Deniz Kanber Açar, Pervin Vural, Cemil Akgül

POLİKİSTİK OVER SENDROMLU HASTALARDA KRONİK İNFLAMMASYON BELİRTEÇLERİ OLAN hS -CRP, sICAM-1, sVCAM-1 VE sE-SELEKTİN DÜZEYLERİ

Amaç: Polikistik over sendromlu hastalar, kardiovasküler hastalık gelişimi için birçok risk faktörü taşırlar. Düşük derecede kronik inflammasyonun endotel disfonksiyonuna neden olarak kardiovasküler hastalığa yol açtıgı bilinmektedir.Biz de polikistik over sendromlu hastalarda bu sürecin belirteçlerinden olabileceğini düşündüğümüz hs-CRP, sICAM-1, sVCAM-1 ve sE-Selektin düzeylerini araştırdık. Materyal ve metod: Rotterdam 2003 PKOS( polikistik over sendromu) tanı kriterleri kullanılarak PKOS tanısı konulan 40 hasta çalışma grubunu oluşturuken 39 sağlıklı premenapozal kadının kontrol grubunu oluşturduğu toplam 79 olgu çalışmaya dahil edildi. Ġnsülin direncini hesaplamada açlık glukoz/insülin oranları ve HOMA indeksi kullanıldı. Plazma hs-CRP, sICAM-1, sVCAM-1 ve sE-Selektin düzeyleri sandviç ELISA yöntemi kullanılarak ölçüldü. Parametrelerin karşılaştırılmasında Mann Whitney –U ve Spearman korelasyon testleri kullanıldı. Bulgular: PKOS‟lu hastaların %40 ında insülin direnci saptandı. PKOS‟lu hastalarda total kolesterol (p < 0,05), VLDL (p < 0,0001) ve trigliserit (p < 0,01) düzeylerinde kontrol grubuna kıyasla anlamlı bir artış saptandı. LDL ve HDL konsantrasyonlarında ise kontrol grubuna kıyaslandığında anlamlı bir fark saptanmadı. hs-CRP, sICAM-1, sVCAM-1 ve sEselektin seviyeleri açısından yapılan karşılaştırmada PKOS‟lu kadınlarda plazma hs-CRP (p < 0,001), sICAM-1 (p < 0,001) ve sEselektin (p < 0,0001) düzeyleri kontrollere kıyasla daha yüksek olduğu saptandı, sVCAM konsantrasyonlarında ise bir fark bulunmadı. Spearman korrelasyon testi uygulandığında hs-CRP/sICAM-1 (r=0,251; p < 0,05) ve sE-selektin/sICAM-1 (r=0,317; p < 0,05) arasında pozitif bir korrelasyon olduğu saptandı. Sonuç: PKOS‟lu hastalarda endotel hasarına neden olarak kardiovasküler hastalık riskini arttıran düşük seviyede kronik inflammasyonun varlığı gösterilmiştir. Her ne kadar kardiovasküler mortalitenin PKOS‟lu hastalarda artmış olduğu tam olarak gösterilememiş olsa da henüz prospektif randomize bir çalışma mevcut değildir

Anahtar Kelimeler:

Polikistik over sendromu, hs-CRP, sICAM-1, sVCAM-1, sE-Selektin

CHRONIC INFLAMMATION MARKERS hs-CRP, sICAM-1, sVCAM-1 AND sE-SELECTIN LEVELS IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Objective: Patients with polycystic ovary syndrome have many risk factors associated with development of cardiovasculardisease development. Presence of low grade chronic inflammation has been indicated as a risk factor for cardiovascular disease.We investigated the levels of hs-CRP, sICAM-1, sVCAM-1 and sE-Selektin as markers of chronic inflammation.Materials and methods: 40 women with diagnosis of PCOS (Polycystic ovary syndrome) according to Rotterdam 2003 PCOSdefining criteria and 39 premenauposal otherwise healthy women taken as a control group were included in the study. Insulinresistance was estimated by fasting glucose/insulin ratio and HOMA index. Plasma hs-CRP, sICAM-1, sVCAM-1 and sE-selektinlevels were determined by sandwich ELISA method. Mann Whitney U and spearman‟s correlation tests were used statistics.Results: Insulin resistance was deteced in 40% of patients with polycystic ovary syndrome.When compared wih control patientstotal cholesterol (p<0.05), VLDL (p<0.0001) and triglyceride (p<0.01) were higher in patients with PCOS. There were nosignificant differences in the levels the LDL and HDL. The levels of hs-CRP (p<0.001), sICAM-1 (p<0.001) and sE-selectin(p<0.0001) in patients with PCOS were higher than control group but there was no difference in sVCAM-1 levels between thegroups. There was positive correlation according to Spearman‟s test between hs-CRP/sICAM-1 (r=0.251; p<0.05) and sEselektin/sICAM-1 (r=0.317; p<0.05).Conclusion In patients with PCOS the presence of chronic low grade inflammation which is a risk factor for endothelialdysfunction hence cardiovascular disease is demonstrated. But there is yet no prospective randomised study dealing withmortality due to cardiovascular disease in patients with PCOS.

Keywords:

Polycystic ovary syndrome, hs-CRP, sICAM-1, sVCAM-1, e-selectin,

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