ivane javaxiSvilis saxelobis Tbilisis saxelmwifo

universiteti medicinis fakulteti

meanoba – ginekologiis da reproduqtologiis departamenti

xelnaweris uflebiT

diana WanuyvaZe

korelaciebi hiperandrogenizmis klinikur

da hormonalur maxasiaTeblebs Soris

disertacia

warmodgenili medicinis doqtoris akademiuri xarisxis

mosapoveblad

samecniero xelmZRvaneli:
med. mec. doqtori. asoc. prof. jenara qristesaSvili

Tbilisi 2012

1
 Sinaarsi
Sesavali ---------------------------------------------------------------------------------------- 5

aqtualoba ---------------------------------------------------------------------------------- 5

amocanebi ----------------------------------------------------------------------------------------------------- 8

mecnieruli siaxle ----------------------------------------------------------------------------------------- 8

praqtikuli Rirebuleba ----------------------------------------------------------------- 10

gamoqveynebuli Sromebis sia ------------------------------------------------------ 11

Tavi 1. literaturis mimoxilva ----------------------------------------- 12

1.1 androgenebis biosinTezi ----------------------------------------------------------------------- 13

1.2 hirsutizmi ------------------------------------------------------------------------------------------------ 18

1.3 seborea da akne ---------------------------------------------------------------------------------------- 20

1.4 hiperandrogenizmis meqanizmebi -------------------------------------------------------------- 21

1.5 androgenebis transportireba ---------------------------------------------------------------- 22

1.6 policistozuri sakvercxeebis sindromi ---------------------------------------------- 24

1.7 adrenogenitaluri sindromi ------------------------------------------------------------------ 30

1.8 hiperandrogenizmis sxva mizezebi -------------------------------------------------------- 32

1.9 idiopaTiuri hirsutizmi ------------------------------------------------------------------------- 33

1.10 hiperandrogenizmis eqstraovariuli faqtorebi -------------------------------- 33

1.11 hirsutizmis Sefaseba da diagnostika ----------------------------------------------- 36

112 hirsutizmis mkurnaloba ---------------------------------------------------------------------- 39

2
Tavi 2. kvlevis obieqti da meTodebi ------------------------------------------ 42

2.1 kvlevis obieqti ----------------------------------------------------------------------------------------- 42

2.2 kvlevis meTodebi ----------------------------------------------------------------------------------- 43

2.2.1 hormonebis raodenobrivi gansazRvra ------------------------------------------------- 43

2.2.2 hirsutuli ricxvis gansazRvra ----------------------------------------------------------- 44

2.2.3 Tavisufali androgenebis indeqsis gansazRvra ----------------------------- 44

2.2.4 Tavisufali da bioSeRwevadi testosteronis

gaangariSebis maTematikuri modelebi ------------------------------------------------------ 44

2.2.5 insulinrezistentobis indeqsis Homa-2 gansazRvra ------------------------- 44

2.2.6 policistozuri sakvercxeebis sindromis dadgenis

kriteriumebi ------------------------------------------------------------------------------------------------ 45

2.2.7 kvlevis ultrabgeriTi meTodi --------------------------------------------------------- 45

2.2.8 monacemebis statistikuri damuSaveba ----------------------------------------------- 45

Tavi 3. საკუთარი კvlevis Sedegebi -------------------------------------- 47

3.1. pacientebis klinikuri da hormonaluri maxasiaTeblebi ------------------ 47

3.2. pacientebSi hiperandrogenizmis klinikuri simptomebis

da androgenuli parametrebis korelaciebiD ------------------------------------------ 52

3.3. korelaciebi hiperandrogenizmis klinikur da

hormonul markerebs Soris qalebSi

policistozuri sakvercxeebis sindromiT,

adrenogenitaluri sindromis araklasikuri formiT

da hiperprolaqtinemiis sindromiT --------------------------------------------------------- 65

3
3.4.hiperandrogenizmis Sefasebis diagnostikuri meTodebis

SedarebiTi analizi axalgazrda qalebSi hirsutizmiT ------------------------ 70

თავი 4. miRebuli Sedegebis ganxilva -------------------------------------- 73

Tavi 5. daskvnebi ----------------------------------------------------------------------- 86

Tavi 6. praqtikuli rekomendaciebi ---------------------------------------- 88

Tavi 7. gamoyenebuli literatura ---------------------------------------- 94

danarTi ------------------------------------------------------------------------------------ 107

4
Semoklebebi
ags – adreno-genitaluri sindromi

kok- kombinirebuli oraluri kontraceptivi

smi – sxeulis masis indeqsi

w.g/T.g. - welis garSemowerilobis da TeZos

garSemowerilobis Tanafardoba

17α-OHP - 17α - hidroqsiprogesteroni

cBio-T - gaangariSebuli bioSeRwevadi testosteroni

cFT - gaangariSebuli Tavisufali testosteroni

DHEA-S - dehidroepiandrosteron- sulfati

E2 – estradioli

FAI - Tavisufali androgenebis indeqsi

FSH - folikulmastimulirebeli hormoni

FT - Tavisufali testosteroni

Homa-IR - insulinrezistentobis indeqsi

LH - maluTeinizirebeli hormoni

Prl – prolaqtini

SHBG - seqssteroidSemboWveli globulini

TSH – Tireomastimulirebeli hormoni

TT – saerTo testosteroni

5
 Sesavali

Temis aqtualoba:

hiperandrogenizmi Tanamedrove endokrinologiuri ginekologiis

mniSvnelovan problemas warmoadgens. hiperandrogenizmi warmoadgens
qalebSi iseTi garegani paTologiuri simptomebis arsebobas, rogoric aris
hirsutizmi, akne, seborea, alopecia da virilizacia. hiperandrogenizmis
uxSires mizezs (40-80%) hiperandrogenia warmoadgens [22,85,129].
literaturuli monacemebiT hiperandrogenia aReniSneba reproduqciuli
asakis qalTa 7-10% [19,54,92].Ahiperandrogenizmis mizezTa Soris ganixileba
aseve sisxlSi sasqeso steroidebis SemboWveli globulinis koncentraciis
daqveiTeba, ris Sedegadac matulobs Tavisufali androgenebis done [15,22].
sakmaod xSiria hiperandrogenizmis is forma, romelic viTardeba kanSi
ferment 5α-reduqtazas aqtivobis momatebis fonze, sisxlSi androgenebis
normaluri Semcvelobisas. Ahiperandrogenizmis am ukanasknel variants
idiopaTiur an konstituciur formad ganixilaven [21,29,35].

mizezebisMdamoukideblad, pacientebis mier TviT hiperandrogenizmi sakmaod

mwvaved aRiqmeba, Ffsiqologiuri stresis mizezi xdeba da xels uSlis
sazogadoebaSi integrirebas. amdenad, hiperandrogenizmi warmoadgens metad
mniSvnelovan, aqtualur ara mxolod samedicino, aramed socialur
problemasac.
hiperandrogenizmis mizezebia: policistozuri sakvercxeebis sindromi,
hiperandrogenuli insulin-rezistentuli acanthosis nigricans sindromi,
Tirkmelzeda jirkvlebis Tandayolili hiperplazia (klasikuri da
araklasikuri forma), kuSingis sindromi, androgenmaproducirebeli
simsivneebi (sakvercxis, Tirkmelzeda jirkvlis), hiperprolaqtinemiis
sindromi [25,31]. hiperandrogenizmis klinikuri gamovlinebebis SemTxvevaTa
5-15% aris idiopaTiuri [21]. am dros aRiniSneba mocirkulire androgenebis
normaluri donis mimarT Tmis folikulebis momatebuli mgrZnobeloba,
romlis mizezi aris 5-α reduqtazas aqtivobis mateba. aRniSnuli
paTologiebi sakmaod farTod aris Seswavlili, Tumca jer kidev rCeba

6
rigi sakiTxebisa, romelTa kvleva mniSvnelovania hiperandrogenizmis
sxvadasxva formebis paTogenezuri meqanizmebis dasazusteblad.

bolo periodSi gansakuTrebul yuradRebas imsaxurebs iseTi tipis

hiperandrogenia, romelic ukavSirdeba simsuqnes da insulinrezistentobas.
kerZod dadgenilia, rom arsebobs urTierTkavSiri hiperinsulinemias da
hiperandrogenias Soris da am ori tipis darRvevis Tanaarseboba qmnis
mankier wres. naklebad aris Seswavlili kavSirebi RviZlis funqciis
gaTvaliswinebiT, zusti korelaciebi sisxlSi seqssteroidSemboWveli
globulinis, saerTo da Tavisufali testosteronis koncentraciebs Soris
daAmsgavsi kavSirebi pacientebSi policistozuri sakvercxeebis sindromiT
an mis gareSe.E aseve xazgasasmelia is faqti, rom simsuqne da
insulinrezistentoba xSirad pacientebis mier ar aRiqmeba saTanadod,
rogorc mZime metaboluri darRveva, maT Soris, Saqriani diabetis tipi II-is
ganviTarebis risk-faqtori. amdenad, es pacientebi jamrTelobis dazianebis
seriozuli riskis qveS imyofebian. aseve, sayuradReboa is faqtic, rom
insulinrezistentoba SeiZleba aRiniSnebodes pacientebSi gamoxatuli
Warbi wonis gareSe cximis Warbi gadanawilebiT, rac miTumetes yuradRebis
gareSe rCeba. cnobilia, rom sisxlSi mocirkulire testosteronis
ZiriTadi nawili 80% SeboWilia seqssteroidSemboWvel globulinTan, 19%
- albuminTan da mxolod 1% cirkulirebs Tavisufal mdgomareobaSi.
seqssteroidSemboWveli globuliniT SeboWili steroidebi Znelad
misaRwevia samizne qsovilebSi SesakavSireblad da samoqmedod. samizne
ujredebSi biologiur efeqts axdens sasqeso hormonebis Tavisufali da
albuminTan SekavSirebuli fraqciebi. amdenad, androgenuli efeqti
korelirebs seqssteroidSemboWveli globulinis donesTan. mozrdil
qalebSi seqssteroidSemboWveli globulinis koncentracia 2-jer maRalia,
vidre mamakacebSi. es sqesobrivi gansxvaveba imiT aixsneba, rom estrogenebi
astimulireben, xolo androgenebi Trgunaven seqssteroidSemboWveli
globulinis produqcias [15,49,78]. am nivTierebis done sisxlSi iTvleba
androgenebsa da estrogenebs Soris biologiur makontrolirebel
faqtorad. seqssteroidSemboWveli globulini aris Sratismieri
glikoproteini, romelic warmoiqmneba RviZlSi. misi sinTezi da gamoyofa

7
regulirdeba garda sasqeso steroidebisa rigi sxva faqtorebiTac,
romelTagan zogierTi (Tireoiduli hormonebi, stresi, naxSirwylebis
maRali koncentracia) zrdis, xolo zogierTi (gacximovneba, insulini,
prolaqtini, zrdis hormoni, progesteroni, glukokortikoidebi) amcirebs
mis dones [6].

ginekologebis da reproduqtologebis mier xSir SemTxvevaSi ar eqceva

saTanado yuradReba hiperandrogenizmis mizezebis dazustebas da aseT
pacientebs Tavazoben ara eTiopaTigenezur, aramed simptomur mkurnalobas
antiandrogenebiT, rac dinamikaSi iwvevs arsebuli metaboluri darRvevebis
gaRrmavebas.

Tavisufali testosteroni yvelaze gavrcelebuli diagnostikuri markeria

qalebSi hiperandrogenemiiT, magram misi gansazRvra rutinulad yvela
laboratoriaSi ver xorcieldeba. Tavisufali testosteronis gansazRvris
“oqros standartia” wonasworobis dializis meTodi da amoniumiT
precipitacia. Tumca es meTodebi aris Zalian Sromatevadi,
ZviradRirebuli da moiTxovs maRal teqnikur kvalifikacias. axlaxans
Seqmnilia Tavisufali testosteronis gaangariSebis modelebi saerTo
testosteronis, seqssteroidSemboWveli globulinis da albuminis
maCveneblebis meSveobiT [151,153]. miuxedeavad SezRuduli korelaciebisa
yvela endokrinul parametrs da Tmianobis xarisxs Soris (aRwerili
feriman-galveis sqemis mixedviT) gaangariSebuli Tavisufali
testosteroni, biologiurad aqtiuri testosteroni da Tavisufali
androgenizaciis indeqsi SesaZloa iyos ufro adekvaturi markerebi
hiperandrogeniis Sesafaseblad qalebSi hirsutizmiT, vidre mxolod
androgenebis donis gansazRvra [106,109]. garda amisa, Tavisufali
testosteronis maCveneblis gansazRvra ar iZleva saSualebas dadgindes,
riT aris ganpirobebuli am maCveneblis mateba testosteronis sekreciis
matebiT Tu Tavisufali biologiurad aqtiuri fraqciis zrdiT
seqssteroidSemboWveli globulinis daqveiTebis fonze. amgvarad, mxolod
Tavisufali testosteronis maCveneblis gansazRvra ar iZleva
hiperandrogenizmis ganviTarebis meqanizmebis dadgenis saSualebas.
dReisaTvis metad aqtualuria hiperandrogenizmis klinikuri

8
gamovlinebebis Sesafaseblad ufro maRal informatiuli, uaxlesi
markerebis gamoyeneba adeqvaturi samkurnalo taqtikis SesamuSaveblad.

zemoT Tqmulidan gamomdinare kvlevis mizans warmoadgenda:

korelaciebis dadgena hiperandrogenizmis klinikur da hormonalur

maCveneblebs Soris axalgazrda qalebSi hiperandrogenizmiT gamovlenili
sxvadasxva endokrinul–ginekologiuri sindromebiT.

kvlevis amocanebi:

1. gaangariSebuli androgenuli parametrebis – Tavisufali

androgenebis indeqsis, gaangariSebuli Tavisufali da bioSeRwevadi
testosteronis da seqssteroidSemboWveli globulinis maCveneblebis
gansazRvris mniSvnelobis dadgena hiperandrogenizmis klinikuri
maxasiaTeblebis ganviTarebis meqanizmebis Sesafaseblad pacientebSi
sxvadasxva ginekologiur–endokrinuli sindromebiT (policistozuri
sakvercxeebis sindromi, adreno-genitaluri sindromis araklasikuri
forma, hiperprolaqtinemiis sindromi).

2. korelaciebis gamovlena hiperandrogenizmis klinikur gamovlinebebsa

da hormonul–androgenul maCveneblebs Soris axalgazrda qalebSi
etiopaTogenezurad gansxvavebuli sindromebiT.

3. visceraluri simsuqnis kavSiris dadgena hiperandrogenizmis

hormonul maCveneblebTan.

4. gaangariSebuli androgenuli parametrebis da imunofermentuli

meTodiT gansazRvruli Tavisufali testosteronis maCveneblebis
SesaZleblobis dadgena hiperandrogenizmis klinikuri simptomebis
SefasebaSi da hiperandrogenizmis meqanizmebis ganviTarebaSi.

9
naSromis mecnieruli siaxle:
pirvelad dadgenil iqna, rom gaangariSebuli androgenuli parametrebi –
Tavisufali androgenebis indeqsi, gaangariSebuli Tavisufali da
bioSeRwevadi testosteroni warmoadgens ufro adekvatur alternatiul
markerebs imunofermentuli meTodiT gansazRvrul Tavisufal
testosteronTan SedarebiT hiperandrogenizmis klinikuri maxasiaTeblebis
ganviTarebis meqanizmebis Sesafaseblad pacientebSi sxvadasxva
ginekologiur–endokrinuli sindromebiT (policistozuri sakvercxeebis
sindromi, adrenogenitaluri sindromis araklasikuri forma,
hiperprolaqtinemiis sindromi).
dadgenil iqna, rom gaangariSebuli androgenuli parameterebis
maCveneblebi da seqssteroidSemboWveli globulinis koncentracia ar
korelirebs hirsutizmis xarisxTan, rac SeiZleba ganpirobebuli iyos imiT,
rom hirsutizmis xarisxi damokidebulia ara mxolod androgenebis
koncentraciaze sisxlis SratSi, aramed Tmis folikulebis
mgrZnobelobaze androgenebis mimarT.
visceraluri simsuqnis mqone pacientebSi hirsutizmiT gamovlinda
gaangariSebuli androgenuli parameterebis statistikurad sarwmunod
maRali da seqssteroidSemboWveli globulinis koncentraciis
statistikurad sarwmunod dabali maCveneblebi im pacientebTan SedarebiT,
romelTac aReniSnebodaT ginoiduri simsuqne msgavsi xarisxis hirsutizmiT.
es albaT ukavSirdeba Homa-IR indeqsis ufro maRal maCvenebels
pacientebSi visceraluri simsuqniT da am fonze testosteronis
biologiurad aqtiuri fraqciis matebas.

gansxvavebiT sxva formebisagan, hirsutizmis mZime xarisxis SemTxvevebSi

gamovlinda gaangariSebuli Tavisufali testosteronis ufro mZlavri
diagnostikuri mniSvneloba imunofermentuli ELISA-meTodiT gansazRvruli
Tavisufali testosteronis maCvenebelTan SedarebiT.
dadginda, rom gaangariSebuli androgenuli parameterebis maCveneblebi da

10
naSromis praqtikuli Rirebuleba:

praqtikuli TvalsazrisiT metad mniSvnelovania kvleviT miRebuli

Sedegebi imis Sesaxeb, rom hiperandrogenizmis ganviTarebis meqanizmebis
dadgenisTvis mizanSewonilia gaangariSebuli androgenuli parameterebis,
rogoric aris gaangariSebuli Tavisufali testosteroni, bioSeRwevadi
testosteroni, seqssteroidSemboWveli globulinis maCveneblebis da
Tavisufali androgenebis indeqsis gansazRvra.
aseve metad mniSvnelovania praqtikuli TvalsazrisiT im faqtis dadgena,
rom axalgazrda qalebSi hirsutizmiT gaangariSebuli Tavisufali
testosteroni, bioSeRwevadi testosteroni, seqssteroidSemboWveli
globulini da Tavisufali androgenebis indeqsi ufro adekvaturi
alternatiuli markerebia hiperandrogenizmis Sesafaseblad, vidre mxolod
imunofermentuli ELISA-meTodiT gansazRvruli Tavisufali testosteronis
maCvenebeli.

11
 gamoqveynebuli Sromebis sia

1. Correlation of biochemical markers and clinical signs of hyperandrogenism in

women with Polycistic Ovary Syndrome (PCOS) and women with Non-classic
Congenital Adrenal Hyperplasia (NCAH). Iranian Journal of Reproductive
Medicine Vol. 10. N 4. July 2012.

2. Influence of abdominal obesity on the calculated androgen parameters in the

young women with different syndromes in Georgia // Proceedings Book of the
XV World Congress of Gynecological Endocrinology ―Gynecological
Endocrinology 2012‖. Firenze, March7-10; 2012.p.129-130.

3. hirsutizmi (literaturis mimoxilva). reproduqtologia 1

(40), 2011, gv. 30-34.

4. Effectivness of different diagnostic methods for assessment of

hyperandrogenism in young women with hirsutism. Georgian Medical News, N
12, 2011. P. 25-30.

5. Корреляции между клиническими и гормональными показателями у

девушек с гирсутизмом. Georgian Medical News, N 12, 2011, с. 30-35.

naSromis aprobacia

naSromis fragmentebis aprobacia ganxorcielda Tsu medicinis

fakultetis koloqviumebze (2011wl) da saerTaSoriso
samedicino konferenciaze “reproduqciuli medicinis
aqtualuri problemebi” 26.11.2011 wl. Tbilisi.

12
 თავი 1

ლიტერატურის მიმოხილვა

hiperandrogenizmi – qalebSi androgenebiT ganpirobebuli garegani

paTologiuri simptomebia: hirsutizmi, akne, seborea, alopecia da
virilizacia. hiperandrogenizmi ZiriTadad viTardeba sakvercxismieri an
Tirkmelzeda jirkvlebis androgenebis Warbi sekreciis Sedegad, rac
hiperandrogeniis terminiT aris cnobili. hiperandrogenizmis ganviTarebis
mTavar mizezs hiperandrogenia warmoadgens, Tumca SesaZloa androgenebis
done iyos normis farglebSi. hiperandrogenia Tanamedrove endokrinuli
ginekologiis mniSvnelovani problemaa. is reproduqciuli asakis qalebSi
reproduqciuli da menstruaciuli funqciis darRvevis (oligomenorea,
anovulacia, uSviloba) erT-erTi yvelaze xSiri mizezia. literaturis
monacemebiT hiperandrogenia vlindeba reproduqciuli asakis qalTa
daaxloebiT 7%-Si [19,54,92]. hiperandrogenemiis klinikur gamovlinebebs
pirvelad hipokratem miaqcia yuradReba. man aRwera ori qali kunZul
kosidan, romlebsac, gaezardaT wverebi. Sua saukuneebSi viliam keisma
(1520-1550 wl.) daxata qali wver-ulvaSiT. hiperandrogenizmis fenomenis
mecnieruli Seswavla me-XΙX saukuneSi daiwyo. 1866 w. moxsenebuli iyo
„mamrobiTi“ sqesis gvamis gakveTis angariSi, sinamdvileSi is aRmoCnda qali
mZime virilizaciiT da Tirkmelzeda jirkvlebis hiperplaziiT. 1935 w.
Steinma da leventalma aRweres sakvercxeebis policistozis sindromi.
Sroma exeboda sakvercxeebis policistozis kliniko-morfologiur
Taviseburebebs. maT mier gamoiTqva mosazreba, rom sakvercxeebis
policistozi aris hormonuli zemoqmedebis Sedegi [140]. hiperandrogeniis
mizezebia: policistozuri sakvercxeebis sindromi, hiperandrogenuli
insulin-rezistentuli acanthosis nigricans sindromi, adrenogenitaluri
sindromi (klasikuri da araklasikuri forma), kuSingis sindromi,
androgenmaproducirebeli simsivneebi (sakvercxis, Tirkmelzeda jirkvlis),

13
hiperprolaqtinemiis sindromi [25,31]. hiperandrogenizmis klinikuri
gamovlinebebis SemTxvevaTa 5-15 % aris idiopaTiuri. am dros aRiniSneba
mocirkulire androgenebis normaluri donis mimarT Tmis folikulebis
momatebuli mgrZnobeloba da romlis mizezi aris 5-α reduqtazas
aqtivobis mateba [21,35,42,161].

