Samy Nervana, Hashim Maha, Sayed Magda, Said Mohamed
Biochemistry Department -National Research Center, Cairo, Egypt.
Dis Markers. 2009;26(4):163-70. doi: 10.3233/DMA-2009-0627.
Women with polycystic ovary syndrome (PCOS) have an increased prevalence of insulin resistance (IR) and related disorders. Elevated serum levels of high sensitivity CRP (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) reflect low-grade chronic inflammation and have been associated with several insulin-resistant states; they are useful cardiovascular risk markers. The objective of this study was to investigate whether soluble inflammatory markers are altered in PCOS focusing on its relationship with obesity and indexes of insulin resistance.
One hundred and eight women with PCOS and 75 healthy women were recruited. Patients were divided according to body mass index (BMI) into two groups; group I (BMI < 27 kg/m(2)) and group II (BMI > or = 27 Kg/m(2)). Serum levels of hs-CRP, IL-6, and TNF-alpha, lipid and hormone profiles were measured.
PCOS patients had increased levels of testosterone, luteinizing hormone (LH), androstendione, insulin level and HOMA index compared to healthy BMI matched controls. High-density lipoprotein (HDL) concentrations were significantly reduced in both patient groups compared to their controls, while triglyceride levels were significantly increased in obese group compared to controls. There were no significant difference in serum inflammatory markers hs-CRP, IL-6 and TNF-alpha between group I and their matched controls. On the other hand, there were significant increase in these markers between group II and their matched controls. There were highly significant positive correlation between hs-CRP and IL-6 (r=0.702, P< 0.001) and between hs-CRP and TNF-alpha (r=0.621, P<0.001), also between IL-6 and TNF-alpha (r=0.543, P< 0.001). These inflammatory markers correlated significantly with BMI and HOMA index. Multiple regression analysis revealed that BMI and HOMA were predictors of IL-6 levels (b=11.173, P< 0.001, b=13.564, P< 0.001 respectively) and BMI was the only predictor of hs-CRP levels (b=12.578, P< 0.001) and TNF-alpha levels (b=0.134, P<0.001).
PCOS and obesity induce an increase in serum inflammatory cardiovascular risk markers. The precise mechanisms underlying these associations require additional studies to clarify the state of the cardiovascular system in women with PCOS compared with controls in large numbers of patients to determine the relative contribution of different factors including insulin resistance, androgen status and BMI.
多囊卵巢综合征（PCOS）女性胰岛素抵抗（IR）及相关疾病的患病率增加。血清高敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子α（TNF-α）水平升高反映低度慢性炎症，且与多种胰岛素抵抗状态相关；它们是有用的心血管风险标志物。本研究的目的是调查PCOS患者可溶性炎症标志物是否改变，重点关注其与肥胖及胰岛素抵抗指标的关系。
招募了108例PCOS女性和75例健康女性。根据体重指数（BMI）将患者分为两组；I组（BMI<27kg/m²）和II组（BMI≥27kg/m²）。测量血清hs-CRP、IL-6、TNF-α水平、血脂和激素谱。
与健康BMI匹配对照组相比，PCOS患者的睾酮、黄体生成素（LH）、雄烯二酮、胰岛素水平和HOMA指数升高。与对照组相比，两组患者的高密度脂蛋白（HDL）浓度均显著降低，而肥胖组的甘油三酯水平与对照组相比显著升高。I组与其匹配对照组之间血清炎症标志物hs-CRP、IL-6和TNF-α无显著差异。另一方面，II组与其匹配对照组之间这些标志物显著升高。hs-CRP与IL-6之间（r=0.702，P<0.001）、hs-CRP与TNF-α之间（r=0.621，P<0.001）以及IL-6与TNF-α之间（r=0.543，P<0.001）存在高度显著正相关。这些炎症标志物与BMI和HOMA指数显著相关。多元回归分析显示，BMI和HOMA是IL-6水平的预测因子（分别为b=11.173，P<0.001，b=13.564，P<0.001），BMI是hs-CRP水平（b=12.578，P<0.001）和TNF-α水平（b=0.134，P<0.001）的唯一预测因子。
PCOS和肥胖导致血清炎症性心血管风险标志物增加。这些关联背后的确切机制需要更多研究来阐明PCOS女性与大量对照组女性相比的心血管系统状态，以确定包括胰岛素抵抗、雄激素状态和BMI等不同因素的相对贡献。
