Gestasyonel diyabetes mellitus hastalarında kimerin ve FABP4 düzeylerinin değerlendirilmesi
Evaluation of chemerin and FABP4 levels in gestational diabetes mellitus patients
Yazar: ALİ ABACI
Danışman: PROF. DR. NİYAZİ TUĞ
Sağlık Bilimleri Üniversitesi / Sancaktepe Şehit Prof.Dr. İlhan Varank Eğitim ve Araştırma Hastanesi / Kadın Hastalıkları ve Doğum Ana Bilim Dalı / Kadın Çalışmaları Bilim Dalı
Derece: Tıpta Uzmanlık, 2023
Konu: Kadın Hastalıkları ve Doğum = Obstetrics and Gynecology

Özet:
Bu çalışmada 75 gr OGTT yapılarak GDM tanısı almış ve test sonucu normal sınırlarda olan gebelerin demografik, klinik özelliklerinin karşılaştırılması ile serum FABP4 ve Kimerin düzeyinin GDM tanısında kullanılmasının yerinin değerlendirilmesi amaçlanmıştır.
GEREÇ VE YÖNTEM: Bu çalışma Sancaktepe Şehit Prof. Dr. İlhan Varank Eğitim ve Araştırma Hastanesi'nde prospektif, kontrollü kohort çalışması olarak planlanmıştır. Hastanemiz Kadın Hastalıkları ve Doğum Kliniğine başvuran, 75 gr OGTT sonucuna göre GDM tanısı almış 44 gebe ve test sonucu normal sınırlarda olan 44 gebe çalışmaya dahil edilmiştir. Olguların Kimerin ve FABP4 dahil laboratuvar sonuçları, demografik özellikleri, obstetrik ve perinatal sonuçları kaydedilmiştir.
BULGULAR: Çalışmamıza katılan 88 kişinin 44 tanesine gestasyonel diyabet tanısı konulmuş olup, 44 tanesi ise gestasyonel diyabeti olmayan kontrol grubunu oluşturmaktadır. Çalışmamıza katılan kişilerin genel özellikleri gestasyonel diyabet olanlar ve olmayanlar açısından değerlendirildiğinde yaş, boy ortalaması, gebelikte alınan kilo, gravida, parite, abort, yaşayan çocuk sayıları, sigara kullanımı, LDL ve IVF gebelik açısından anlamlı bir fark izlenmedi (p>0.05). Kimerin düzeyi açısından değerlendirildiğinde gestasyonel diyabet tanısı alan grup ile almayan grup arasında anlamlı bir fark yoktu (p>0.05). FABP4 düzeyi (p:0.001; p<0.05) ile açlık kan şekeri, insülin düzeyleri, Hba1c, trigliserit düzeyleri de gestasyonel diyabet grubunda kontrol gruba göre istatistiksel anlamda anlamlı derecede yüksek izlenirken, HDL düzeyi gestasyonel diyabet grubunda anlamlı derecede düşük izlendi (p:0.001; p<0.05). Gestasyonel diyabet grubundaki bebeklerin doğum haftaları kontrol grubundan istatistiksel olarak anlamlı düzeyde kısa izlenirken (p:0.043; p<0.05) gruplar arasında doğum kiloları, Apgar skorları (1.dakika ve 5.dakida), cinsiyet ve LGA açısından anlamlı bir fark izlenmedi (p>0.05).
SONUÇ: Bu çalışmada gestasyonel diyabetli gebelerde Kimerin düzeyi anlamlı derecede yüksek olmayıp FABP4 düzeyi anlamlı derecede yüksek bulunmuştur. FABP4'ün GDM tanısına alternatif ya da mevcut tanıda kullanılan OGTT'ye yardımcı olarak kullanabileceğimiz bir marker olduğu kanaatindeyiz.
Anahtar Kelimeler: Kimerin, FABP4, Gebelik, Gestasyonel diyabetes mellitus

Abstract:
In this study, it was aimed to compare the demographic and clinical characteristics of pregnant women who were diagnosed with GDM according to the 75-g OGTT results and whose test results were normal, and to evaluate the use of serum FABP4 and Chemerin levels in the diagnosis of GDM.
MATERIALS AND METHODS: This study was planned as a prospective, controlled cohort study at Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital. 44 pregnant women who consulted to the Gynecology and Obstetrics Clinic of our hospital and were diagnosed with GDM according to the 75-g OGTT result and 44 pregnant women whose test results were within normal limits were included in the study. Laboratory results, demographic characteristics, obstetric and perinatal outcomes of the cases, including Chemerin and FABP4, were recorded.
All patients received spinal anesthesia, and the amount of intraoperative bleeding, the duration of surgery from the patients' admission to the operating room until the end of the operation, and whether intraoperative hypotension developed or not were recorded. The patients were transferred to the postoperative intensive care unit, and their VAS score (at 4th, 12th, and 24th hours) was recorded in the first 24 hours. The Confusion Assessment Method (CAM/CAM-ICU) test for preoperative, postoperative 1st day, and pre-discharge confusion assessment was performed and recorded. In addition, the time from femur fracture to surgery, postoperative intensive care unit stay, postoperative hospital stays, and total hospital stay were recorded for the patients. Mortality in the first 3 months after discharge was recorded by reaching out to the patients and their families. Patients who received albumin infusion, had a mini-mental score below 21, developed delirium, or received preoperative and intraoperative blood transfusions were not included in the study.
RESULTS: A total of 88 pregnant women were included in the study. Among those 44 of them were diagnosed with gestational diabetes and 44 of them without gestational diabetes were included in the control group. When the participants in our study were evaluated in terms of those with and without gestational diabetes, it was found that there was no significant difference in terms of age, average height, weight
gained during pregnancy, gravida, parity, abortion, number of living children, smoking, LDL and IVF pregnancy (p>0.05). When evaluated in terms of chemerin level, there was no statistically significant difference between the group diagnosed with gestational diabetes and the group without (p>0.05). While FABP4 level (p:0.001; p<0.05) as well as fasting blood sugar, insulin levels, HbA1c and triglyceride levels were statistically significantly higher in the gestational diabetes group than in the control group, HDL level was statistically significantly lower in the gestational diabetes group (p: 0.001; p<0.05). While the birth weeks of the babies in the gestational diabetes group were observed to be statistically significantly shorter than the control group (p:0.043; p<0.05), there was no statistically significant difference between the groups in terms of birth weight, 1st minute and 5th minute Apgar scores, LGA and gender (p >0.05).
CONCLUSION: In this study, it was found out that levels of Chemerin was not significantly high in pregnant women with gestational diabetes, but level of FABP4 was has been found significantly high.
We believe that FABP4 is a marker that can be used as an alternative to the diagnosis methods of GDM or as an adjunct to OGTT used in the current diagnosis methods.
Key words: Chemerin, FABP4, pregnancy, gestational diabetes mellitus.