1.1 androgenebis biosinTezi

androgenebi - mamakacis sasqeso hormonebia, romlebic qimiuri

struqturis mixedviT C19 - steroidebs miekuTvnebian. qalis organizmSi
ZiriTadad sinTezirdeba Semdegi androgenebi: dehidroepiandrosteroni,
dehidroepiandrosteron-sulfati, androstendioni, androstendioli,
testosteroni da dihidrotestosteroni. cnobilia, rom qalis organizmSi
androgenebi ZiriTadad gamomuSavdeba sakvercxeebSi, Tirkmelzeda
jirkvlebis badisebur SreSi da periferiul qsovilebSi.
testosteronis 25%-i gamomuSavdeba sakvercxeebSi, 25%-i Tirkmelzeda
jirkvlebis mier da daaxloebiT 50%-i warmoiqmneba periferiul
qsovilebSi androstendionis konversiis Sedegad. androstendionis
sekreciis naxevari xdeba sakvercxeebSi, xolo meore naxevri Tirkmelzeda
jirkvlebSi [138]. qalis organizmis fiziologiaSi androstendioni
TamaSobs mniSvnelovan rols, rogorc testosteronis an estronis
prehormoni periferiul qsovilebSi.

Tirkmelzeda jirkvlebSi sinTezirdeba dehidroepiandrosteroni

(90%) da dehidroepiandrosteron – sulfati (100%) [99]. (ix.sur.1)

14
sur. 1

androgenebis dReRamuri sekrecia sakvercxeebis da Tirkmelzeda

jirkvlebis mier (Speroff L., Glass R.H., Kase N.G. Clinical Gynecologic Endocrinology and
Infertility. 5th ed., Williams & Wilkins, 1994; 487)

15
androgenebis steroidogenezi sakvercxeebSi da Tirkmelzeda jirkvlebSi
msgavsi biosinTezuri gzebiT mimdinareobs. androgenebis sawyisi
substrati - qolesterinia. misi androgenad gardaqmna xdeba ujredis
sxvadasxva warmonaqmnSi: mitoqondriebSi, mikrosomebSi, endoplazmur
badeSi da citozolSi rigi fermentebis zemoqmedebiT. pirvel etapze
Tanmimdevruli reaqciebis Sedegad xdeba pregnenolonis warmoqmna,
romelsac ar axasiaTebs biologiuri aqtivoba. pregnenolonidan
androgenebis warmoqmna xdeba ori gziT - Δ 5 da Δ 4. Δ 5 gziT pregnenoloni
17α-hidroqsilazis zemoqmedebiT gardaiqmneba 17α-pregnenolonad da
Semdgom 17,20-liazebis aqtivobiT transformirdeba
dehidroepiandrosteronad, romlisgan Tavis mxriv warmoiqmneba
epiandrostendioni da testosteroni. Δ 4-gziT androgenebis sinTezisas
pregnenoloni 3β-oldehidrogenazas zemoqmedebiT gardaiqmneba
progesteronad. progesteroni - pirveli bioaqtiuri hormonia
steroidogenezis jaWvSi. is 17αα–hidroqsilazis meSveobiT gardaiqmneba
17α-oqsiprogesteronad, romelic Semdgom aseve testosteronad da
androstendionad gardaiqmneba. androgenebis biosinTezis erTi gzidan
meore gzaze gadasvla SesaZlebelia nebismieri Sualeduri produqtis
doneze anu xdeba e.w. Δ5 da Δ4 gzebis Suntireba. androgenebis
biosinTezis orive gza warmoebs, rogorc sakvercxeebSi, ise Tirkmelzeda
jirkvlebSi, magram Δ5 gza upiratesad Tirkmelzeda jirkvlebSi, xolo
Δ4 gza - sakvercxeebSi mimdinareobs [138].

16
androgenebis biosinTezis sqema (cvlilebebiT ) Speroff L., Glass R.H., Kase N.G. Clinical
Gynecologic Endocrinology and Infertility. 5th ed., Williams & Wilkins, 1994; 333)

aRsaniSnavia, rom qalebSi androgenebis warmoqmnis ZiriTadi gzaa -

testosteronis periferiuli sinTezi. swored periferiaze - kanSi,
cximovan qsovilSi, RviZlSi da kunTebSi xdeba androstendionis
gardaqmna testosteronad. amas amtkicebs is faqti, rom saerTo
testosteronis ≈50% warmoiqmneba kanSi, gansakuTrebiT cximovan
jirkvlebSi da Tmis folikulebSi [121].

17
Semdgom etapze testosteroni SesaZlebelia „gaaqtiurdes“ da
5α-reduqtazas meSveobiT gardaiqmnas 5α–dihidrotestosteronad
(5α –DHT) an „inaqtivirdes“ anu aromatazas zemoqmedebiT gardaiqmnas
estrogenad [65].

5 α - reduqtaza - enzimia, romelic awarmoebs testosteronis konversias

5α-DHT -ad. testosteronis konversia 5α–DHT-ad zrdis androgenul efeqts
2 meqanizmiT: 1) 5α–DHT – testosteronisgan gansxvavebiT, ver aromatizirdeba
estrogenad da amgvarad misi efeqti absoluturad androgenulia da
2) in vitro 5α–DHT ukavSirdeba androgenul receptorebs ufro Zlierad vidre
testosteroni da 5α–DHT/androgenis receptoris kompleqsi ufro
stabiluria [14]. bolo oci wlis ganmovlobaSi molekuluri kvlevebiT
gamoiyo 5α- reduqtazas ori izoenzimi: tipi 1 da tipi 2 lokalizebuli
sxvadasxva qromosomebze. maT axasiTebT sxvadasxvagvari bioqimiuri
Tvisebebi da qsovilebSi gadanawileba [17]. 5α-reduqtazas orive izoenzimis
aqtiuroba farTod gavrcelebulia mTel sxeulze, Tumca Tanamedrove
kvlevebiT dadginda, rom tipi 2 izoenzimi dominirebs saTesleebSi,
winamdebare jirkvalSi, wver-ulvaSis da genitaluri Tmebis folikulebSi
[144]. zogierTi mklevari aRniSnavs, rom Tavis Tmis folikulebSi
mxolod tipi 2 5α-reduqtazaa, xolo tipi 1 da tipi 2 warmodgenilia

adamianis cximovan jirkvlebSi [29]. 5α –DHT - metabolizdeba naklebad

potentur androgenebad: 3-α da 3β-androstendionad,

3-α და 3-β-glukuronidebad. es reaqcia katalizdeba kanSi enzim

3α-hidroqsisteroid dehidrogenazas (3α–HSD) aqedan gamomdinare, es enzimi
SesaZloa iyos DHT-is donis mniSvnelovani regulatori [115]. zogierTi
kvleviT hirsutizmis dros 3α-androstendiol glukuronidis done
mniSvnelovanad momatebulia da warmoadgens testosteronis periferiuli
metabolizmis Sesafasebel kriteriums [65].

18
1.2 hirsutizmi

hiperandrogenizmis erT-erTi xSiri klinikuri gamovlinebaa - hirsutizmi

anu paTologiuri Tmianoba. R.Azziz da Tanaavtorebis mier Catarebul
kvlevaSi, romelSic monawileobda 800 qali hiperandrogeniiT, hirsutizmi
gamouvlinda 75%-s, romelTa Soris 4%-s aReniSneboda Tmis cvena, xolo
4,8%-s akne [22].

qalebSi arsebobs paTologiuri Tmianobis ori forma - hirsutizmi da

hipertriqozi.

hipertriqozi - androgendamoukidebeli memkvidruli faqtorebiT

ganpirobebuli Warbi gaTmianebaa qalebisTvis damaxasiaTebel adgilebSi.
aseT SemTxvevaSi Tmis sigrZe da sisqe matulobs. izolirebuli
hipertriqozi ar warmoadgens hiperandrogeniis simptoms Tumca, SesaZloa
misi arseboba hirsutizmTan erTad hiperandrogeniis dros [129].

hirsutizmi - paTologiuri Tmianobaa (terminaluri Tma) mamakacisaTvis

damaxasiaTebel adgilebSi (zeda tuCze, nikapze, mkerdze, mucelze, welze)
da aReniSneba qalebis 5 – 10 %-s [22,85]. hirsutizmi ar aris daavadeba.
is endokrinologiur ginekologiaSi yvelaze xSiri simptomia, radganac
xSirad Tan axlavs iseT paTologiebs rogoricaa: policistozuri
sakvercxeebis sindromi, insulinrezistentuli metaboluri sindromi,
adrenogenitaluri sindromi, hiperprolaqtinemiis sindromi,
androgenmaproducirebeli simsivneebi da a.S [3].

Baron-is mier 15-19 wlis hirsutizmis mqone gogonebSi Catarebuli kvleviT

gamovlinda,rom hirsutizmis mizezi SemTxvevaTa 72,4%–Si aris sakvercxeebis
policistozi, 24,1%–Si – adrenogenitaluri sindromis araklasikuri
(gvian gamovlenili) forma da 3,4%-Si aris adrenogenitaluri sindromis
klasikuri forma [27].

Moran da Tanaavtorebis kvlevis Tanaxmad, 13-38 wlamde asakobriv jgufSi

hirsutizmis mizezi SemTxvevaTa 53%-Si sakvercxeebis policistozi, 18%-Si -
simsuqne, 2%-Si – adrenogenitaluri sindromis postpubertatuli forma,

19
0,8%-Si - sakvercxeebis simsivne da 0,4%-Si - kuSingis sindromi an
specifiuri medikamentebis miReba iyo [104].

qalebSi, garda samedicino problemisa, hirsutizmi iwvevs stress,

aqveiTebs cxovrebis xarisxs da fsiqoemociur ganviTarebas [125].

sxvadasxva avtorebi aRniSnaven, rom hirsutizmi azielebSi SedarebiT

iSviaTia, Tundac saxeze iyos metaboluri da endokrinuli darRvevebi
[18,38,63]. magaliTad, iaponel qalebs dadasturebuli hiperandrogeniiT
naklebad aReniSnebaT androgenizaciis movlenebi, vidre CrdiloeT amerikis
an italiel qalebs hiperandrogeniis igive xarisxiT [38,51]. nebismieri
Savgremani, SavTmiani qalebi ufro midrekili aris hirsutizmisken, vidre
TeTrkaniani qera qalebi [28].

50 milionamde Tmis folikuli faravs mTel sxeuls. maTgan 100,000- dan

150,000-de Tavzea, xolo danarCeni folikulebi saxeze da sxeulis sxva
nawilebzea. Tmis folikulebi ar aris mxolod fexis, xelis gulebze da
tuCebze. Tmis folikulebis umravlesoba viTardeba mucladyofnisas
gestaciis me-9-12 kvireebs Soris, xolo Tmis zrda iwyeba me-16-20 kviraze.
dabadebis Semdeg viTardeba SedarebiT mcire axali Tmis folikulebi da
maTi raodenoba qveiTdeba 40 wlis Semdeg. Tmis zrda moicavs
ganviTarebis 3 fazas. pirveli fazis (anageni) ganmavlobaSi Tmis Rero
aqtiurad izrdeba. anagenis fazis xangrZlivoba ZiriTadad damokidebulia
individualuri Tmis srul sigrZeze. meore fazaSi (katageni) Tmis zrda
wydeba, Tmis folikuli gadadis e.w. „mZinare mdgomareobaSi“. Tmis bolqvi
TandaTanobiT wydeba dvrils. katagenis faza Zalian xanmoklea daaxloebiT
3-4 kvira. mesame (telogeni) fazaSi Zveli Tma cviva da axali iwyebs
zrdas. am drois ganmavlobaSi Tmis folikulSi ujredebis ganaxleba
Sewyvetilia (daaxloebiT 3 Tve). axalad sinTezirebuli Tmis folikuli
uerTdeba Tmis dvrils da axali Tma Sedis anagenis fazaSi. TiToeul Tmas
aqvs cxovrebis „individualuri gegma“. amitomac sxvadasxva Tma erTsa da
imave dros aris ganviTarebis ciklis sxvadasxva stadiaSi, kerZod: 85% -
aqtiuri zrdis fazaSi (anagenSi), 1% - mosvenebis fazaSi (katagenSi), 14%-
cvenis fazaSi (telogenSi) [21]. struqturulad gamoyofilia Tmis 3 saxeoba:

20
Canasaxovani RinRli, RinRli da terminaluri Tma. Canasaxovani RinRli
rbili, arapingmentirebuli Tmaa, romelic faravs nayofis da axalSobilis
kans. RinRlic, aseve rbili da arapigmentirebuli Tmaa, xolo terminaluri
Tma - uxeSi, grZeli da pigmentirebulia. misgan Sedgeba Tavis Tma, warbebi,
wamwamebi, boqvenis da iRliis fosos Tmebi orive sqesis warmomadgenlebSi,
xolo mamakacebSi is ganviTarebulia aseve sxeulze da saxeze.

1.3 seborea da akne

mTel rig avtorTa monacemebiT [56,66] seborea da acne vulgaris

ganpirobebulia Tirkmelzeda jirkvlismieri hiperandrogeniiT -
dehidroepiandrosteron da dehidroepiandrosteron-sulfatis sekreciis
momatebiT. am hormonebs gaaCniaT tropizmi kanis cximovani jirkvlebis
mimarT da amdenad, maTi hipersekrecia ganapirobebs kanis cximovan
jirkvlebSi cximis Warb warmoebas [113,145]. seboreazea dafuZvnebuli aknes
ganviTareba, romelic multifaqtoruli hormondamokidebuli paTologiaa,
romelic warmoadgens cximovani jirkvlebis gamomtani sadinrebis
hiperkeratozis da cximis Segubebis Sedegad formirebul komedons. aknes
korinobaqteriis zemoqmedebiT viTardeba perifokaluri aseptiuri anTeba.
gamomdinare iqidan, rom DHEA-S da DHEA umTvresad gamomuSavdeba
Tirkmelzeda jirkvalSi akne da seborea Tirkmelzeda jirkvlismieri
hiperandrogeniis klinikur markerad iTvleba. Tumca, zogierTi avtoris
mier aRniSnulia, rom am simptomebis gamovlinebaze pasuxismgebelia
testosteronic.

avtorTa sxva jgufi aRniSnavs, rom aknes verifikacia hiperandrogenizmis

dros ar aris specifiuri simptomi, radganac is mozardebis 50%-s
aReniSneba da xSirad mxolod kosmetikuri problemaa. amavdroulad,
policistozuri sakvercxeebis sindromis diagnoziT pacientTaA 45%-s
aReniSneboda akne. Ees faqti miuTiTebs, rom hiperandrogenizmis dasadgenad
akne mniSvnelovani simptomia, magram gasaTvaliswinebelia aknes
ganviTarebis asaki da ganviTarebis paTogenezi [11].

21
1.4 hiperandrogenezmis meqanizmebi

Tmis tipis da sxeulze ganawilebis gansazRvraSi androgenebi mTavar

rols TamaSobs. androgenebis zemoqmedebiT: Zlierdeba epidermisis
ujredebis mitozuri aqtivoba da diferencireba, matulobs ujredSorisi
lipidebis sinTezi, izrdeba epidermaluri Sris sisqe, xdeba Tmis zrdis da
pigmentaciis stimulacia, matulobs kanis cximianoba da qveiTdeba
seqssteroidSemboWveli globulinis (ssSg) sinTezi RviZlSi. avtorebi
Tvlian, rom testosteronis gansazRvra adekvaturad asaxavs qalis
organizmSi sasqeso da Tirkmelzeda jirkvlebis androgenul funqcias,
androgenizaciis xarisxs, magram ar gvaZlevs saSualebas vimsjeloT
androgenebis wyaroze da mis mimarT samizne ujredebis mgrZnobelobaze
[53,115]. Tavisufali testosteroni yvelaze gavrcelebuli diagnostikuri
markeria qalebSi hiperandrogeniiT, magram misi gansazRvra rutinulad
yvela laboratoriaSi ara ganxorcielebadia. Tavisufali testosteronis
gansazRvris “oqros standartia” wonasworobis dializis meTodi da
amoniumiT precipitacia. Tumca es meTodebi aris Zalian Sromatevadi,
ZviradRirebuli da moiTxovs maRal teqnikur kvalifikacias. axlaxans
Seqmnilia Tavisufali testosteronis gaangariSebis modelebi saerTo
testosteronis, seqssteroidSemboWveli globulinis da albuminis
maCveneblebis meSveobiT [109]. Tavisufali testosteronis gamoTvla
SesaZlebelia veb–saitze http://www.issam.ch/freetesto.htm A.Vermeulen at al.
monacemebiT am programiT miRebuli Tavisufali da bioSeRwevadi
testosteronis monacemebi dadebiTad korelirebda wonasworobis dializis
da mas–speqtrometriiT miRebul monacemebTan [153]. miuxedeavad SezRuduli
korelaciebisa yvela endokrinul parametrsa da Tmianobis xarisxs Soris
(aRwerili feriman-galveis sqemis mixedviT) gaangariSebuli Tavisufali
testosteroni, bioSeRwevadi testosteroni da Tavisufali
androgenizaciis indeqsi SesaZloa iyvnen ufro adekvaturi markerebi
hiperandrogeniis Sesafaseblad qalebSi hirsutizmiT, vidre mxolod
androgenebis gansazRvra [108]. Tirkmelzeda jirkvlebis da sakvercxeebis
saerTo embriologiuri warmoSoba, steroidogenezSi analogiuri
fermentebis monawileoba da Tirkmelzeda jirkvlis paTologiis dros

22
sakvercxeebis paTologiur procesSi meoradad CarTvis SesaZlebloba,
arTulebs androgenebis hipersekreciis wyaros dadgenas. dReisaTvis
dadasturebulia genetikuri kavSiri Tirkmelzeda jirkvalsa da sakvercxes
Soris. dadgenilia orive jirkvalSi androgenebis biosinTezis
garkveulwilad identuri mimdinareoba zogierTi analogiuri fermentis
monawileobiT. aqedan gamomdinare, Tirkmelzeda jirkvlis qerqis
funqciuri mdgomareobis cvlileba SeiZleba aisaxos sakvercxis funqciaze
da piriqiT [9,10].

aRwerilia oTxi saxis meqanizmi, romelic marTavs Sereuli, adreno-

ovariuli hiperandrogeniis ganviTarebas [8,10,128].

1) ferment - 3β-hidroqsisteroiddehidrogenazas aqtivobis daqveiTeba,

romelic gvxvdeba rogorc sakvercxeebSi, aseve Tirkmelzeda jirkvalSi;
2) Tirkmelzeda jirkvlis steroidogenezSi monawile fermentebis
aqtivobis daqveiTeba sakvercxismieri androgenebiT;
3) Tirkmelzeda jirkvlis androgenebis zemoqmedebiT sakvercxeebis
policistozis ganviTareba;
4) sakvercxeSi Tirkmelzeda jirkvlis hormonebis eqtopiuri sekrecia
maTSi Tirkmelzeda jirkvlis narCeni qsovilebis arsebobis gamo.

1.5 androgenebis transportireba

mocirkulire androgenebis didi nawili aris SeboWili plazmis

specifiuri proteinebiT, rogorebicaa: seqssteroidSemboWveli globulini,
kortizolSemboWveli globulini da albumini. testosteronis 80%
SeboWilia seqssteroidSemboWveli globuliniT (ssSg), 19% - albuminiT
da mxolod 1% cirkulirebs Tavisufal mdgomareobaSi [131]. hirsutizmis
dros Tavisufali testosteronis done xSirad momatebulia, maSin rodesac
saerTo testosteronis done SesaZlebelia iyos normis farglebSi [129].
hirsutizmian qalebSi es ganpirobebulia ssSg-is SedarebiT dabali doniT.
seqssteroidSemboWveli globulini (ssSg) warmoiqmneba RviZlSi [91,72] da
gamoiyofa sisxlSi. is warmodgens sasqeso steroidebis moqmedebis
modulators. ssSg-is koncentracia sisxlSi sasqeso hormonebis

23
fiziologiuri moqmedebis da samizne qsovilebSi maTi SeRwevis ZiriTadi
gadamwyveti faqtoria [134]. ssSg-s geni lokalizebulia me-17 qromosomis,
mokle mxris p12-p13 lokusze. ssSg-i pirvelad identificirebuli iyo,
rogorc β-globulini, romelic boWavs 17β-estradiols da testosterons
adamianis sisxlis plazmaSi [89,94,126,132,153]. janmrTel qalTa populaciaSi
ssSg-is dones axasiaTebs didi cvalebadoba, rac nawilobriv axsnilia
genetikuri foniT an TviT hormonis garemos da kvebis SecvliT [77,131].
aRsaniSnavia, rom qalebSi ssSg-s donis cvalebadoba aseve nawilobriv
asocirebulia adamianis Shbg genSi lokalizebul kodificirebul da
arakodificirebul Tanmimdevrobebis polimorfizmTan da mutaciebTan
[78,79].

orive sqesis adamianebSi ssSg-is done dabadebisas Zalian dabalia.

sicocxlis pirveli kvireebis ganmavlobaSi misi done iwyebs matebas
da daaxloebiT 2-3 TvisTvis aRwevs mudmiv dones. pubertatis
periodisTvis, rodesac mdedrobiTi da mamrobiTi sqesis mozardebSi
iwyeba sasqeso steroidebis mateba, ssSg-s koncentracia SesamCnevlad
ecema mamakacebSi da SedarebiT mcired qalebSi. es sqesobrivi dimorfizmi
narCundeba mamakacebSi 60 wlamde, xolo qalebSi - postmenopauzamde.
Semdgom ssSg-s done mamakacebSi umniSvnelod matulobs da qalebSi
klebulobs [15,36]. orsulobis dros ssSg-s koncentracia sisxlSi 7-jer
matulobs. tradiciulad miCneuli iyo, rom androgenebi Trgunaven, xolo
estrogenebi astimulireben ssSg-is gamomuSavebas RviZlSi. estrogenebis
oraluri an transdermaluri daniSvna mniSvnelovnad zrdis ssSg-is dones,
magram mkurnalobis Sewyvetis Semdeg is ubrundeba bazalur dones [146].
iTvleba, rom hiperandrogenia ar warmoadgens ssSg-is koncentraciis
daqveiTebis mizezs. gonadotropin-rilizing hormonis agonistebiT
androgenebis sinTezis daTrgunvisas ssSg-is koncentracia ar icvleboda.
diazoqsidiT insulinis donis daqveiTebis Semdeg aRiniSneboda ssSg-is
koncentraciis mateba. am faqts adastureben sxva mklevarebic [62,112,118].
aRsaniSnavia, rom msuqan mozard gogonebSi ssSg-s dabali koncentracia
miuTiTebs uaryofiT kavSirze sxeulis masis indeqsis matebas da insulinis
sekrecias Soris [50,119]. aseve naadrevi pubarxes dros dasabuTebulia

24
momatebuli androgenizaciis da insulin rezistentobis ganviTarebis riski
[84]. Pierre-Henri Ducluzeau da Tanaavtorebis monacemebiT pacientebSi
normaluri sxeulis masiT da policistozuri sakvercxeebis sindromiT
insulinrezistentoba da glukuzo/insulinis Tanafardoba aris myar
kavSirSi ssSg-s donesTan. insulinrezistentobis xarisxzea damokidebuli
ssSg-is done [57].

