Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
권호 표지
DOI QR코드

DOI QR Code

Relationship between hematologic parameters related to systemic inflammation and insulin resistance-associated metabolic parameters in women with polycystic ovary syndrome

  • Minkyung Cho (Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, College of Medicine, Inje University) ;
  • Suji Kim (Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, College of Medicine, Inje University) ;
  • Sungwook Chun (Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, College of Medicine, Inje University)
  • Received : 2023.01.30
  • Accepted : 2023.04.25
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: The aim of the present study was to evaluate the associations between hematologic parameters related to systemic inflammation and insulin resistance-associated metabolic parameters in women with polycystic ovary syndrome (PCOS). Methods: Eighty-two women between the ages of 18 and 35 years who were diagnosed with PCOS were included in this study. A 2-hour 75-g oral glucose tolerance test (OGTT) was administered to all study participants; fasting and postprandial glucose and insulin levels were measured simultaneously during the 2-hour OGTT. Hematologic parameters were derived from a standard complete blood count and a differential count of fasting-state blood samples. The correlations between hematologic parameters and insulin resistance-associated clinical and metabolic parameters were evaluated using the Spearman rank correlation and partial correlation coefficients. Hematologic parameters related to systemic inflammation were compared between the two groups, categorized by the presence or absence of insulin resistance. Results: Significant differences in the absolute neutrophil count, absolute monocyte count, platelet count, and neutrophil-lymphocyte ratio were found between the insulin-resistant group and insulin-nonresistant group. Correlation analysis found that all hematological parameters, except for the platelet-lymphocyte ratio, were associated with at least one insulin resistance-associated metabolic parameter. However, these significant correlations between hematological and metabolic parameters were attenuated after controlling for the effects of other covariates using partial correlation analysis. Conclusion: The association between hematologic parameters indicative of systemic inflammation and insulin resistance-associated metabolic parameters seems to be strongly influenced by other anthropometric covariates in women with PCOS.

