Eðßðåäá ëåðôßíçò óå ëåðôüóùìåò êáé ðá÷ýóáñêåò
ãõíáßêåò ìå óýíäñïìï ðïëõêõóôéêþí ùïèçêþí

Ä. Ðáíßäçò[1]
A. Kïýñôçò[1]
Ä. Pïýóóïò[2]
I. Káëá÷Üíçò[1]
M. Máìüðïõëïò[2]
1B' MáéåõôéêÞ êáé ÃõíáéêïëïãéêÞ KëéíéêÞ AÐÈ
2Ã' MáéåõôéêÞ êáé ÃõíáéêïëïãéêÞ KëéíéêÞ AÐÈ
KáôáôÝèçêå: 21/01/02
Eãêñßèçêå: 28/01/02

Ðåñßëçøç
H ðáñïýóá ìåëÝôç ó÷åäéÜóôçêå, äéüôé ôá âéâëéïãñáöéêÜ äåäïìÝíá üóïí áöïñÜ óôçí åêôßìçóç ôùí åðéðÝäùí ôçò ëåðôßíçò óå áóèåíåßò ìå PCOS åßíáé áíôéêñïõüìåíá êáé áöïñïýí ìéêñü áñéèìü ðåñéðôþóåùí. MåëåôÞèçêáí 49 ãõíáßêåò, çëéêßáò 16 Ýùò 34 åôþí, ïé ïðïßåò êáôáôÜ÷èçêáí óå ôÝóóåñéò ïìÜäåò áíÜëïãá ìå ôç äéÜãíùóç ôïõ óõíäñüìïõ ôùí ðïëõêõóôéêþí ùïèçêþí êáé áíÜëïãá ìå ôçí ôéìÞ ôïõ äåßêôç ìÜæáò óþìáôïò. Tá áðïôåëÝóìáôÜ ìáò Ýäåéîáí üôé: á) ïé áóèåíåßò ìå PCOS êáé öõóéïëïãéêü BMI åìöÜíéæáí óçìáíôéêÜ ÷áìçëüôåñåò ôéìÝò ëåðôßíçò ïñïý áðü ôéò ìÜñôõñåò ìå öõóéïëïãéêü BMI, â) ïé áóèåíåßò ìå PCOS êáé ðáèïëïãéêü BMI åìöÜíéæáí óçìáíôéêÜ õøçëüôåñåò ôéìÝò ëåðôßíçò ïñïý áðü ôéò ìÜñôõñåò ìå ðáèïëïãéêü BMI, ã) õðÞñ÷å õøçëÞ èåôéêÞ óõó÷Ýôéóç áíÜìåóá óôéò ôéìÝò ôïõ BMI, óôá åðßðåäá ôçò éíóïõëßíçò êáé óôá åðßðåäá ôçò ôåóôïóôåñüíçò áðü ôç ìéá ìåñéÜ êáé óôéò óõãêåíôñþóåéò ôçò ëåðôßíçò áðü ôçí Üëëç, êáé ä) õðÞñ÷å õøçëÞ áñíçôéêÞ óõó÷Ýôéóç ìåôáîý ôùí åðéðÝäùí ôçò SHBG êáé ôùí óõãêåíôñþóåùí ôçò ëåðôßíçò. Tá áðïôåëÝóìáôÜ ìáò åíéó÷ýïõí ôçí Üðïøç üôé óå ìéá õðïïìÜäá ðá÷ýóáñêùí áóèåíþí ìå PCOS ç ëåðôßíç åìðëÝêåôáé åíäå÷ïìÝíùò óôçí ðáèïãÝíåéá ôïõ óõíäñüìïõ áõôïý.
¼ñïé åõñåôçñßïõ: Ëåðôßíç, PCOS, éíóïõëßíç, ôåóôïóôåñüíç, SHBG, BMI.

