بررسی سطوح آنتیژن اختصاصی پروستات در بیماران مبتلا به سندرم تخمدان پلی‌کیستیک: مرور سیستماتیک و متاآنالیز

نوع مقاله : مروری

نویسندگان

1 دکتری بهداشت باروری، کمیته پژوهشی دانشجویان، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 استاد، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 دانشیار گروه ناباروری، مرکز تحقیقات بهداشت باروری، دانشگاه علوم پزشکی ارومیه، ارومیه، ایران.

4 دانشجوی دکتری اپیدمیولوژی، دانشکده بهداشت و ایمنی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

5 دانشجوی کارشناسی ارشد مامایی، مرکز تحقیقات بهداشت باروری، دانشگاه علوم پزشکی گیلان، رشت، ایران.

6 متخصص زنان و مامایی، دانشگاه علوم پزشکی البرز، کرج، ایران.

7 دانشیار گروه مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

چکیده

مقدمه: در طی سال­های اخیر شواهد متناقضی در کاربرد سنجش آنتی­ژن اختصاصی پروستات در تشخیص سندرم تخمدان پلی­کیستیک گزارش شده است. مطالعه حاضر با هدف تعیین سطوح آنتی­ژن اختصاصی پروستات در بیماران مبتلا به سندرم تخمدان پلی­کیستیک به صورت مرور سیستماتیک و متاآنالیز انجام شد.
روش‌کار: در این مطالعه مرور سیستماتیک و متاآنالیز جستجوی الکترونیک در پایگاه داده­های PubMed،web of science،Scopus ،Cochran Library انجام گرفت. از نرم‌افزارهای EndNote X6، Stata 14 و Review Manager 5.3 جهت مدیریت مقالات جستجو شده، آنالیز داده­ها و کیفیت‌سنجی استفاده شد. جهت بررسی سوگیری انتشار از Begg's test و Egger's test استفاده شد.
یافته‌ها: در این مطالعه مقالاتی که واجد معیارهای ورود به مطالعه بودند، 17 مطالعه با 1,467 شرکت کننده بود. نتایج متاآنالیز نشان داد که میزان آنتی­ژن اختصاصی پروستات نوع تام در مبتلایان به سندرم تخمدان پلی­کیستیک به‌طور معناداری از گروه کنترل بیشتر بود (001/0>p، 39/2-26/1:CI 95%، 83/1: SMD). به علاوه سطح آنتی­ژن اختصاصی پروستات نوع آزاد نیز در گروه مبتلایان به سندرم تخمدان پلی­کیستیک به‌طور معناداری بیشتر از گروه کنترل بود (005/0=p، 12/2-38/0:CI 95%، 25/1 :SMD).
نتیجه‌گیری: بر اساس یافته‌های مطالعه، سطوح سرمی آنتی­ژن اختصاصی پروستات در بیماران مبتلا به سندرم تخمدان پلی­کیستیک بالاتر بود. به‌نظر می­رسد تفاوت­های نژادی و تفاوت­های تکنیک­های سنجش می­تواند میزان سطوح آنتی­ژن اختصاصی پروستات در افراد مبتلا به سندرم تخمدان پلی­کیستیک را تحت تأثیر قرار دهد. اندازه‌گیری سطح این آنتی‌ژن می‌تواند در تشخیص سندرم تخمدان پلی‌کیستیک کمک کننده باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The level of Prostate specific antigen (PSA) in patients with polycystic ovarian syndrome: Systematic review and Meta-analysis

نویسندگان [English]

  • Marzieh Saei Ghare Naz 1
  • Fahimeh Ramezani Tehrani 2
  • Tahereh Behroozi-Lak 3
  • Fatemeh Koohi 4
  • Seyedeh Fatemeh Dalil Heirati 5
  • Masoumeh Abed 6
  • Giti Ozgoli 7
1 PhD in Reproductive Health, Student Research Committee, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Professor, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Science, Tehran, Iran.
3 Associate professor, Department of Infertility, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.
4 PhD student of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Science, Tehran, Iran.
5 M.Sc. student of Midwifery, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.
6 Gynecologist, Alborz University of Medical Science, Karaj, Iran.
7 Associate professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Introduction: Several controversial evidences have been recently reported on the use of prostate-specific antigens in the diagnosis of polycystic ovary syndrome (PCOS). This systematic review and meta-analysis study was performed with aim to determine the levels of prostate-specific antigens (PSA) in patients with PCOS.
Methods: In this systematic and meta-analytical review, an electronic search was conducted in the databases of PubMed, Web of Science, Scopus, and Cochran Library. EndNote X6, Stata 14, and Review Manager 5.3 were used to manage the searched articles, data analysis, and quality evaluation. Begg's test and Egger's test were used to evaluate the publication bias.
Results: In this study, 17 studies with 1,467 participants were included. Meta-analysis results showed that the amount of Prostate specific antigen in PCOS patients was significantly higher than the control group (Standardized mean difference: 1.83, 95% CI: 1.26-2.39; P<0.001), and the mean of fPSA was significantly higher in the PCOS group than the control group (Standardized mean difference: 1.25, 95% CI: 0.38-2.12, P=0.005).
Conclusion: The results of this study showed that serum levels of PSA were higher in PCOS patients. It seems that racial differences and differences in assay techniques can affect the levels of PSA levels in PCOS patients. Measurement of the level of this antigen can be helpful in the diagnosis of PCOS.

