Preeklamptik hastalarda ovaryan ve adrenal kaynaklı androjenlerin prognozla ilişkisi
The relationship of ovarian and adrenal induced androgens with prognosis in preeclamptic patients
Yazar: ALİ SAMİ GÜRBÜZ
Danışman: PROF. DR. AHMET NURİ DANIŞMAN
Sağlık Bakanlığı / Zekai Tahir Burak Kadın Sağlığı Eğitimi ve Araştırma Hastanesi / Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2003
Konu: Kadın Hastalıkları ve Doğum = Obstetrics and Gynecology
Dizin: Androjenler = Androgens ; Preeklampsi = Pre-eclampsia

Özet:
Amaç:  Preeklampsi tanısı almış hastalarda androjen seviyeleri ile  fetal ve maternal komplikasyon ilişkisini saptamak.
Yöntemler:  Çalışmaya Zekai Tahir Burak  Kadm  Sağlığı  Egitim  ve Araştirma Hastanesi Yuksek Riskli Gebelikler Servisi'ne preeklampsi tanısıyla yatırılp takip edilen ve dogum yapan  hastalar  dahil edildi. Alınan venöz kan numunelerinden androstenodion (A), dehidroepiandesteron sülfat (DHEAS), total testosteron(TT) ve free testosteron(FT)  seviyeleri ölçüldü. 
Maternal ve fetal komplikasyonlar tespit edildi ve androjen düzeyleriyle ilişkileri  incelendi.

Bulgular:
Çalışmaya dahil edilen 103 hastamn yaş ortalamasmı 27,49±5,32  idi. RIA ile ölçülen TT (n:75) ,DHEAS  (n:97),  FT ( n:30) ve A ( n:61) ortalama degerleri Sirasıyla 222.87± 206,32mg/dl,   1.11± 0,73 ml,  1.01± 0,65 pg/ml ve 6.27± 5ng/ml olarak bulundu.
FT düzeyi 1. Dakika Abgar   skoru 7 nin altmdaki grupta 7nin üstündeki gruba  oranla fazla bulundu (P=0,042). Preterm eylem izlenenen  grupta TTdüzeyi diger gruptan daha düşük  olarak bulundu (P=0,026). A seviyeleri IUGR saptanan grupta saptanmayanlara  gore belirgin olarak yiiksekti (P=0,034) . Fetal distress gelişen hastalarda TT düzeyi daha düşük izlendi.AST ve ALT düzeyleri 40' m üstünde olan hastaların TT(P=0,01) ve androstenodion (P=0,008) düzeyleri 40'm altmda 
olanlarınkinden bariz olarak yuksek tcspit edilmiştir. 
TT  maternal  komplikasyon  olan grupta bariz olarak yüksek saptandı (P=0,028). 
Sonuç:
Preeklampside yüksek TT maternal komplikasyonun oluşumuna işaret ederken fetal distress ve preterm eylemde düşük seviyede izlenmiştir.A ise IUGRde ve kc enzim yüksekliğinde artmış olarak izlenmiştir. DHEAS düzeylerinin fetal veya maternal komplikasyonlarla herhangi bir ilişkisi görülmemiştir.

Abstract:
Abstract
Introduction: Preeclampsia (PE) is a multisystem disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. Abnormal placental steroidogenesis has also been reported in women with PE. Androgens are associated with hypertension was demonstrated. Androgens also decrease prostacyclin production in vitro and increase production of other eicosanoids resulting in a thromboxane to prostacyclin ratio which favors vascular constriction and coagulation in a way similar to that seen in preeclampsia The purpose of this study was to determine the relationship between androgen levels and fetal and maternal complications in patients with preeclampsia.
Materials and Methods:  This study included patients who were followed up with the diagnosis of preeclampsia and gave birth in High-Risk Pregnancy Clinic of Zekai Tahir Burak Women's Health Research and Education Hospital. Androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), total testosterone (TT) and free testosterone (FT) levels were measured in venous blood samples. Maternal complications and fetal complications were recorded. The relationship between these complications and androgen levels was examined.
Results: A total of 103 patients were included in the study. The mean levels of A (n:61), DHEAS (n:97), TT (n:75) and FT (n:30) measured by RIA were respectively 6.27±5 ng/ml, 1.11±0.73 μg/dl, 222.87±206.32 ng/dl and 1.01±0.65 pg/ml.
FT levels were significantly higher in those with a 1-min Apgar score <7 than in those with a 1-min Apgar score ≥7 (p=0.042). TT levels were significantly lower in the preterm group than in the non-preterm group (p=0.026). A levels were significantly higher in the IUGR group than in the non-IUGR group (p=0.034). TT levels were significantly lower in the fetal distress group than in the non-fetal distress group (p=0.039). TT (p=0.01),  (p=0.018)  and A (p=0.008), (p=0.039)  levels were significantly higher in those with AST and ALT levels greater than 40 U/L. TT levels were significantly higher in the group with maternal complications than in the group without maternal complications (p=0.028).
Conclusion: While higher TT levels indicated maternal complications in preeclampsia, TT levels were shown to be lower in those with preterm birth and fetal distress. A levels were shown to be higher in those with IUGR and elevated liver enzyme levels. No significant association was found between DHEAS levels and fetal/maternal complications.