Polikistik Over Sendromlu İnfertilite Olgularında İnsülin Rezistansı ve Leptin Düzeyleri

Abstract

ÖZET Çalışmanın amacı : Çalışma, polikistik over sendromlu infertilite olgularında insülin rezistansı ve leptin düzeylerini araştırmak için yapıldı. Bu çalışma Ondokuz Mayıs Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğinde 2000 Kasım - 2001 Eylül aylan arasında yapılmış, klinik prospektif bir çalışmadır. Uygulanan yöntemler : Çalışma grubu 37'si polikistik over sendrom'lu ve 35'i kontrol olmak üzere 72 infertil olgudan oluştu. Oligo-amenore şikayeti olan ve 21. gün progesteron düzeyi 3ng/dl altında olan ve ultrasonografik olarak polikistik over görünümü olan hastalar polikistik over sendromu(PCOS) olarak kabul edildi. Kontrol grubu infertilite nedeniyle başvuran; fakat düzenli adet gören, ultrasonografisinde överleri normal görünümde olan ovulatuar kadınlardı. Tüm hastalara 3 günlük karbonhidrattan zengin diyet sonrası, sabah aç kamına 2 saatlik 75 gr oral glukoz tolerans testi yapıldı(OGTT). OGTT esnasında glukoz ve insülin değerleri ölçüldü. Yine sabah aç olarak alman kan örneklerinde FSH, LH, estradiol, androjenler, prolaktin, leptin ve lipid düzeylerine bakıldı. Kan örneklerinin hepsi menstrual siklusun erken folliküler fazında alındı. Hastaların vücut kilo indeksini ölçmek için ağırlık ve boy ölçüleri alındı. Bazal insülin düzeyleri ve bazal glukoz düzeyleri kullanılarak HOMA(homeostasis model assesment) formülü ile insülin rezistansı hesaplandı(HOMA=Bazal insülin/22,5*e-'n(bazal gIukoz)). Tüm veriler SSPS programı ile bilgisayarda değerlendirildi. İstatistiksel değerlendirmelerde student t, regresyon analizi testleri kullanıldı. Çalışmanın bulguları : Ortalama bazal insülin düzeyi PCOS grubunda 17,62+8,92 miu/dl, kontrol grubunda 9,13+3,25 miu/dl idi. OGTT'ye yanıt olarak gelişen 1. saat insülin düzeyi ortalaması PCOS grubunda 91,31 ±42,99 miu/dl, kontrol grubunda 39,40+24,90 miu/dl idi. 2.saat insülin düzeyi ortalaması ise PCOS grubunda 52,57±55,89 miu/dl, kontrol grubunda 25,49±22,64 miu/dl idi. Ortalama bazal glukoz düzeyi PCOS grubunda 91,31+15,93 mg/dl, kontrol grubunda 91,20+10,27 mg/dl idi. OGTT sonrası ortalama rvl.saat glukoz düzeyi PCOS grubunda 134,84±40,26 mg/dl, kontrol grubunda 117,91+31,06 mg/dl idi. Ortalama 2.saat glukoz düzeyi PCOS grubunda 114,21±28 mg/dl, kontrol grubunda 99,26+21,54 mg/dl idi. PCOS'lu hastalarda bazal insulin düzeyleri, OGTT'ye yanıt olarak gelişen 1. saat ve 2. saat insülin düzeyleri kontrol grubundan yüksek bulunmuştur(P<0,0001, P=0,041, P=0,010). PCOS'lu hastalarda OGTT sonrası l.saat ve 2. saat glukoz düzeyleri kontrol grubundan yüksek bulunmuştur(P=ABSTRACT Objective : This study was designed to investigate insulin resistance and circulating leptin levels in infertile patients with policystic ovary syndrome. This is a prospective clinical study that was performed at the Department of Obstetrics and Gynaecology, Ondokuz Mayıs University Medical School between November 2000 and October 2001. Material and methods : Female partners of 72 in fertile couple were in eluded in this study. These women were studied as two groups: 37 women with the diagnosis of policystic ovary syndrome and 35 women with regular menstrual cyclicity. Policystic ovary syndrome was diagnosed when the following criteria were fulfillerd: 1) oligomenorrhea, anovulatory cycles or secondary amenorrhea; 2) presence of policystic ovaries on transvaginal ultrasound examination; 3) mid luteal serum progesterone levels <3ng/dl. The control group consisted of 35 infertile remaining ovulating women with regular menstrual cycles. Normal ovaries were also verified by vaginal ultrasonography. A 2-hour 75 gr oral glucose tolerance test (OGTT) was performed on all subjects after an overnight fast and a 3 -day standardized diet. Insulin and glucose were measured throughout OGTT. FSH, LH, estradiol, androgens, prolactin, lipids, leptin were measured in the baseline fasting blood sample from an OGTT. Blood samples were obtained in the early follicular phase of the menstrual cycle. Height and weight were measured for calculation of body mass index(BMI). insulin resistance measured with formüle of HOMA(homeostasis model assesment) (HOMA=Baseline insulin/22,5*e -ln(-baseline zlucose\ Data were analysed by SSPS program on computer. Student's test, regression analysis tests were used for statistical analyses. Results : Mean baseline insulin levels were 17,62+8,92 mm/dl in the PCOS group and 9,13+3,25 miu/dl in the control group. Insulin levels 60 min after the OGTT were 91,31 ±42,99 miu/dl in the PCOS group and 39,40±24,90 miu/dl in the control group. Insulin levels 120 min after the OGTT were 52,57+55,89 rruu/dl in the PCOS group and VI 'S^»»^25,49+22,64 mıu/dl in the control group. Mean baseline glucose levels were 91,31 + 15,93 mg/dl in the PCOS group and 91,20+10,27 mg/dl in the control group. Glucose levels 120 min after the OGTT were 1 14,21+28,00 mg/dl in the PCOS group and 99,26+21,54 mg/dl in the control group. Mean baseline insulin levels were higher in the PCOS group than in the control group(P' ().()()() I ). Insulin levels 60 min and 120 min aller the OGTT wore higher in the PCOS group than in the control group(P 0,041, P 0,010 respectively). Glucose levels 60 min and 120 min aller the OGTT were higher in the PCOS group than in the control group(P-0,042, P0,014) Mean MOM A levels were 4,11+2,03 in the PCOS group and 1,95+0,75 in the control group. NOMA levels were higher in (he PCOS group than in the control group(P<0,0001). Mean leptin levels were 27,36+13,42 ng/ml in the PCOS group and 14,32+6,70 ng/ml in the control group. Leptin levels were higher in infertyl women with PCOS than control group(P<0,0001). When leptin values were corrected for BMI with covariance analysis, there was no significant difference in leptin levels between two groups. Leptin levels correlated significantly with body mass index in the PCOS and control groups(r=0,77 and P<0,001) and also with basal insulin concentrations in the PCOS and control groups(r=0,82 and P<0,001). Conclusion : Insulin concentrations were higher in infertile women with PCOS than the control group. Insulin resistance in infertile women with PCOS was also revealed. Although the leptin concentrations were significantly higher in infertile women with PCOS, difference was disappeared after correction of leptin levels with BMI by covariance analysis. Hence, our study didn't support the hypothesis of elevated leptin levels in PCOS patients. Key words: PCOS, insulin resistance, leptin VII