EIÓAÃÙÃH
H áíáêÜëõøç ôçò ëåðôßíçò, ôï ìüñéï ôçò ïðïßáò ôáõôïðïéÞèçêå ôï 1995, áðïôÝëåóå Ýíá áðü ôá óçìáíôéêüôåñá ãåãïíüôá ôçò åíäïêñéíïëïãßáò ôá ôåëåõôáßá ÷ñüíéá.(1,2) H ëåðôßíç åßíáé ðñùôåúíéêÞ ïñìüíç ðïõ áðïôåëåßôáé áðü 167 áìéíïîÝá,(3) Ý÷åé ìïñéáêü âÜñïò 16 kDa(4,5) êáé ç ïíïìáóßá ôçò ðñïÝñ÷åôáé áðü ôçí åëëçíéêÞ ëÝîç ÒëåðôüòÓ. H ïñìüíç Ý÷åé ðñïóåëêýóåé ôï åðéóôçìïíéêü åíäéáöÝñïí, áëëÜ êáé ôï åíäéáöÝñïí ôùí ìÝóùí ìáæéêÞò åíçìÝñùóçò, êáèþò Ý÷åé èåùñçèåß üôé áðïôåëåß ôï ìÝóï áíôéìåôþðéóçò ôçò ðá÷õóáñêßáò.(6)
Eßíáé ãíùóôü üôé ïé ãõíáßêåò ðáñïõóéÜæïõí õøçëüôåñá åðßðåäá ëåðôßíçò áðü ôïõò Üíäñåò.(7) O öõëåôéêüò áõôüò äéìïñöéóìüò ôùí óõãêåíôñþóåùí ôçò ëåðôßíçò áðïäßäåôáé óôéò õøçëüôåñåò ôéìÝò ôùí áíäñïãüíùí óôïõò Üíäñåò. Tï óýíäñïìï ôùí ðïëõêõóôéêþí ùïèçêþí (PCOS) åßíáé ç óõ÷íüôåñç åíäïêñéíéêÞ äéáôáñá÷Þ ðïõ ðñïêáëåß áíùïèõëáêéïññçîßá êáé õðïãïíéìüôçôá.(8-10) H õðåñÝêêñéóç áíäñïãüíùí áðïôåëåß ôõðéêü âéï÷çìéêü ÷áñáêôçñéóôéêü ôïõ PCOS. EðéðëÝïí, ïé áóèåíåßò ìå PCOS åìöáíßæïõí óõ÷íÜ õðåñÝêêñéóç LH êáé áíôßóôáóç óôçí éíóïõëßíç.(8-11) ¸ôóé, ïé áóèåíåßò ìå ôï óýíäñïìï áõôü áðïôåëïýí ÷ñÞóéìï ÒìïíôÝëïÓ ãéá ôçí åêôßìçóç ôçò áëëçëåðßäñáóçò áíäñïãüíùí - ëåðôßíçò êáé éíóïõëßíçò - ëåðôßíçò óôïí Üíèñùðï.
Oé ìåëÝôåò ðïõ áíáöÝñïíôáé óôçí åêôßìçóç ôùí åðéðÝäùí ôçò ëåðôßíçò óå áóèåíåßò ìå óýíäñïìï ðïëõêõóôéêþí ùïèçêþí åìöáíßæïõí áíôéêñïõüìåíá áðïôåëÝóìáôá. Añêåôïß åñåõíçôÝò õðïóôÞñéîáí ôçí Üðïøç üôé ôá åðßðåäá ôçò ëåðôßíçò ôïõ ïñïý ãõíáéêþí ìå PCOS äåí äéÝöåñáí áðü åêåßíá ôùí ìáñôýñùí ìå ôïí ßäéï äåßêôç ìÜæáò óþìáôïò (BMI).(12-16) Eíôïýôïéò, Üëëïé åñåõíçôÝò äéáôýðùóáí ôçí Üðïøç üôé ïé ôéìÝò ôçò ëåðôßíçò ôïõ ïñïý óå ìéá õðïïìÜäá ãõíáéêþí ìå PCOS Þôáí õøçëüôåñåò áðü ôéò áíáìåíüìåíåò ãéá ôï BMI, êáé ïé õøçëÝò áõôÝò ôéìÝò ôçò ïñìüíçò åíäÝ÷åôáé íá åðçñåÜæïõí áñíçôéêÜ ôçí ùïèçêéêÞ ëåéôïõñãßá.(17,18) Oé äéáôáñá÷Ýò, äçëáäÞ, ôùí ìçíõìÜôùí ôçò ëåðôßíçò óôï áíáðáñáãùãéêü óýóôçìá ôùí ãõíáéêþí áõôþí åíäÝ÷åôáé íá åìðëÝêïíôáé óôçí ðáèïãÝíåéá ôïõ óõíäñüìïõ ôùí ðïëõêõóôéêþí ùïèçêþí.
EðåéäÞ ôá âéâëéïãñáöéêÜ äåäïìÝíá, üóïí áöïñÜ óôçí åêôßìçóç ôùí åðéðÝäùí ôçò ëåðôßíçò óå áóèåíåßò ìå PCOS, åßíáé áíôéêñïõüìåíá êáé áöïñïýí ìéêñü áñéèìü ðåñéðôþóåùí, ó÷åäéÜóèçêå ç ðáñïýóá ìåëÝôç. Ðñïóäéïñßóôçêáí ôá åðßðåäá ôçò ëåðôßíçò óå áóèåíåßò ìå PCOS êáé óå ìÜñôõñåò ìå öõóéïëïãéêü êáé ìå ðáèïëïãéêü äåßêôç ìÜæáò óþìáôïò.

