Abstract
Background
Previous studies have shown increased inflammatory activity in patients with polycystic ovary syndrome (PCOS); however, it remains uncertain whether this increased inflammatory activity is a consequence of the disorder itself or of the accompanying obesity. We therefore aimed to test the inflammatory marker levels in obese and lean patients with PCOS by using two separate control groups with matching body mass index (BMI).
Method
A total of 120 women in reproductive age with (n = 62) and without (n = 60) PCOS were recruited for the study. Patients with PCOS were divided into two groups as obese (n = 32) and lean (n = 30) PCOS groups according to BMI. Two BMI-matched control groups were created. Furthermore, high sensitive CRP protein (hsCRP), neutrophils, lymphocytes, white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) were evaluated with complete blood count.
Results
The hsCRP (5.5 ± 0.8 vs. 3.1 ± 0.7, p < 0.001), neutrophil count (3.8 ± 0.4 vs. 2.9 ± 0.7, p < 0.001), leukocyte count (7.2 ± 1.8 vs. 5.6 ± 1.6, p < 0.001), and NLR (2.6 ± 1.4 vs. 1.5 ± 0.4, p < 0.001) were higher in patients with PCOS compared to the control group while lymphocyte count was lower (1.71 ± 0.65 vs. 1.98 ± 0.39, p = 0.008). Similarly, both obese and lean patients with PCOS had higher levels of hsCRP, neutrophils, leukocytes and NLR ratios compared to BMI-matched controls. The correlation analysis revealed a moderate correlation between NLR and hsCRP (r 0.459, p < 0.001), and between HOMA-IR (r 0.476 p < 0.001) and BMI (r 0.310, p 0.001).
Conclusion
Our study results demonstrated that both lean and obese patients with PCOS have increased inflammatory markers compared to BMI-matched control groups indicating that the inflammation seen in PCOS might be related with the presence of the disorder rather than with obesity.
Similar content being viewed by others
References
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89:2745–2749
Legro RS (2003) Diagnostic criteria in polycystic ovary syndrome. Semin Reprod Med 21:267–275
Kelly CC, Lyall H, Petrie JR, Gould GW, Connell JM, Sattar N (2001) Low grade chronic inflammation in women with polycystic ovarian syndrome. J Clin Endocrinol Metab 86:2453–2455
Diamanti-Kandarakis E, Alexandraki K, Piperi C, Protogerou A, Katsikis I, Paterakis T et al (2006) Inflammatory and endothelial markers in women with polycystic ovary syndrome. Eur J Clin Invest 36:691–697
Orio F Jr, Palomba S, Cascella T, Di Biase S, Manguso F, Tauchmanova L et al (2005) The increase of leukocytes as a new putative marker of low-grade chronic inflammation and early cardiovascular risk in polycystic ovary syndrome. J Clin Endocrinol metab 90:2–5
Festa A, D’Agostino R Jr, Williams K, Karter AJ, Mayer-Davis EJ, Tracy RP et al (2001) The relation of body fat mass and distribution to markers of chronic inflammation. Int J Obes Rel Metab Disord : J Int Assoc Study Obes 25:1407–1415
Mohlig M, Spranger J, Osterhoff M, Ristow M, Pfeiffer AF, Schill T et al (2004) The polycystic ovary syndrome per se is not associated with increased chronic inflammation. Eur J Endocrinol/Eur Fed Endocr Soc 150:525–532
Kaya A, Kaya Y, Topcu S, Gunaydin ZY, Kurt M, Tanboga IH et al (2013) Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. doi:10.1177/0003319713484789
Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184
Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T et al (2012) Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 19:217–224
Okyay GU, Inal S, Onec K, Er RE, Pasaoglu O, Pasaoglu H et al (2013) Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail 35:29–36
Celikbilek M, Dogan S, Ozbakir O, Zararsiz G, Kucuk H, Gursoy S, et al. (2013) Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal 27:72–6
Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S (2012) Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 5:2
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25
Pangaribuan B, Yusuf I, Mansyur M, Wijaya A (2011) Serum adiponectin and resistin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome. Ther Adv Endocrinol Metab 2:235–245
Boulman N, Levy Y, Leiba R, Shachar S, Linn R, Zinder O et al (2004) Increased C-reactive protein levels in the polycystic ovary syndrome: a marker of cardiovascular disease. J Clin Endocrinol Metab 89:2160–2165
Zahorska-Markiewicz B, Janowska J, Olszanecka-Glinianowicz M, Zurakowski A (2000) Serum concentrations of TNF-alpha and soluble TNF-alpha receptors in obesity. Int J Obes Relat Metabol Disord: J Int Assoc Study Obes 24:1392–1395
Kim JW, Han JE, Kim YS, Won HJ, Yoon TK, Lee WS (2012) High sensitivity C-reactive protein and its relationship with impaired glucose regulation in lean patients with polycystic ovary syndrome. Gynecol Endocrinol 28:259–263
Kahal H, Aburima A, Ungvari T, Rigby AS, Dawson AJ, Coady AM et al (2013) Polycystic ovary syndrome has no independent effect on vascular, inflammatory or thrombotic markers when matched for obesity. Clin Endocrinol 79:252–258
Escobar-Morreale HF, Luque-Ramirez M, Gonzalez F (2011) Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and meta analysis. Fertil Steril 95(1048–58):e1–e2
Nunez J, Nunez E, Bodi V, Sanchis J, Minana G, Mainar L et al (2008) Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 101:747–752
Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 102:653–657
Ibanez L, Jaramillo AM, Ferrer A, de Zegher F (2005) High neutrophil count in girls and women with hyperinsulinaemic hyperandrogenism: normalization with metformin and flutamide overcomes the aggravation by oral contraception. Hum Reprod 20:2457–2462
Herlihy AC, Kelly RE, Hogan JL, O’Connor N, Farah N, Turner MJ (2011) Polycystic ovary syndrome and the peripheral blood white cell count. J Obstet Gynaecol: J Inst Obstet Gynaecol 31:242–244
Tarkun I, Arslan BC, Canturk Z, Turemen E, Sahin T, Duman C (2004) Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation. J Clin Endocrinol Metab 89:5592–5596
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Keskin Kurt, R., Okyay, A.G., Hakverdi, A.U. et al. The effect of obesity on inflammatory markers in patients with PCOS: a BMI-matched case–control study. Arch Gynecol Obstet 290, 315–319 (2014). https://doi.org/10.1007/s00404-014-3199-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-014-3199-3