G.Cross da Tanaavtorebis azriT ssSg-is done SesaZloa monawileobdes

hirsutizmis ganviTarebaSi mozardobis asakSi da ara prepubertatul da
zrdasrul asakSi. maTi kvlevis Tanaxmad 13-14 wlis gogonebSi
mocirkulire androgenebis da ssSg-is koncentracia msgavsi iyo, rogorc
hirsutizmis mqone jgufSi, aseve sakontrolo jgufSi. 15-16 wlis gogonebSi
ssSg-is done hirsutizmis mqone gogonebis jgufSi mniSvnelovnad dabali
iyo sakontrolo jgufTan SedarebiT, amave dros androgenebis
koncentracia orive jgufSi msgavsi iyo. mozrdil qalebSi ki ssSg-is
koncentracia hirsutizmis mqone jgufSi umniSvnelod iyo daqveiTebuli

[46].

pacientebSi izolirebuli hirsutizmiT an akneTi nanaxia sarwmunod

daqveiTebuli ssSg-is done. Tavisufali testosteronis da testosteron
/ssSg-is Sefardeba ufro maRalia vidre sakontrolo jgufSi, Tumca
sarwmuno statistikuri sxvaoba jgufebs Soris nanaxi ar iyo [145].

1.6 policistozuri sakvercxeebis sindromi

hiperandrogenia da hirsutizmi yvelaze xSirad viTardeba policistozuri

sakvercxeebis sindromis dros. Azziz R. da Tanaavtorebis kvlevis Tanaxmad
hiperandrogeniis klinikuri gamovlinebebis mqone 878 qalTa 82%-s
aReniSneboda sakvercxeebis policistozi [22].

policistozuri sakvercxeebis sindromis dros hirsutizmi aRiniSneba

SemTxvevaTa 75%-Si, xolo araregularuli menstruaciuli ciklis dros
hirsutizmi gamovlinda SemTxvevaTa 75%-90%-Si [22,45]. hirsutizmi sxvadasxva

25
xarisxiT manifestirdeba. zogierT pacients paTologiuri Tmianoba ar
aReniSneba, rac SeiZleba aixsnas periferiuli qsovilebis mgrZnobelobis
daqveiTebiT androgenebis mimarT [4,98].

sakvercxeebis policistozi - xSiri endokrinuli sindromia, romelic

vlindeba reproduqciuli asakis qalTa 5-10%-Si [54,58]. roterdamis
konferenciis (2003) Tanaxmad sakvercxeebis policistozis
diagnostirebisTvis SeTavazebulia Semdegi kriteriumebi, romlebidanac
2 mainc unda iyos dadebiTi: 1. oligomenorea da/an anovulacia 2. sisxlSi
androgenebiss donis mateba da/an hiperandrogeniis klinikuri
gamovlinebebi da 3. policistozuri sakvercxeebi dadgenili ultrabgeriTi
kvleviT. amave dros unda iyos gamoricxuli yvela sxva SesaZlo mizezi,
romelsac axasiaTebs araregularuli menstruaciuli cikli da
hiperandrogenia (adrenogenitaluri sindromi, kuSingis sindromi,
androgenmaproducirebeli simsivne) [142]. amJamad cnobilia, rom qalebs
regularuli cikliT, hiperandrogeniiT da/an policistozuri
sakvercxeebis ultrabgeriTi suraTiT sakvercxeebis policistozis
sindromis diagnozi udgindebaT. aseve aRsaniSnavia, rom zogierT qals
sakvercxeebis policistozis sindromiT aReniSnebaT policistozuri
sakvercxeebi, sakvercxeebis disfunqcia da ar aRniSnebaT hiperandrogeniis
klinikuri gamovlinebebi [39]. qalebSi sakvercxeebis policistoziT
daaxloebiT 35%-Si aRiniSneba saerTo testosteronis, 70%-Si Tavisufali
testosteronis da 25%-Si dehidroepiandrosteron-sulfatis donis mateba
[20]. Tavisufali testosteroni yvelaze mgrZnobiarea bioqimiurad
hiperandrogeniis gamosavlenad qalebSi [136]. aRsaniSnavia, rom androgenebis
gansazRvra, Tavisufali testosteronis CaTvliT aris sakvercxeebis
policistozis diagnostirebis nawili da ara erTaderTi kriteriumi.
androgenebis gansazRvra mniSvnelovania hiperandrogeniis
diagnostirebisTvis pacientebSi hiperandrogeniis klinikuri
gamovlinebebis gareSe, rogorebicaa mag: mozardebi, azielebi da sxva
qalebi msubuqi hirsutizmiT [35].

literaturaSi arsebuli monacemebiT hiperandrogenia sakvercxeebis

policistozis dros warmoiSveba sakvercxis Teka ujredebSi CP17α-s

26
Tandayolili defeqtis Sedegad. CP17α (citoqrom P450C17α) - enzimia,
romelic akatalizebs 2 sxvadasxva SenaerTs: 17α- hidroqsilazas da 17, 20-
liazebs, romlebic sakvercxismieri androgenebis sekreciis mTavari
„gasaRebebia“. 17α-hidroqsilaza progesterons gardaqmnis
17α-hidroqsiprogesteronad, romelic 17,20-liazebis zemoqmedebiT
gardaiqmneba androstendionad, xolo androstendioni 17β-reduqtazas
zemoqmedebiT gardaiqmneba testosteronad [128,141]. In vitro, policistozuri
sakvercxeebis Teka ujredebSi, normalur sakvercxeebTan SedarebiT,
vlindeba 17α-hidroqsilazis, 17,20-liazebis da
3β-hidroqsisteroiddehidrogenazas momatebuli aqtivoba, rac umeteswilad
xsnis hiperandrogenias policistozuri sakvercxeebis sindromis dros
[111,157].

cnobilia rom, sakvercxismieri androgenebis gamoyofas aseve astimulirebs

maluTinizirebeli hormonis (mlh) Warbi sekrecia, romelic Tavis mxriv
aaqtivebs CP17α-s. mlh hipersekrecia sakvercxeebis policistozis
erT-erTi paTognomuri niSania da vlindeba SemTxvevaTa 40-80%-Si. mlh-is
hipersekreciis ganviTarebis mravali Teoria arsebobs, Tumca arcerTi ar
aris srulad dasabuTebuli [13,159]. mlh-is koncentraciis momatebis fonze
folikulmastimulirebeli hormonis (flh-is) koncentracia normaSi an
daqveiTebulia. Barnes-i da Tanaavtorebi [26] TavianT naSromSi miuTiTeben
gonadotropinebis centralur rolze androgenebis sinTezSi sakvercxeebis
policistozis dros. aseve gamovlinda, rom mlh-is stimulaciis sapasuxod,
matulobs 17α-hidroqsiprogesteronis da androstendionis sinTezi.
Minnanni-მ da Tanaavtorebma TavianT naSromSi gamoavlines dadebiTi
korelacia mlh-s da saerTo testosterons Soris sakvercxeebis
policistozis dros miuxedavad wonisa, rac miuTiTebs mlh-is wamyvan
rolze sakvercxeebis policistozis dros [101]. es kvlevebi Seesabameba
klinikur dakvirvebebs qalebze sakvercxeebis policistoziT, sadac mlh-is
done dadebiTad korelirebs mocirkulire testosteronis

koncentraciasTan [98]. sakvercxeebis policistozis GnRH-agonistebiT

mkurnalobis Semdeg mlh-s done klebulobs da Sesabamisad klebulobs

27
androgenebis done da hirsutizmis xarisxic [43]. amgvarad, mlh-s maRal
dones SeiZleba hqondes wamyvani roli hiperandrogeniis ganviTarebaSi.
Tumca aqve aRsaniSnavia, rom Teka ujredebis funqciis Seswavlis
safuZcelze Gilling-Smith da Tanaavtorebi [73] mividnen sawinaarmdego
daskvnamde, rom gonadotropuli funqciis daTrgunva ar aqveiTebs
androgenebis sinTezs Teka ujredebSi sakvercxeebis policistozis dros.
avtorebma gamoTqves mosazreba androgenebis avtonomiuri sekreciis
Sesaxeb.

wlebis manZilze policistozuri sakvercxeebis sindromis diagnozis

mTavar kriteriumad iTvleboda mlh/flh-is Tanafardobis gazrda ( >3-2,5 ).
magram, Dunaif da Tanaavtorebi [58] miiCneven, rom mlh/fmh Tanafardobis
gansazRvra ar unda iyos Setanili policistozuri sakvercxeebis
sindromis diagnozis kriteriumebSi. Mmlh da flh sekrecia xasiaTdeba
pulsaciuri riTmiT da hormonebis erTjeradi gansazRvra ar asaxavs mlh-is
donis da mlh/flh Tanafardobis realur suraTs.

policistozuri sakvercxeebis sindromiis dros xSirad mlh-s done normis

farglebSia, rac metyvelebs imaze, rom sxva faqtorebsac Seaqvs wvlili
hiperandrogeniis ganviTarebaSi. am faqtorebs Soris yvelaze
mniSvnelovania - insulini. jer kidev 1921 wels Archard-ma da Thiers-ma
SeniSnes kavSiri hiperandrogeniasa da naxSirwylebis cvlis darRvevas
Soris. am paTologias ewoda „wveriani qalebis diabeti“. 1980 w. Burghen,
Givens da Tanaavtorebma aRweres kavSiri hiperinsulinemiasa da hirsutizms
Soris qalebSi sakvercxeebis policistoziT. receptorebi insulinis
mimarT lokalizebulia sakvercxis Teka ujredebze, rogorc janmrTl,
aseve policistozuri sakvercxeebis sindromis mqone qalebSi. insulini
moqmedebs sakvercxeebze Tavisi receptorebis meSveobiT [60,158]. janmrTeli
sakvercxis Teka qsovilis in vitro SeswavliT daadgines, rom insulins
SeuZlia androgenebis sekreciis gazrda rogorc mlh-iT stimulaciis
sapasuxod, aseve damoukidebli moqmedebiT [30]. aRwerilia ramodenime
sindromi, romlis drosac aRiniSneba insulinrezistentobis da
hiperandrogeniis Tanxvedra. maTgan yvelaze xSirad gvxvdeba sakvercxeebis
policistozi. Tumca hiperandrogeniis da hiperinsulinemiis
28
urTierTmoqmedebis meqanizmebi bolomde Seswavlili ar aris. Teoriulad
SesaZloa maTi urTierTkavSiris ramodenime varianti: hiperandrogenia
ganapirobebs hiperinsulinemias, hiperinsulinemia ganapirobebs androgenebis
donis zrda da arsebobs sxva, mesame faqtori, romelic pasuxismgebelia
orive fenomenze [14]. sayuradReboa, is faqtic, rom literaturaSi arsebuli
monacemebiT insulinrezistentoba ganpirobebulia insulinis receptoris
autofosforilirebis darRveviT [13]. In vitro da in vivo kvlevebiT
sakvercxeebis policistozis mqone pacientTa naxevarSi adgili aqvs
serinofosfolirebis process insulinis receptorSi, rac signalis
Semdgom gadacemas aferxebs. mTeli rigi avtorebi amtkiceben, rom
serinofosfolireba warmoadgens erT-erT mTavar meqanizms ferment
citoqrom P450C 17α-hidroqsilazas gaaqtiurebaSi, romelic, rogorc
aRvniSneT, mniSvnelovani fermentia androgenebis sinTezis zrdaSi, rogorc
sakvercxeebSi, aseve Tirkmelzeda jirkvalSi [30,60]. rogorc cnobilia,
insulini sakvercxeze moqmedebs ara mxolod insulinis receptorebis
meSveobiT, aramed insulinismagvari zrdis faqtoris (i.m.z.f.)
receptorebiTac. insulinisgan gansxvavebiT, romelic sinTezirdeba
pankreasis da tvinis zogierTi midamos mier, imzf-1 gamomuSavdeba TiTqmis
yvela qsovilebSi ganviTarebis sxvadasxva periodSi. kerZod, sakvercxeebSi
imzf-1-is ZiriTadi sinTezi mimdinareobs granulozas ujredebSi.
granulozas ujredebSi insulini da imzf-1 zrdis bazalur da aseve
gonadotripinebiT da cikliuri adenozinmonofosfatis (camf) mier
stimulirebuli progesteronis da estrogenebis dones, aZlierebs
citoqromis enzimuri sistemis aqtivobas, zrdis mlh-is receptorebis
raodenobas da simWidroves. cnobilia, rom insulini da imzf-1 mlh-is
meSveobiT zrdian androgenebis sekrecias sakvercxeebis stromis da Teka
ujredebis mier, rac iwvevs hiperandrogenias da folikulebis kistozur
atrezias. Tirkmelzeda jirkvlebSi imzf-1 zemoqmedebiT izrdeba
badiseburi zonis ujredebis mgrZnobeloba adrenokortikotropuli
hormonis mimarT. aseve, aRsaniSnavia, rom insulinis Seyvana Tirkmelzeda
jirkvlebis ujredebSi ganapirobebs maT mier steroidebis sinTezis zrdas
androgenebis dagrovebis upiratesobiT, 17α-hidroqsilazis da
17,20-desmolazis aqtiurobis matebis xarjze [6]. albaT, amiT SeiZleba iyos

29
axsnili sakvercxismieri da Tirkmelzeda jirkvlismieri hiperandrogeniis
xSiri Tanxvedra. amave dros, policistozuri sakvercxeebis struqtura
damtkicebuli insulinrezistentobis da hiperinsulinemiis dros aReniSneba
mxolod pacientTa 13,1%-s. Sesabamisad sakvercxeebis policistozis
ganviTarebisTvis garda arsebuli insulinrezistentobisa unda arsebobdes
genetikuri ganwyoba am daavadebis mimarT [2]. insulins SeuZlia pirdapir
RviZlSi daTrgunos seqssteroidSemboWveli globulinis sekrecia, ris
Sedegadac sisxlSi matulobs Tavisufali testosteronis done da
vlindeba hiperandrogeniis simptomebi. sakvercxeebis policistozis mqone
pacientebSi miuxedavad wonisa ssSg-is koncentracia gacilebiT dabalia
sakontrolo jgufTan SedarebiT. es kanonzomiereba ufro gamokveTilia -
cximovani qsovilis matebasTan erTad. rac ufro metia sxeulis masis
indeqsi miT ufro dabalia ssSg-is koncentracia sisxlSi [106]. Tumca, sxva
kvlevis monacemebiT, romelSic monawileobas iRebda qalTa 2 jgufi - 21
qali sakvercxeebis policistoziT da sakontrolo jgufis 17 qali - ssSg-
is koncentraciis mixedviT sarwmuno sxvaoba ar gamovlinda [49].

Kajaia da Tanaavtorebis kvlevis SedegebiT ssSg-is done SeiZleba

gamoyenebuli iyos insulinrezistentobis sadiagnostiko markerad yvela
qalSi hiperandrogeniiT, ukeTesi korelaciiT Warbi wonis dros [88]. am
monacemnebs eTanxmeba sxva avtorebis monacemebic, Tumca es kvlevebi
moicavs pacientebis mcire jgufebs [32,86].

ssSg-is koncentracia gansxvavdeba qalebSi da mamakacebSi, amitom Saqriani

diabetis tipi 2 ganviTarebis riski SesaZloa gansxvavdebodes sqesis
mixedviT. korelaciuri kavSiri ssSg-is dabal donesa da Saqriani diabetis
tipi 2 ganviTarebis risks Soris, rogorc ukve cnobilia, ufro Zlieria
qalebSi, vidre mamakacebSi [55,76]. F.Bonnet da Tanaavtorebis [34] Catarebuli
kvlevis Tanaxmad, romelic grZeldeboda 9 weli, dakvirvebis qveS
imyofebodnen mamakacebi da qalebi 30-dan - 64-wlamde. 3482 pacients pirvel
vizitze aReniSneboda normoglikemia. maT Soris 227-s me-3 vizitze
(9 wlis Semdeg) aRmoaCnda hiperglikemia. isini Sedarebuli iyvnen sqesis,
asakis da sxeulis masis indeqsis mixedviT Sesabamis sxva 227 adamianTan,
romlebsac am droisTvis jer kidev normoglikemia aReniSneboda. kvlevis

30
Sedegad avtorebi Tvlian, rom ssSg-s dabali done, damoukideblad
insulinisa da adiponektinis donesa, aris Zlieri damoukidebeli markeri
Saqriani diabeti tipi 2 ganviTarebis momatebuli riskis dasadgenad
qalebSi, da ara mamakacebSi.

1.7 adreno-genitaluri sindromi

hirsutizmis sxva mizezebidan aRsaniSnavia - adrenogenitaluri sindromi

(ags), romelic moicavs hirsutizmis mqone pacientebis 2,7-4,5% [41,74].
ags ganpirobebulia im fermentul sistemaTa ukmarisobiT, romlebic
Tirkmelzeda jirkvalis qerqovan nivTierebaSi warmarTavs steroidebis
biosinTezis process. amis gamo ferxdeba glukokortikoidebis,
mineralkortikoidebis da androgenebis warmoqmna, anu viTardeba
steroidogenezis saboloo produqtebis naklovaneba da xdeba im
Sualeduri SenaerTebis Warbi dagroveba, rac ar gamoiyofa fiziologiur
pirobebSi an gamomuSavdeba umniSvnelo raodenobiT [7].
ags-i autosomur - recesiulad paTologiaa, romlis drosac aRiniSneba
21α-hidroqsilazas, 3β-hidroqsisteroiddehidrogenazis an
11β-hidroqsilazis deficiti [100]. 21α-hidroqsilazas deficiti aRiniSneba
pacientTa 95%-Si da vlindeba kortizolis deficitiT, aldosteronis
deficitiT an mis gareSe da hiperandrogeniiT. 21α-hidroqsilazas
deficitis markeria 17αα-hidroqsiprogesteronis mateba.
3-β-hidroqsisteroiddehidrogenazis deficitis Sedegad matulobs
pregnanolonis, 17α -hidroqsipregnenolonis da dehidroepiandrosteronis
done. 11 β-hidroqsilazis deficiti xasiaTdeba 11 -deoqsikortizolis,
deoqsikortikosteronis da mineralkortikoidebis momatebuli doniT.
adrenogenitaluri sindromis klinikuri gamovlineba mrafelferovania da
moicavs rogorc mZime formebs anu klasikur ags-s, aseve msubuq formebs
e.w. ags-s araklasikur anu postpubertatul formas. ags-is klasikuri
formis sixSire 1:15000 axalSobilze [143]. xolo ags-is araklasikuri forma

31
sakmaod xSiri paTologia da misi siSire TeTrkanian populaciaSi Seadgens
1:500-ze [148].
ags-iT klasikuri formiT mdedrobiTi sqesis axalSobilebi mucladyofnis
periodSi imyofebian androgenebis maRali koncentraciis zemoqmedebis qveS
da ibadebian gaurkveveli sasqeso organoebiT, rac moicavs gadidebul
klitors, Serwymul sasircxo bageebs da urogenitalur sinuss. SigniTa
sasqeso organoebi saSvilosno, kvercxsavali milebi da sakvercxeebi
normis farglebSia. am paTologiis diagnostireba Cveulebriv xdeba
adreul bavSvobis asakSi da amJamad SesaZlebelia misi prenataluri
diagnostika.
pacientebSi ags-iT araklasikuri formiT kortizolis deficitis da
hiperandrogeniis simptomebis gamovlineba iwyeba prepubartatul an
adreuli pubertatis periodSi [113]. aseT pacientebs axasiaTebs adreuli
pubarxe an hirsutizmi (60%), oligomenorea an amenorea (54%) sakvercxeebis
policistoziT da akne (33%) [103]. avtorebi miuTiTeben, rom Tirkmelzeda
jirkvlis paTologiis dros hirsutizmi aRiniSneba TiTqmis yvela
SemTxvevaSi. zogierTi avtoris monacemiT, paTologiuri gaTmianeba iwyeba
menarxemde, romelic Semdgom progresirebs [4]. hirsutizmis ganviTareba
adreno-genitaluri sindromis dros, iseve rogorc sxva paTologiis
SemTxvevaSi, dakaSirebulia yvelaze aqtiuri androgenis,
dihidrotestosteronis donis momatebasTan, romlis sinTezSic
monawileobs rogorc Tirkmelzeda jirkvali, aseve sakvercxe [56]. ags-is
paTofiziologiis SeswavliT naCvenebia endokrinopaTiebi damaxasiaTebeli
anomaliebiT Tirkmelzeda jirkvlebis qerqis, rac moicavs
adrenomedularul disfunqcias da insulinrezistentobas. qalebSi
hiperandrogenia damoukidebeli risk faqtoria hiperinsulinemiis
ganviTarebis da SesaZloa monawileobdes insulinrezistentobis an
sakvercxeebis policistozis ganviTarebaSi ags-is mqone pacientebSi [75,82].

32
1.8 hiperandrogenizmis sxva mizezebi

bolo wlebSi didi yuradReba eqceva prolaqtins, rogorc Tirkmelzeda

jirkvlebis qerqSi androgenebis sekreciis regulators. amis safuZvels
warmoadgens is faqti, rom hiperprolaqtinemiis da hipofizis adenomis
mqone pacientebSi aRmoCenili iqna dehidroepiandrosteronis koncentraciis
mateba zomieri testosteronemiis dros [107], Tumca sruli korelacia
prolaqtins da androgenebs Soris nanaxi ar iqna. R. Azziz da Tanaavtorebis
monacemebiT kvlevaSi monawile 1000 pacientidan hiperandrogeniiT
hiperprolaqtinemia aReniSneboda mxolod erT pacients (0,3%). maTi
monacemebi aseve emTxveva sxva avtorebis monacemebs [22,25,52,105,162].

hiperandrogeniis ganviTarebas fariseburi jirkvlis funqciis darRvevis

dros safuZvlad udevs seqssteroidSemboWveli globulinis donis
mniSvnelovani daqveiTeba, ris Sedegadac izrdeba androstendionis
testosteronad gardaqmnis siCqare da Tavisufali testosteronis fraqciis
gazrda. cnobilia, rom hipoTireozis dros rigi fermentebis da
hormonebis metabolizmi icvleba, maT Soris estrogenebisac. estrogenebis
sinTezi ZiriTadad ixreba estriolis da ara estradiolis mxares.
estradioli ar grovdeba da Sesabamisad pacientebs uviTardebaT
testosteronis biologiuri efeqtis klinikuri suraTi. С. Йена da Р. Джаффе
monacemebiT pacientebSi hipoTireoziT SesaZlebelia sakvercxeebis
meoradi policistozis ganviTareba [6]. Tumca, arsebobs kvlevebi, romelTa
Tanaxmadac hiperandrogeniis dros fariseburi jirkvlis disfunqcia,
kerZod hipoTireozi, aReniSneboda erTeul pacientebs [22,33,68].

wamlismieri hirsutizmi gamowveulia rigi samedicino preparatebiT.

esenia: ciklosporini, diazoqsidi, danazoli, glukokortikoidebi,
penicilamini, minoqsidili da androgenSemcveli hormonaluri preparatebi.
Tumca antiepilefsiuri preparatebic, rogoricaa fenitoini (difenini) da
fenobarbitali SesaZloa iwvevdnen hirsutizms [124].