YËIKO KAI MEÈOÄOÓ
MåëåôÞèçêáí 49 ãõíáßêåò, çëéêßáò 16 Ýùò 34 åôþí, ïé ïðïßåò ðñïóÞëèáí óôá Iáôñåßá Ãïíéìüôçôáò êáé Oéêïãåíåéáêïý Ðñïãñáììáôéóìïý ôçò Ã' MáéåõôéêÞò êáé ÃõíáéêïëïãéêÞò KëéíéêÞò ôïõ A.Ð.È. Káìßá ãõíáßêá äåí áíÝöåñå ëÞøç öáñìÜêùí ôï ôåëåõôáßï åîÜìçíï, ðïõ èá ìðïñïýóáí íá åðçñåÜóïõí ôç ëåéôïõñãßá ôïõ Üîïíá õðïèÜëáìïò - õðüöõóç - ùïèÞêåò.
Oé 49 ãõíáßêåò êáôáôÜ÷èçêáí óå ôÝóóåñéò ïìÜäåò áíÜëïãá ìå ôç äéÜãíùóç ôïõ óõíäñüìïõ ôùí ðïëõêõóôéêþí ùïèçêþí êáé áíÜëïãá ìå ôçí ôéìÞ ôïõ äåßêôç ìÜæáò óþìáôïò: á) ç ðñþôç ïìÜäá (ïìÜäá I) áðïôåëïýôáí áðü 19 ãõíáßêåò, çëéêßáò 20 Ýùò 29 åôþí (ìÝóç ôéìÞ ±SD 24,0±3,6 Ýôç), ìå PCOS, ÷ùñßò áíôßóôáóç óôçí éíóïõëßíç êáé ìå öõóéïëïãéêü BMI ðïõ êõìáéíüôáí áðü 19,1 Ýùò 24,9 (21,5±1,5), â) ç äåýôåñç ïìÜäá (ïìÜäá II) ðåñéëÜìâáíå 10 ãõíáßêåò, çëéêßáò 16 Ýùò 30 åôþí (24,7±3,9 Ýôç), ìå PCOS, ìå áíôßóôáóç óôçí éíóïõëßíç êáé ìå ðáèïëïãéêü BMI ðïõ êõìáéíüôáí áðü 25,3 Ýùò 39,5 (31,6±4,4), ã) óôçí ôñßôç ïìÜäá (ïìÜäá III) áíÞêáí 15 ãõíáßêåò, çëéêßáò 18 Ýùò 34 åôþí (21,9±3,7 Ýôç), ìå öõóéïëïãéêïýò ùïèõëáêéïññçêôéêïýò êýêëïõò êáé ìå öõóéïëïãéêü BMI ðïõ êõìáéíüôáí áðü 20,3 Ýùò 24,8 (22,0±1,5), êáé ä) ç ôÝôáñôç ïìÜäá (ïìÜäá IV) áðïôåëïýôáí áðü 5 ãõíáßêåò, çëéêßáò 20 Ýùò 32 åôþí (23,4±5,3 Ýôç), ìå öõóéïëïãéêïýò ùïèõëáêéïññçêôéêïýò êýêëïõò êáé ìå ðáèïëïãéêü BMI ðïõ êõìáéíüôáí áðü 25,4 Ýùò 36,2 (28,7±4,4).
TÝèçêå ç äéÜãíùóç ôïõ PCOS, üôáí ïé áóèåíåßò åìöÜíéæáí ðÝíôå Þ ðåñéóóüôåñá áðü ôá ðáñáêÜôù êëéíéêïåñãáóôçñéáêÜ óôïé÷åßá: 1) ïëéãïìçíüññïéá Þ áìçíüññïéá, 2) ìßá ôïõëÜ÷éóôïí ùïèÞêç ìå üãêï >10cm3 êáé ìå ðåñéóóüôåñá áðü 10 ìéêñÜ ùïèõëÜêéá, äéáìÝôñïõ 2-8mm, äéáôåôáãìÝíá óôçí ðåñéöÝñåéá ôçò ùïèÞêçò, 3) õðåñôñß÷ùóç, ðá÷õóáñêßá Þ äéáôáñá÷Ýò ôçò åììÞíïõ ñýóåùò áðü ôçí åììçíáñ÷Þ, 4) ôéìÞ BMI >25kg/m2, 5) õøçëÜ åðßðåäá ôåóôïóôåñüíçò Þ áíäñïóôåíäéüíçò, 6) ó÷Ýóç LH/FSH >2,5. EîÜëëïõ, ç äéÜãíùóç ôçò áíôßóôáóçò óôçí éíóïõëßíç Ýãéíå ìå ôïí ðñïóäéïñéóìü ôùí åðéðÝäùí ãëõêüæçò êáé éíóïõëßíçò íçóôåßáò.