Keywords

References

  1. Kuzbari O, Doralis J, Peterson CM. Endocrine disorders. In: Berek JS. editors. Berek & Novak's gynecology. 15th ed. Lippincott Williams & Wilkins; 2012. p.1075-80.
  2. Diamanti-Kandarakis E, Papavassiliou AG. Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol Med 2006;12:324-32. https://doi.org/10.1016/j.molmed.2006.05.006
  3. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012;33:981-1030. https://doi.org/10.1210/er.2011-1034
  4. de Luca C, Olefsky JM. Inflammation and insulin resistance. FEBS Lett 2008;582:97-105. https://doi.org/10.1016/j.febslet.2007.11.057
  5. Deligeoroglou E, Vrachnis N, Athanasopoulos N, Iliodromiti Z, Sifakis S, Iliodromiti S, et al. Mediators of chronic inflammation in polycystic ovarian syndrome. Gynecol Endocrinol 2012;28:974-8. https://doi.org/10.3109/09513590.2012.683082
  6. Dandona P, Aljada A, Chaudhuri A, Bandyopadhyay A. The potential influence of inflammation and insulin resistance on the pathogenesis and treatment of atherosclerosis-related complications in type 2 diabetes. J Clin Endocrinol Metab 2003;88:2422-9. https://doi.org/10.1210/jc.2003-030178
  7. Kahal H, Aburima A, Ungvari T, Rigby AS, Dawson AJ, Coady AM, et al. Polycystic ovary syndrome has no independent effect on vascular, inflammatory or thrombotic markers when matched or obesity. Clin Endocrinol (Oxf) 2013;79:252-8. https://doi.org/10.1111/cen.12137
  8. Kim JW, Han JE, Kim YS, Won HJ, Yoon TK, Lee WS. High sensitivity C-reactive protein and its relationship with impaired glucose regulation in lean patients with polycystic ovary syndrome. Gynecol Endocrinol 2012;28:259-63. https://doi.org/10.3109/09513590.2011.613967
  9. Cakiroglu Y, Vural F, Vural B. The inflammatory markers in polycystic ovary syndrome: association with obesity and IVF outcomes. J Endocrinol Invest 2016;39:899-907. https://doi.org/10.1007/s40618-016-0446-4
  10. Ozay AC, Ozay OE. The importance of inflammation markers in polycystic ovary syndrome. Rev Assoc Med Bras (1992) 2021;67:411-7. https://doi.org/10.1590/1806-9282.20200860
  11. Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M, et al. Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther 2014;16:524-30. https://doi.org/10.1089/dia.2013.0264
  12. Lou M, Luo P, Tang R, Peng Y, Yu S, Huang W, et al. Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMC Endocr Disord 2015;15:9.
  13. Hussain M, Babar MZ, Akhtar L, Hussain MS. Neutrophil lymphocyte ratio (NLR): a well assessment tool of glycemic control in type 2 diabetic patients. Pak J Med Sci 2017;33:1366-70. https://doi.org/10.12669/pjms.336.12900
  14. Gonzalez F. Inflammation in polycystic ovary syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids 2012;77:300-5. https://doi.org/10.1016/j.steroids.2011.12.003
  15. Keskin Kurt R, Okyay AG, Hakverdi AU, Gungoren A, Dolapcioglu KS, Karateke A, et al. The effect of obesity on inflammatory markers in patients with PCOS: a BMI-matched case-control study. Arch Gynecol Obstet 2014;290:315-9. https://doi.org/10.1007/s00404-014-3199-3
  16. Pergialiotis V, Trakakis E, Parthenis C, Hatziagelaki E, Chrelias C, Thomakos N, et al. Correlation of platelet to lymphocyte and neutrophil to lymphocyte ratio with hormonal and metabolic parameters in women with PCOS. Horm Mol Biol Clin Investig 2018;34:20170073.
  17. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25. https://doi.org/10.1016/j.fertnstert.2003.10.004
  18. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018;33:1602-18. https://doi.org/10.1093/humrep/dey256
  19. Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, Ku SY, et al. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod 2008;23:1924-31. https://doi.org/10.1093/humrep/den239
  20. Chun S. 1-h Postprandial glucose level is related to the serum anti-Mullerian hormone level in women with polycystic ovary syndrome. Gynecol Endocrinol 2015;31:815-8. https://doi.org/10.3109/09513590.2015.1056143
  21. Park CH, Chun S. Association between serum gonadotropin level and insulin resistance-related parameters in Korean women with polycystic ovary syndrome. Obstet Gynecol Sci 2016;59:498-505. https://doi.org/10.5468/ogs.2016.59.6.498
  22. Kim N, Chun S. Association between the serum estrone-to-estradiol ratio and parameters related to glucose metabolism and insulin resistance in women with polycystic ovary syndrome. Clin Exp Reprod Med 2021;48:374-9. https://doi.org/10.5653/cerm.2021.04553
  23. Chun S, Lee S. Optimal cutoff value of 1-hour postload glucose to identify insulin resistance in women with polycystic ovary syndrome. Clin Exp Obstet Gynecol 2022;49:219.
  24. The Korean Society of Gynecologic Endocrinology. The Korean Society of Gynecologic Endocrinology clinical guideline 2016. The Korean Society of Gynecologic Endocrinology; 2016. p.27.
  25. Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003;9:505-14. https://doi.org/10.1093/humupd/dmg044
  26. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care 2018;41(Suppl 1):S13-27. https://doi.org/10.2337/dc18-S002
  27. Negishi H, Nakao K, Kimura M, Takenaka H, Horikawa M. Insulin resistance in nonobese Japanese women with polycystic ovary syndrome is associated with poorer glucose tolerance, delayed insulin secretion, and enhanced insulin response. Reprod Med Biol 2015;14:123-9. https://doi.org/10.1007/s12522-015-0204-x
  28. Kim JJ, Hwang KR, Oh SH, Chae SJ, Yoon SH, Choi YM. Prevalence of insulin resistance in Korean women with polycystic ovary syndrome according to various homeostasis model assessment for insulin resistance cutoff values. Fertil Steril 2019;112:959-66. https://doi.org/10.1016/j.fertnstert.2019.06.035
  29. Chen X, Yang D, Li L, Feng S, Wang L. Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome. Hum Reprod 2006;21:2027-32. https://doi.org/10.1093/humrep/del142
  30. Pina-Aguero MI, Zaldivar-Delgado A, Salas-Fernandez A, Martinez-Basila A, Bernabe-Garcia M, Maldonado-Hernandez J. Optimal cut-off points of fasting and post-glucose stimulus surrogates of insulin resistance as predictors of metabolic syndrome in adolescents according to several definitions. J Clin Res Pediatr Endocrinol 2018;10:139-46. https://doi.org/10.4274/jcrpe.4873
  31. Taylor, Hugh S, Seli E. Speroff's clinical gynecologic endocrinology and infertility. 9th ed. Wolters Kluwer; 2020. p.395-441.
  32. Akboga MK, Canpolat U, Yuksel M, Yayla C, Yilmaz S, Turak O, et al. Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: a single center large-scale study. Platelets 2016;27:178-83. https://doi.org/10.3109/09537104.2015.1064518
  33. Demirtas L, Degirmenci H, Akbas EM, Ozcicek A, Timuroglu A, Gurel A, et al. Association of hematological indicies with diabetes, impaired glucose regulation and microvascular complications of diabetes. Int J Clin Exp Med 2015;8:11420-7.
  34. Yilmaz MA, Duran C, Basaran M. The mean platelet volume and neutrophil to lymphocyte ratio in obese and lean patients with polycystic ovary syndrome. J Endocrinol Invest 2016;39:45-53. https://doi.org/10.1007/s40618-015-0335-2
  35. Zeng X, Xie YJ, Liu YT, Long SL, Mo ZC. Polycystic ovarian syndrome: correlation between hyperandrogenism, insulin resistance and obesity. Clin Chim Acta 2020;502:214-21. https://doi.org/10.1016/j.cca.2019.11.003