Polikistik over sendromlu hastalarda metabolik parametreler, serum androjen düzeyleri ve insülin direnci göstergesi olarak trigliserid/HDL-k oranı arasındaki ilişkinin incelenmesi
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Date
2017
Authors
Ulutaş, Firdevs
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Polikistik Over Sendromu (PKOS) tüm kadınların %6-10'unu etkileyen en yaygın endokrinopatilerden biridir. Kadınlardaki androjen fazlalığının ve menstrüel düzensizliğinin en önemli sebebidir. Klinik olarak oligomenore ve hiperandrojenizm ile karakterize bu sendroma; tip 2 diabetes mellitus (DM), bozulmuş glukoz toleransı, insülin direnci, obezite, dislipidemi, obstruktif uyku apne sendromu gibi kardiyovasküler hastalık risk faktörü oldukları bilinen durumların eşlik ettiği bilinmektedir. PKOS'lu kadınların yaklaşık %40-85'i kendi yaşındaki kadınlarla kıyaslandığında fazla kilolu veya obezdir. İnsülin direnci hem zayıf hem de obez PKOS'lu kadınlarda sırasıyla %30 ve %70 oranında bulunmaktadır. Bu hastalarda ayrıca tip 2 DM riski artmıştır. Bugün için insülin direncinin; PKOS'ta intrinsik bir faktör olduğu, artmış vücut kitle indeksi ile şiddetlendiği bilinmektedir. PKOS'lu çoğu kadının normal kadınlarla kıyaslandığında obeziteden bağımsız olarak insülin dirençlerinin olduğu ve hiperinsülinemik oldukları gösterilmiştir. PKOS'ta metabolik sendromun parçası olarak dislipidemi sık görülmektedir. PKOS'lu kadınlarda yapılan çok sayıdaki çalışmada bu hastalarda insülin direnci ile orantılı olarak yüksek yoğunluklu lipoprotein-kolesterol (HDL-K) düşüklüğü, trigliserid (TG) yüksekliği ve düşük yoğunluklu lipoprotein-kolesterol (LDL-K) yüksekliği saptanmaktadır. TG/HDL-K oranı birçok çalışmada kardiyovasküler risk faktörlerinin belirlenmesi açısından bel çevresi, homeostatic model assessment insulin resistance (HOMA-IR) değeri ile karşılaştırılmış ve aralarında korelasyon saptanmıştır. Çalışmamıza obez olan ve olmayan PKOS'lu hastalar ile PKOS olmayan sağlıklı toplam 60 hasta dâhil edildi. Tüm hastaların antropometrik ölçümleri, insülin dirençleri ve hiperandrojenizm bulguları not edildi. Tüm hastalarda kilo, vücut kitle indeksi (VKİ), bel çevresi, bel/ kalça oranı (BKO), kan basıncı, vücut yağ oranı (VYO), modifiye Ferriman Gallwey skorlaması ve diğer hiperandrojenemi bulguları değerlendirildi. Tüm hastaların açlık glukoz, açlık insülin, lipid profili, total testosteron, serbest androjen indeksi, dihidroepiandrosteronsülfat düzeyleri kaydedildi. İnsülin direnci göstergesi olarak TG/HDL-K oranı ile HOMA-IR, VKİ, BKO, VYO arasındaki korelasyon incelendi. Çalışmamızda obez PKOS'lu hastalarda, obez olmayan PKOS'lu ve PKOS olmayan kontrol grubuna göre daha yüksek TG/HDL-K oranı ve bununla ilişkili olarak daha yüksek HOMA-IR değeri, VKİ, BKO, VYO saptandı. PKOS'lu obez olmayan hastalarda sağlıklı grupta olduğu gibi insülin direnci yoktu. Tüm hastalar değerlendirildiğinde TG/HDL-K oranı ile HOMA-IR, VKİ, BKO, VYO, hiperandrojenizm klinik ve laboratuvar sonuçları arasında korelasyon saptandı. PKOS'lu hastalarda yaygın metabolik hastalıklar ve kardiyovasküler risk faktörleri mevcuttur. Bu yüzden bu hastalarda erken tanı ve tedavi çok önemlidir. PKOS olan hastalarda artmış kardiyovasküler risk ile insülin direnci arasındaki ilişki günümüzde net olarak bilinmektedir. Kardiyovasküler hastalıklar ve aterosklerozu öngörmede TG/HDL-K oranı belirleyici bir parametre olarak öngörülmektedir. İnsülin direncinin göstergesi olarak klinik pratikte kolaylıkla bakılabilen TG/HDL-K oranının değerlendirilmesi hastaların kardiyovasküler risklerini saptamada önemli bilgiler verebilecektir.
The polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women, affecting between 6 and 10 percent of women overall. It is the important cause of both menstrual irregularity and androgen excess in women. The syndrome is characterized clinically by oligomenorhea and hyperandrogenism, as well as the frequent presence of associated risk factors for cardiovascular disease, including type 2 diabetes (DM), impaired glucose intolerance, insülin resistance, obesity, dyslipidemia, obstructive sleep apnea. Approximately 40 to 85 percent of women with PCOS are overweight or obese compared with age matched controls. Insulin resistance is present in both lean and obese women with PCOS (30 and 70 percent, respectively) compared with age and weight matched controls. These patients are also at increased risk for type 2 DM. Today we know that insulin resistance is definitively intrinsic to PCOS and exacerbated by body mass index (BMI). Most women with PCOS are also hyperinsulinemic and insulin resistant, independent of obesity compared with normal women. Dyslipidemia is common as part of metabolic syndrome. Most studies of women with PCOS have demonstrated having low high density lipoprotein cholesterol (HDL-C) and high triglyceride concentrations (TG), consistent with their insulin resistance, as well as an increase in low density lipoprotein cholesterol. In many studies, TG/HDL-C ratio was compared with the value of waist circumference, Homeostatic Model Assessment Insulin Resistance (HOMA-IR) for the determination of cardiovascular risk factors and correlation was determined. A total of 60 patients non obese and obese PCOS and non PCOS were included in the study. The anthropometric measurements, insulin resistance and hyperandrogenism of all patients were noted. In our study we investigated the relationship between insülin resistance, antropometric values, laboratory findings in all 60 patients. For this purpose, we evaluated these parameters all of patients; body weight, body mass index, waist circumference, waist/hip ratio, blood pressure, acne, alopecia and modified Ferriman Gallway score. We studied laboratory results including liver enzymes, fasting glucose, fasting insülin, lipid profiles, total testosterone, free androgen index, dehydroepiandrosterone sulfate, HOMA-IR, vitamine D all of the patients. In our study, we found higher TG/HDL-C ratio and higher HOMA-IR value, body mass index, waist/hip ratio, body fat ratio in obese PCOS patients than non obese PCOS and non PCOS control group. Non obese patients with PCOS had no insulin resistance, as in the healthy group. When all patients were evaluated, there was a correlation between TG/HDL-C ratio and clinical and laboratory results of HOMA-IR, body mass index, waist/hip ratio, body fat ratio and hyperandrogenism. Patients with PCOS have common metabolic disorders and cardiovascular risk factors. So early diagnosis and treatment is very important for this patients. We agree that in the future TG/HDL-K ratio can be used predictor of atherosclerose and cardiovascular diseases. TG/HDL-C ratio is predicted as a determining parameter in predicting cardiovascular diseases and atherosclerosis. Assessing the TG/HDL-C ratio, which can be readily viewed in clinical practice as a marker of insulin resistance, may provide important information in detecting cardiovascular risks in patients.
The polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women, affecting between 6 and 10 percent of women overall. It is the important cause of both menstrual irregularity and androgen excess in women. The syndrome is characterized clinically by oligomenorhea and hyperandrogenism, as well as the frequent presence of associated risk factors for cardiovascular disease, including type 2 diabetes (DM), impaired glucose intolerance, insülin resistance, obesity, dyslipidemia, obstructive sleep apnea. Approximately 40 to 85 percent of women with PCOS are overweight or obese compared with age matched controls. Insulin resistance is present in both lean and obese women with PCOS (30 and 70 percent, respectively) compared with age and weight matched controls. These patients are also at increased risk for type 2 DM. Today we know that insulin resistance is definitively intrinsic to PCOS and exacerbated by body mass index (BMI). Most women with PCOS are also hyperinsulinemic and insulin resistant, independent of obesity compared with normal women. Dyslipidemia is common as part of metabolic syndrome. Most studies of women with PCOS have demonstrated having low high density lipoprotein cholesterol (HDL-C) and high triglyceride concentrations (TG), consistent with their insulin resistance, as well as an increase in low density lipoprotein cholesterol. In many studies, TG/HDL-C ratio was compared with the value of waist circumference, Homeostatic Model Assessment Insulin Resistance (HOMA-IR) for the determination of cardiovascular risk factors and correlation was determined. A total of 60 patients non obese and obese PCOS and non PCOS were included in the study. The anthropometric measurements, insulin resistance and hyperandrogenism of all patients were noted. In our study we investigated the relationship between insülin resistance, antropometric values, laboratory findings in all 60 patients. For this purpose, we evaluated these parameters all of patients; body weight, body mass index, waist circumference, waist/hip ratio, blood pressure, acne, alopecia and modified Ferriman Gallway score. We studied laboratory results including liver enzymes, fasting glucose, fasting insülin, lipid profiles, total testosterone, free androgen index, dehydroepiandrosterone sulfate, HOMA-IR, vitamine D all of the patients. In our study, we found higher TG/HDL-C ratio and higher HOMA-IR value, body mass index, waist/hip ratio, body fat ratio in obese PCOS patients than non obese PCOS and non PCOS control group. Non obese patients with PCOS had no insulin resistance, as in the healthy group. When all patients were evaluated, there was a correlation between TG/HDL-C ratio and clinical and laboratory results of HOMA-IR, body mass index, waist/hip ratio, body fat ratio and hyperandrogenism. Patients with PCOS have common metabolic disorders and cardiovascular risk factors. So early diagnosis and treatment is very important for this patients. We agree that in the future TG/HDL-K ratio can be used predictor of atherosclerose and cardiovascular diseases. TG/HDL-C ratio is predicted as a determining parameter in predicting cardiovascular diseases and atherosclerosis. Assessing the TG/HDL-C ratio, which can be readily viewed in clinical practice as a marker of insulin resistance, may provide important information in detecting cardiovascular risks in patients.
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Keywords
Polikistik over sendromu, İnsülin direnci, TG/HDL-K oranı, Polycystic ovary syndrome, İnsulin resistance, TG/HDL-C ratio
Citation
Ulutaş, F. (2017). Polikistik over sendromlu hastalarda metabolik parametreler, serum androjen düzeyleri ve insülin direnci göstergesi olarak trigliserid/HDL-k oranı arasındaki ilişkinin incelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.