Aéìïëçøßåò ãéá ôïí ðñïóäéïñéóìü ôçò ëåðôßíçò, ôùí ãïíáäïôñïöéíþí (FSH, LH), ôçò ðñïëáêôßíçò (PRL), ôùí áíäñïãüíùí (T, Ä4A, DHEA-S), ôçò 17á-õäñïîõðñïãåóôåñüíçò (17á-OHP), ôçò óöáéñßíçò ðïõ óõíäÝåé ôéò ïñìüíåò ôïõ öýëïõ (SHBG) êáé ôçò éíóïõëßíçò, óôéò ãõíáßêåò ôùí ïìÜäùí I êáé II Ýãéíáí ìßá öïñÜ, áíÜìåóá óôçí 3ç êáé óôçí 7ç çìÝñá áõôüìáôïõ Þ ðñïêëçôïý (ýóôåñá áðü ÷ïñÞãçóç ðñïãåóôåñüíçò) åììçíïññõóéáêïý êýêëïõ. Eðßóçò, áéìïëçøßåò ãéá ôïí ðñïóäéïñéóìü ôçò ëåðôßíçò óôéò ãõíáßêåò ôùí ïìÜäùí III êáé IV Ýãéíáí ìßá öïñÜ ìåôáîý ôçò 3çò êáé ôçò 7çò çìÝñáò ôïõ êýêëïõ. ¼ëïé ïé ïñïß äéáôçñÞèçêáí óôïõò -20°C ìÝ÷ñé íá ãßíïõí ïé ìåôñÞóåéò. Oé ðñïóäéïñéóìïß ôùí ïñìïíþí äéåîÞ÷èçóáí ìå áíôéäñáóôÞñéá ôçò ßäéáò ðáñôßäáò. H ëåðôßíç ôïõ ïñïý ìåôñÞèçêå ìå ôç ìÝèïäï IRMA (Human Leptin: Diagnostic Systems Laboratories, Inc., Corporate Headquarters, 445 Medical Center Blvd., Texas, USA), êáé ïé ôéìÝò ôçò FSH, ôçò LH, ôçò PRL, ôùí áíäñïãüíùí, ôçò éíóïõëßíçò, ôçò 17á-OHP êáé ôçò SHBG ðñïóäéïñßóèçêáí ìå ñáäéïáíïóïëïãéêÞ ìÝèïäï (FSH: Radioisotopic Kit, Nichols Institute Diagnostics, San Juan Capistrano, California, 92675, USA. LH: Radioisotopic Kit, Nichols Institute Diagnostics, San Juan Capistrano, California, 92675, USA PRL: Radioisotopic Kit, Nichols Institute Diagnostics, San Juan Capistrano, California, 92675, USA. T: Direct Radio-immunoassay Kit, Sorin, Biomedica. Ä4A: Gamma Coat [125I] Radio-immunoassay Kit, Incstar Corporation. DHEA-S: Direct Radio-immunoassay Solid Phase Coated Tubes, Zer Science Based Industries Ltd. 17á-OHP: ImmuChem Double Antibody [125I] Radio-immunoassay Kit, ICN Pharmaceuticals, Inc. SHBG: ([125]I) Immunoradiometric Assay Kit, Orion Diagnostica).
H óôáôéóôéêÞ áíÜëõóç ôùí áðïôåëåóìÜôùí ðñáãìáôïðïéÞèçêå ìå ôç âïÞèåéá ôïõ unpaired t-test, åíþ ïé óõó÷åôßóåéò áíÜìåóá óôéò äéÜöïñåò ðáñáìÝôñïõò Ýãéíáí ìåôÜ ôïí õðïëïãéóìü ôïõ óõíôåëåóôÞ óõó÷Ýôéóçò Pearson.

AÐOTEËEÓMATA
O áñéèìüò ôùí ãõíáéêþí êÜèå ïìÜäáò, ç äéÜãíùóç, ç çëéêßá ôïõò êáé ïé ôéìÝò ôïõ BMI ðáñïõóéÜæïíôáé óôïí ðßíáêá 1. Äåí õðÞñ÷áí óçìáíôéêÝò äéáöïñÝò óôçí çëéêßá ôùí ãõíáéêþí ôùí ôåóóÜñùí ïìÜäùí. Eðßóçò, äåí õðÞñ÷áí óçìáíôéêÝò äéáöïñÝò óôéò ôéìÝò ôïõ BMI áíÜìåóá óôéò ãõíáßêåò ôùí ïìÜäùí I êáé III êáé áíÜìåóá óôéò ãõíáßêåò ôùí ïìÜäùí II êáé IV.
