DISTURBED SERUM LEVELS OF ADIPOCYTOKINES, INSULIN RESISTANCE AND GYNECOLOGICAL NEOPLASTIC LESIONS: A TRIANGLE OF DANGER
Hany A. El-Kallaf and Adel A. Al-Kholy
Departments of Obstetrics & Gynecology & Medical Biochemistry*, Faculty of Medicine, Benha University
Aim of Work: To evaluate the relationship between estimated serum levels of adipocytokines and insulin resistance (IR) parameters in women with definite gynecological disorders. Patients & Methods: The study included 75 patients; 31 had uterine myoma (UM), 19 had endometrial carcinoma (EC) and 25 had endometriosis (EM) as diagnosed by US examination and pathological examination of hystroscopic biopsy for EM and EC. All women gave two fasting blood samples for colorometric estimation of fasting blood glucose (FBG) and ELISA estimation of serum insulin (FSI), adiponectin (APN), leptin and YKL-40 levels. Homeostasis model assessment index of IR (HOMA-IR) and leptin/adiponectin (L/A) ratio were calculated. Results: FBG and FSI levels and HOMA-IR index were significantly higher in patients than controls and in EC patients than other patients. Serum YKL-40 and leptin were significantly higher with significantly lower APN levels in patients than controls. Serum YKL-40 levels in EM patients were significantly higher than other patients, but were significantly higher in EC than UM patients. Serum leptin levels were significantly lower in UM patients than other patients. Serum APN levels were significantly lower in EC patients than other patients, but were significantly lower in EM than UM patients. Calculated L/A ratio was significantly lower in UM than in other patients and was non-significantly lower in EM than EC patients. ROC curve and Regression analyses showed that lower levels of APN and disturbed L/A ratio can predict the presence of EC, while elevated levels of YKL 40 and leptin can characterize patients with EM, but high HOMA-IR index can predict UM presence. Conclusion: Elevated serum YKL-40 could be used for discrimination of EM out of other pathologies. Lower serum APN levels and high L/A ratio could be used as a significant predictor for presence of EC. High HOMA-IR index can predict the presence of UM. A diagnostic panel of estimation of serum YKL-40 and APN could define and differentiate between EC and EM patients.