Estudio de casos y controles en síndrome de ovario poliquísticodeterminantes analíticos, trombofilias y calidad de vida útiles para su evaluación clínica

Abstract

Objectives: 1. Compare hormonal and metabolic parameters, as well as hemostasis markers (basal thrombophilias and C-reactive protein) as cardiovascular risk factors, between patients with and without PCOS. We studied whether there were differences in the metabolic profile between the different PCOS phenotypes. 2. Evaluate the hormonal status of patients with PCOS and investigate the usefulness of HAM for the diagnosis of this syndrome, alone or in combination with other hormones. 3. Assess whether there are differences in health-related quality of life between women with PCOS -and their phenotypes- with respect to control women. Material and method: An observational study of cases and controls was carried out in the Gynecology Service of the Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, between September 2014 and May 2016. The cases and controls were women between 18 and 40 years old selected under criteria of inclusion and exclusion. Those who were pregnant or lactating, those exposed to cancer treatment, those with endocrine disorders (such as Cushing's syndrome, congenital adrenal hyperplasia, androgen-secreting tumors, hyperprolactinemia or hyper- or hypothyroidism), pelvic organ prolapse, or se found taking metformin and / or contraceptives during the 3 months prior to their participation in the study. The group of cases was made up of women who were recruited in the endocrine gynecology clinic of the hospital. The cases were classified as such after a medical history that included anamnesis, modified Ferriman-Galwey scale (mF-G), transvaginal ultrasound and hormonal levels between the second and fourth days of the cycle. The diagnosis of PCOS was established when the patient fulfilled at least 2 of the 3 Rotterdam criteria, which are: 1) clinical or biochemical hyperandrogenism with or without androgenic alopecia or presence of acne; 2) oligo-anovulation; 3) polycystic ovary morphology (MOP) by transvaginal ultrasound. Anamnesis, a hormonal blood test (including HAM), androgenic profile, prolactin, insulin and thyroid stimulating hormone levels, coagulation and thrombophilias study, and an anthropometric study were performed on all women. In addition, they underwent a transvaginal ultrasound and physical examination with measurements of the anogenital distance (AGD). They were also provided with questionnaires on physical activity, quality of life and diet. In turn, PCOS cases were classified into the different phenotypes: (A) hyperandrogenism + oligo / amenorrhea, (B) hyperandrogenism + polycystic ovary morphology (MOP), (C) oligo / amenorrhea + POM and (D) hyperandrogenism + oligo / amenorrhea + POM. A statistical analysis was performed to assess the association between PCOS and thrombophilias, the usefulness of HAM and SHBG in the diagnosis of the disease, and the assessment of the quality of life of these patients using a health-related quality of life questionnaire. Conclusions: 1. The phenotype of PCOS with hyperandrogenism and anovulation (H + O) is the one that showed the worst metabolic profile. Our results suggest that there are no differences in baseline thrombophilias between women with and without PCOS, since there were no differences in levels of protein C, antithrombin III, prothrombin time, homocysteine, D-dimer, Leyden factor V, polymorphism in the prothrombin gene or C-reactive protein among women with and without PCOS. 2. HAM was the best individual marker for the diagnosis of PCOS. Furthermore, the combination of serum levels of HAM together with those of SHBG showed the largest area under the curve for the diagnosis of the syndrome. 3. Health-related quality of life is significantly decreased in women with PCOS especially in those with anovulatory phenotype and compared to controls.