Óôïí ðßíáêá 2 áíáãñÜöïíôáé ïé ôéìÝò ôçò ëåðôßíçò ôïõ ïñïý óôéò ãõíáßêåò üëùí ôùí ïìÜäùí, êáèþò êáé ïé ôéìÝò ôùí ãïíáäïôñïöéíþí (FSH, LH), ôçò ðñïëáêôßíçò (PRL), ôùí áíäñïãüíùí (T, Ä4A, DHEA-S), ôçò 17á-õäñïîõðñïãåóôåñüíçò (17á-OHP), ôçò óöáéñßíçò ðïõ óõíäÝåé ôéò ïñìüíåò ôïõ öýëïõ (SHBG) êáé ôçò éíóïõëßíçò óôéò ãõíáßêåò ôùí ïìÜäùí I êáé II. Oé óõãêåíôñþóåéò ôçò ëåðôßíçò ôùí áóèåíþí ìå PCOS (ïìÜäåò I êáé II) äåí äéÝöåñáí óçìáíôéêÜ áðü åêåßíåò ôùí ìáñôýñùí (ïìÜäåò III êáé IV), üôáí ïé áóèåíåßò ìå PCOS êáé ïé ìÜñôõñåò åêôéìÞèçêáí ùò óýíïëï.
Oé ìÜñôõñåò, üìùò, ìå öõóéïëïãéêü BMI (ïìÜäá III) ðáñïõóßáæáí óçìáíôéêÜ õøçëüôåñåò ôéìÝò ëåðôßíçò áðü ôéò áóèåíåßò ìå PCOS êáé öõóéïëïãéêü BMI (ïìÜäá I) (p<0,03994). Aíôßèåôá, ïé áóèåíåßò ìå PCOS êáé ðáèïëïãéêü BMI (ïìÜäá II) åìöÜíéæáí óçìáíôéêÜ õøçëüôåñåò ôéìÝò ëåðôßíçò áðü ôéò ìÜñôõñåò ìå ðáèïëïãéêü BMI (ïìÜäá IV) (p<0,03236). Óçìåéþíåôáé üôé üëåò ïé áóèåíåßò ìå PCOS êáé ðáèïëïãéêü BMI (ïìÜäá II) ðáñïõóßáæáí õøçëÝò ôéìÝò ëåðôßíçò, êáé óôéò ôÝóóåñéò áðü ôéò äÝêá áõôÝò áóèåíåßò ïé óõãêåíôñþóåéò ôçò ëåðôßíçò Þôáí >40ng/ml, ôéìÞ ðïëý ìåãáëýôåñç áðü ôçí õøçëüôåñç ôéìÞ ôùí ìáñôýñùí ìå ðáèïëïãéêü BMI (ïìÜäá IV), ðïõ Þôáí 31,1ng/ml. Äåí õðÞñ÷áí óçìáíôéêÝò äéáöïñÝò óôá åðßðåäá ôùí ãïíáäïôñïöéíþí êáé ôçò ðñïëáêôßíçò áíÜìåóá óôéò ãõíáßêåò ôùí ïìÜäùí I êáé II. Eðßóçò, äåí õðÞñ÷áí óçìáíôéêÝò äéáöïñÝò óôéò ôéìÝò ôçò DHEA-S, ôçò 17á-OHP êáé ôçò SHBG áíÜìåóá óôéò ãõíáßêåò ôùí äýï ïìÜäùí, ìïëïíüôé ïé ôéìÝò ôçò SHBG ôùí ãõíáéêþí ôçò ïìÜäáò II Þôáí áñêåôÜ ÷áìçëüôåñåò áðü ôéò áíôßóôïé÷åò ôéìÝò ôùí ãõíáéêþí ôçò ïìÜäáò I. Aíôßèåôá, ïé ôéìÝò ôçò ôåóôïóôåñüíçò Þôáí óçìáíôéêÜ õøçëüôåñåò óôéò ãõíáßêåò ôçò ïìÜäáò II (p<0,03457), åíþ ïé ôéìÝò ôçò áíäñïóôåíäéüíçò Þôáí óçìáíôéêÜ õøçëüôåñåò óôéò ãõíáßêåò ôçò ïìÜäáò I (p<0,03906). TÝëïò, ïé ôéìÝò ôçò éíóïõëßíçò Þôáí óçìáíôéêÜ õøçëüôåñåò óôéò ãõíáßêåò ôçò ïìÜäáò II (p<0,0000001).
