Polikistik over sendromlu hastalarda serum endocan ve YKL-40 seviyeleri ile kardiyometabolik risk faktörleri arasındaki ilişkinin değerlendirilmesi
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2023
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Amaç: Polikistik over sendromunun (PCOS) incelenen popülasyona bağlı olarak, kadınlarda en sık görülen endokrinopatilerden biri olduğu ve kadınların %5-10'unu etkilediği düşünülmektedir. Sendrom klinik olarak oligomenore ve hiperandrojenizmin yanı sıra obezite, glukoz intoleransı, dislipidemi, yağlı karaciğer ve obstrüktif uyku apnesi gibi kardiyovasküler hastalıkla ilişkili risk faktörlerinin sık görülmesi ile karakterizedir. Endocan, endotelyal aktivasyonu yansıtan, vasküler endotel tarafından salgılanan bir dermatan sülfat proteoglikandır. Endocanın, anjiogenezis ve inflamatuvar sürecin regülasyonunda önemli rolü olduğu ve vasküler disfonksiyon ve buna bağlı kardiyovasküler riskin bir belirteci olarak kullanılabileceği öne sürülmektedir. Yapılan çalışmalarda endocan düzeyinin, kanser, sepsis, obezite, hipertansiyon ve enfeksiyon durumlarında da yükseldiği belirlenmiştir. YKL-40 (Chitinase-3-like protein) makrofaj ve nötrofillerden endotel hasarına yanıt olarak salgılanan bir glikoproteindir. Yapılan çalışmalarda artan YKL-40 seviyelerinin endotel disfonksiyonu ile bağlantılı olarak kardiyovasküler mortalite ile ilişkili olduğu bulunmuştur. Bu çalışmamızda PCOS tanısına sahip hastalarda endocan ve YKL-40 düzeylerinin bu hastalardaki artmış kardiyovasküler riskin bir belirteci olarak kullanılıp kullanılamayacağının tespiti amaçlanmıştır. Gereç ve yöntem: Çalışmamıza, Endokrinoloji polikliniğinde polikistik over sendromu tanısı alan 44 hastadan ve 40 kontrol grubundan (sağlıklı gönüllüler) YKL-40 ve endocan düzeyleri için, biyokimya tüplerine yaklaşık 5 ml venöz kan alındı, alınan numune düz ve içinde koruyucu içeren plastik tüpler içerisine konuldu ve 5°C’de 4000 rpm’de 5 dk santrifüj edildi.
Elde edilen numuneler eppendorf tüplerine alınarak çalışma gününe kadar -80°C’de saklandı. Endokrin polikliniğinde ultrasonografi kullanılarak karotis intima media kalınlığı (CIMT) değerlendirildi. Diyet polikliniğinde hastaya vücut yağ oranını belirlemek için TANİTA ölçüm cihazı ile ölçüm yapıldı. Boy kilo ve vücut kitle indeksi (VKİ) ölçümü yapıldı. Hastaların ve kontrol grubunun glukoz, insülin, lipid parametleri (LDL, HDL, trigliserid ve total kolesterol) crp (c reaktif protein), testesteron ve dehidroepiandrosteron (DHEAS) seviyeleri dosyalarından alındı. Sistolik ve diastolik kan basıncı ölçümleri yapıldı. Glikoz ve insülin sonuçlarına göre HOMA-IR skoru hesaplandı. Serum endocan ve YKL-40 düzeyleri, ELISA yöntemiyle çalışıldı. İstatistiksel hesaplamalar SPSS 22.0 (Statistical Package for Social Sciences) programı kullanılarak yapıldı. Sürekli değişkenler dağılım normal ise ortalama ± standart sapma, dağılım normal değilse ortanca (minimum-maksimum) olarak verildi. Parametrik test varsayımları sağlandığında bağımsız grup farklılıklarının karşılaştırılmasında iki ortalama arasındaki farkın önemlilik testi (Independent samples t test); parametrik test varsayımları sağlanmadığında ise bağımsız grup farklılıklarının karşılaştırılmasında Mann-Whitney U testi kullanıldı. Ayrıca değişkenler arası ilişkiyi incelemek için Pearson ve Spearman korelasyon analizleri kullanıldı. Farklılıklar için, p<0.05 düzeyi istatistiksel olarak anlamlı kabul edildi. Bulgular: PCOS’u olan bireylerle serum YKL-40 seviyesi kontrollerle kıyaslandığında daha yüksek saptanmıştır. Ancak bu fark istatistiksel olarak anlamlı bulunmamıştır (p=0,09). Serum endocan düzeyleri arasında PCOS ve kontrol grubu arasında istatistiksel olarak anlamlı fark saptanmıştır (p=0.014). PCOS hasta grubunda serum endocan düzeyi yüksek saptanmıştır.