33
1.9 idiopaTiuri hirsutizmi
iTvleba, rom hirsutizmi pacientebis 5-15%-Si aris idiopaTiuri [21].
idiopaTiuri hirsutizmis zusti gavrcelebis Sefaseba rTulia, vinaidan
bolo sami aTwleulis ganmavlobaSi idiopaTiuri hirsutizmis ganmartebaSi
Setanilia cvlilebebi. amJamad idiopaTiur hirsutizmad ganixileba,
hirsutizmis arseboba qalebSi normaluri ovulatoruli cikliT, sisxlSi
mocirkulire androgenebis normaluri doniT da sakvercxeebis
ultrasonografiuli kvleviT policistozuri sakvercxeebis ararsebobiT.
avtorebi Tvlian, rom idiopaTiuri hirsutizmi mocirkulire androgenebis
normaluri donis mimarT Tmis folikulebis momatebuli mgrZnobelobis
Sedegia, romlis mizezi savaraudod aris 5-α reduqtazas aqtivobis mateba
[29,65]. zogierTi kvlevis Tanaxmad idiopaTiuri hirsutizmis ganviTarebis
mizezad miCneulia androgenis receptoris genis polimorfizmi. androgenis
receptori lokalizebulia X-qromosomaze. Lyon-is hipoTezis Tanaxmad,
Cveulebriv mxolod erTi alelia samizne qsovilebSi gamoxatuli da
damokidebuli X-qromosomis inaqtivaciis SemTxveviT nimuSebze.
dauzustebelia, romeli X-damokidebuli alelia gamoxatuli hirsutizmis
mqone qalTa qsovilebSi, radganac bevr qals androgenis receptoris
genSi ganmeorebadi CAG regionis zomis mimarT aReniSneba
heterozigoturoba. aqedan gamomdinare, saWiroa Semdgomi kvlevebi, rom
ganisazRvros androgenuli receptoris genis polimorfizmis roli
idiopaTiuri hirsutizmis ganviTarebaSi [21].

1.10 hiperandrogenizmis eqstraovariuli faqtorebi

hiperandrogenizmis ganviTarebis eqstraovariuli faqtorebidan
mniSvnelovan rols TamaSobs cximovani qsovili, sadac warmoebs sasqeso
steroidebis - androgenebis da estrogenebis (ZiriTadad estronis)
aragonaduri sinTezi. am process aqvs avtonomiuri xasiaTi da ar aris
damokidebuli gonadotropul stimulaciaze. cximovani qsovili aris erT-
erTi mTavari adgili, sadac xdeba androgenebis efeqtis realizacia. bolo
wlebSi damtkicebulia, rom cximovani qsovili warmoadgens ara mxolod

34
energiis depos da steroiduli hormonebis metabolozmis adgils, aramed
is damoukidebeli endokrinuli organoa [12]. mniSvnelovania ara sxeulis
absoluturi wona, aramed cximovani qsovilis gadanawileba sxeulze.
ganasxvaveben mamakacuri (visceraluri, androiduli) tipis da qaluri
(ginoiduri) tipis simsuqnes. visceraluri tipis simsuqnis dros cximovani
qsovili upiratesad gadanawilebulia beWebis areSi, kisris ukana
zedapirze da muclis wina kedelze [13,50]. cximovani qsovili warmoadgens
cximovani ujredebis – adipocitebis erTobliobas. Ganasxvaveben TeTr da
rux cximovan qsovils. adamianis organizmSi farTod gavrcelebulia
TeTri cximovani qsovili, romelic ganlagebulia kanqveS ZiriTadad
muclis faris qvemo nawilSi, TeZoebze, dunduloebze da
intraabdominalurad (jorjalSi, retroperitonealur midamoSi) [5]. ruxi
cximovani qsovili ZiriTadad gvxvdeba bavSvebSi, Tumca SesaZloa
umniSvnelo raodenobiT zrdasrul adamianebSic aRiniSnebodes.
Termogenezi ZiriTadad ruxi cximovani qsovilis meSveobiT mimdinareobs,
romlis ujredebi efeqturad axdenen glukozis da cximovani mJaveebis
daJangvas [44]. gacximovnebis mqone adamianebs ruxi cximovani qsovili
SesaZloa saerTod ar hqondeT, rac aqveiTebs Termogenezs.
morfologiurad visceraluri cxomovani qsovilisaTvis damaxasiaTebelia
cximovani ujredebis hipertrofia, xolo ginoidurisaTvis cximovani
ujredebis zrda, amitom sxvanairad visceralur cximovan qsovils
hipertrofirebuls eZaxian, xolo ginoidurs hiperplaziurs [1]. simsuqnis
tipis gansazRvrisaTvis gamoiyeneba welisa da barZayis garSemowerilobis
Tanafardobis gansazRvra. Tu Tanafardobis indeqsi 0,8-ze metia, adgili
aqvs visceraluri tipis simsuqnes.
qalebSi visceraluri simsuqniT Cveulebriv ssSg-is done SedarebiT ufro
dabalia, vidre amave asakis da wonis qalebSi cximovani qsovilis Tanabari
gadanawilebiT [154]. amave azris arian sxva avtorebic [145]. rigi avtorebis
azriT, testosteronis koncentracia prepubertatSi myofi, rogorc msuqani,
aseve normaluri wonis gogonebSi ar gansxvavdeba [71,117]. Tumca sxva
avtorebis monacemebiT Warbi wonis mqone gogonebSi vlindeba
testosteronis da dehidroepiandrosteron-sulfatis sarwmunod
momatebuli done, normaluri wonis gogonebTan SedarebiT [147,155],

35
romelTa maCveneblebic wonis daqveiTebis SemTxvevaSi iklebs [145].
gacximovnebis visceraluri tipis formireba warmoadgens ufro
mniSvnelovan klinikur niSans metaboluri darRvevebis ganviTarebis
midrekilebis TvalsazrisiT, vidre sxeulis absoluturi masa. cximovani
qsovilis topografiis da metaboluri darRvevebis urTierTkavSiris
Seswavlis Sedegebi gvafiqrebinebs, rom visceraluri simsuqne genetikurad
ganpirobebuli insulinrezistentobis asaxvaa. insulinrezistentobas
safuZvled udevs insulinis signalis gadacemis meqanizmebis darRveva,
rogorc receptoruli, aseve postreceptorul doneze [60].
insulinrezistentoba simsuqnis dros viTardeba TandaTanobiT, pirvel
rigSi kunTebSi da RviZlSi. mxolod adipocitebSi lipidebis didi
raodenobiT dagrovebis, maTi zomaSi matebis Semdeg insulinrezistentoba
viTardeba cximovan qsovilSi, rac xels uwyobs insulinrezistentobis
Semdgom gaRrmavebas [117,158]. S.Cupisti da Tanaavtorebis azriT pacientebSi
hirsutizmiT da sakvercxeebis policistoziT simsuqne asocirebulia
saerTo testosteronis koncentraciis matebasTan da ssSg-is koncentraciis
daqveiTebasTan, ris Sedegadac matulobs gaangariSebuli Tavisufali da
bioSeRwevadi testosteroni [47]. simsuqne policistozuri sakvercxeebis
sindromis erT-erTi mTavari klinikuri simptomia. am sindromis mqone
pacientTa daaxloebiT 50%-Si simsuqne vlindeba sxvadasxva xarisxiT da
xSirad win uswrebs hiperandrogeniis da oligomenoreis ganviTarebas, rac
miuTiTebs simsuqnis paTogenezur mniSvnelobaze policistozuri
sakvercxeebis sindromis ganviTarebaSi [69]. simsuqnis mqone pacientebSi
sakvercxeebis funqciis darRvevis genezSi wamyvani faqtoria
hiperinsulinemia, ris Sedegadac viTardeba hiperandrogenemia da
policistozuri sakvercxeebi. amave dros policistozuri sakvercxeebis
struqtura damtkicebuli insulinrezistentobis da hiperinsulinemiis
dros aReniSneba mxolod pacientTa 13,1%-s. Sesabamisad sakvercxeebis
policistozis ganviTarebisTvis garda arsebuli insulinrezistentobis
unda arsebobdes genetikuri midrekileba am daavadebis mimarT [2].
sakvercxeebis policistozis mqone pacientebSi miuxedavad wonisa ssSg-is
koncentracia gacilebiT dabalia sakontrolo jgufTan SedarebiT. es
kanonzomiereba ufro gamokveTilia - cximovani qsovilis matebasTan erTad,

36
rac ufro metia sxeulis masis indeqsi miT ufro dabalia ssSg-is
koncentracia sisxlSi [116]. Tumca, sxva kvlevis monacemebiT, romelSic
monawileobas iRebda qalTa 2 jgufi - 21 qali sakvercxeebis
policistoziT da 17 qali sakontrolo jgufidan - ssSg-s koncentraciis
sarwmuno sxvaoba ar gamovlinda [49].

1.11 hirsutizmis Sefaseba da diagnostika

hirsutizmis gamoxatulobis xarisxi damokidebulia androgenebis donesa

da periferiaze androgenebis mimarT receptorebis mgrZnobelobis
urTierTkavSirze. androgenebis donis 2-jer da ufro metad matebis
SemTxvevaSi aRiniSneba hirsutizmis sxvadasxva xarisxi. miuxedavad amisa,
rig SemTxvevebSi hirsutizmis xarisxi dadebiTad ar korelirebs
androgenebis donesTan, radganac androgendamokidebuli Tmis
folikulebis pasuxi androgenebis matebaze individualuria sxvadasxva
adamianSi. rig SemTxvevebSi hirsutizmi viTardeba androgenebis normaluri
donis pirobebSi (idiopaTiuri hirsutizmi) [130], romelic msubuqi
hirsutizmis (feriman-galveis cxrilis mixedviT 8-16 qula) mqone
pacientebis 50%-Si xvdeba. xolo danarCen 50%-Si da mkveTrad gamoxatuli
hirsutizmis dros sisxlSi aRiniSneba androgenebis maRali done [122].
hirsutizmis xarisxis Sefaseba xdeba Ferriman, Galwey (1961w) mier
mowodebuli sqemis safuZvelze (sur.1), rac iTvaliswinebs, sxeulze
gamoyofil 11 zonaze 4 quliani sistemiT Tmianobis intensivobis Sefasebas
[67]. Ferriman da Galwey mier modificirebuli sqemis mixedviT, sadac
hirsutizmi fasdeba sxeulis 9 zonaze (fexis wvivebis da xelebis
gamoklebiT) 161 qalidan 9,9%-s hirsutizmi Seufasda 5 qulaze zemoT,
4,3 %s - 7 qulaze zemoT da 12%-s - 10 qulaze zemoT [67]. am monacemebiT
paTologiuri Tmianoba 8 qulaze zemoT ganixileba, rogorc hirsutizmi,
Tumca zogierTi eqspertis azriT hirsutizmi aRiniSneba 6 qulaze da
ufro zemoT [129]. gamoxatulobis xarisxis mixedviT hirsutizms yofen 3
formad: msubuqi ( 8-16 qulamde), saSualo simZimis (17-24 qulamde) da mZime
(25 qula da meti).

37
suraTi 1. hirsutizmis xarisxis Sefasebis feriman–galveis sqema

38
klinikur praktikaSi metad mosaxerxebelia hirsutizmis xarisxis
dasadgenad Baron -is sqema, sadac gamoyofilia hirsutizmis msubuqi,
saSualo da mZime xarisxi Tmianobis lokalizaciis gaTvaliswinebiT.

hirsutizmis Sefaseba BBaron-is mixedviT, 1974

I xarisxi-msubuqi
2 1 muclis TeTri xazi
(2) zeda tuCi
9 9 (3)Mdvrilebis irgvliv zona
6 9
3 3
7 II xarisxi-saSualo
1,2,3+
1 4 nikapi
8 8 5 TeZoebis Sida zedapiri
55
5
III xarisxi-mZime
1,2,3,4,5+
6 mkerdi
7 zurgi xerxemlis gaswvriv
8 dundulebi
9 beWebi

39
1.12 hirsutizmis mkurnaloba

hirsutizmis mkurnaloba iwyeba misi ganviTarebis yvela SesaZlo mizezebis

dadgenis, androgenmaproducirebeli simsivnis da kuSingis daavadebis
gamoricxvis Semdeg. hirsutizmis efeqturi mkurnaloba moicavs Semdeg
kombinacias: cxovrebis wesis Secvlas, Tmis meqanikur moSorebas da
medikamentur Terapias. medikamenturi Terapia Sedgeba androgenebis
supresoruli preparatebisgan, antiandrogenebisgan da androgenuli
receptorebis blokatorebisgan.

cxovrebis wesis Secvla, rac moicavs jansaR kvebas, varjiSs da wonis

daklebas aris mkurnalobis safuZveli msuqani hirsutizmis mqone
pacientebisTvis. wonis dakleba awesrigebs naxSirwylebis da cximebis
cvlas, aqveiTebs insulinis dones, sakvercxismieri androgenebis sekrecias
da androstendionis konversias testosteronSi [93]. wonis dakleba da
insulinis donis daqveiTeba iwvevs seqssteroidSemboWveli globulinis
sekreciis matebas, rac ganapirobebs Tavisufali androgenebis donis
Semdgom daqveiTebas [70].

terminaluri Tmebis sicocxliunarianobis mixedviT efeqtis misaRwevad

saWiroa aranakleb eqvsi Tve, rom Tma gaxdes SedarebiT nazi da Txeli.
mkurnalobis Sedegad axali Tmebis amosvla wydeba, xolo Zveli Tmebi
cviva. Tmis meqanikurma moSorebam SesaZloa daaCqaros es procesi.
aRsaniSnavia, rom Tmis folikulebis destruqcia SesaZloa miRweuli iyos
deniT an lazero epilaciiT, Tumca is midrekilia xelaxla daiwyos zrda
medikamentebiT mkurnalobis Sewyvetis Semdeg. Tmis meqanikuri mocileba
SesaZlebelia ramodenime meTodiT. gauferuleba, gaparsva da depilaciis
kremebi umtkivneulo da iafi meTodebia, magram am dros ar xdeba Tmis
folikulze zemoqmedeba da efeqti xanmoklea. cviliT depilacia, nemsiT
eleqtro epilacia da lazeroepilacia SedarebiT Zviri da arakomfortuli
proceduraa, magram saboloo jamSi medikamentur TerapiasTan erTad
amcirebs Tmis zrdas da aCqarebs mkurnalobis efeqts [123].

androgenebis supresiuli Terapia mizanSewonilia androgenebis sekreciis

dasaqveiTeblad, gansakuTrebiT sakvercxismieri hiperandrogeniis dros. is

40
Zalian xelsayrelia hiperandrogeniiT gamowveuli hirsutizmis
samkurnalod, Tumca SesaZloa idiopaTiuri hirsutizmis mkurnalobaSic
TamaSobdes garkveul rols. androgenebis supresiuli Terapia pirvel
rigSi moicavs kombinirebul oralur kontraceptivebs (kok-ebs). kok-ebi
moqmedeben Semdegnairad: Trgunaven gonadotropinebis da ovariuli
androgenebis sekrecias, zrdian ssSg-is sekracias RviZlis mier, rac
amcirebs Tavisufali testosteronis dones [149]. SesaZloa
antiandrogenebis damateba, Tu mxolod kok-ze klinikuri pasuxi
aradamakmayofilebelia. alternatiulia, kok-i, romelic Seicavs
progestinis saxiT antiandrogens - ciproteron acetats. aseTi preparati
moqmedebs, rogorc sakvercxismieri androgenebis supresori da aseve
androgenebis receptorebis blokatori [90].

miuxedavad imisa, rom glukokortikoidebi Trgunaven Tirkmelzeda

jirkvlismier androgenebs, androgenebis receptorebis blokatorebi zrdis
efeqturobas, maSinac ki rodesac hirsutizmi ganpirobebulia
adrenogenitaluri sindromiT. erT-erT placebo kontrolirebad
randomizirebul kvlevaSi mkurnaloba tardeboda ciproteron acetatiT
an hidrokortizoniT [139]. 1 wlis Sedegad ciproteron acetatiT
namkurnaleb pacientebs aReniSnebodaT hirsutizmis xarisxis Semcireba
54%-iT, xolo hidrokortizoniT namkurnaleb pacientebs 26%-iT.

gonadotropin rilizing hormonis agonistebi SesaZloa gamoyenebuli iqnes

sakvercxismieri hiperandrogeniis da refraqteruli hirsutizmis
samkurnalod. isini iwveven medikamentozur ooforeqtomias [37]. Tumca, am
preparatebis xSiri hipoestrogenuli efeqti da osteoporozis
ganviTareba aucilebels xdis kombinirebuli gestagenebis damatebas.
insulinrezistentuli metaboluri sindromisas sakvercxeebis meoradi
policistoziT gamoiyeneba biguanidebis jgufis preparatebi (siofori,
metformini). am jgufis preparatebi pirvelad 1974 wels iyo warmodgenili.
biguanidebi iwvevs insulinrezistentobis donis daqveiTebas, zrdis
receptorebis mgrZnobelobas insulinisadmi da Sesabamisad umjobesdeba
glukozis utilizacia RviZlSi [97]. insulinis sekreciis daqveiTebas Tan
mohyveba Tavisufali testosteronis donis Semcireba da ssSg-is

41
koncentraciis mateba. Tumca, hirsutizmis mkurnalobaSi isini ar
xasiaTdeba swrafi efeqturubiT, rogorc antiandrogenebi [124].

antiandrogenuli moqmedebiT xasiaTdeba veroSpironi (spirolaqtoni). misi

xangrZlivi moqmedebisas aReniSneba hipertriqozis Semcireba. veroSpironi
Trgunavs ferment 5α-reduqtazas aqtivobas, romelsac testosteroni
gadayavs yvelaze aqtiur androgenSi dihidrotestosteronSi [110]. misi
gamoyeneba SesaZloa damoukideblad 100-dan -200-s mg dReSi an kombonaciaSi
kok-Tan [61].

flutamidi pirveli arasteroiduli antiandrogenia. mxolod flutamidi an

misi kombinacia kok-Tan ufro efeqturia vidre finasteridi an
spironolaqton - kok-is kombinacia [150]. misi hepatotoqsiuroba iSviaTia,
magram rekomendirebulia periodulad RviZlis funqciebis kontroli.
gverdiTi efeqtebi da hepatotoqsiuroba naklebad vlindeba 250 mg dozis
SemTxvevaSi.

finasteridi - ablokirebs 5α-reduqtazas da ZiriTadad gamoiyeneba

idiopaTiuri hirsutizmis mkurnalobaSi [102]. avtorTa monacemebiT
finasteridis zemoqmedebiT hirsutizmis xarisxi mcirdeba 30-60%-iT, aseve
mcirdeba Tmis sisqe. finasteridis efeqti msgavsia sxva antiandrogenebis
moqmedebis.

problemis aqtualobidan gamomdinare miznad davisaxeT korelaciebis

dadgena hiperandrogenizmis klinikur da hormonalur maCveneblebs Soris
axalgazrda qalebSi hiperandrogenizmiT gamovlenili sxvadasxva
endokrinul–ginekologiuri sindromebiT ( policistozuri sakvercxeebis
sindromi, adrenogenitaluri sindromis araklasikuri forma,
hiperprolaqtinemiis sindromi).

42
 Tavi 2

Kkvlevis obieqti da meTodebi

2.1 kvlevis obieqti

kvleva Catarda i. Jordanias saxelobis adamianis reproduqciis s/k

institutis bazaze. kvlevaSi monawileobda 13-dan 30 wlamde asakis 111
pacienti, romelTa saSualo asaki Seadgenda 17,7 (±3,3). kvlevaSi monawile
pacientTa ZiriTadi Civilebi iyo: menstruaciuli ciklis darRveva,
WarbTmianoba, akne. kvlevaSi pacientTa CarTvis kriteriumebi iyo:
menarxedan gasuli unda yofiliyo 2 weli da pacienti ar unda yofliyo
namkurnalevi, maT Soris kontraceptivebiT.

pacientebs diagnozebis mixedviT Semdegnairad iyvnen gadanawilebuli:

policistozuri sakvercxeebis sindromi – 43 pacienti, adrenogenitaluri
sindromis araklasikuri forma –38 pacienti da hiperprolaqtinemiis
sindromi 30 pacienti. policistozuri sakvercxeebis sindromis dadgena
xdeboda roterdamis konsesusis (2003 w.) Tanaxmad. adrenogenitaluri
sindromis dadgena xdeboda Tirkmelzeda jirkvlis hormonis 17α–
hidroqsiprogesteronis maCveneblis mixedviT, xolo hiperprolaqtinemiis
sindromi dadgena xdeboda prolaqtinis maCveneblis mixedviT.

sakontrolo jgufi Sedgeboda 15–30 wlis askobrivi jgufis 20

praqtikulad janmrTeli qalisagan, romelTac ar aReniSnebodaT
hiperandrogenizmis klinikuri gamovlinebebi da menstruaciuli ciklis
darRvevebi.

43
2.2 kvlevis meTodebi

pacientebis obieqturi statusis Seswavlisas dgindeboda sxeulis

aRnagobis tipi. G. Brey-is (1978 w) mier mowodebuli formuliT isazRvreboda
sxeulis masis indeqi: sxeulis wona kg–Si gayofili sxeulis simaRlis
kvadratze (kg/m2). normaSi sxeulis masis indeqsi (smi) 20–dan – 25–is
farglebSia. I xarisxis simsuqnis dros smi 25–dan – 30–mdea; II xarisxis
simsuqnis dros smi – 30–dan – 35–mde; III xarisxis simsuqnis dros smi –
35–dan – 40–mde; IV xarisxis simsuqnis dros smi – 40–ze metia. cximovani
qsovilis gadanawilebis Taviseburebebis dadgenis mizniT xdeboda welisa
da barZayis garSemowerilobis Tanafardobis gansazRvra. zemo tipis,
visceraluri, anu mamakacuri tipis simsuqnis dros, welisa da barZayis
garSemowerilobis Tanafardobis indeqsad miCneulia 0,8–ze meti, xolo
qvemo, qaluri, ginoiduri tipis simsuqnis dros – 0,8–ze naklebi.

yuradReba eqceoda sxeulis safarvelis Taviseburebebs: kanis

hiperpigmentaciur ubnebs – acantosis nigricans, seboreas, aknes, alopecias da
klimaqteruli kuzis arsebobas.

2.2.1 hormonebis raodenobrivi gansazRvra

sisxlSi hormonebis raodenorivi gansazRvra xorcieldeboda

imunofermentuli meTodiT (ELISA) menstruaciuli ciklis me – 3–5 dReebSi
diliT uzmoze. isazRvreboda Semdegi maCveneblebis koncentracia: saerTo
testosteroni, Tavisufali testosteroni, seqssteroidSemboWveli
globulini, dehidroepiandrosteron–sulfati, 17 α –hidroqsiprogesteroni,
estradioli, prolaqtini, folikulmastimulirebeli da maluTinizirebeli
hormonis, C-peptidi, Tireomastimulirebeli hormoni. bioqimiuri meTodiT
sisxlSi uzmoze isazRvreboda glukozis koncentracia.