YøçëÞ èåôéêÞ óõó÷Ýôéóç, óôáôéóôéêÜ óçìáíôéêÞ, âñÝèçêå áíÜìåóá óôéò ôéìÝò ôïõ BMI êáé óôéò óõãêåíôñþóåéò ôçò ëåðôßíçò, åßôå üôáí ïé ãõíáßêåò åëÝã÷èçêáí ùò óýíïëï (r=+0,8252, p<0,0001), åßôå üôáí åëÝã÷èçêáí ÷ùñéóôÜ ïé ãõíáßêåò ìå PCOS (r=+0,8870, p<0,0001) êáé ïé ìÜñôõñåò (r=+0,5679, p<0,009). Eðßóçò, õøçëÞ èåôéêÞ óõó÷Ýôéóç õðÞñ÷å ìåôáîý ôùí ôéìþí ôçò ôåóôïóôåñüíçò êáé ôçò ëåðôßíçò (r=+0,6178, p<0,024) êáé ìåôáîý ôùí åðéðÝäùí ôçò éíóïõëßíçò êáé ôçò ëåðôßíçò (r=+0,9367, p<0,0001) êáé õøçëÞ áñíçôéêÞ óõó÷Ýôéóç áíÜìåóá óôéò óõãêåíôñþóåéò ôçò SHBG êáé ôçò ëåðôßíçò (r=-0,6326, p<0,020). Aíôßèåôá, äåí õðÞñ÷å óõó÷Ýôéóç ìåôáîý ôùí åðéðÝäùí ôçò FSH, ôçò LH, êáé ôçò PRL áðü ôç ìéá ìåñéÜ êáé ôùí óõãêåíôñþóåùí ôçò ëåðôßíçò ôïõ ïñïý áðü ôçí Üëëç.



ÓYZHTHÓH
Óçìáíôéêü åýñçìá ôçò ðáñïýóáò ìåëÝôçò, ðïõ äåí Ý÷åé áíáöåñèåß óôç âéâëéïãñáößá, Þôáí üôé ïé ëåðôüóùìåò áóèåíåßò ìå PCOS (ïìÜäá I) ðáñïõóßáæáí óçìáíôéêÜ ÷áìçëüôåñá åðßðåäá ëåðôßíçò áðü ôéò ëåðôüóùìåò ìÜñôõñåò (ïìÜäá III). Tá ÷áìçëüôåñá åðßðåäá ëåðôßíçò èá ìðïñïýóáí íá áðïäïèïýí óôï åëáöñþò ÷áìçëüôåñï BMI óôçí ïìÜäá I óå ó÷Ýóç ìå ôçí ïìÜäá III, ìïëïíüôé ïé äéáöïñÝò óôéò ôéìÝò ôïõ BMI áíÜìåóá óôéò äýï áõôÝò ïìÜäåò ôùí ãõíáéêþí äåí Þôáí óçìáíôéêÝò.
Eßíáé ãíùóôü üôé ï óçìáíôéêüôåñïò ðáñÜãïíôáò ðïõ ñõèìßæåé ôçí Ýêêñéóç ôçò ëåðôßíçò åßíáé ôï BMI.(2,4,5,13,14,19-23) H Üðïøç áõôÞ ôåêìçñéþèçêå êáé óôçí ðáñïýóá ìåëÝôç, óôçí ïðïßá âñÝèçêå õøçëÞ èåôéêÞ óõó÷Ýôéóç áíÜìåóá óôéò ôéìÝò ôïõ BMI êáé óôéò óõãêåíôñþóåéò ôçò ëåðôßíçò, åßôå üôáí ïé ãõíáßêåò åëÝã÷èçêáí ùò óýíïëï (r=+0,8252, p<0,0001), åßôå üôáí åëÝã÷èçêáí ÷ùñéóôÜ ïé ãõíáßêåò ìå PCOS (r=+0,8870, p<0,0001) êáé ïé ìÜñôõñåò (r=+0,5679, p<0,009). Oé ÷áìçëüôåñåò ôéìÝò ôçò ëåðôßíçò óôçí ïìÜäá I óå ó÷Ýóç ìå ôçí ïìÜäá III èá ìðïñïýóáí íá áðïäïèïýí óôéò õøçëüôåñåò ôéìÝò ôçò ôåóôïóôåñüíçò óôïí ïñü ôùí ãõíáéêþí ôçò ïìÜäáò I. ¸÷åé áðïäåé÷èåß üôé ôá åðßðåäá ôçò ëåðôßíçò åßíáé óçìáíôéêÜ õøçëüôåñá óôéò ãõíáßêåò áðü ü,ôé óôïõò Üíäñåò. O öõëåôéêüò äéìïñöéóìüò óôá åðßðåäá ôçò ëåðôßíçò åìöáíßæåôáé áðü ôï äåýôåñï óôÜäéï ôçò Þâçò êáé ðáñáìÝíåé óå üëç ôç äéÜñêåéá ôçò åíÞëéêçò æùÞò.(24) Tá ÷áìçëüôåñá åðßðåäá ôçò ëåðôßíçò óôïõò Üíäñåò áðïäüèçêáí óôá õøçëüôåñá åðßðåäá ôåóôïóôåñüíçò ïñïý, äåäïìÝíïõ üôé ç ÷ïñÞãçóç ôåóôïóôåñüíçò óå õðïãïíáäéêïýò Üíäñåò ïäÞãçóå óå åëÜôôùóç ôùí åðéðÝäùí ôçò ëåðôßíçò.(20,24,25) H èÝóç üìùò áõôÞ äåí åðéâåâáéþèçêå óôçí ðáñïýóá ìåëÝôç, óôçí ïðïßá âñÝèçêå èåôéêÞ óõó÷Ýôéóç, óôáôéóôéêÜ óçìáíôéêÞ, áíÜìåóá óôéò ôéìÝò ôçò ôåóôïóôåñüíçò êáé óôéò óõãêåíôñþóåéò ôçò ëåðôßíçò (r=+0,6178, p<0,024).
