International Journal of Reproductive BioMedicine
International Journal of Reproductive BioMedicine
IJRM
Medical Sciences
http://ijrm.ir
1
admin
2476-4108
2476-3772
10.29252/ijrm
en
jalali
1396
5
1
gregorian
2017
8
1
15
7
online
1
fulltext
en
ارتباط لپتین و مقاومت به انسولین در بیماران PCOS : یک مطالعه مورد شاهد
Association of leptin and insulin resistance in PCOS: A case-controlled study
Original Article
Original Article
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقدمه: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بیماری تخمدان پلی­کیستیک (</span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) و اشکالات هورمونی مرتبط با آن یک مسئله مهم بالینی می­باشد.</span></span><span dir="LTR"><span style="font-size:11.0pt;"></span></span><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هدف: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هدف از انجام مطالعه مقایسه لپتین سرم در خانم­های نازای با و بدون </span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، درجه­بندی حساسیت شش روش غیرمستقیم تشخیص مقاومت به انسولین </span></span><span dir="LTR"><span style="font-size:11.0pt;">(</span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span><span dir="LTR"><span style="font-size:11.0pt;">)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و بررسی ارتباط بین لپتین و </span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در بیماران </span></span> <span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بود.</span></span><strong><span dir="LTR"><span style="font-size:11.0pt;"></span></span></strong><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مواد و روش­ها: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">این مطالعه مورد-شاهدی روی 189 خانم نازای مراجعه کننده به مرکز نازایی بیمارستان مادر و کودک شیراز بین سال­های 2015-2012 انجام شده است. 99 نفر </span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">براساس کرایتریای روتردام، با 90 نفر که </span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">نداشتند، مقایسه شدند. لپتین سرم، چگالی توده بدنی (</span></span><span dir="LTR"><span style="font-size:10.0pt;">BMI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، تعدادی از هورمون­ها و ارتباط آنها با لپتین بین دو گروه مقایسه شد. </span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در گروه </span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">با استفاده از روش­های غیر­مستقیم شامل: قند خون ناشتا (</span></span><span dir="LTR"><span style="font-size:10.0pt;">FBS</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، نسبت گلوکز به انسولین، مدل هموستاتیک (</span></span><span dir="LTR"><span style="font-size:10.0pt;">HOMA-IR</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، انسولین ناشتا (</span></span><span dir="LTR"><span style="font-size:10.0pt;">FI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، روش </span></span><span dir="LTR"><span style="font-size:10.0pt;">Quantitative Insulin Sensitivity Check Index</span></span><span dir="LTR"><span style="font-size:11.0pt;"> (</span></span><span dir="LTR"><span style="font-size:10.0pt;">QUICKI</span></span><span dir="LTR"><span style="font-size:11.0pt;">)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و روش </span></span><span dir="LTR"><span style="font-size:10.0pt;">MacAuley index</span></span><span dir="LTR"><span style="font-size:11.0pt;"> (</span></span><span dir="LTR"><span style="font-size:10.0pt;">MCA</span></span><span dir="LTR"><span style="font-size:11.0pt;">)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> اندازه گیری و ارتباط بین لپتین و </span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بررسی گردید.</span></span><strong><span dir="LTR"><span style="font-size:11.0pt;"></span></span></strong><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتایج: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">خانم­های </span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> میانگین </span></span><span dir="LTR"><span style="font-size:10.0pt;">BMI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> (</span></span><span dir="LTR"><span style="font-size:10.0pt;">kg/m<sup>2</sup></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> 62/3</span></span><strong><span style="font-size:11.0pt;">±</span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">47/26 در مقابل 18/5</span></span><strong><span style="font-size:11.0pt;">±</span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">82/24) و لپتین بالاتری (</span></span><span dir="LTR"><span style="font-size:10.0pt;">ng/mL</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> 89/187</span></span><strong><span style="font-size:11.0pt;">±</span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">79/41 در مقابل 57/12</span></span><strong><span style="font-size:11.0pt;">±</span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">38/19) داشتند. لپتین با قد و</span></span> <span dir="LTR"><span