44
2.2.2 hirsutuli ricxvis gansazRvra

hirsutuli ricxvi isazRvreboda Ferriman-Gallway (1961 w.) modificirebuli

sqemis mixedviT, rac iTvaliswinebs sxeulze gamoyofil 9 zonaze 4
quliani sistemiT Tmianobis intensivobis Sefasebas. hirsutuli ricxvis
mixedviT pacientebi dayofil iqna 3 jgufad: I – hirsutizmi ar aris (0–7
qula), msubuqi hirsutizmi (8–16 qula) da saSualo simZimis da mZime
hirsutizmi (17 qula da meti).

2.2.3 Tavisufali androgenebis indeqsis gansazRvra

Tavisufali androgenebis indeqsis gamoTvla xdeba Semdegi formuliT

FAI = TT *100 / SHBG (nmol/l), sadac TT – saerTo testosteroni nmol/l da
SHBG -steroidSemboWveli globulini nmol/l.

2.2.4 Tavisufali da bioSeRwevadi testosteronis gaangariSebis

maTematikuri modelebi

Tavisufali da bioSeRwevadi testosteronis gaangariSeba SesaZlebelia

veb–saitze: http://www.issam.ch/freetesto.htm. am maTematikuri modelebis
gamoTvlisTvis aucilebelia saerTo testosteronis,
seqssteroidSemboWveli globulinis da albuminis koncentraciis
gansazRvra sisxlSi.

2.2.5 insulinrezistentobis indeqsis Homa-2 gansazRvra

insulinrezistentobis indeqsis Homa-2 kalkulatoris naxva

SesaZlebelia veb–saitze www.dtu.ox.ac.uk/homa. Homa-IR (the homeostasis model
assessment for insulin resistance) gamoTvlisTvis saWiroa bazaluri glukozis,
C-peptidis an insulinis koncentraciis gansazRvra.

45
2.2.6 policistozuri sakvercxeebis sindromis dadgenis
kriteriumebi

roterdamis konsesusis (2003 w.) Tanaxmad policistozuri sakvercxeebis

sindromis diagnostirebisTvis gamoyofilia 3 kriteriumi, saidanac 2 mainc
unda iyos dadebiTi: 1. oligomenorea da/an anovulacia 2. sisxlSi
hiperandrogenia da/an klinikuri hiperandrogenia 3. policistozuri
sakvercxeebi dadgenili ultrabgeriTi kvleviT. amave dros gamoricxuli
unda iyos yvela sxva SesaZlo mizezi, romelsac axasiaTebs
araregularuli menstruaciuli cikli da hiperandrogenia
(adrenogenitaluri sindromi, kuSingis sindromi, hiperprolaqtinemia,
androgenmaproducirebeli simsivne).

2.2.7 ultrabgeriTi kvlevis meTodi

yvela pacients utardeboda mcire menjis Rrus organoebis abdominaluri

an endovaginaluri ultrabgeriTi gamokvleva Siemens firmis Sonoline G 50
aparatiT. policistozuri sakvercxeebis dadgenis kriteriumad iTvleboda
Semdegi, Tu erT sakvercxeSi mainc aRiniSneboda 2–9 mm. zomis 12–ze meti
siTxuri CanarTi da/an sakvercxeebis moculoba iyo 10 sm3 meti (roterdamis
konsesusis (2003 w).

2.2.8 monacemebis statistikuri damuSaveba

monacemebi muSavdeboda statistikuri programiT SPSS software (statistical

Package for the Social Sciences, version 17.0 for windows XP; SPSS, Inc, Chicago, I17).
statistikurad sarwmunod ganixileboda sarwmunoebis maCvenebeli P–s
mniSvneloba naklebi 0,05–ze (P<0,05). ori jgufis saSualoebi Sedarebuli
iyo erTmaneTTan Independent-Samples T-test gamoyenebiT, xolo araparametruli
monacemebis SemTxvevaSi Mann-Whitney U test gamoyenebiT. or jgufze meti
jgufebis saSualoebi Sedarebuli iyo ANOVA with post hoc gamoyenebiT.

46
korelaciebi monacemebs Soris dgindeboda Pearson’s correlation–is
saSualebiT. meTodebis sadiagnostiko mniSvnelobis da erTmaneTis mimarT
damokidebulebis mrudis ageba xorcieldeboda ROC curve meTodiT.

47
 Tavi III

sakuTari kvlevis Sedegebi

3.1 pacientebis klinikuri da hormonaluri maxasiaTeblebi

kvlevaSi monawileobas Rebulobda 13–28 wlamde 111 pacienti, romelTa

saSualo asaki Seadgenda 17,7 (±3,3) wels. pacientTa mTel jgufSi
hirsutizmi aReniSneboda 86 (77,5%) pacients , akne – 76 (68,5%), kanis
hiperpigmentacia acantosis nigricans – 30 (27%), sxeulis Warbi wona – 37 (33,3%),
visceraluri, mamakacuri tipis gacximovneba – 39 (35,1%). araregularuli
menstruaciuli cikli hqonda 85 (76,6%) pacients. diagnozebis mixedviT
pacientebi gadanawilda Semdegnairad: policistozuri sakvercxeebis
sindromi daudginda 43 pacients (38,7%), araklasikuri forma
adrenogenitaluri sindromis 38 pacients (34,2%) da hiperprolaqtinemiis
sindromi 30 pacients (27%).

mcire menjis Rrus organoebis ultrabgeriTi gamokvleviT savercxeebSi

mravlobiTi CanarTebi gamovlinda 42 pacientSi (37,8%), maT Soris 30
pacients (71,4%) sakvercxeebi gazrdili hqonda moculobaSi. xolo normis
farglebSi sakvercxeebis struqtura hqonda 69 pacients (62,2%), aqedan 18
pacients (43,2%) gazrdili hqonda sakvercxeebis moculoba (ix. diagrama 1).

diagrama 1. pacientebis ganawileba normaluri da policistozuri

sakvercxeebis struqturis mixedviT %

48
ojaxuri anamnezis SekrebiT pacientebis axlo naTesavebSi Warbi wona
gamovlinda 7 SemTxvevaSi (6,3%), WarbTmianoba - 20 SemTxvevaSi (18%),
Saqriani diabeti tipi 2 – 21 SemTxvevaSi (18,9%), Saqriani diabetis da
WarbTmianobas Tanaarseboba - 3 SemTxvevaSi (2,7%), pacientis dedas
anamnezSi sakvercxeebis policistozi aReniSneboda 10 SemTxvevaSi (9%),
janmrTeli memkvidreoba - 50 SemTxvevaSi (45%) (ix. diagrama 2).

diagrama 2. pacientTa ganawileba damZimebuli memkvidreobis da ojaxuri

anmnezis mixedviT %

49
gadatanili daavadebebis SeswavliT wiTela, wiTura, Cutyvavila
gadatanili hqonda - 63 pacients (56,8%), tonzileqtomia -25 (22,5%),
virusuli hepatiti „a“– 3 pacients (2,7%), raime gadatanil daavadebas ar
aRniSnavda -20 pacienti (18%) (ix. diagrama 3).

diagrama 3. pacientebis ganawileba gadatanili daavadebebis mixedviT (%)

sakontrolo jgufi Seadgina sakvlevi jgufis Sesabamisi asakis (15–30 w.

saSualo asakis) praqtikulad janmrTelma qalma, romlebsac ar
aReniSnebodaT androgenizaciis gamovlinebebi da menstruaciuli ciklis
darRvevebi.

50
pacientTa saerTo jgufSi Catarda hormonaluri maCveneblebis saSualoebis
SedarebiTi analizi sakontrolo jgufSTan. jgufebs Soris parametruli
monacemebi Sedarebuli iyo erTmaneTTan Independent-Samples T-test gamoyenebiT,
xolo araparametruli monacemebis SemTxvevaSi Mann-Whitney U test-is
gamoyenebiT. pacientTa saerTo jgufSi saerTo testosteronis (TT) saSualo
maCvenebeli (2,4±1,1 ng/ml) iseve rogorc Tavisufali testosteronis (FT)
saSualo maCvenebeli (3,7±1,7 pgr/ml) statistikurad sarwmunod maRali iyo
sakontrolo jgufis monacemebTan SedarebiT, (1,7±0,4 ng/ml, p=0,001; 1,7±0,7
pgr/ml, p=0,037). Tavisufali androgenebis indeqsi (FAI) 15±4,8 statistikurad
sarwmunod maRali aRmoCnda sakontrolo jgufis Sesabamis maCvenebelTan
SedarebiT 4,8±2,2 (p=0,001). sapirispirod seqsteroidSemboWveli globulinis
(SHBG) saSualo maCvenebeli 28,7±23,1 nmol/l sakvlev pacientTa jgufSi
iyo statistikurad sarwmunod dabali sakontrolo jgufis maCvenebelTan
SedarebiT (40,5±23 nmol/l, p=0,044), gaangariSebuli Tavisuali
testosteronis (cFT) saSualo maCvenebeli pacientTa jgufSi iyo 2,3±0,8
statistikurad sarwmunod maRali sakontrolo jgufTan SedarebiT 1,7±0,4
(p=0,001), aseve gaangariSebuli bioSeRwevadi testosteroni
(cBio-T) statistikurad maRali iyo sakontrolo jgufTan SedarebiT 53,3±18,3
(p=0,001). dehidroepiandrosteron-sulfatis (DHEA-S) da
17α -oqsihidroqsiprogesteronis (17α–OHP) saSualo maCvenebeli pacientTa
jgufSi iyo statistikurad maRali sakontrolo jgufTan SedarebiT
(p=0,001; p=0,021). pacientTa saerTo jgufSi C–peptidi (C-peptide) saSualo
maCvenebeli iyo 2,2 ±1,1 ng/ml, statistikurad sarwmunod maRali aRmoCnda
sakontrolo jgufis Sesabamis maCvenebelTan SedarebiT
(1,3±0,2 ng/ml, p=0,001). insulinrezistentobis indeqsi (Homa-IR) 1,6±0,8; aseve
sarwmunod maRali aRmoCnda pacientTa jgufSi (p=0,041). prolaqtinis (Prl)
saSualo maCvenebeli pacientTa jgufSi 21,3 ±15,9 ng/ml, rac statistikurad
sarwmunod maRali iyo sakontrolo jgufis maCvenebelTan SedarebiT
13,8±8,5 ng/ml (p=0,005). statistikurad sarwmuno sxvaoba ar aRiniSna
jgufebs Soris folikulmastimulirebeli hormoni (FSH),
maluTeinizirebeli hormoni (LH), estradioli (E2) da

51
Tireomastimulirebeli hormoni (TSH) saSualo maCveneblebis mixedviT
(p=0,909; p=0,130; p=0,223; p=0,452).

cxrili 1

pacientTa sakvlev saerTo jgufSi da sakontrolo jgufSi hormonaluri

maCveneblebis saSualoebis SedarebiTi analizi

maCveneblebi sakvlevi saerTo sakontrolo P -value

jgufi jgufi

TT 2,4 (±1,1)* 1,7 (±0,4) 0,001

FT 3,7 (±1,7)* 1,7 (±0,7) 0,037

SHBG 28,7 (±23,1)* 40,5 (±23) 0,044

FAI 15 (±4,8)* 4,8 (±2,2) 0,001

cFT 2,3 (±0,8)* 1,7 (±0,4) 0,001

cBio-T 53,3 (±18,3)* 39,8 (±9,2) 0,001

DHEA-S 2,8 (±1,7)* 1,5 (±0,4) 0,001

17α - OHP 1,3 (±0,6)* 0,9 (±0,2) 0,021

C-peptide 2,2 (±1,1)* 1,5 (±0,3) 0,001

Homa-IR 1,6 (±0,8)* 1,3 (±0,2) 0,041

FSH 8,8 (±3,0) 8,9 (±1,9) 0,909

LH 8,7 (±7,4) 5,1 (±1,6) 0,130

E2 38,2,6 (±30,6) 27,1 (±15,2) 0,223

Prl 21,3 (±15,9)* 13,8 (±8,5) 0,005

TSH 2,1 (±1,2)* 1,9 (±1,2 ) 0,452

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad.

* – sarwmuno sxvaoba jgufebs Soris
52
3.2 pacientebSi hiperandrogenizmiT klinikuri simptomebis da androgenuli
parametrebis korelaciebi

sakvlevi pacientebi dayofil iqna 2 ZiriTad jgufad : I jgufi Sedgeboda

hirsutizmis mqone 86 pacientisgan (77,5%) da II jgufi – 25 pacientisgan
hirsutizmis gareSe (22,5%). hirsutizmis mqone pacientebis jgufSi akne
aReniSneboda 61 pacients (70,9%), acantosis nigricans – 25 pacients (29,1%),
Warbi wona hqonda 28 pacients (32,6%), visceraluri simsuqne –
30 pacients (34,9%), araregularuli menstruaciuli cikli – 62 (72,1%)–s.
hirsutizmis ar mqone jgufSi akne aReniSneboda 15 pacients (60%), acantosis
nigricans – 5 pacients (20%), Warbi wona hqonda 9 (36%) pacients, visceraluri
simsuqne – 9 (36%), araregularuli menstruaciuli cikli hqonda 23 (92%).
(ix. diagrama 4).

diagrama 4. klinikuri simptomebis sixSire sakvlev I da II jgufebSi

(%).

53
I jgufSi sakvercxeebis policistozi daudginda 38 pacients (44,2%),
araklasikuri forma adrenogenitaluri sindromis 27 pacients (31,4%) da
hiperprolaqtinemiis sindromi daudginda 21 pacients (24,4%). II jgufSi
policistozuri sakvercxeebis sindromi daudginda 5 pacients (20%),
adrenogenitaluri sindromis araklasikuri forma 11 (44%) pacients da
hiperprolaqtinemiis sindromi daudginda 9 pacients (36%) (ix. diagrama 5).
hirsutizmis mqone pacientTa jgufSi akne gamovlinda ufro xSirad
hiperprolaqtinemiis sindromis dros 76%-Si, vidre policistozuri
sakvercxeebis sindromis (63%) da adrenogenitaluri sindromis
araklasikuri formis (59%) dros. xolo hirsutizmis ar mqone jgufSi akne
gamovlinda ufro xSirad adrenogenitaluri sindromis araklasikuri
formis mqone pacientebSi 81%-Si, vidre policistozuri sakvercxeebis
sindromis (40%) da hiperprolaqtinemiis dros (44,4%).

diagrama 5. I da II jgufis pacientebis ganawileba diagnozebis mixedviT (%)

54
I, II da sakontrolo jgufebSi sisxlis SratSi isazRvreboda hormonebis
da gaangariSebuli androgenuli parametrebis saSualo maCveneblebi da
Semdeg Catarebul iqna SedarebiTi analizi.

rogorc cxrili 2-dan Cans I jgufSi saerTo testosteronis (TT) saSualo

maCvenebeli (2,7±1,1 ng/ml), aseve Tavisufali testosteronis (FT) saSualo
maCvenebeli (4,0±3,2 pgr/ml) statistikurad sarwmunod maRali iyo
sakontrolo jgufTan SedarebiT (1,7±0,4 ng/ml, p=0,009; 1,7±0,7 pgr/ml,
p=0,005). Tavisufali androgenebis indeqsis (FAI) (14,0±10,9) saSualo
maCvenebeli statistikurad sarwmunod maRali aRmoCnda sakontrolo
jgufTan SedarebiT (4,8±2,2 p=0,001), sapirispirod seqssteroidSemboWveli
globulinis (SHBG) saSualo maCvenebeli sakvlev pacientTa jgufSi
(28,9±22,4 nmol/l) statistikurad sarwmunod dabali iyo sakontrolo
jgufis maCvenebelTan SedarebiT (40,5±23 nmol/l, p=0,006). gaangariSebuli
Tavisufali testosteronis (cFT) saSualo maCvenebeli (2,2±0,8) da
bioSeRwevdi testosteronis (cBio-T) saSualo maCvenebeli (52,7±17,8)
statistikurad sarwmunod maRali iyo sakontrolo jgufTan SedarebiT
(1,7±0,4;p=0,001;39,8±9,2;p=0,001).
17α-hidroqsiprogesteronis (17α-OHP) saSualo maCvenebeli (1,2±0,8 ng/ml) da
dehidroepiandrosteron-sulfatis (DHEA-S) saSualo maCvenebeli iyo
(2,9±1,8 µg/dl) aRmoCnda statistikurad sarwmunod maRali sakontrolo
jgufTan SedarebiT (0,5±0,2 ng/ml, p=0,015; 1,8±0,4 µg/dl, p=0,001). jgufebs
Soris statistikurad sarwmuno sxvaoba ar gamovlinda C–peptidis
(C-peptide), insulinrezistentobis indeqsi (Homa-IR),
folikulmastimulirebeli hormoni (FSH), maluTeinizirebeli hormoni (LH),
estradioli (E2), prolaqtini (Prl) da Tireomastimulirebeli hormonis
(TSH) saSualo maCveneblebis mixedviT (p >0,05) (ix. cxrili 2).

55
 cxrili 2

hirsutizmis mqone da sakontrolo jgufebSi hormonaluri maCveneblebis

saSualoebis SedarebiTi analizi

maCveneblebi I jgufi sakontrolo p -value

hirsutizmiT jgufi

TT 2,7 (±1,1)* 1,7 (±0,4) 0,009

FT 4,0 (±3,2)* 1,7 (±0,7) 0,005

SHBG 28,9 (±22,4)* 40,5 (±23) 0,006

FAI 14,0 (±10,9)* 4,8 (±2,2) 0,001

cFT 2,2 (±0,8)* 1,7 (±0,4) 0,001

cBio-T 52,7 (±17,8)* 39,8 (±9,2) 0,001

DHEA-S 2,9 (±1,8)* 1,8 (±0,4 ) 0,001

17α - OHP 1,2 (±0,8)* 0,5 (±0,2) 0,015

C-peptide 2,0 (±1,5) 1,5 (±0,3) 0,140

Homa-IR 1,5 (±1,3) 0,8 (±0,2) 0,303

FSH 8,6 (±3,1) 8,9 (±1,9) 0,783

LH 8,8 (±8,0) 5,1 (±1,6) 0,409

E2 42,7 (±34) 27,1 (±15,2) 0,205

Prl 20,5 (±16,6) 14,2 (±8,5) 0,067

TSH 2,2 (±1,9) 1,2 (±1,1) 0,426

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad.

* – sarwmuno sxvaoba jgufebs Soris

56
hirsutizmis ar mqone II jgufSi (ix. cxrili 3) saerTo testosteronis (TT)
saSualo maCvenebeli (2,1±0,7 ng/ml) ar iyo statistikurad sarwmunod
maRali sakontrolo jgufis maCvenebelTan SedarebiT (1,7±0,4 ng/ml; p=0,155).
Tavisufali testosteronis (FT) saSualo maCvenebeli (3,1±1,7 pgr/ml)
statistikurad sarwmunod maRali iyo sakontrolo jgufis Sesabamis
maCvenebelTan SedarebiT (1,6±0,7 pgr/ml; p=0,027). seqssteroidSemboWveli
globulinis (SHBG) saSualo maCvenebeli (29,9±25,6 nmol/l) statistikurad
sarwmunod dabali iyo sakontrolo jgufis maCvenebelTn SedarebiT
(40,5±23 nmol/l; p=0,027). Tavisufali androgenebis indeqsis (FAI) saSualo
maCvenebeli (11,6±7,9), gaangariSebuli Tavisufali testosteronis (cFT)
saSualo maCvenebeli (2,2±0,8), gaangariSebuli bioSeRwevadi testosteronis
(cBio-T) saSualo maCvenebeli (52,2±17,6) statistikurad sarwmunod maRali
iyo sakontrolo jgufis maCvenebelTan SedarebiT (4,8±2,2; p=0,004; 1,7±0,4
p=0,008; 39,8±9,2 p=0,004). aseve 17α-hidroqsiprogesteronis (17-OHP) saSualo
maCvenebeli (1,6±0,8 ng/ml) da dehidroepiandrosteron-sulfatis (DHEA-S)
saSualo maCvenebeli (2,6±1,2 µg/dl) statistikurad sarwmunod maRali iyo
sakontrolo jgufis maCvenebelTan SedarebiT (0,9±0,2 ng/ml, p=0,001;
1,5±0,4 g/dl, p=0,034). C-peptidis (C-peptide) saSualo maCvenebeli (2,7±1,0 ng/ml)
da insulinrezistentobis indeqsi (Homa-IR) (1,9±0,7) aRmoCnda statistikurad
sarwmunod maRali sakontrolo jgufis maCvenebelTan SedarebiT
(1,5±0,3 ng/ml, p=0,001; 1,9±0,7ng/ml; p=0,005). prolaqtinis (Prl) saSualo
maCvenebeli iyo (24,5±13,8 ng/ml) statistikurad sarwmunod maRali
sakontrolo jgufis maCvenebelTn SedarebiT (13,8±8,5 ng/ml; p=0,004).
jgufebs Soris statistikurad sarwmuno sxvaoba ar gamovlinda
folikulmastimulirebeli hormonis (FSH), maluTeinizirebeli hormonis
(LH), estradiolis (E2) da Tireomastimulirebeli hormonis (TSH) saSualo
maCveneblebis mixedviT (p >0,05).

57
 cxrili 3

hirsutizmis ar mqone da sakontrolo jgufebSi hormonaluri

maCveneblebis saSualoebis SedarebiTi analizi

maCveneblebi II jgufi sakontrolo P -value

hirsutizmis gareSe jgufi

TT 2,1 (±0,7) 1,7 (±0,4) 0,155

FT 3,1 (±1,7)* 1,6 (±0,7) 0,027

SHBG 29,9 (±25,6)* 40,5 (±23) 0,027

FAI 11,6 (±7,9)* 4,8 (±2,2) 0,004

cFT 2,2 (±0,8)* 1,7 (±0,4) 0,008

cBio-T 52,2 (±17,6)* 39,8 (±9,2) 0,004

DHEA-S 2,6 (±1,2)* 1,5 (±0,4) 0,034

17α - OHP 1,6 (±0,8)* 0,9 (±0,2) 0,001

C-peptide 2,7 (±1,0)* 1,5 (±0,3) 0,001

Homa-IR 1,9 (±0,7)* 1,3 (±0,2) 0,005

FSH 9,5 (±2,6) 8,9 (±1,9) 0,568

LH 7,9 (±5,6) 5,1 (±1,6) 0,273

E2 26,6 (±13,8) 27,1 (±15,2) 0,938

Prl 24,5 (±13,8)* 13,8 (±8,5) 0,004

TSH 1,9 (±1,1) 1,9 (±1,2 ) 0,913

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad.