Serum endocan ve YKL-40 düzeyleri ile; kardiyometabolik risk değerlendirmesinde önemli belirteçler olan HOMA-IR skoru, VKİ, insülin, crp, CIMT, total testesteron, DHEAS ve lipid profili (trigiserid, HDL, LDL, kolesterol) ölçümleri arasında ilişki olup olmadığı korelasyon analizleri ile değerlendirildi. Ykl-40 düzeyi ile VKİ, crp, CIMT, total testesteron, dheas ve lipid profili (trigiserid, HDL, LDL, kolesterol) ölçümleri arasında ilişki saptanmamıştır. Endocan düzeyi ile HOMA-IR skoru, VKİ, insülin, crp, CIMT, total testesteron, DHEAS ve lipid profili (trigiserid, HDL, LDL, kolesterol) ölçümleri arasında ilişki saptanmamıştır. Çalışmamızda ayrıca her iki grupta YKL- 40 ile Endocan arasında r = .626 korelasyon değeri ile istatistiksel olarak anlamlı bir ilişki bulunmuştur (p<0.05). Sonuç: Polikistik over sendromu, artan sayıda kardiyovasküler komorbidite ile ilişkilidir. PCOS hastalarında endocan anlamlı şekilde artmış olsa da, KVH risk biyobelirteci
olarak kullanımının kabul edilebilmesi için daha geniş hasta populasyonuna ve daha uzun süreli hasta kohortuna ihtiyaç vardır. Aynı şekilde YKL-40’ın da PCOS’lu hastalarda daha yüksek saptamamıza rağmen kontrol grubu ile anlamlı ilişki bulamamış olmamız, KVH riskinin belirlenmesinde kullanımının daha ileri araştırmalara ihtiyaç duyduğunu göstermektedir. Yine de endocan ile YKL-40’ın anlamlı korelasyonu, bize bu iki parametrenin kardiyovasküler hastalık riski öngörülmesi ve takibi için faydalı olabileceğinin bir göstergesidir.