Aíôßèåôá ìå ü,ôé óõíÝâáéíå óôéò ëåðôüóùìåò áóèåíåßò, ïé ðá÷ýóáñêåò áóèåíåßò ìå PCOS (ïìÜäá II) åìöÜíéæáí óçìáíôéêÜ õøçëüôåñá åðßðåäá ëåðôßíçò áðü ôéò ðá÷ýóáñêåò ìÜñôõñåò (ïìÜäá IV). Óôï 40% ôùí ðá÷ýóáñêùí áóèåíþí ìå PCOS ïé óõãêåíôñþóåéò ôçò ëåðôßíçò Þôáí >40ng/ml, ôéìÞ ðïëý ìåãáëýôåñç áðü ôçí õøçëüôåñç ôéìÞ ôùí ìáñôýñùí ìå ðáèïëïãéêü BMI (ïìÜäá IV), ðïõ Þôáí 31,1ng/ml. Tï åýñçìÜ ìáò áõôü óõìöùíåß ìå ôá áðïôåëÝóìáôá Üëëùí óõããñáöÝùí, ðïõ ðáñáôÞñçóáí üôé óå ìéá õðïïìÜäá ðá÷ýóáñêùí áóèåíþí ìå PCOS (30%) ïé óõãêåíôñþóåéò ôçò ëåðôßíçò Þôáí õøçëüôåñåò áðü ôéò áíáìåíüìåíåò ãéá ôï BMI.(18,26) YðïóôÞñéîáí, ëïéðüí, üôé ôá éäéáßôåñá õøçëÜ åðßðåäá ëåðôßíçò óôçí õðïïìÜäá áõôÞ ôùí áóèåíþí ìå PCOS åíäÝ÷åôáé íá åðçñåÜæïõí áñíçôéêÜ ôçí ùïèçêéêÞ ëåéôïõñãßá êáé üôé ïé äéáôáñá÷Ýò ôùí ìçíõìÜôùí ôçò ëåðôßíçò óôï áíáðáñáãùãéêü óýóôçìá ôùí ãõíáéêþí áõôþí åíäÝ÷åôáé íá åìðëÝêïíôáé óôçí ðáèïãÝíåéá ôïõ óõíäñüìïõ ôùí ðïëõêõóôéêþí ùïèçêþí. Añêåôïß ðÜíôùò åñåõíçôÝò áíÝöåñáí üôé ôá åðßðåäá ôçò ëåðôßíçò ôïõ ïñïý ôùí ãõíáéêþí ìå PCOS äåí äéáöÝñïõí áðü åêåßíá ôùí ìáñôýñùí ìå ôï ßäéï BMI.(12-16)
H áíåýñåóç õøçëÞò èåôéêÞò óõó÷Ýôéóçò áíÜìåóá óôá åðßðåäá ôçò éíóïõëßíçò êáé óôéò óõãêåíôñþóåéò ôçò ëåðôßíçò (r=+0,9367, p<0,0001) åíéó÷ýåé ôç èÝóç üôé ç õðåñéíóïõëéíáéìßá äéåãåßñåé ôçí Ýêêñéóç ôçò ëåðôßíçò. Oé áðüøåéò ðïõ õðÜñ÷ïõí ãéá ôç äñÜóç ôçò éíóïõëßíçò óôçí Ýêêñéóç ôçò ëåðôßíçò åßíáé áíôéêñïõüìåíåò.(20) H âñá÷õ÷ñüíéá õðåñéíóïõëéíáéìßá äåí öáßíåôáé íá Ý÷åé åðßäñáóç óôçí Ýêêñéóç ôçò ëåðôßíçò, åíþ, áíôßèåôá, ç ìáêñï÷ñüíéá õðåñéíóïõëéíáéìßá Þ ç áíôßóôáóç óôçí éíóïõëßíç ðñïêáëåß áýîçóç ôùí åðéðÝäùí ôçò ëåðôßíçò.(25,27-30) Eíôïýôïéò, áñêåôïß åñåõíçôÝò õðïóôÞñéîáí üôé ç áýîçóç ôùí åðéðÝäùí ôçò ëåðôßíçò óå áóèåíåßò ìå áíôßóôáóç óôçí éíóïõëßíç êáé ìå õðåñéíóïõëéíáéìßá ðñÝðåé íá áðïäïèåß óôï õøçëü BMI ðïõ åìöáíßæïõí ôá Üôïìá áõôÜ.(14)
H ýðáñîç áñíçôéêÞò óõó÷Ýôéóçò, óôáôéóôéêÜ óçìáíôéêÞò, áíÜìåóá óôéò óõãêåíôñþóåéò ôçò SHBG êáé óôéò ôéìÝò ôçò ëåðôßíçò (r=-0,6326, p<0,020) åßíáé éäéáßôåñá åíäéáöÝñïõóá êáé åíáñìïíßæåôáé ìå ôçí ýðáñîç õøçëÞò èåôéêÞò óõó÷Ýôéóçò áíÜìåóá óôá åðßðåäá ôçò éíóïõëßíçò êáé óôéò ôéìÝò ôçò ëåðôßíçò (r=+0,9367, p<0,0001), êáèþò êáé ìå ôçí ýðáñîç õøçëÞò