* – sarwmuno sxvaoba jgufebs Soris

58
I da II jgufebs Soris Catarebuli saSualoebis SedarebiTi analiziT ar
gamovlinda statistikurad sarwmunod sxvaoba arcerT parametrs Soris
(p >0,05) (ix. cxrili 4). amgvarad, hirsutizmis mqone da ar mqone pacientTa
jgufebSi gamovlinda hormonaluri maCveneblebis da androgenuli
parametrebis saSualo maCveneblebis matebis tendencia, Tumca jgufebs
Soris statistikurad sarwmuno sxvaoba ar gamovlinda.

cxrili 4
hirsutizmis da hirsutizmis ar mqone jgufebSi hormonaluri maCveneblebis
saSualoebis SedarebiTi analizi

მაჩვენებლები I ჯგუფი II ჯგუფი P -value

TT 2,4 (±1,1) 2,1 (±0,7) 0,230

FT 4,0 (±3,2) 3,1 (±1,6) 0,733

SHBG 28,9 (± 22,4) 29,9 (±25,6) 0,951

FAI 14,0 (±10,9) 11,6 (±7,9) 0,505

cFT 2,2 (±0,8) 2,2 (±0,8) 0,894

cBio-T 52,7 (±17,8) 52,2 (±17,6) 0,895

DHEA-S 2,9 (±1,8) 2,6 (±1,2) 0,704

17α - OHP 1,2 (±0,5) 1,6 (±0,9) 0,060

C-peptide 2,0 (±1,1) 2,7 (±1,0) 0,043

Homa-IR 1,5 (±0,8) 1,9 (±0,7) 0,044

FSH 8,6 (±3,1) 9,5 (±2,6) 0,431

LH 8,8 (±8,0) 7,9 (±5,6) 0,782

E2 42,7 (±34) 26,6 (±13,8) 0,151

Prl 20,5 (±16,6) 24,5 (±13,8) 0,078

TSH 2,2 (±1,2) 1,9 (±1,1) 0,463

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad.

59
hirsutizmis xarisxis Sefaseba moxda Ferriman, Galwey (1961w) mier
modificirebuli sqemis mixedviT, sadac hirsutizmi fasdeba sxeulis 9
zonaze (fexis wvivebis da xelebis gamoklebiT) da gamoxatulobis
xarisxis mixedviT gamoyofilia hirsutizmis 3 forma: msubuqi (8-16 qula),
saSualo simZimis (17-24 qula) da mZime (25 qula da meti). Sesabamisad
pacientebi dayofili iyvnen 3 jgufad: msubuqi hirsutizmi aReniSneboda
25 pacients (22,5%), saSualo simZimis hirsutizmi - 50 pacients (45%) da mZime
hirsutizmi - 36 pacients (32,4%). jgufebs Soris Catarebuli androgenuli
markerebis saSualoebis parametruli monacemebi Sedarebuli iyo
erTmaneTTan Independent-Samples T-test gamoyenebiT, xolo araparametruli
monacemebis SemTxvevaSi Mann-Whitney U test-is gamoyenebiT. sarwmunod maRali
msubuqi hirsutizmis mqone pacientTa jgufis saSualo maCvenebelTan
SedarebiT (P1=0,008, P2=0,029), xolo mZime da saSualo simZimis hirsutizmis
mqone pacientTa jgufebs Soris saerTo testosteronis (TT) saSualo
maCvenebeli statistikurad sarwmunod ar gansxvavdeboda (P3=0,815).
aRsaniSnavia, rom Tavisufali testosteronis (FT) saSualo maCvenebeli
msubuqi, saSualo da mZime hirsutizmis mqone pacientTa jgufebs Soris
statistikurad sarwmunod ar gansxvavdeboda (P1=0,097, P2=0,082, P3=0,796).
seqssteroidSemboWveli globulinis (SHBG) saSualo maCvenebeli msubuqi,
saSualo da mZime hirsutizmis mqone pacientTa jgufebs Soris aseve
statistikurad sarwmunod ar gansxvavdeboda (P1=0,210, P2=0,340, P3=0,854).
Tavisufali androgenebis indeqsis (FAI) saSualo maCvenebeli mZime da
saSualo simZimis hirsutizmis mqone pacientebSi iyo statistikurad
sarwmunod maRali msubuqi hirsutizmis mqone pacientebis maCvenebelTan
SedarebiT (P1=0,007, P2=0,019). sainteresoa rom, mZime da saSualo simZimis
hirsutizmis mqone pacientTa jgufebes Soris Tavisufali androgenebis
indeqsis (FAI) saSualo maCvenebeli statistikurad sarwmunod ar
gansxvavdeboda (P3=0,922). aRmoCnda, rom gaangariSebuli Tavisufali
testosteronis (cFT) saSualo maCvenebeli. msubuqi, saSualo da mZime
hirsutizmis mqone pacientTa jgufebs Soris statistikurad sarwmunod ar
gansxvavdeboda (P1=0,094, P2=0,182, P3=0,852). aseve gaangariSebuli
bioSeRwevadi testosteronis (cBio-T) saSualo maCvenebeli msubuqi, saSualo

60
da mZime hirsutizmis mqone pacientTa jgufebs Soris sarwmunod ar
gansxvavdeboda (P1=0,075, P2=0,153, P3=0,852). dehidroepiandrosteron–sulfatis
(DHEA-S) saSualo maCvenebeli msubuq hirsutizmis da saSualo simZimis
hirsutizmis mqone pacientTa jgufebs Soris statistikurad sarwmunod ar
gansxvavdeboda (P1=0,545). Tumca aRsaniSnavia, rom mZime xarisxis
hirsutizmis pacientTa jgufSi dehidroepiandrosteron–sulfatis (DHEA-S)
saSualo maCvenebeli iyo statistikurad sarwmunod maRali (P2=0,002,
P3=0,004) vidre msubuqi hirsutizmis da saSualo simZimis hirsutizmis mqone
pacientTa jgufebSi. 17α – OHP saSualo maCvenebeli msubuqi, saSualo da
mZime hirsutizmis mqone pacientTa jgufebs Soris statistikurad
sarwmunod ar gansxvavdeboda (P1=0,546, P2=0,831, P3=0,714) (ix. cxrili 5).
hirsutizmis armqone jgufis pacientebSi androgenuli parametrebis mateba
aRniSneboda 15 SemTxvevaSi (60%). saerTo testosteronis mateba -
15 pacientSi (60%), Tavisufali androgenebis indeqsis 8-ze zemoT –
15 pacientSi (60%), gaangariSebuli Tavisufali testosteronis da
bioSeRwevadi testosteronis maRali maCvenebeli - 14 pacientSi (56%), xolo
seqssteroidSemboWveli globulinis normaze dabali maCvenebeli –
12 SemTxvevaSi (48%). sainteresoa, rom 8 SemTxvevaSi (32%) gamovlinda
saerToO testosteronis maCvenebeli normis farglebSi da
seqssteroidSemboWveli globulinis dabali maCvenebeli.

61
 cxrili 5
sakvlevi jgufis pacientebSi hirsutizmis xarisxis da androgenuli
parametrebis SedarebiTi analizi

maCveneblebi 0 – 7 qula 8 -16 qula 17 > qula

TT 1,9 (±0,6) 2,5 (± 1,2) 2,4 (± 1,2)
P1=0,008 P2=0,029
P3=0,815
FT 2,5 (± 1,4) 3,9 (±2,5) 4,1 (±4,0)
P1=0,097 P2=0,082
P3=0,796
SHBG 34,6 (±24,8) 28,5 (±21,7) 29,5 (±23,7)
P1=0,210 P2=0,340
P3=0,854
FAI 8,6 (±6,9) 14,1 (±11,1) 13,9 (±10,9)
P1=0,007 P2=0,019
P3=0,922
cFT 2,0 (±0,7) 2,3 (±0,8) 2,2 (±0,7)
P1=0,094 P2=0,182
P3=0,852
cBio-T 46,7 (±15,7) 53 (±18,2 ) 52,3 (±17,5)
P1=0,075 P2=0,153
P3=0,852
DHEA-S 2,1 (±1,1) 2,4 (±1,4) 3,6 (±2,0)
P1=0,545 P2=0,002
P3=0,004
17α - OHP 1,2 (±0,8) 1,1 (±0,6) 1,2 (±0,4)
P2=0,546 P2=0,831
P3=0,714
SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad.
* – sarwmuno sxvaoba jgufebs Soris

62
pacientTa sakvlev jgufSi pirsonis meTodiT Catarebuli korelaciuri
analiziT sxeulis masis indeqsa da androgenul parametrebs Soris
gamovlinda statistikurad sarwmuno dadebiTi korelaciebi sxeulis masis
indeqssa da Tavisufali androgenuli indeqsis (FAI) (r=0,234; p=0,008),
gaangariSebuli Tavisufali testosteronis (cFT) (r=0,216; p=0,014),
gaangariSebuli bioSeRwevadi testosteronis (cBio-T) (r=0,218; p=0,013)
maCveneblebs Sorisn da statistikurad sarwmuno uaryofiTi korelacia
seqsteroidSembowvel globulinTan (SHBG) (r=-0,248; p=0,005). aseve, sxeulis
masis indeqsa da insulinrezistentobis indeqsis (Homa-IR) maCveneblebs
Soris gamovlinda statistikurad sarwmunod dadebiTi korelacia
(r=0,454; p=0,001). aRsaniSnavia, rom korelacia ar gamovlinda sxeulis masis
indeqsa da saerTo testosterons (TT) (r=0,119; p=0,179), Tavisufali
testosteronis (FT) (r=-0,009; p=0,948) maCveneblebs Soris (ix. cxrili 6).

cxrili 6
sakvlev pacientTa jgufSi korelaciuri analizi pirsonis meTodiT
sxeulis masis indeqsa da androgenul parametrebs Soris

maCveneblebi r - koeficienti p-value

TT 0,119 0,179

FT -0,009 0,948

SHBG -0,248 0,005

FAI 0,234 0,008

cFT 0,216 0,014

cBio-T 0,218 0,013

Homa-IR 0,454 0,001

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad.

63
I jgufis pacientebi davyaviT 2 qvejgufad cximovani qsovilis ganawilebis
mixedviT. Ia - qvejgufi Seadgina 30 pacientma, romelTa welis da TeZos
garSemowerilobis Sefardeba (w.g/T.g.) iyo ≥0,8 da Ib - qvejgufi –
56 pacientma, romelTa w.g/T.g. iyo ≤0,79. sainteresoa, rom Ib - qvejgufSi
Tavisufali androgenebis indeqsis (FAI) (23,2 ±19,6; p=0,022), gaangariSebuli
Tavisufali testosteronis (2,6±0,7; p=0,005) da gaangariSebuli bioSeRwevadi
testosteronis (61,1±16,6; p=0,005) saSualo maCvenebeli statistikurad
sarwmunod maRali iyo Ia - qvejgufis Sesabamis saSualo maCvenebelTan
SedarebiT. sapirispirod, Ib-qvejgufis pacientebSi seqssteroidSemboWveli
globulinis (SHBG) (p=0,001) saSualo maCvenebeli statistikurad sarwmunod
dabali iyo Ia -qvejgufis saSualo maCvenebelTan SedarebiT. arcerT
qvejgufSi ar gamovlinda statistikurad sarwmuno sxvaoba saerTo
testosteronis (TT), Tavisufali testosteronis
(FT),dehidroepiandrosteron–sulfatis(DHEA-S),
17α-hidroqsiprogesteronis (17α-OHP), C–peptidis (C-peptide) da
insulinrezistentobis indeqsis (Homa-IR) maCveneblebs Soris (p>0,05)
(ix. cxrili 7).

64
 cxrili 7
I jgufis ginoiduri da visceraluri simsuqnis mqone pacientebis
hormonaluri maCveneblebis saSualoebis SedarebiTi analizi
Ia qvejgufi – I b qvejgufi –
maCveneblebi pacientebi pacientebi P -value
ginoiduri visceraluri
simsuqniT simsuqniT
TT 2,4 (±1,2) 2,5 (±1,0) 0,647

FT 4,0 (±2,9) 3,9 (±3,7) 0,971

SHBG 33,4 (±25,0)* 18,9 (±12,4) 0,016

FAI 12,1 (±10,0)* 23,2 (±19,6) 0,032

cFT 2,1 (±0,8)* 2,6 (±0,7) 0,018

cBio-T 49,5 (±18,6)* 61,1 (±16,6) 0,019

DHEA-S 2,8 (±1,8) 3,0 (±1,9) 0,729

17α- OHP 1,1 (±0,5) 1,4 (±0,9) 0,206

C-peptide 1,8 (±1,1) 2,2 (±1,0) 0,106

Homa-IR 1,3 (±0,8) 1,6 (±0,7) 0,090

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad.

*– sarwmuno sxvaoba jgufebs Soris

65
3.3 korelaciebi hiperandrogenizmis klinikur da hormonul markerebs
Soris qalebSi policistozuri sakvercxeebis sindromiT,
adrenogenitaluri sindromis araklasikuri formiT da
hiperprolaqtinemiis sindromiT.

diagnozebis mixedviT pacientebi ganawilda 3 jgufSi. I jgufi

policistozuri sakvercxeebis sindromiT Seadgina – 43 pacientma, II jgufi
adrenogenitaluri sindromis araklasikuri formiT - 38 pacientma da III
jgufi hiperprolaqtinemiis sindromiT - 30 pacientma.

policistozuri sakvercxeebis sindromis mqone pacientT jgufSi sxeulis

Warbi wona aReniSneboda 24 pacients (55,8%), visceraluri simsuqne –
22 (51,2%), hirsutizmi – 38 (88,4%), akne – 29 (67,4%) da acantosis nigricans –
15 (34,9%). araregularuli menstruaciuli cikli aReniSneboda 35 pacients
(81,4%) da ultrabgeriTi gamokvleviT policistozuri sakvercxeebi
13 pacients (30,2%).

araklasikuri adrenogenitaluri sindromis mqone pacientTa jgufSi

sxeulis Warbi wona aReniSneboda 7 pacients (18,4%), visceraluri simsuqne-
7 (18,4%), hirsutizmi – 27 (71,1%), akne – 27 (71,1%) da acantosis nigricans –
5 (13,2%). araregularuli menstruaciuli cikli gamouvlinda 25 pacients
(65,8%) da ultrabgeriTi gamokvleviT policistozuri sakvercxeebi
16 pacients (42,1%).

hiperprolaqtinemiis sindromis mqone pacientTa jgufSi Warbi wona

aReniSneboda 11 pacients (36,7%), visceraluri simsuqne – 10 (33,3%),
hirsurtizmi – 21 (70%), akne – 20 (66,7%) da acantosis nigricans 10 (33,3%).
araregularuli menstruaciuli cikli aReniSneboda 25 pacients (83,3%) da
ultrabgeriTi gamokvleviT policistozuri sakvercxeebi 13 pacients
(43,3%). (ix.diagrama 6.)

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diagrama 6. sxvadasxva klinikuri simptomis sixSire pacientebSi
policistozuri sakvercxeebis sindromiT, adrenogenitaluri sindromis
araklasikuri formiT da hiperprolaqtinemiis sindromiT (%).

67
policistozuri sakvercxeebis sindromis mqone pacientT jgufSi (43)
androgenuli markerebis saSualo maCveneblebi Seadgenda: saerTo
testosteroni (TT) 2,4±1,1 ng/ml; Tavisufali testosteroni (FT) 3,4 ±1,9
pgr/ml; seqssteroidSemboWveli globulini (SHBG) 28,3±21 nmol/l;
Tavisufali androgenebis indeqsi (FAI) 14,9±12,2; gaangariSebuli Tavisufali
testosteroni (cFT) 2,3 (±0,8); gaangariSebuli bioSeRwevadi testosteroni
(cBio-T) 53,3±20; dehidroepiandrosteron–sulfaTi (DHEA-S) 3,0 ±2,3 g/dl;
estradioli (E2) 40,3±31,2 ng/ml; insulinrezistentobis maCveneblebi
C–peptidi (C-peptide) 2,0 ±1,1 ng/ml; insulinrezistentobis indeqsi (Homa-IR)
1,5 ±0,9.

araklasikuri adrenogenitaluri sindromis mqone pacientTa jgufSi (38)

androgenuli markerebis saSualo maCveneblebi Seadgenda: saerTo
testosteroni (TT) 2,4±1,0 ng/ml; Tavisufali testosteroni (FT)
4,2 ±2,8 pgr/ml; seqssteroidSemboWveli globulini (SHBG) 32,2 ±26,4 nmol/l;
Tavisufali androgenebis indeqsi (FAI)12,4±9,4; gaangariSebuli androgenuli
testosteroni (cFT) 2,1±0,7; gaangariSebuli bioSeRwevadi testosteroni
(cBio-T) 50,2 ±17,3; dehidroepiandrosteron–sulfaTi (DHEA-S) 2,9 ±1,5g/dl;
estradioli (E2) 30,1±22,6 ng/ml; insulinrezistentobis maCveneblebi
C–peptidi (C-peptide) 2,1 ±0,7 ng/ml; insulinrezistentobis indeqsi (Homa-IR)
1,4 ±0,6.

hiperprolaqtinemiis sindromis mqone pacientTa jgufSi (30) androgenuli

markerebis saSualo maCveneblebi Seadgenda: saerTo testosteroni (TT)
2,2±1,0 ng/ml; Tavisufali testosteroni (FT) 3,9±3,4 pgr/ml;
seqssteroidSemboWveli globulini (SHBG) 26,4 ±21,8 nmol/l; Tavisufali
androgenebis indeqsi (FAI) 12,9±8,6; gaangariSebuli Tavisufali
testosteroni (cFT) 2,3±0,7; gaangariSebuli bioSeRwevadi testosteroni
(cBio-T) 54,5 (±16,9); dehidroepiandrosteron–sulfaTi (DHEA-S) 2,6±1,2 µg/dl;
estradioli (E2) 42,5 ±34,5 ng/ml; insulinrezistentobis maCveneblebi
C–peptidi (C-peptide) 2,5 ±1,2 ng/ml; insulinrezistentobis indeqsi (Homa-IR)
1,9 (±0,8).

68
jgufebs Soris Catarebuli androgenuli da insulinrezistentobis
markerebis saSualoebis parametruli monacemebi Sedarebuli iyo
erTmaneTTan Independent-Samples T-test gamoyenebiT, xolo araparametruli
monacemebis SemTxvevaSi Mann-Whitney U test-is gamoyenebiT. Catarebuli
analiziT jgufebs Soris arcerTi maCveneblis mixedviT statistikurad
sarwmunod sxvaoba ar gamovlinda (p >0,05) (ix. cxrili 8).

amgvarad, policistozuri sakvercxeebis sindromis, araklasikuri

adrenogenitaluri sindromis da hiperprolaqtinemiis sindromis mqone
pacientebSi gamovlinda yvela androgenuli parametris maRali
maCveneblebi. Tumca, aRsaniSnavia, rom jgufebs Soris am parametrebs Soris
statistikurad sarwmuno sxvaoba ar gamovlinda.

69
 cxrili 8

sxvadasxva sindromebis mqone pacientTa androgenuli da

insulinrezistentobis markerebis saSualoebis SedarebiTi analizi

maCvenebeli sakvercxeebis adrenogenitaluri hiperprolaqtinemis p-value

policistozi sindromis sibdromi (n=30)
(n=43) araklasikuri
forma (n=38)

TT 2,4 (±1,1) 2,4 (±1,0) 2,2 (±1,0) p >0,05

FT 3,4 (±1,9) 4,2 (±2,8) 3,9 (±3,4) p >0,05

SHBG 28,3 (±21) 32,2 (±26,4) 26,4 (±21,8) p >0,05

FAI 14,9 (±12,2) 12,4 (±9,4) 12,9 (±8,6) p >0,05

cFT 2,3 (±0,8) 2,1 (±0,7) 2,3 (±0,7) p >0,05

cBio-T 53,3 (±20) 50,2 (±17,3) 54,5 (±16,9) p >0,05

DHEA-S 3,0 (±2,3) 2,9 (±1,5) 2,6 (±1,2 ) p >0,05

E2 40,3 (±31,2) 30,1 (±22,6) 42,5 (±34,5) p >0,05

C-peptide 2,0 (±1,1) 2,1 (±0,7) 2,5 (±1,2) p >0,05

Homa-IR 1,5 (±0,9) 1,4 (±0,6) 1,9 (±0,8) p >0,05

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad

70
3.4 hiperandrogenizmis Sefasebis sxvadasxva diagnostikuri meTodebis
SedarebiTi analizi axalgazrda qalebSi hirsutizmiT

35 pacients hirsutizmiT da sxvadasxva diagnoziT Cautarda Tavisufali

androgenebis indeqsis, Tavisufali da bioSeRwevadi testosteronis
gaangariSeba da Tavisufali testosteronis gansazRvra sisxlSi -
imunofermentuli (ELISA) meTodiT. Catarda korelaciuri analizi
gamokvlevis mocemuli meTodebiT miRebul Sedegebs Soris. gamovlinda
sarwmunod dadebiTi korelaciebi ELISA–meTodiT gansazRvrul Tavisufal
testosteronsa, saerTo testosteronsa (r=0,592; p=0,001) da Tavisufali
androgenebis indeqss (r=0,461; p=0,005) Soris. Tavisufal testosterons da
seqsteroidSemboWveli globulinisa (SHBG), gaangariSebuli Tavisufali
testosteronisa (cFT), gaangariSebuli bioSeRwevadi testosteronisa
(cBio-T), hirsutul ricxvTan korelaciebi ar gamovlinda (ix. cxrili 9).

cxrili 9

pirsonis korelaciebi imunofermentuli (ELISA) meTodiT gansazRvruli

Tavisufal testosteronis maCvenebels da hiperandrogenemiis hormonalur
parametrebs, gaangariSebul androgenul parametrebs, hirsutul ricxvTan

maCveneblebi r- koeficienti p-value

TT 0,461 0,005

SHBG -0,251 0,146

FAI 0,592 0,001

cFT 0,298 0,082

cBio-T 0,229 0,081

hirsutuli ricxvi 0,083 0,637

(feriman-galvei-iT)

SeniSvna: P<0,05 miCneuli iyo statistikurad sarwmuno maCveneblad

71
gaangariSebuli androgenuli markerebis diagnostikuri mniSvnelobis
dasadgenad hirsutizmis sxvadasxva xarisxis dros agebul iqna ROC
(Receiver operating characteristics) mrudeebi. hirsutizmis saSualo xarisxis mqone
pacientTa jgufSi FT da FAI diagnostikuri mniSvneloba iyo Tanabari
(saSualo simZimis hirsutizmisTis (n=21) auROC (FT)=0,554; auROC (cFT) = 0,493;
auROC (FAI) = 0,539). saSualo simZimis hirsutizmis mqone pacientebSi
gamovlinda Tavisufali testosteronis da Tavisufali androgenebis
indeqsis TiTqmis Tanabari diagnostikuri mniSvneloba. hirsutizmis mZime
xarisxis mqone pacientTa jgufSi gamovlinda gaangariSebuli Tavisufali
testosteronis ufro mZlavri diagnostikuri mniSvneloba, vidre
Tavisufali testosteronisa da Tavisufali androgenebis indeqsisa (mZime
hirsutizmisTis (n=14) auROC (FT)=0,446; auROC (cFT) = 0,507; auROC (FAI) = 0,461).

diagrama 7.
ROC (Receiver operating characteristics) mrude hirsutizmis saSualo xarisxsa
da FT, FAI, cFT Soris

72
 diagrama 8

ROC (Receiver operating characteristics) mrude hirsutizmis saSualo xarisxsa da

FT,FAI, cFT Soris

73
 Tavi 4

miRebuli Sedegebis ganxilva

hiperandrogenizmi Tanamedrove endokrinologiuri ginekologiis

mniSvnelovan problemas warmoadgens. termini hiperandrogenizmi aRniSnavs
qalebSi iseTi garegani paTologiuri simptomebis arsebobas, rogoric aris
hirsutizmi, akne, seborea, alopecia da virilizacia uxSiresad
hiperandrogenemiis fonze. qalebSi, garda samedicino problemisa
hiperandrogenizmi socialur problemasac warmoadgens, vinaidan misTvis
damaxasiaTebeli klinikuri gamovlinebebi iwvevs stress, aqveiTebs
cxovrebis xarisxs da fsiqoemociur ganviTarebas. hiperandrogenizmi
ZiriTadad sakvrcxeebSi an Tirkmelzeda jirkvlebSi androgenebis Warbi
sekreciis Sedegad viTardeba. Tumca, paTologiuri Tmianoba SesaZloa
gamoxatuli iyos androgenebis normaluri sekreciis fonze idiopaTiuri
hirsutizmis dros.

yovelive zemoT aRniSnulidan gamomdinare, naSromis mizans warmoadgenda

korelaciebis dadgena hiperandrogenizmis klinikur da hormonalur
parametrebs Soris im axalgazrda qalebSi, romelTac aReniSnebodaT
hiperandrogenizmiT gamovlenili sxvadasxva endokrinul–ginekologiuri
sindromebi (policistozuri sakvercxeebis sindromi, adrenogenitaluri
sindromis araklasikuri forma, hiperprolaqtinemiis sindromi).

kvlevis farglebSi gamokvleul iqna 13-dan - 30 wlamde asakis 111 pacienti,

romelTa ZiriTadi Civilebi iyo: menstruaciuli ciklis darRveva da/an
WarbTmianoba, akne.