Introduction: Polycystic ovary syndrome (PCOS) is thought to be one of the most common endocrinopathies in women, affecting 5-10% of women, depending on the population studied. The syndrome is clinically characterized by oligomenorrhea and hyperandrogenism, as well as frequent cardiovascular disease-related risk factors such as obesity, glucose intolerance, dyslipidemia, fatty liver, and obstructive sleep apnea. Endocan is a dermatan sulfate proteoglycan secreted by the vascular endothelium, reflecting endothelial activation. It has been suggested that endocan has an important role in the regulation of angiogenesis and the inflammatory process and can be used as a marker of vascular dysfunction and related cardiovascular risk. YKL-40 (Chitinase-3-like protein) is a glycoprotein secreted from macrophages and neutrophils in response to endothelial damage. Studies have found that increased levels of YKL-40 are associated with cardiovascular mortality in association with endothelial dysfunction. In this study, we aimed to determine whether endocan and YKL-40 levels in patients with PCOS can be used as a marker of increased cardiovascular risk in these patients. Materials and Methods: In our study, approximately 5 ml of venous blood was taken into biochemistry tubes for YKL-40 and endocan levels from 44 patients diagnosed with polycystic ovary syndrome in the Endocrinology outpatient clinic and 40 control groups (healthy volunteers), the sample was placed in flat plastic tubes with a protective inside and placed at 5°C. It was centrifuged at 4000 rpm for 5 min at C. The obtained samples were taken into Eppendorf tubes and stored at -80°C until the working day. Carotid intima media thickness (CIMT) was evaluated using ultrasonography in the endocrine outpatient clinic. In the diet outpatient clinic, the patient was measured with a TANITA measuring device to determine the body fat ratio. Height, weight and body mass index (BMI) were measured. Glucose, insulin, lipid parameters (LDL, HDL, triglyceride and total cholesterol), crp (c reactive protein), testosterone and dehydroepiandrosterone (DHEAS) levels of the patients and control group were taken from their files. Systolic and diastolic blood pressure measurements were made. HOMA-IR score was calculated according to glucose and insulin results. Serum endocan and YKL-40 levels were studied by ELISA method. Statistical calculations were made using the SPSS 22.0 (Statistical Package for Social Sciences) program. Continuous variables were given as mean ± standard deviation if the distribution was normal, and as the median (minimum-maximum) if the distribution was not normal. Significance test of the difference between two means in comparison of independent group differences when parametric test assumptions are met (Independent samples t test); When parametric test assumptions were not met, the Mann-Whitney U test was used to compare independent group differences. In addition, Pearson and Spearman correlation analyzes were used to examine the relationship between variables. For the differences, the p<0.05 level was considered statistically significant. Findings: Serum YKL-40 level was found to be higher in individuals with PCOS when compared to controls. However, this difference was not found to be statistically significant (p = 0.09). There was a statistically significant difference in serum endocan levels between the PCOS and control groups (p = 0.014). Serum endocan level was found to be high in the PCOS patient group. With serum endocan and YKL-40 levels; Correlation analyzes were used to determine whether there was a relationship between HOMA-IR score, BMI, insulin, crp, CIMT, total testosterone, DHEAS and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements, which are important markers in cardiometabolic risk assessment. No correlation was found between Ykl-40 level and BMI, crp, CIMT, total testosterone, dheas and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements. No correlation was found between endocan level and HOMA-IR score, BMI, insulin, crp, CIMT, total testosterone, DHEAS and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements. In our study, a statistically significant correlation was found between YKL-40 and Endocan with r = .626 correlation value in both groups (p<0.05). Result: Polycystic ovary syndrome is associated with an increasing number of cardiovascular comorbidities. Although endocan was significantly increased in PCOS patients, a larger patient population and longer-term patient cohort are needed before its use as a CVD risk biomarker can be accepted. Likewise, although we found that YKL-40 was higher in patients with PCOS, we did not find a significant relationship with the control group, indicating that its use in determining CVD risk requires further research. Nevertheless, the significant correlation between endocan and YKL-40 indicates that these two parameters may be useful for predicting and monitoring cardiovascular disease risk.