style="font-size:10.0pt;">BMI</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در هر دو گروه و همچنین با سن در خانم­های بدون </span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> ارتباط آماری معنی داری ( 001/0></span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) نشان داد. </span></span><span dir="LTR"><span style="font-size:10.0pt;">HOMA-IR</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بیشترین تعداد بیماران </span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> را تشخیص داد و پس از آن روش­های </span></span><span dir="LTR"><span style="font-size:10.0pt;">FI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">QUICK</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بودند. مقادیر متوسط سطوح لپتین ارتباط مثبت معنی</span></span><span dir="LTR"><span style="font-size:11.0pt;">­</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">داری با </span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> که با روش­های </span></span><span dir="LTR"><span style="font-size:10.0pt;">HOMA-IR</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> (001/0></span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، </span></span><span dir="LTR"><span style="font-size:10.0pt;">QUICKI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> (001/0></span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، </span></span><span dir="LTR"><span style="font-size:11.0pt;">FI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> (002/0 =</span></span><span dir="LTR"><span style="font-size:10.0pt;"> p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) و قند ناشتا (02/0 =</span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) بدست آمده بود نشان داد.</span></span><strong><span dir="LTR"><span style="font-size:11.0pt;"></span></span></strong><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتیجه­ گیری: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">لپتین سرم ارتباط آماری مثبتی با </span></span><span dir="LTR"><span style="font-size:10.0pt;">BMI</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">و </span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در خانم­های نازای </span></span><span dir="LTR"><span style="font-size:10.0pt;">PCOS</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">دارد. روش </span></span><span dir="LTR"><span style="font-size:10.0pt;">HOMA-IR</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">FI</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">و </span></span><span dir="LTR"><span style="font-size:10.0pt;">QUICKI</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">به ترتیب بیشترین حساسیت را برای تشخیص </span></span><span dir="LTR"><span style="font-size:10.0pt;">IR</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">داشتند.</span></span><strong><span dir="LTR"><span style="font-size:11.0pt;"></span></span></strong>
<strong>Background: </strong>Endocrine abnormalities related to polycystic ovary Syndrome (PCOS) are important problems.<br>
<strong>Objective: </strong>To compare serum leptin levels between infertile women with and without PCOS. To rank sensitivity of six indirect methods for detection of insulin resistance (IR) and to evaluate the association between leptin and IR in PCOS group.<br>
<strong>Materials and methods:</strong> This Case-controlled study performed on 189 infertile women referred to Shiraz Mother and Child Hospital during 2012-2015. Ninety-nine PCOS cases according to Rotterdam criteria were compared to 90 cases without PCOS. Serum leptin, body mass index (BMI), several hormones, and their correlation coefficients with leptin were compared. IR in PCOS women was measured by indirect methods, including fasting blood sugar (FBS), fasting insulin (FI), glucose/insulin, homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and MacAuley index. Association between IR and leptin was evaluated. Independent sample t-test and Pearson’s test were used.<br>
<strong>Results:</strong> Infertile women with PCOS had higher BMI (26.47±3.62 vs. 24.82±5.18 kg/m2) and serum leptin levels (41.79±187.89 vs. 19.38±12.57 ng/mL). Leptin showed significant association with weight and BMI in both groups (p<0.001) and to age in non-PCOS group. HOMA-IR showed the highest rate of IR followed by FI and QUICKI methods. The mean leptin levels had positive association with IR assessed by HOMA-IR (p<0.001), QUICKI (p<0.001), FI (p=.002), and FBS (p=0.02).<br>
<strong>Conclusion:</strong> BMI and IR have positive association with serum leptin in PCOS infertile women. HOMA-IR followed by FI and QUICKI is the most sensitive test for detection of IR.
لپتین, بیماری تخمدان پلی کیستیک, نازایی, مقاومت به انسولین.
Leptin, Polycystic ovarian syndrome, Infertility, Insulin resistance.
423
428
http://ijrm.ir/browse.php?a_code=A-10-1-68&slc_lang=en&sid=1
Bahia
Namavar Jahromi
بهیه
نام آور جهرمی
namavarb@sums.ac.ir