Cvens mier gamokvleuli 111 pacientidan 86-s aReniSneboda hirsutizmi

(77,5%), 76 pacients – akne (68,5%). hirsutizmis mqone pacientebSi akne
gamoxatuli hqonda 61 pacients (70,9%). literaturis monacemebiT
hirsutizmi hiperandrogenizmis erT-erTi yvelaze xSiri klinikuri
gamovlinebaa. R.Azziz da Tanaavtorebis (21) mier Catarebul kvlevaSi,

74
romelSic monawileobda 800 qali hiperandrogenemiiT, hirsutizmi
gamouvlinda 75%-s, maT Soris 4,8%-s - akne. sayuradReboa, rom Cveni kvlevis
farglebSi akne gamovlinda hirsutizmis mqone pacientTa ufro did nawils.
es albaTAdakavSirebulia imasTan, rom Cvens kvlevaSi monawile pacientTa
34,2% aReniSneboda adrenogenitaluri sindromis araklasikuri forma,
romlisTvis akne damaxasiTebeli simptomia.

Cven mier gamokvleul pacientebs menstruaciuli cikli upiratesad

darRveuli hqondaT oligoamenoreis tipiT (76,6%). literaturaSi arsebuli
monacemebiT policistozuri sakvercxeebis sindromis mqone pacientTaA
60-85%-Si aReniSnebaT menstruaciuli ciklis darRveva ZiriTadad
oligoamenoreis tipiT [21, 41]. gansakuTrebiT sainteresoa is faqti, rom
kvlevaSi monawile hirsutizmis da araregularuli menstruaciuli ciklis
mqone pacientebSi akne aReniSneboda - 64,5%-Si, xolo pacientebSi
hirsutizmis gareSe da araregularuli menstruaciuli cikliT - 56,5%-Si,
rac albaT aixsneba imiT, rom sakvlev jgufSi CarTul pacientebis
mniSvnelovan wils garda policistozuri sakvercxeebis sindromis
aReniSneboda sxva sindromebic.

literaturaSi arsebuli monacemebiT hirsutizmis mqone pacientTa

mdedrobiTi sqesis naTesavebSi paTologiuri Tmianoba ufro xSirad
aRiniSneba, rogorc idiopaTiuri hirsutizmis SemTxvevebSi, aseve sxvadasxva
endokrinuli paTologiebis dros [81]. am paTologiebis ojaxuri
ganviTarebis tendencias SesaZloa hqondes genetikuri safuZveli
mag: policistozuri sakvercxeebis sindroms axasiaTebs mZlavri
memkvidruli winaswarganwyoba. Cveni monacemebiT pacientTa ojaxuri
anmnezis Sekrebisas axlo naTesavebSi gamovlinda: WarbTmianoba (18%),
Saqriani diabeti tipi 2 (18,9%) da pacientis dedas policistozuri
sakvercxeebis sindromi (9%).

Cveni kvlevis farglebSi CavatareT pacientTa saerTo jgufis da

sakontrolo jgufis SedarebiTi analizi hormonaluri androgenuli
saSualo parametrebis mixedviT. pacientTa saerTo jgufSi yvela
androgenuli parametris saSualo maCvenebeli, rogoric aris

75
testosteroni, Tavisufali testosteroni, Tavisufali androgenebis
indeqsi, gaangariSebuli Tavisufali da bioSeRwevadi testosteroni,
dehidroepiandrosteron-sulfati da 17α-hidroqsiprogesteroni
statistikurad sarwmunod maRali aRmoCnda sakontrolo jgufTan
SedarebiT. xolo seqssteroidSemboWveli globulinis maCvenebeli ki
statistikurad sarwmunod dabali iyo sakontrolo jgufTan SedarebiT.
literaturaSi arsebuli monacemebic adastureben, rom hiperandrogenizmis
mqone pacientebSi uxSiresad aRiniSneba zemoT mocemuli androgenuli
parametrebis maRali maCveneblebi [46,53,85].

literaturis monacemebiT hiperandrogenizmi damaxasiaTebelia iseTi

paTologiebisaTvis, rogoric aris: policistozuri sakvercxeebis
sindromi, hiperandrogenuli insulin-rezistentuli acanthosis nigricans
sindromi, Tirkmelzeda jirkvlebis Tandayolili hiperplazia (klasikuri
da araklasikuri forma), kuSingis sindromi, androgenmaproducirebuli
simsivneebi (sakvercxis, Tirkmelzeda jirkvlis), hiperprolaqtinemiis
sindromi) [25,28,53]. roterdamis konsesusis (2003 w.) Tanaxmad
policistozuri sakvercxeebis sindromis diagnostirebisTvis gamoyofilia
3 kriteriumi, saidanac 2 mainc unda iyos dadebiTi: 1. oligomenorea da/an
anovulacia 2. sisxlSi hiperandrogenia da/an hiperandrogenizmis klinikuri
simptomebi 3. ultrabgeriTi kvleviT dadgenili policistozuri
sakvercxeebi. amave dros gamoricxuli unda iyos yvela sxva SesaZlo
mizezi, romelsac axasiTebs araregularuli menstruaciuli cikli da
hiperandrogenia (adrenogenitaluri sindromi, kuSingis sindromi,
hiperprolaqtinemia, adrogenmaproducirebeli simsivne) [142]. Cveni kvlevis
safuZvelze hiperandrogenizmis mqone pacientebSi policistozuri
sakvercxeebis sindromi gamovlinda SemTxvevaTa - 38,7%-Si,
adrenogenitaluri sindromis araklasikuri forma - 34,2%-Si,
hiperprolaqtinemiis sindromi - 27%-Si. avtorebi aRniSnaven, rom
hiperandrogenemia da hirsutizmi yvelaze xSirad viTardeba
policistozuri sakvercxeebis sindromis dros. Moran da Tanaavtorebis
[105] monacemebiT 13-38 wlamde asakobriv jgufSi hirsutizmis mizezi
SemTxvevaTa 53%-Si policistozuri sakvercxeebis sindromi, 18%-Si –

76
simsuqne, 2%-Si –adrenogenitaluri sindromis araklasikuri forma, 0,8%-Si
– sakvercxeebis simsivne da 0,4%-Si – kuSingis sindromi an specifiuri
medikamentebis miReba iyo. Tumca, gansxvavebiT literaturis monacemebisgan
Cveni kvlevis monacemebiT hiperandrogenizmis mqone pacientebSi pacientebSi
gacilebiT xSiri aRmoCnda adrenogenitaluri sindromis araklasikuri
forma da hiperprolaqtinemiis sindromi.

ultrabgeriTi kvleviT dadgenili policistozuri sakvercxeebi

roterdamis konsesusis Tanaxmad erT-erTi Semadgeneli kriteriumia
policistozuri sakvercxeebis sindromis. Tumca, amave dros SesaZlebelia
sakvercxeebis normaluri morfologiuri suraTis SemTxvevaSi, rodesac
saxezea hiperandrogenizmi da menstruaciuli ciklis darRveva, daisvas
policistozuri sakvercxeebis sindromis diagnozi [142,83]. am kriteriumis
Tanaxmad ultrabgeriTi kvleviT sakvercxeebi moculobaSi gazrdili unda
iyos da/an erT sakvercxeSi mainc aRiniSnebodes 12-ze meti wvrilcisturi
CanarTi. sayuradReboaE is faqtic, rom policistozuri sakvercxeebi
SesaZloa dadgenil iqnes im SemTxvevaSic ki, rodesac erT sakvercxeSi
mainc aReniSneba 12-ze meti wvrilcisturi CanarTi, diametriT 2-9mm [23].
uaxlesi monacemebiT policistozuri sakvercxeebis sindromis
gansazRvraSi ufro didi mniSvneloba eniWeba sakvercxeebis moculobas,
vidre wvrilcistur CanarTebis arsebobas [87]. ACvens kvlevaSi monawile
pacientTa 37,8%-sNsakvercxeebis ultrabgeriTi kvleviT daudginda
policistozuri sakvercxeebisTvis damaxasiaTebeli morfologiuri
struqtura (12-ze meti wvrilcisturi CanarTi) da maT Soris 71,4%-s
sakvercxeebi gazrdili iyo moculobaSi. sakvercxeebis normaluri
struqtura dadginda pacientTa 62,2%-Si, aqedan 43,2%-s gazrdili hqonda
sakvercxeebis moculoba. zemoaRniSnuli monacemebi miuTiTebs imaze, rom
ultrabgeriTi gamokvleviT calsaxad sakvercxeebis gansazRvra moiTxovs
seriozul araerTmniSvnelovan Sefasebas.

imisaTvis rom gagverkvia Tu rogor damokidebulebaSia hiperandrogenizmis

sxvadasxva sindromebi erTmaneTTan androgenuli parametrebis mixedviT
pacientebi dayofil iqna 3 jgufad nozologiebis mixedviT:
I - policistozuri sakvercxeebis sindromi (38,7%), II - adrenogenitaluri

77
sindromis araklasikuri forma (34,3%) da III - hiperprolaqtinemiis
sindromi (27%). Catarebuli analiziT jgufebs Soris arcerTi
androgenuli parametris saSualo maCvenebels Soris ar gamovlinda
statistikurad sarwmunod sxvaoba (P>0,05). literaturaSi arsebuli
monacemebiT pacientebSi policistozuri sakvercxeebis sindromiT da
adrenogenitaluri sindromis arklasikuri formiT androgenuli
parametrebis maCveneblebi ar gansxvavdebodnen erTmaneTisgan da
statistikurad sarwmunod maRali iyo, vidre idiopaTiuri hirsutizmis
dros [41]. amasTan, literaturaSi ar moipoveba sakmarisi informacia am
sindromebs da hiperprolaqtinemiis sindroms Soris androgenuli
parametrebis urTierTdamokidebulebis Sesaxeb, rac Cvens kvlevaSi iyo
asaxuli. kerZod, miuxedavad etiopaTogenezuri sxvaobisa,
hiperprolaqtinemiis sindromis mqone pacientebis androgenuli parametrebi
aseve ar gansxvavdeboda policistozuri sakvercxeebis sindromis da
adrenogenitaluri sindromis araklasikuri formis mqone pacientebis
jgufSi dadgenili Sesabamisi maCveneblebisgan.

Tumca zemoT mocemuli sindromebis SemTxvevebSi androgenuli

parametrebis maCveneblebis mixedviT ar gamovlinda statistikurad
sarwmuno sxvaoba, policistozuri sakvercxeebis sindromis mqone
pacientebSi ufro xSirad gamovlinda Warbi wona, cximovani qsovilis
visceralur tipad gadanawileba da menstruaciuli ciklis darRveva, vidre
adrenogenitaluri sindromis araklasikuri formis da hiperprolaqtinemiis
sindromis dros. Carmina E da Tanaavtorebi [39] Tavisi kvlevis safuZvelze
aRniSnaven, rom pacientebSi policistozuri sakvercxeebis sindromis dros
Warbi wona ufro xSiria, vidre sxva hiperandrogenuli sindromebis dros.
isini Tvlian, rom sxeulis masis gazrda SesaZloa iyos policistozuri
sakvercxeebis sindromis fenotipis da aseve anovulaciis ganmsazRvreli
mniSvnelovani komponenti.

hiperandrogenizmis erT-erTi yvelaze xSiri klinikuri simptomis mixedviT,

rogoric aris hirsutizmi, kvlevaSi monawile pacientebi dayofil iqna
2 ZiriTad jgufad. I jgufSi gaerTianda hirsutizmis mqone 86 pacienti
(77,5%), II jgufSi – 25 pacienti (29,1%) hirsutizmis gareSe. hirsutizmis

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xarisxis Sefaseba xdeboda Ferriman, Galwey (1961w) [67] mier modificirebuli
sqemis mixedviT, sadac hirsutizmi fasdeboda sxeulis 9 zonaze (fexis
wvivebis da xelebis gamoklebiT). jgufebs Soris ar gamovlinda
statistikurad sarwmuno sxvaoba hiperandrogenizmis sxva klinikur
simptomebis mixedviT, rogoricaa akne, acantosis nigricans, Warbi wona,
visceraluri simsuqne da menstruaciuli ciklis darRveva. ris
safuZvelzec SeiZleba davaskvnaT, rom hiperandrogenizmis erT-erTi
klinikuri simptomi - hirsutizmi ar korelirebs hiperandrogenizmis sxva
klinikur simptomebTan. am TvalsazrisiT literaturaSi ar arsebobs raime
sarwmuno monacemebi.

pacientTa orive jgufis (hirsutizmiT da hirsutizmis gareSe) androgenuli

parametrebi SevadareT rogorc erTmaneTs, aseve sakontrolo jgufis
maCveneblebs. orive jgufSi yvela androgenuli parametri statistikurad
sarwmunod maRali iyo sakontrolo jgufis maCveneblebTan SedarebiT,
xolo jgufebs Soris statistikurad sarwmuno sxvaoba arcerT
androgenul parameters Soris ar gamovlinda. avtorebis erTi jgufi
miiCnevs, rom hirsutizmi azielebSi da mozardebSi [133] SedarebiT iSviaTia,
TviT metaboluri da endokrinuli darRvevebis drosac. Savgremani,
SavTmiani TeTrkaniani qalebi ufro midrekili aris hirsutizmisken, vidre
TeTrkaniani qera qalebi [21, 51]. avtorTa monacemebiT hirsutizmi
mozardebSi aRiniSneba ufro xSirad adrenogenitaluri sindromis
araklasikuri formis dros ufro xSirad, vidre sxva hiperandrogenizmiT
mimdinare sindromebis dros [41]. AimisaTvis, rom gagverkvia Tu romel
asakobriv jgufSi aRiniSneba paTologiuri Tmianoba ufro xSirad
hirsutizmis mqone pacientebi davyaviT 3 asakobriv jgufad: I jgufi - 13-14
wl, II jgufi- 15-18 wl. da III jgufi - 19-30wl. Cvens masalis analiziT
gamovlinda, rom 13-14 wlis mozardebSi hirsutizmi aReniSneboda pacientTa
A-15%-Si, 15-18 wlis asakobriv jgufSi - 52,3%-Si, xolo 19-30 wl -32,6%-Si.
imave asakobriv jgufebSi aseve davadgineT aknes sixSire. gamovlinda, rom
pacientTa 13-14 wl jgufSi akne aReniSneboda- 17,1%-Si, 15-18 wl – 51,3%-Si
da 19-30 wl -31,6%-Si. amgvarad, Cveni monacemebiT rogorc hirsutizmis, aseve
aknes sixSire ufro naklebi aRmoCnda 13-14 wlis mozardebSi da

79
mniSvnelovnad ufro maRali 15-18 wlis asakobriv jgufSi. es faqti
SesaZlebelia aixsnas paTologiuri procesis progresirebiT dinamikaSi,
magram am TvalsazrisiT Znelad asaxsnelia hiperandrogenizmis klinikuri
gamovlinebebis SedarebiT dabali sixSire 19-30 wlis asakis qalebSi. aseve
sainteresoa aRiniSnos, rom gamoyofil asakobriv jgufebSi hirsutizmis da
aknes sixSire korelirebs erTmaneTTan.

Cveni kvlevis Sedegebis analizis safuZvelze SeiZleba davaskvnaT, rom

hiperandrogenizmis SefasebaSi mniSvnelovani roli eniWeba androgenuli
parametrebis gansazRvras, miuxedavad imisa hirsutizmi gamoxatulia Tu
ara. Cvens masalaze 25 pacientidan hirsutizmis gareSe akne gamouvlinda
15 pacients (60%), menstruaciuli ciklis darRveva oligoamenoreis tipiT
23 pacients (92%). amave jgufis pacientebSi policistozuri sakvercxeebis
sindromi dadginda – 5 SemTxvevaSi (20%), adrenogenitaluri sindromis
araklasikuri forma – 11 SemTxvevaSi (44%), hiperprolaqtinemiis sindromi –
9 SemTxvevaSi (36%). pacientebSi policistozuri sakvercxeebis sindromiT
akne gamovlinda 2 SemTxvevaSi (40%), adrenogenitaluri sindromis
araklasikuri formis mqone pacientebSi – 9 SemTxvevaSi (81,8%),
hiperprolaqtinemiis sindromis mqone pacientebSi – 4 SemTxvevaSi (44,4%).
amgvarad, hirsutizmis armqone pacientTa Soris hiperandrogenizmiT akne
yvelaze xSirad aRmoCnda (81,8%-Si) adrenogenitaluri sindromis
araklasikuri formis mqone jgufSi.

metad sainteresoa, rom hirsutizmis mqone pacientTa jgufSi akne

gamovlinda yvelaze xSirad hiperprolaqtinemiis sindromis dros - 76%-Si,
policistozuri sakvercxeebis sindromsa (63%) da adrenogenitaluri
sindromis araklasikur formasTan (59%) SedarebiT. hirsutizmis ar mqone
pacientTa jgufSi akne gamovlinda yvelaze xSirad adrenogenitaluri
sindromis araklasikuri formis mqone pacientebSi 81%-Si, vidre
policistozuri sakvercxeebis sindromis (40%) da hiperprolaqtinemiis
dros (44,4%). literaturaSi ar moipoveba monacemebis hiperprolaqtinemiis
da aknes kavSirze. Tumca, SeiZleba axsnili iyos imiT, rom
hiperprolaqtinemiis mqone pacientebSi xSirad aRiniSneba

80
dehidroepiandrosteronis da dehidroepiandrosteron-sulfatis
koncentraciis mateba [6,107], testosteronis da androstendionis
koncentraciis normaluri maCveneblebis fonze. Cveni kvlevis farglebSi
hiperprolaqtinemiis sindromis mqone pacientebSi dehidroepiandrosteron-
sulfatis maRali maCvenebeli gamovlinda 35%-Si, xolo testosteronis
maRali maCvenebeli -50%-Si.

hirsutizmis armqone jgufis pacientebSi androgenuli parametrebis mateba

aRniSneboda 15 SemTxvevaSi (60%). saerTo testosteronis mateba - 15
pacientSi (60%), Tavisufali androgenebis indeqsis 8-ze zemoT – 15
pacientSi (60%), gaangariSebuli Tavisufali testosteronis da
bioSeRwevadi testosteronis maRali maCvenebeli - 14 pacientSi (56%), xolo
seqssteroidSemboWveli globulinis normaze dabali maCvenebeli –
12 SemTxvevaSi (48%). sainteresoa, rom 8 SemTxvevaSi (32%) gamovlinda
saerToO testosteronis maCvenebeli normis farglebSi da
seqssteroidSemboWveli globulinis dabali maCvenebeli. es faqti SeiZleba
aixsnas imiT, rom aknes da hirsutizmis ganviTarebaSi androgenebis
maCveneblebTan erTad mniSvnelovan rols TamaSobdes cximis da Tmis
folikulebis receptorebis gansxvavebuli mgrZnobeloba androgenebis
mimarT. aqedan gamomdinare gaangariSebuli androgenuli parametrebis –
Tavisufali androgenebis indeqsis, gaangariSebuli Tavisufali da
bioSeRwevadi testosteronis da seqssteroidSemboWveli globulinis
maCveneblebis gansazRvra mniSvnelovania hiperandrogenizmis klinikuri
maxasiaTeblebis ganviTarebis meqanizmebis dadgenaSi pacientebSi sxvadasxva
ginekologiur–endokrinuli sindromebiT (policistozuri sakvercxeebis
sindromi, adrenogenitaluri sindromis araklasikuri forma,
hiperprolaqtinemiis sindromi).

metad saintereso iyo korelaciebis dadgena hirsutizmis xarisxsa da

androgenul parametrebs Soris. hirsutizmis gamoxatulobis xarisxis
mixedviT gamovyaviT hirsutizmis 3 forma: msubuqi (8-16 qula), saSualo
simZimis (17-24 qula) da mZime (25 qula da meti). imis gasarkvevad Tu ra
diagnostikuri mniSvneloba gaaCnia sxvadasxva androgenul parametrs
hirsutizmis Sesafaseblad pacientebi dayofili iyvnen 3 jgufad: I jgufi-