èåôéêÞò óõó÷Ýôéóçò áíÜìåóá óôá åðßðåäá ôçò ôåóôïóôåñüíçò êáé óôéò ôéìÝò ôçò ëåðôßíçò (r=+0,6178, p<0,024). H ðáñáôÞñçóÞ ìáò áõôÞ óõìöùíåß ìå ôá áðïôåëÝóìáôá ðñïçãïýìåíùí ìåëåôþí(12) êáé èá ìðïñïýóå íá åñìçíåõèåß áðü ôï ãåãïíüò üôé ôüóï ç õðåñéíóïõëéíáéìßá üóï êáé ç õðåñáíäñïãïíáéìßá ïäçãïýí óå åëÜôôùóç ôùí åðéðÝäùí ôçò SHBG.(31) KáôÜ óõíÝðåéá, ç áñíçôéêÞ áõôÞ óõó÷Ýôéóç åßíáé Ýììåóç.
TÝëïò, ç áðïõóßá óõó÷Ýôéóçò áíÜìåóá óôéò ôéìÝò ôçò FSH, ôçò LH, ôçò ðñïëáêôßíçò, ôçò áíäñïóôåíäéüíçò, ôçò DHEA-S êáé ôçò 17á-OHP êáé óôéò óõãêåíôñþóåéò ôçò ëåðôßíçò åíéó÷ýåé ôçí Üðïøç üôé ïé ïñìüíåò áõôÝò äåí õðåéóÝñ÷ïíôáé óôçí Ýêêñéóç ôçò ëåðôßíçò, åýñçìá ðïõ áíáöÝñèçêå êáé áðü Üëëïõò óõããñáöåßò.(14)

Summary
Panidis D1, Kourtis A1, Roussos D2, Kalahanis J1, Mamopoulos M2.
Serum leptin levels in lean and obese women with PCOS.
Hellen Obstet Gynecol 14(3):223-228, 2002
Correspondence: D. Panidis
119 Mitropoleos str, 54622 Thessaloniki
Tel: 0310992915, 0310230333
This study was designed since the literature data, as far as serum leptin levels in patients with PCOS are concerned, are contradictory and limited in number. We studied 49 women, aged 16-34 years, which were divided in four groups according to the diagnosis of PCOS and BMI values. Our results showed that: a) patients with PCOS and normal BMI presented significantly lower serum leptin levels than those of women with normal BMI, b) patients with PCOS and abnormal BMI had significantly higher serum leptin levels than those of controls with abnormal BMI, c) there was high positive correlation between BMI values, insulin and testosterone levels on the one hand and leptin concentrations on the other, and d) there was high negative correlation between SHBG levels and leptin concentrations. Our results support the view that, in a subgroup of obese patients with PCOS, leptin probably interferes in the pathogenesis of this syndrome.
Key words: Leptin, PCOS, insulin, testosterone, SHBG, BMI.
1B' Department of Obstetrics Gynecology, Aristotle University of Thessaloniki
2C' Department of Obstetrics Gynecology, Aristotle University of Thessaloniki

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