کلیدواژه‌ها [English]

  • Meta-analysis
  • Polycystic ovarian syndrome
  • Prostate specific antigen
  1. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013; 6:1-13.
  2. Bharathi RV, Swetha S, Neerajaa J, Madhavica JV, Moorthy J, Rekha SN, et al. An epidemiological survey: Effect of predisposing factors for PCOS in Indian urban and rural population. Middle East Fertility Society Journal 2017; 22(4):313-6.
  3. Choudhary A, Jain S, Chaudhari P. Prevalence and symptomatology of polycystic ovarian syndrome in Indian women: is there a rising incidence? International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2017; 6(11):4971-5.
  4. Musrap N, Diamandis EP. Prostate-specific antigen as a marker of hyperandrogenism in women and its implications for antidoping. Clin Chem 2016; 62(8):1066-74.
  5. Kamenov Z, Todorova M, Khristov V. Prostate-specific antigen (PSA) in women. Vutr Boles 2001; 33(1):40-7.
  6. Dash P. Reconnoitring the status of prostate specific antigen and its role in women. Indian J Clin Biochem 2015; 30(2):124-33.
  7. Escobar-Morreale HF, Ávila S, Sancho J. Serum prostate-specific antigen concentrations are not useful for monitoring the treatment of hirsutism with oral contraceptive pills. J Clin Endocrinol Metab 2000; 85(7):2488-92.
  8. Mashkoor FC, Al-Asadi JN, Al-Naama LM. Serum level of prostate-specific antigen (PSA) in women with breast cancer. Cancer Epidemiol 2013; 37(5):613-8.
  9. Mardanian F, Heidari N. Diagnostic value of prostate-specific antigen in women with polycystic ovary syndrome. J Res Med Sci 2011; 16(8):999-1005.
  10. Burelli A, Cionini R, Rinaldi E, Benelli E, Fiore E, Canale D, et al. Serum PSA levels are not affected by the menstrual cycle or the menopause, but are increased in subjects with polycystic ovary syndrome. J Endocrinol Invest 2006; 29(4):308-12.
  11. Diamandis EP, Stanczyk FZ, Wheeler S, Mathew A, Stengelin M, Nikolenko G, et al. Serum complexed and free prostate-specific antigen (PSA) for the diagnosis of the polycystic ovarian syndrome (PCOS). Clin Chem Lab Med 2017; 55(11):1789-1797.
  12. Melegos DN, Yu H, Ashok M, Wang C, Stanczyk F, Diamandis EP. Prostate-specific antigen in female serum, a potential new marker of androgen excess. J Clin Endocrinol Metab 1997; 82(3):777-80.
  13. Tokmak A, Bodur S, Erkilinc S, Ozel S, Engin-Ustun Y. The Value of Prostate-Specific Antigen in Diagnosis of Polycystic Ovarian Syndrome in Adolescent Girls. J Pediatr Adolesc Gynecol 2018; 31(3):263-9.
  14. Sharaf AE, El Mongy NN, Fawzy MM, El Razik HA. Prostate-specific antigen as a diagnostic marker in female hyperandrogenism. Journal of the Egyptian Women’s Dermatologic Society 2013; 10(2):58-62.
  15. Crowther M, Lim W, Crowther MA. Systematic review and meta-analysis methodology. Blood 2010; 116(17):3140-6.
  16. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151(4):264-9.
  17. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al . The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. Ottawa Health Research Institute Web site 2014; 7.
  18. Banu H, MA H, Akhtar N, Shah S, Sultana T, Tuqan S. Prostate specific antigen is raised in polycystic ovary syndrome. Endocrinol Metab Int J 2018; 6(4):297-300.
  19. Panigrahy R, Singh B, Pattnaik TK, Misra S. Role of insulin sensitising agents in altering PSA level in PCOS. Int J Reprod Contracept Obstet Gynecol 2017; 6(11):4986-9.
  20. Bili E, Dampala K, Iakovou I, Tsolakidis D, Giannakou A, Tarlatzis BC. The combination of ovarian volume and outline has better diagnostic accuracy than prostate-specific antigen (PSA) concentrations in women with polycystic ovarian syndrome (PCOs). Eur J Obstet Gynecol Reprod Biol 2014; 179:32-5.
  21. Hussain N, Rzaij Z. Evalution of PSA tumor marker in some Iraqi women with Polycystic Ovarian Syndrome. Iraqi J Embryosand Infertil Res 2012; 2(4):22-24.
  22. ÜkinÇ K, Ersoz HO, Erem C, Hacihasanoglu AB. Diagnostic value of prostate-specific antigen (PSA) and free prostate specific antigen (fPSA) in women with ovulatory and anovulatory polycystic ovary syndrome. Endocrine 2009; 35(1):123-9.
  23. Hadi SMA, Al-Bayatti A, Jebri N. Prostate Specific Antigen in Polycystic Ovary Syndrome. Iraqi Academic Scientific Journal 2010; 9(3):270-273.