81
hirsutizmi ar aReniSneboda (0-7qula) - 25 pacients (22,5%), II jgufi -
msubuqi hirsutizmi - 50 pacients (45%), III jgufi - saSualo simZimis da
mZime hirsutizmi – 36 pacients (32,4%). Catarebuli analiziT gamovlinda,
rom saerTo testosteroni da Tavisufali androgenebis indeqsi
statistikurad sarwmunod maRali iyo hirsutizmis nebismieri xarisxis
dros, vidre pacientebSi hirsutizmis gareSe. aseve sayuradReboa, rom
dehidroepiandrosteron - sulfatis maCvenebeli statistikurad sarwmunod
ufro maRali aRmoCnda mZime hirsutizmis mqone pacientebSi, vidre
pacientebSi msubuqi hirsutizmiT da hirsutizmis gareSe. jgufebs Soris
sxva androgenuli parametrebis maCveneblebis mixedviT statistikurad
sarwmunod sxvaoba ar gamovlinda, Tumca hirsutizmis msubuqi da mZime
formebis dros gamovlinda androgenuli parametrebis maCveneblebis
matebis da seqssteroidSemboWveli globulinis maCveneblis daqveiTebis
tendencia. amgvarad, gaangariSebuli androgenuli parameterebis
maCveneblebi da seqssteroidSemboWveli globulinis koncentracia
sarwmunod ar korelirebs hirsutizmis xarisxTan, rac SeiZleba
ganpirobebuli iyos imiT, rom hirsutizmis xarisxi damokidebulia ara
mxolod androgenebis koncentraciaze sisxlis SratSi, aramed Tmis
folikulebis mgrZnobelobaze androgenebis mimarT. literaturaSi ar aris
sakmarisi monacemebi kavSirze hirsutizmis hiperandrogenemiis xarisxs
Soris.

literaturaSi arsebuli monacemebiT hiperandrogenizmis SemTxvevebSi

xSiri klinikuri gamovlinebaa sxeulis Warbi wona. Cven mier Seswavlili
pacientebis 33,3%-Si gamovlinda Warbi wona. imisTvis, rom dagvedgina
kavSiri wonis matebasa da androgenul parametrebs Soris CavatareT
korelaciuri analizi pirsonis meTodiT. Catarebuli analiziT sxeulis
masis indeqsa (smi) da androgenul parametrebs Soris gamovlinda
statistikurad sarwmunod dadebiTi korelaciebi smi-sa da gaangariSebul
Tavisufal testosterons, gaangariSebul bioSeRwevad testosterons da
Tavisufal androgenebis indeqss Soris. statistikurad sarwmunod
dadebiTi korelacia gamovlinda aseve sxeulis masis indeqssa da
insulinrezistentobis indeqs Soris da sapirispirod gamovlinda

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statistikurad sarwmunod uaryofiTi korelacia smi-sa da
seqssteroidSemboWveli globulinis maCveneblebs Soris. S.Cupisti da
Tanaavtorebis monacemebiT pacientebSi hirsutizmiT da sakvercxeebis
policistoziT simsuqne asocirebulia saerTo testosteronis
koncentraciis matebasTan da ssSg-is koncentraciis daqveiTebasTan, ris
Sedegadac matulobs gaangariSebuli Tavisufali da bioSeRwevadi
testosteroni [47].

bolo monacemebiT mniSvnelovania ara marto sxeulis absoluturi masa,

aramed cximovani qsovilis gadanawilebis tipi – ginoiduri Tu
visceraluri gacximovneba. cximovani qsovilis gadanawilebis
Taviseburebebis dadgenis mizniT xdeboda welisa da barZayis
garSemowerilobis Tanafardobis gansazRvra. zemo tipis, visceraluri, anu
mamakacuri tipis simsuqnis dros, welisa da barZayis garSemowerilobis
Tanafardobis indeqsad miCneulia maCvenebeli 0,8–ze meti, xolo qvemo,
qaluri, ginoiduri tipis simsuqnis dros – 0,8–ze naklebi. imisaTvis, rom
gagverkvia, Tu ra kavSirSia cximovani qsovilis gadanawileba androgenul
parametrebTan I jgufis hirsutizmis mqone pacientebi cximovani qsovilis
gadanawilebis tipis mixedviT, davyaviT qvejgufebad (Ia qvejgufi –
ginoiduri simsuqniT da Ib qvejgufi – visceraluri simsuqniT) da
gamovikvlieT sxvadasxva androgenuli parametri cximovani qsovilis
visceralur tipad gadanawilebasTan mimarTebaSi.

kvlevis miRebuli Sedegebi gviCveneben, rom hirsutizmis mqone pacientebSi

visceraluri tipis simsuqnT gaangariSebuli Tavisufali testosteroni,
gaangariSebuli bioSeRwevadi testosteroni da Tavisufali androgenebis
indeqsis saSualo maCveneblebi statistikurad sarwmunod maRalia,
ginoiduri tipis simsuqnis mqone pacientebTan SedarebiT. sapirispiro
maCvenebeli miviReT seqssteroidSemboWveli globulinTan mimarTebaSi. misi
saSualo maCvenebeli statistikurad sarwmunod dabali iyo visceraluri
simsuqnis mqone pacientebSi ginoiduri tipis simsuqnis mqone pacientebTan
SedarebiT. statistikurad sarwmuno sxvaoba ar gamovlinda
insulinrezistentobis indeqsis, C-peptidis, saerTo da Tavisufali
testosteronis, dehidroepiandrosteron-sulfatis da 17α-

83
oqsiprogestoronis saSualo maCveneblebs Soris, Tumca aRiniSneboda maTi
matebis tendencia w.g/T.g Sefardebis maCveneblis gaTvaliswinebiT. Mmsgavsi
monacemebi gamovlinda mTel rig avtorTa kvlevebSic [47,145,154]. maTi azriT
visceraluri simsuqnis dros seqssteroidSemboWvveli globulinis
maCvenebeli dabalia da saerTo testosteronis koncentracia ufro maRali,
vidre qalebSi cximovani qsovilis Tanabari gadanawilebiT. Sesabamisad
matulobs gaangariSebuli Tavisufali da bioSeRwevadi testosteroni.
hirsutizmis mqone pacientebSi visceraluri simsuqniT aReniSneba
hiperandrogenizmis gaRrmaveba da hirsutizmis progresireba. es albaT
ukavSirdeba imas, rom visceraluri simsuqnis dros aRiniSneba
insulinrezistentoba, rac ganapirobebs seqssteroidSemboWveli
globulinis sekreciis daTrgunvas, ris fonzec matulobs testosteronis
biologiurad aqtiuri fraqcia da Sesabamisad hiperandrogenizmis
klinikuri gamovlinebebis intensivoba.

qalebSi hiperandrogenizmis Sesafaseblad Tavisufali testosteroni

yvelaze gavrcelebuli markeria. Tavisufali testosteronis gansazRvris
“oqros standartad” miCneulia wonasworobis dializis da mass-
speqtrometriis meTodebi. Tumca, am meTodebiT misi gansazRvra rutinulad
yvela laboratoriaSi ver xorcieldeba. axlaxans Seqmnilia Tavisufali
testosteronis gaangariSebis modelebi saerTo testosteronis,
seqssteroidSemboWveli globulinis da albuminis maCveneblebis meSveobiT.
A.Vermeulen at al. monacemebiT aseTi gamoTvlebiT miRebuli Tavisufali da
bioSeRwevadi testosteronis monacemebi dadebiTad korelirebda
wonasworobis dializis da mas–speqtrometriiT miRebul monacemebTan
[151,152,153]. xSirad Tavisufali testosteronis koncentracia SeiZleba
momatebuli iyos maSin, rodesac saerTo testosteronis maCvenebeli
normis farglebSia, rac ganpirobebulia imiT, rom seqssteroidSemboWveli
globulinis dabali koncentracia ganapirobebs testosteronis
Tavisufali fraqciis matebas sisxlis plazmaSi [11,20,53,88].

imisaTvis, rom dagvedgina Tu romeli meTodiT miRebuli androgenuli

parametrebis maCvenebeli korelirebs hirsutizmTan kvlevis farglebSi Cven
movaxdineT Tavisufali testosteronis gansazRvra imunofermentuli

84
meTodiT (ELISA) da androgenuli parametrebis gaangariSeba saerTo
testosteronis da seqssteroidSemboWveli globulinis meSveobiT,
rogoric aris gaangariSebuli Tavisufali testosteroni, gaangariSebuli
bioSeRwevadi testosteroni da Tavisufali androgenebis indeqsi. miRebuli
SedegebiT calsaxad gamovlinda statistikurad sarwmonod dadebiTi
korelaciebi imunofermentuli ELISA-meTodiT gansazRvrul Tavisufal
testosteronsa da Tavisufali androgenebis indeqs Soris hirsutizmian
pacientebSi. agebuli ROC (Receiver operating characteristics) mrudeebiT saSualo
simZimis hirsutizmis mqone pacientebSi gamovlinda Tavisufali
testosteronis da Tavisufali androgenebis indeqsis TiTqmis Tanabari
diagnostikuri mniSvneloba. xolo hirsutizmis mZime xarisxis mqone
pacientTa jgufSi gamovlinda gaangariSebuli Tavisufali testosteronis
ufro mZlavri diagnostikuri mniSvneloba, vidre Tavisufali
testosteronis da Tavisufali androgenebis indeqsis. avtorTa jgufi
Brannian at al.; Morrimoto at al. da Qiao at al. [103,120]. miiCneven, rom Tavisufali
androgenebis indeqsis gansazRvra aucilebeli da farTod gamoyenebadi
meTodia androgenuli statusis Sesafaseblad. es meTodi SesaZloa iyos
Tavisufali testosteronis gansazRvris alternativa qalebSi, romelTac
aReniSnebaT menstruaciuli ciklis darRveva oligomenoreis tipiT da
hirsutizmi. Vermeulen-is and Kaufmann-is [152] azriT Tavisufali androgenebis
indeqsis gamoyeneba ar aris adekvaturi yvela pacientSi
hiperandrogenizmiT da is Sesaferisi markeria mxolod pacientebSi
hirsutizmiT da policistozuri sakvercxeebis sindromiT. isini aseve
miiCneven, rom gaangariSebuli Tavisufali testosteroni aris
alternatiuli meTodi Tavisufali testosteronis gansazRvris
wonasworobis dializis da amoniumis sulfatiT precipitaciis meTodebisa.

amgvarad, Catarebuli kvlevis safuZvelze SeiZleba davaskvnaT, rom

gaangariSebuli androgenuli parametrebiT – Tavisufali testosteroni,
bioSeRwevadi testosteroni da Tavisufali androgenebis indeqsi –
SesaZlebelia hiperandrogenizmis ganviTarebis meqanizmebis dadgena
(testosteronis absoluturi maCveneblis mateba da/an
seqssteroidSemboWveli globulinis daqveiTeba) da Sesabamisad

85
hiperandrogenizmis mkurnalobis adekvaturi taqtikis SemuSaveba
etiopaTogenezuri faqtorebis gaTvaliswinebasTan erTad.

86
 Tavi 5

daskvnebi

1. axalgazrda qalebSi sxvadasxva sindromebiT (policistozuri

sakvercxeebis sindromi, adrenogenitaluri sindromis araklasikuri
forma, hiperprolaqtinemiis sindromi) hiperandrogenizmis
damaxasiaTebeli klinikuri gamovlinebebiT sisxlis SratSi dadginda
yvela gaangariSebuli androgenuli parametris statistikurad
sarwmunod maRali da seqsteroidSemboWveli globulinis
statistikurad sarwmunod dabali saSualo maCvenebeli sakontrolo
jgufTan SedarebiT.

2. ar gamovlinda statistikurad sarwmuno sxvaoba gaangariSebuli

androgenuli parametrebis da seqssteroidSemboWveli globulinis
koncentraciis mixedviT sxvadasxva klinikuri sindromebis mqone
(policistozuri sakvercxeebis sindromi, adrenogenitaluri
sindromis araklasikuri forma, hiperprolaqtinemiis sindromi)
pacientebis saSualo maCveneblebs Soris.

3. gaangariSebuli androgenuli parameterebis maCveneblebi da

seqssteroidSemboWveli globulinis koncentracia ar korelirebs
hirsutizmis xarisxTan, rac SeiZleba ganpirobebuli iyos imiT, rom
hirsutizmis xarisxi damokidebulia ara mxolod androgenebis
koncentraciaze sisxlis SratSi, aramed Tmis folikulebis
mgrZnobelobaze androgenebis mimarT.

4. visceraluri simsuqnis mqone pacientebSi hirsutizmiT gamovlinda

gaangariSebuli androgenuli parameterebis statistikurad
sarwmunod maRali da seqssteroidSemboWveli globulinis

87
 koncentraciis statistikurad sarwmunod dabali saSualo
maCveneblebi im pacientebTan SedarebiT, romelTac aReniSnebodaT
ginoiduri simsuqne msgavsi xarisxis hirsutizmiT. es albaT
ukavSirdeba Homa-IR indeqsis ufro maRal maCvenebels pacientebSi
visceraluri simsuqniT da am fonze testosteronis biologiurad
aqtiuri fraqciis matebas.

5. gansxvavebiT sxva formebisagan hirsutizmis mZime xarisxis dros

dadginda gaangariSebuli Tavisufali testosteronis ufro mZlavri
diagnostikuri mniSvneloba imunofermentuli ELISA-meTodiT
gansazRvruli Tavisufali testosteronis maCvenebelTan SedarebiT.

6. gaangariSebuli androgenuli parametrebiT – Tavisufali

testosteroni, bioSeRwevadi testosteroni da Tavisufali
androgenebis indeqsi – SesaZlebelia hiperandrogenizmis ganviTarebis
meqanizmebis dadgena (testosteronis absoluturi maCveneblis mateba
da/an seqssteroidSemboWveli globulinis daqveiTeba) da Sesabamisad
hiperandrogenizmis mkurnalobis adekvaturi taqtikis SemuSaveba
etiopaTogenezuri faqtorebis gaTvaliswinebasTan erTad.

88
 Tavi 6.

praqtikuli rekomendaciebi

1. hiperandrogenizmis ganviTarebis meqanizmebis dadgenisTvis

mizanSewonilia gaangariSebuli androgenuli parameterebis, rogoric
aris gaangariSebuli Tavisufali testosteroni, gaangariSebuli
bioSeRwevadi testosteroni, seqssteroidSemboWveli globulinis
maCveneblebis da Tavisufali androgenebis indeqsis gansazRvra.

2. axalgazrda qalebSi hirsutizmiT gaangariSebuli Tavisufali

testosteroni, bioSeRwevadi testosteroni, seqssteroidSemboWveli
globulini da Tavisufali androgenebis indeqsi ufro adekvaturi
alternatiuli markerebia hiperandrogenizmis Sesafaseblad, vidre
mxolod imunofermentuli ELISA-meTodiT gansazRvruli Tavisufali
testosteronis maCvenebeli.

89
 Ivane Javakhishvili Tbilisi State University, Faculty of Medicine,

Department of Obstetrics - Gynecology and Reproductology

With the right of manuscript

Diana Chanukvadze

The correlations between the clinical and hormonal characteristics of

hyperandrogenism

The Ph.D Thesis

Presented for the academic degree of Doctor of Medicine

Research Director: Doctor of Medical Sciences, Associated Professor Jenara Kristesashvili

Tbilisi, 2012

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The theme importance:

Hyperandrogenism - the existence of androgen depending symptoms in women such as acne,

seborrhea, hirsutism and alopecia is a quite common condition. The main cause of
hyperandrogenism (40-80%) is hyperandrogenemia [22,85,129]. According to the references,
hyperandrogenism is marked in 7-10% of women of reproductive age [19,54,92]. Among the
reasons of hyperandrogenism decrease of sex steroid binding globulin concentration in the blood is
also considered, resulting in increased levels of free androgens [15,22]. Quite common is the form
of hyperandrogenism that develops on the basis of increase of the enzyme 5α-reductase activity in
the skin with the normal concentration of androgens in the blood. This form of hyperandrogenism is
considered idiopathic or constitutional form [21,29,35].

Irrespective the reasons, hyperandrogenism is perceived by patients rather severally, it becomes the
cause of psychological stress and affects their quality of life. Therefore, hyperandrogenism is a very
important and actual medical as well as social problem.

The causes of hyperandrogenism are: polycystic ovary syndrome, hyperandrogenic insulin -

resistant acanthosis nigricans syndrome, congenital adrenal hyperplasia (classical and non-
classical forms), Cushing's syndrome, androgen producing tumors (ovarian, adrenal gland),
hyperprolactinemia syndrome [25, 31]. 5-15% out of all cases of hyperandrogenism clinical
manifestations is idiopathic [21]. In such cases there is marked hypersensitivity of hair follicles to
normal levels of circulating androgens, the reason for which is increase of 5-α reductase activity.
These pathologies have been widely studied, but there still remain a number of issues that are
important for research to clarify the pathogenic mechanisms of hyperandrogenism of different
forms. In recent years special attention deserves the type hyperandrogenism, linked to obesity and
insulin resistance. In particular, it is stated that there is a relationship between hyperinsulinemia
and hyperandrogenism and coexistence of these two types of disorders creates a vicious circle. The
relations are less explored with consideration of liver function, the exact correlation between blood
sex hormone binding globulin, total and free testosterone concentrations, and similar relations in
patients with polycystic ovary syndrome or without it. The fact should be also highlighted that
obesity and insulin resistance is often not considered by patients appropriately as severe metabolic
disorders, including a risk – factor for diabetes mellitus type II development. Therefore, these
patients are at risk of serious health damage. Also noteworthy is the fact that insulin resistance can
be found in patients without excessive weight, with visceral obesity, which is so left without
attention. It is known that the main part of circulating in the blood testosterone - 80% is bound with

91
sex hormone binding globulin, 19% - with albumin, and only 1% circulates in free condition.
Steroids, bound with sex hormone binding globulin can not achieve in target tissues for activating.
Therefore, the androgenic effects are in correlation with sex hormone binding globulin levels. In
adult women sex hormone binding globulin concentration is twice as higher as in men. This gender
difference can be explained by the fact that estrogens stimulate and androgens inhibit sex hormone
binding globulin producing. This substance level in blood is considered a biological controlling
factor between androgens and estrogens [15,49,78].. The sex hormone binding globulin is a serum
of glycoprotein, produced in the liver. Its synthesis and expression in addition to the sex steroids, is
regulated by a number of other factors, some of which (thyroid hormones, stress, high carbohydrate
concentration) increase, while others (obesity, insulin, prolactine, growth hormone, progesterone,
glucocorticoids) decrease its level [6].

Gynecologists and reproductologists often do not pay adequate attention to specification of the
reasons of hyperandrogenism, and offer to such patient’s not ethio-pathogenetic, but symptomatic
treatment with androgens. This in dynamics leads to the enhancement of existing metabolic
disorders.

Free testosterone is the most common marker in women with hyperandrogenism, but its
determination cannot be carried out routinely in all laboratories. The "gold standard" of free
testosterone measuring is the method of the equilibrium dialysis and ammonium precipitation.
However, these methods are very time-consuming, expensive and require high technical
qualifications. Recently there have been developed the models for calculating free testosterone
through total testosterone, sex hormone binding globulin and albumin indices [151,153]. Despite
the limited correlations between all the endocrine parameters and the degree of hirsutism
(described by Feriman – Gallwey scheme), calculated free testosterone, biologically active
testosterone and free androgen index may be more appropriate markers to assess
hyperandrogenism in women with hirsutism than definition of only androgens [106,109]. In
addition, the level of free testosterone determination does not allow stating what causes this index
increase: the increase of testosterone secretion or increase of free biologically active fraction on
the background of sex hormone binding globulin decrease. Therefore, the determination of free
testosterone index only does not allow specifying the mechanisms of hyperandrogenism. Currently
it is important to use more informative latest markers to evaluate the clinical manifestations of
hyperandrogenism in order to develop adequate tactics of treatment.

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Based on the above-mentioned, the objective of the research was:

To detection the correlation between clinical signs and hormonal parameters of hyperandrogenism
in young women with various endocrine - gynecological syndromes manifested with
hyperandrogenism (polycystic ovary syndrome, non-classical form of the congenital adrenogenital
syndrome, hyperprolcatinemia syndrome)

Study objectives:

1. Based on the calculated androgenic parameters - calculated free and bioavailable testosterone,
free androgen index and sex hormone binding globulin- detected the importance of determination
for evaluation of mechanisms of development of hyperandrogenism clinical characteristics in
patients with various gynecological - endocrine syndromes (polycystic ovary syndrome, non-
classical form of the congenital adrenogenital syndrome, hyperprolcatinemia syndrome).

2. Revealing the correlations between clinical manifestations of hyperandrogenism and hormonal -

androgenic parametres in young women with pathogenetically different syndromes.

3. Determination of the correlation between visceral obesity with hormonal parametres of

hyperandrogenism.

4. Determination of diagnostic power of the calculated androgenic parameters and free

testosterone level determined by immunoferment method for evaluation of the hyperandrogenism
clinical symptoms and the development of hyperandrogenism mechanisms.

Scientific novelty of the work:

Firstly it was stated that the calculated androgenic parameters - free androgen index, calculated
free and bioavailable testosterone - are more adequate alternative markers for evaluation of the
mechanisms of hyperandrogenism than free testosterone determined by the immunoferment
method for clinical characteristics development in patients with various gynecological - endocrine
syndromes (polycystic ovary syndrome, non-classical form of congenital adrenogenital syndrome,
hyperprolactinemia syndrome).

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It was detected that the calculated androgenic parameters and the concentration of sex hormone
binding globulin is not correlated with the degree of hirsutism, which may be due to the fact that
the degree of hirsutism depends not only on androgen concentrations in serum, but on the
sensitivity of hair follicles to the androgens.

In the patients with visceral obesity with hirsutism there were detected statistically reliable higher
levels of calculated androgenic parameters, and statistically reliable lower levels of sex hormone
binding globulin compared to those in the patients with gynoid obesity with the similar degree of
hirsutism. This is probably related to the higher Homa-IR index in patients with visceral obesity
with increased on this background biologically active fraction of testosterone.

Unlike other forms, in case of severe degree hirsutism, it was detected that calculated free
testosterone has more diagnostic power than free testosterone level determined by ELISA
immunoferment method.

It was revealed that the levels of calculated androgenic parameters and the concentration of sex
hormone binding globulin is not correlated with the degree of hirsutism, which may be due to the
fact that the degree of hirsutism depends not only on androgen concentrations in serum, but also
on the sensitivity of hair follicles to the androgens.

The practical value of the work:

In practical terms the research results are very important, as they show that it is reasonable to
determine calculated androgenic parameters such as calculated free testosterone, bioavailable
testosterone, sex steroid binding globulin and free androgen index in order to determine
mechanisms of hyperandrogenism development.

In practical terms it is also most important to establish the fact that in young women with hirsutism
the calculated free testosterone, bioavailable testosterone, sex hormone binding globulin and free
androgen index are more adequate alternative markers for evaluation of hyperandrogenism than
free testosterone concentration only determined by ELISA immunoferment method.

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 თავი V

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danarTi

suraTi 1. saSualo simZimis hirsutizmi pacientis mkerdze

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suraTi 2. mZime hirsutizmi pacientis mkerdze da kiserze

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suraTi 3. mZime hirsutizmi pacientis saxeze da kiserze

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suraTi 4. mZime hirsutizmi pacientis saxeze

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suraTi 5. mZime hirsutizmi pacientis dunduloebze

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suraTi 6. mZime hirsutizmi pacientis mucelze

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