştırdık. Gereç ve Yöntem: Erzincan Binali Yıldırım Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum polikliniğine başvuran 18-28 yaş arası, Rotterdam 2003 kriterlerine göre PKOS tanısı alan 64 hasta ve 60 kontrol grubu çalışmaya dahil edildi. Hastalara pelvik ultrasonografi yapıldı. Kilo, boy, tansiyon ölçüldü. HDL, LDL, trigliserid, total kolesterol, açlık insulin, LH, FSH, estradiol, total testesteron, serbest testesteron, homosistein, CRP, TSH, prolaktin, açlık glukoz, DHEAS, AMH, ALT, AST, HbA1c ve irisin düzeylerine bakıldı. Vücut kitle indeksleri ve HOMA-IR değerleri hesaplandı. Bulgular:PKOS’lu hastalar ve kontrol grubu klinik özellikler açısından karşılaştırıldığında her iki grup arasında yaş, boy, HDL, trigliserit, açlık insulin, FSH, LH, estradiol, TSH, prolaktin, ALT, AST, HOMA-IR indeks arasında istatistiksel olarak anlamlı bir fark izlenmedi. Kilo, vücut kitle indeksi, tansiyon, LDL, total kolesterol, total testesteron, serbest testesteron, homosistein, CRP, açlık glukoz, DHEAS, HbA1c değerleri açısından PKOS grubundaki hastalarda istatistiksel anlamlı olarak daha yüksek izlendi (p<0,05). İrisin düzeyleri PKOS grubundaki hastalarda istatistiksel anlamlı olarak daha düşük izlendi (p<0,05). Sonuç: PKOS hasta grubunda irisin düzeyleri kontrol grubuna göre istatistiksel anlamlı olarak daha düşük bulunmuştur.

Anahtar Kelimeler:

Polikistik over sendromu, irisin, insulin direnci, ileri dönem risk

EVALUATION OF IRISIN LEVELS IN BLOOD IN PATIENS WITH POLYCYSTIC OVARY SYNDROME AGED BETWEEN 18-28 YEARS

Objective: Women with polcystic ovary syndrome (PCOS) show high levels of insulin resistance and compensatory hyperinsulinemia compared to unaffected women. It has recently been shown that insulin resistance plays a role in the ethiopathogenesis of PCOS and it has also been shown lately that it is related with long term health risks such as obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and ischemic heart disease, obstructive sleep apnea syndrome, endometrium cancer and mood disorders. Irisin , a newly identified myokine, has been shown to be associated with insulin resistance and metabolic syndrome.The purpose of this study was to determine and compare the serum levels of irisin in PCOS patients and the control groups and thereas to predict their long term health risks such as the increased metabolic syndrome and cardiovasculer risk. Material and Methods: 64 patients with PCOS diagnosed according to Rotterdam 2003 criteria and 60 healthy controls who admitted to Erzincan Binali Yıldırım University Obstetrics and Gynecology out-patient clinics between 18-28 years in age were enrolled. Pelvic ultrasounds were performed during a gynecological examination. Height, weight, blood pressure were measured. Fasting glukoz, fasting insulin, total cholesterol, LDL, HDL, trigliserid, total testosterone, FSH, LH, estradiol,free testesteron, homosistein, CRP, TSH, prolactin, DHEAS, ALT, AST, HbA1c and irisin levels were measured. Patients were evaluated for hirsutism according to the Ferriman Gallwey scoring system. HOMA-IR values were calculated. Results: When the patients withPCOS and control group were compared in terms of clinical features, there was no statistically significant difference between the two groups in terms of age, height, HDL, TG, fasting insulin, FSH, LH, estradiol, TSH, prolactin, ALT, AST, HOMA-IR index. There was statistically significant difference between two groups in term of weight,body mass index, blood pressure, LDL, total cholesterol, total testesteron, free testesteron, homosistein, CRP, fasting glucose, DHEAS, HbA1c (p<0,05). The irisin levels in the PCOS group were statistically significantly lower than the control group. Conclusion: In our research the irisin levels in the PCOS group were statistically significantly lower than the control group.

Keywords:

Polikistik over sendromu, irisin, insulin direnci, ileri dönem risk,

PDF

___

Referans1. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: Hormonal and metabolic profile. JClin Endocrinol Metab. 1999 Nov;84(11):4006-11
Referans2. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012 Jan;97(1):28-38.
Referans3. Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young womenClin Endocrinol (Oxf). 1999 Dec;51(6):779-86.
Referans4. Marshall JC, Eagleson CA. Neuroendocrine aspects of polycystic ovary syndromeEndocrinol Metab Clin North Am. 1999 Jun;28(2):295-324.
Referans5. Rosner W, Vesper H; Endocrine Society; American Association for Clinical Chemistry; American Association of Clinical Endocrinologists; Androgen Excess/PCOS Society; American Society for Bone and Mineral Research; American Society for Reproductive Medicine; American Urological Association; Association of Public Health Laboratories; Endocrine Society; Laboratory Corporation of America; North American Menopause Society; Pediatric Endocrine Society. Toward excellence in testosterone testing: a consensus statement. J Clin Endocrinol Metab. 2010 Oct;95(10):4542-8.
Referans6. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E; American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society (AES). American Association Of Clinical Endocrinologists, American College Of Endocrinology, And Androgen Excess And PCOS Society Disease State Clinical Review: Guide To The Best Practices in The Evaluationn And Treatment Of Polycystic Ovary Syndrome—Part. Endocr Pract. 2015 Nov;21(11):1291-300.
Referans7. Legro RS, Schlaff WD, Diamond MP, Coutifaris C, Casson PR, Brzyski RG, Christman GM, et al. Total testosterone assays in women with polycystic ovary syndrome: precision and correlation with hirsutism Reproductive Medicine Network. J Clin Endocrinol Metab. 2010 Dec;95(12):5305-13.
Referans8. Auchus RJ. Steroid assays and endocrinology: best practices for basic scientists. Endocrinology. 2014 Jun;155(6):2049-51.
Referans9. Shaw LJ, Bairey Merz CN, Azziz R, Stanczyk FZ, Sopko G, Braunstein GD, et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health--National Heart, Lung, and Blood Institute sponsored Women's Ischemia Syndrome Evaluation. J Clin Endocrinol Metab. 2008 Apr;93(4):1276-84.
Referans10. Fauser BC, Bouchard P. Uncertainty remains in women with PCOS regarding the increased incidence of cardiovascular disease later in life, despite the indisputable presence of multiple cardiovascular risk factors at a young age. J Clin Endocrinol Metab. 2011 Dec;96(12):3675-7.
Referans11. Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014 Sep-Oct;20(5):748-58.
Referans12. Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage. J Clin Endocrinol Metab. 2015 Mar;100(3):911-9.
Referans13. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E,et al. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. N Engl J Med. 2016 Jun 23;374(25):2430-40.
Referans14. Lujan ME, Chizen DR, Pierson RA. Diagnostic criteria for polycystic ovary syndrome: pitfalls and controversies. J Obstet Gynaecol Can. 2008 Aug;30(8):671-679.
Referans15. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective studyJ Clin Endocrinol Metab. 1998 Sep;83(9):3078-82.
Referans16. Farquhar CM, Birdsall M, Manning P, Mitchell JM, France JT. The prevalence of polycystic ovaries on ultrasound scanning in a population of randomly selected women. Aust N Z J Obstet Gynaecol. 1994 Feb;34(1):67-72.
Referans17. Michelmore K, Ong K, MasonS Bennett S, Perry L, Vessey M, et al. Clinical features in women with polycystic ovaries: relationships to insulin sensitivity, insulin gene VNTR and birth weight. Clin Endocrinol (Oxf). 2001 Oct;55(4):439-46.
Referans18. 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 Jan;81(1):19-25.
Referans19. Liu JJ, Wong MD, Toy WC, Tan CS, Liu S, Ng XW, Tavintharan S, Sum CF, Lim SC. Lower circulating irisin is associated with type 2 diabetes mellitus. J Diabetes Complications. 2013 Jul-Aug;27(4):365-9.
Referans20. Park MJ, Kim D, Choi JH, Heo YR, Park SH. New role of irisin in hepatocytes: The protective effect of hepatic steatosis in vitro. Cell Signal 2015 Sep;27(9):1831-9.
Referans21. Park KH, Zaichenko L, Brinkoetter M, Thakkar B, Sahin-Efe A, Joung KE, et al. Circulating irisin in relation to insulin resistance and the metabolic syndrome. J Clin Endocrinol Metab. 2013 Dec;98(12):4899-907.
Referans22. Zhang Y, Li R, Meng Y, Li S, Donelan W, Zhao Y, et al. Irisin stimulates browning of white adipocytes through mitogen-activated protein kinase p38 MAP kinase and ERK MAP kinase signaling. Diabetes. 2014 Feb;63(2):514-25.
Referans23. Liu S, Du F, Li X, Wang M, Duan R, Zhang J,et al. Effects and underlying mechanisms of irisin on the proliferation and apoptosis of pancreatic β cells. PLoS One. 2017 Apr 10;12(4)
Referans24. Boström P, Wu J, Jedrychowski MP, Korde A, Ye L, Lo JC, et al. A PGC1-α-dependent myokine that drives brown-fat-like development of white fat and thermogenesis. Nature. 2012 Jan 11;481(7382):463-8.
Referans25. Aydin S. Three new players in energy regulation: preptin, adropin and irisin. Peptides. 2014 Jun;56:94-110.
Referans26. Pukajło K, Łaczmański Ł, Kolackov K, Kuliczkowska-Płaksej J, Bolanowski M, Milewicz A, et al. Irisin plasma concentration in PCOS and healthy subjects is related to body fat content and android fat distribution. Gynecol Endocrinol. 2015;31(11):907-11.
Referans27. Chang CL, Huang SY, Soong YK, Cheng PJ, Wang CJ, Liang IT. Circulating irisin and glucose-dependent insulinotropic peptide are associated with the development of polycystic ovary syndrome. J Clin Endocrinol Metab. 2014 Dec;99(12)
Referans28. Rosenfield RL. Ovarian and adrenal function in polycystic ovary syndrome. Endocrinol Metab Clin North Am. 1999 Jun;28(2):265-93.
Referans29. Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev. 2016 Oct;37(5):467-520.
Referans30. Polak K, Czyzyk A, Simoncini T, Meczekalski B. New markers of insulin resisitence in polycystic ovary syndrome. J Endocrinol Invest. 2017 Jan;40(1):1-8
Referans31. Adamska A, Karczewska-Kupczewska M, Lebkowska A, Milewski R, Górska M, Otziomek E, et al. Serum irisin and its regulation by hyperinsulinemia in women with polycystic ovary syndrome. Endocr J. 2016 Dec 30;63(12):1107-1112.