Introduction: Polycystic ovary syndrome (PCOS) is thought to be one of the most common endocrinopathies in women, affecting 5-10% of women, depending on the population studied. The syndrome is clinically characterized by oligomenorrhea and hyperandrogenism, as well as frequent cardiovascular disease-related risk factors such as obesity, glucose intolerance, dyslipidemia, fatty liver, and obstructive sleep apnea. Endocan is a dermatan sulfate proteoglycan secreted by the vascular endothelium, reflecting endothelial activation. It has been suggested that endocan has an important role in the regulation of angiogenesis and the inflammatory process and can be used as a marker of vascular dysfunction and related cardiovascular risk. YKL-40 (Chitinase-3-like protein) is a glycoprotein secreted from macrophages and neutrophils in response to endothelial damage. Studies have found that increased levels of YKL-40 are associated with cardiovascular mortality in association with endothelial dysfunction. In this study, we aimed to determine whether endocan and YKL-40 levels in patients with PCOS can be used as a marker of increased cardiovascular risk in these patients. Materials and Methods: In our study, approximately 5 ml of venous blood was taken into biochemistry tubes for YKL-40 and endocan levels from 44 patients diagnosed with polycystic ovary syndrome in the Endocrinology outpatient clinic and 40 control groups (healthy volunteers), the sample was placed in flat plastic tubes with a protective inside and placed at 5°C. It was centrifuged at 4000 rpm for 5 min at C. The obtained samples were taken into Eppendorf tubes and stored at -80°C until the working day. Carotid intima media thickness (CIMT) was evaluated using ultrasonography in the endocrine outpatient clinic. In the diet outpatient clinic, the patient was measured with a TANITA measuring device to determine the body fat ratio. Height, weight and body mass index (BMI) were measured. Glucose, insulin, lipid parameters (LDL, HDL, triglyceride and total cholesterol), crp (c reactive protein), testosterone and dehydroepiandrosterone (DHEAS) levels of the patients and control group were taken from their files. Systolic and diastolic blood pressure measurements were made. HOMA-IR score was calculated according to glucose and insulin results. Serum endocan and YKL-40 levels were studied by ELISA method. Statistical calculations were made using the SPSS 22.0 (Statistical Package for Social Sciences) program. Continuous variables were given as mean ± standard deviation if the distribution was normal, and as the median (minimum-maximum) if the distribution was not normal. Significance test of the difference between two means in comparison of independent group differences when parametric test assumptions are met (Independent samples t test); When parametric test assumptions were not met, the Mann-Whitney U test was used to compare independent group differences. In addition, Pearson and Spearman correlation analyzes were used to examine the relationship between variables. For the differences, the p<0.05 level was considered statistically significant. Findings: Serum YKL-40 level was found to be higher in individuals with PCOS when compared to controls. However, this difference was not found to be statistically significant (p = 0.09). There was a statistically significant difference in serum endocan levels between the PCOS and control groups (p = 0.014). Serum endocan level was found to be high in the PCOS patient group. With serum endocan and YKL-40 levels; Correlation analyzes were used to determine whether there was a relationship between HOMA-IR score, BMI, insulin, crp, CIMT, total testosterone, DHEAS and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements, which are important markers in cardiometabolic risk assessment. No correlation was found between Ykl-40 level and BMI, crp, CIMT, total testosterone, dheas and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements. No correlation was found between endocan level and HOMA-IR score, BMI, insulin, crp, CIMT, total testosterone, DHEAS and lipid profile (triglyceride, HDL, LDL, cholesterol) measurements. In our study, a statistically significant correlation was found between YKL-40 and Endocan with r = .626 correlation value in both groups (p<0.05). Result: Polycystic ovary syndrome is associated with an increasing number of cardiovascular comorbidities. Although endocan was significantly increased in PCOS patients, a larger patient population and longer-term patient cohort are needed before its use as a CVD risk biomarker can be accepted. Likewise, although we found that YKL-40 was higher in patients with PCOS, we did not find a significant relationship with the control group, indicating that its use in determining CVD risk requires further research. Nevertheless, the significant correlation between endocan and YKL-40 indicates that these two parameters may be useful for predicting and monitoring cardiovascular disease risk.
Açıklama
Anahtar Kelimeler
PCOS (polikistik over sendromu), Endocan, YKL-40, PCOS (polycystic ovary syndrome)
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WoS Q Değeri
Scopus Q Değeri
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Künye
Kocadağ, Ü. Ç. (2023). Polikistik over sendromlu hastalarda serum endocan ve YKL-40 seviyeleri ile kardiyometabolik risk faktörleri arasındaki ilişkinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
