Polikistik over sendrom tanılı hastaların fenotiplerinin prolaktin düzeyi ile nötrofil/lenfosit oranı arasındaki ilişki
Yükleniyor...
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Polikistik Over Sendromu ve hiperprolaktinemi, üreme dönemindeki kadınlarda görülen en yaygın iki endokrinopati olup HPRL ve PKOS arasında patofizyolojik bir bağın varlığı ileri sürülmüştür. Diğer taraftan yapılan çalışmalarda PKOS'un patogenezinde, kronik bir inflamasyon sürecinin olduğu gösterilmiş, çeşitli inflamatuar markerlar PKOS'ta incelenmiştir. Bu çalışmada, PKOS hastaları fenotip gruplarına göre sınıflandırılmış ve çalışmaya bir kontrol grubu eklenmiştir. Sınıflandırılan gruplar arasında, prolaktin düzeyleri ve inflamasyonun göstergelerinden biri olan NLO karşılaştırarak, PKOS olgularında inflamasyon ile ilişkili olup olmadığını araştırmayı planladık. Çalışmaya Ocak 2018-Mayıs 2021 tarihleri arasında Kadın Hastalıkları ve Doğum kliniğine başvurmuş, 19-40 yaş arası adet düzensizliği veya klinik hiperandrojenizm bulguları olan, Rotterdam PKOS tanı kriterlerine göre 3 kriterden 2'sini taşıyan hastalar dahil edildi. Rotterdam PKOS tanı kriterleri; ovulatuar disfoksiyonu olan, hirşutizm, akne gibi klinik hiperandrojenizm bulguları olan, biyokimyasal hiperandrojenizm; serbest androjen indeksi 2.85'in üzerine olan ve ultrasonagrafide polikistik over görünümü ve diğer androjen yüksekliğine sebep olan nedenlerin ekarte edildiği hastalar olarak tanımlanmıştır. PKOS tanısı almış hastalar alınan anamnez ve labaratuar tetkiklerine bakılarak NIH in belirlediği 4 fenotipik gruba ayrıldı. Hiperandrojenizmin, oligo-anovulasyonun ve polikistik over morfolojisinin beraber görüldüğü grup fenotip 1, polikistik over morfolojisinin görülmediği sadece hiperandrojenizmin ve oligo-anovulasyonun olduğu grup fenotip 2, normal ovulatuar siklusa sahip fakat hiperandrojenizmi ve polikistik over morfolojisinin görüldüğü hastalar ise fenotip 3, hiperandrojemisi olmayan, sadece oligo-anovulasyonu ve polikistik over morfolojisi olan hastalar ise fenotip 4 olarak sınıflandırıldı. Dört grubun dışında PKOS tanısı almamış sağlıklı bireylerden oluşan kontrol grubu oluşturuldu. Çalışmada bakılan NLO parametresinin, Fenotip-1 grubundaki hastalarda, Fenotip-4 grubundaki hastalara kıyasla anlamlı şekilde yüksek olduğu izlendi(p=.012). Çalışma grupları arasında PLR seviyeleri istatistiksel olarak anlamlı şekilde farklılık göstermedi (p=.683). FSH parametresinin PKOS gruplarında kontrol grubuna göre daha yüksek olduğu (p=.002) izlendi. LH seviyelerinin PKOS gruplarında kontrol grubuna göre daha yüksek olduğu (p<.001) görüldü. Çalışmada bakılan DHEA-S seviyelerinin, Fenotip-1 grubundaki hastalarda, Fenotip-4 grubundaki hastalara göre anlamlı şekilde yüksek bulundu (p<.001). Sonuç olarak bu çalışmada, PKOS fenotipleri ile prolaktin seviyeleri arasında istatistiksel olarak anlamlı bir ilişki olmadığını gösterdik. PKOS tanılı hastalarda yüksek prolaktin seviyeleri olması durumunda hiperprolaktinemi yapan diğer sebeplerin araştırılması gerektiğini düşünmekteyiz. Çalışmamızda, PKOS fenotiplerinde inflamasyon parametrelerinden biri olan NLO'yi inceledik ve NLO'nin kontrol grubu ile PKOS fenotipleri arasında anlamlı farklılık göstermediğini fakat fenotip 1 yani klasik PKOS sayılan grupta, non-hiperandrojenik PKOS olarak sınıflandırılan fenotip 4'e göre istatistiksel olarak anlamlı şekilde daha yüksek olduğunu gösterdik ve PKOS fenotipleri arasında inflamasyon şiddetlerinin farklı olabileceğini düşündürmektedir. PKOS ve alt fenotiplerinde, pekçok çalışmada vurgulanan subklinik inflamasyonu göstermek ve değerlendirmek için geniş çaplı yeni çalışmalara ihtiyaç vardır.