  24. Bahceci M, Bilge M, Tuzcu A, Tuzcu S, Bahceci S. Serum prostate specific antigen levels in women with polycystic ovary syndrome and the effect of flutamide+ desogestrel/ethinyl estradiol combination. J Endocrinol Invest 2004; 27(4):353-6.
  25. Kocak M, Tarcan A, Beydilli G, Koç S, Haberal A. Serum levels of prostate-specific antigen and androgens after nasal administration of a gonadotropin releasing hormone-agonist in hirsute women. Gynecol Endocrinol 2004; 18(4):179-85.
  26. Güllü S, Emral R, Asik M, Cesur M, Tonyukuk V. Diagnostic value of prostatic specific antigen in hirsute women. J Endocrinol Invest 2003; 26(12):1198-202.
  27. Al-Bayatti AA, Al-Samak SH, Al-Bahar AJ. Can serum prostate-specific antigen be a promising marker for patients with polycystic ovary syndrome and hirsutism. Middle East Fertility Society Journal 2004; 9(3):227.
  28. Rudnicka E, Radowicki S, Suchta K. Prostate specific antigen (PSA) in diagnosis of polycystic ovarian syndrome–a new insight. Gynecol Endocrinol 2016; 32(11):931-5.
  29. Vural B, Özkan S, Bodur H. Is prostate‐specific antigen a potential new marker of androgen excess in polycystic ovary syndrome? J Obstet Gynaecol Res 2007; 33(2):166-73
  30. Escobar-Morreale HF, Serrano-Gotarredona J, Avila S, Villar-Palasí J, Varela C, Sancho J. The increased circulating prostate-specific antigen concentrations in women with hirsutism do not respond to acute changes in adrenal or ovarian function. J Clin Endocrinol Metab 1998; 83(7):2580-4.
  31. Metawie MAH, Azab H, El Sarafy T, El-Biely M, El-Kattan S. Serum-prostatic specific antigen level as a promising marker in infertile women with polycystic ovarian disease. Middle East Fertility Society Journal 2008; 13(1):28-32.
  32. Obiezu CV, Scorilas A, Magklara A, Thornton MH, Wang CY, Stanczyk FZ, et al. Prostate-specific antigen and human glandular kallikrein 2 are markedly elevated in urine of patients with polycystic ovary syndrome. J Clin Endocrinol Metab 2001;86(4):1558-61.
  33. Aksoy H, Akçay F, Umudum Z, Yildirim AK, Memisogullari R. Changes of PSA concentrations in serum and saliva of healthy women during the menstrual cycle. Ann Clin Lab Sci 2002; 32(1):31-6.
  34. Taheripanah R, Sepahvandi M, Entezari A, Amiri Z, Neisani Samani E. Evaluation of serum PSA after cyproterone compound treatment compared with oral contraceptive pill in hirsute polycystic ovary syndrome patients. Middle East Fertility Society Journal 2010; 15(3):159-62.
  35. Negri C, Tosi F, Dorizzi R, Fortunato A, Spiazzi GG, Muggeo M, et al. Antiandrogen drugs lower serum prostate-specific antigen (PSA) levels in hirsute subjects: evidence that serum PSA is a marker of androgen action in women. J Clin Endocrinol Metab 2000; 85(1):81-4.
  36. Zaviacic M, Ablin RJ. The female prostate and prostate-specific antigen. lmmunohistochemical localization, implications of this prostate marker in women and reasons for using the term" prostate" in the human female. Histol Histopathol 2000; 15(1):131-42.
  37. Nagar R, Msalati AA. Changes in Serum PSA during normal menstrual cycle. Indian J Clin Biochem 2013; 28(1):84-9.
  38. Clements J, Mukhtar A. Glandular kallikreins and prostate-specific antigen are expressed in the human endometrium. J Clin Endocrinol Metab 1994; 78(6):1536-9.
  39. Borchert G, Melegos DN, Tomlinson G, Giai M, Roagna R, Ponzone R, et al. Molecular forms of prostate-specific antigen in the serum of women with benign and malignant breast diseases. Br J Cancer 1997; 76(8):1087-94.
  40. Diamandis EP, Eklund E, Muytjens C, Fiala C, Wheeler S, Nikolenko G, et al. Effect of age on serum prostate-specific antigen in women. Clin Chem Lab Med 2017; 55(12):e271-e272.
  41. Diamandis EP, Yu H. Nonprostatic sources of prostate-specific antigen. Urol Clin North Am 1997; 24(2):275-82.
  42. Black MH, Diamandis EP. The diagnostic and prognostic utility of prostate-specific antigen for diseases of the breast. Breast Cancer Res Treat 2000; 59(1):1-14.
  43. Zhang X, Lin Y, Xie X, Shen M, Huang G, Yang Y. Is acne in adolescence associated with prostate cancer risk? Evidence from a meta-analysis. PloS one 2018; 13(11):e0206249.