Polycystic Ovary Syndrome and hyperprolactinemia are the two most common endocrinopathy in reproductive period women, and a pathophysiological link between HPRL and PCOS has been suggested. On the other hand, studies have shown that there is a chronic inflammation process in the pathogenesis of PCOS, and various inflammatory markers have been examined in PCOS. In this study, PCOS patients were classified according to phenotype groups and a control group was added to the study. We planned to investigate whether it is associated with inflammation in PCOS cases by comparing prolactin levels and NLR, one of the indicators of inflammation, among the classified groups. Patients between the ages of 19 and 40 who applied to the Gynecology and Obstetrics Clinic between January 2018 and May 2021, who had menstrual irregularity or clinical signs of hyperandrogenism, and who met 2 of the 3 criteria according to the Rotterdam PCOS diagnostic criteria were included in the study. Rotterdam PCOS diagnostic criteria; biochemical hyperandrogenism with ovulatory dysfunction, clinical signs of hyperandrogenism such as hirsutism, acne; It was defined as patients with a free androgen index above 2.85 and in whom the causes of polycystic ovary appearance and other androgen elevation in ultrasonography were excluded. Patients diagnosed with PCOS were divided into 4 phenotypic groups determined by the NIH, based on their anamnesis and laboratory tests. Group phenotype 1 with hyperandrogenism, oligo-anovulation and polycystic ovary morphology together, group phenotype 2 with only hyperandrogenism and oligo-anovulation without polycystic ovary morphology, phenotype 3 in patients with normal ovulatory cycle but with hyperandrogenism and polycystic ovary morphology, patients without hyperandrogemia but with only oligo-anovulation and polycystic ovarian morphology were classified as phenotype 4. A control group consisting of healthy individuals who were not diagnosed with PCOS, except for four groups, was formed. It was observed that the NLR parameter measured in the study was significantly higher in patients in the Phenotype-1 group compared to the patients in the Phenotype-4 group (p=.012). PLR levels were not statistically significantly different between study groups (p=.683). It was observed that FSH parameter was higher in PCOS groups than in the control group (p=.002). LH levels were found to be higher in PCOS groups than in the control group (p<.001). The DHEA-S levels measured in the study were found to be significantly higher in patients in the Phenotype-1 group than in the patients in the Phenotype-4 group (p<.001). In conclusion, in this study, we showed that there is no statistically significant relationship between PCOS phenotypes and prolactin levels. We think that in case of high prolactin levels in patients with PCOS, other causes of hyperprolactinemia should be investigated. In our study, we examined NLR, one of the inflammation parameters in PCOS phenotypes, and found that NLR did not differ significantly between the control group and PCOS phenotypes, but phenotype 1, that is, in the classical PCOS group, was statistically significantly higher than phenotype 4, which is classified as non-hyperandrogenic PCOS. We have shown that it is high, suggesting that the severity of inflammation may differ between PCOS phenotypes. Large-scale new studies on PCOS and its subphenotypes are needed to demonstrate and evaluate subclinical inflammation, which has been highlighted in many studies.
Polycystic Ovary Syndrome and hyperprolactinemia are the two most common endocrinopathy in reproductive period women, and a pathophysiological link between HPRL and PCOS has been suggested. On the other hand, studies have shown that there is a chronic inflammation process in the pathogenesis of PCOS, and various inflammatory markers have been examined in PCOS. In this study, PCOS patients were classified according to phenotype groups and a control group was added to the study. We planned to investigate whether it is associated with inflammation in PCOS cases by comparing prolactin levels and NLR, one of the indicators of inflammation, among the classified groups. Patients between the ages of 19 and 40 who applied to the Gynecology and Obstetrics Clinic between January 2018 and May 2021, who had menstrual irregularity or clinical signs of hyperandrogenism, and who met 2 of the 3 criteria according to the Rotterdam PCOS diagnostic criteria were included in the study. Rotterdam PCOS diagnostic criteria; biochemical hyperandrogenism with ovulatory dysfunction, clinical signs of hyperandrogenism such as hirsutism, acne; It was defined as patients with a free androgen index above 2.85 and in whom the causes of polycystic ovary appearance and other androgen elevation in ultrasonography were excluded. Patients diagnosed with PCOS were divided into 4 phenotypic groups determined by the NIH, based on their anamnesis and laboratory tests. Group phenotype 1 with hyperandrogenism, oligo-anovulation and polycystic ovary morphology together, group phenotype 2 with only hyperandrogenism and oligo-anovulation without polycystic ovary morphology, phenotype 3 in patients with normal ovulatory cycle but with hyperandrogenism and polycystic ovary morphology, patients without hyperandrogemia but with only oligo-anovulation and polycystic ovarian morphology were classified as phenotype 4. A control group consisting of healthy individuals who were not diagnosed with PCOS, except for four groups, was formed. It was observed that the NLR parameter measured in the study was significantly higher in patients in the Phenotype-1 group compared to the patients in the Phenotype-4 group (p=.012). PLR levels were not statistically significantly different between study groups (p=.683). It was observed that FSH parameter was higher in PCOS groups than in the control group (p=.002). LH levels were found to be higher in PCOS groups than in the control group (p<.001). The DHEA-S levels measured in the study were found to be significantly higher in patients in the Phenotype-1 group than in the patients in the Phenotype-4 group (p<.001). In conclusion, in this study, we showed that there is no statistically significant relationship between PCOS phenotypes and prolactin levels. We think that in case of high prolactin levels in patients with PCOS, other causes of hyperprolactinemia should be investigated. In our study, we examined NLR, one of the inflammation parameters in PCOS phenotypes, and found that NLR did not differ significantly between the control group and PCOS phenotypes, but phenotype 1, that is, in the classical PCOS group, was statistically significantly higher than phenotype 4, which is classified as non-hyperandrogenic PCOS. We have shown that it is high, suggesting that the severity of inflammation may differ between PCOS phenotypes. Large-scale new studies on PCOS and its subphenotypes are needed to demonstrate and evaluate subclinical inflammation, which has been highlighted in many studies.
Açıklama
Anahtar Kelimeler
Polikistik Over Sendromu, Nötrofil Lenfosit Oranı, Prolaktin, Polycystic Ovary Syndrome, Neutrophil Lymphocyte Ratio, Prolactin
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Tosun, Ö. (2021). Polikistik over sendrom tanılı hastaların fenotiplerinin prolaktin düzeyi ile nötrofil/lenfosit oranı arasındaki ilişki. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
