Association of Insulin Resistance, High-Sensitivity C-Reactive Protein, and Selected Inflammatory Biomarkers with Clinical Phenotypes of Polycystic Ovary Syndrome

Dr. Hnan Faleh Almaamory; Adhra’a Ajeel Hadi; Nadia Abd Naif

Authors

Dr. Hnan Faleh Almaamory Babylon Educating Hospital of Gynaecology and Obestatric Care
Adhra’a Ajeel Hadi Samawah Health Directorate, Al-Rumaitha
Nadia Abd Naif Al Iskandaria General Hospital

Keywords:

Polycystic ovary syndrome, Phenotypes, Insulin resistance, HOMA-IR, High-sensitivity C-reactive protein, Interleukin-6, Tumour necrosis factor-alpha, Chronic inflammation, Iraq

Abstract

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder in which insulin resistance and chronic low-grade inflammation are thought to drive long-term cardiometabolic risk. Whether these abnormalities differ across the four Rotterdam phenotypes remains incompletely defined, particularly in Middle Eastern populations. Objective: To assess the association of insulin resistance, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α) and white blood cell (WBC) count with the clinical phenotypes of PCOS among women attending Babylon Teaching Hospital for Gynaecology and Obstetrics, Iraq. Methods: A hospital-based case–control study enrolled 180 women with PCOS diagnosed by the Rotterdam criteria and classified into phenotype A (n = 72), B (n = 34), C (n = 40) and D (n = 34), together with 60 age-matched women with regular ovulatory cycles as controls. Anthropometric, hormonal and metabolic variables were measured. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). Serum hs-CRP was measured by immunoturbidimetry, and IL-6 and TNF-α by enzyme-linked immunosorbent assay. Results: HOMA-IR, hs-CRP, IL-6 and TNF-α were significantly higher in all PCOS phenotypes than in controls (p < 0.001), with a graded pattern A > B > C > D. Insulin resistance (HOMA-IR ≥ 2.5) was present in 69.4% of phenotype A versus 26.5% of phenotype D. In women with PCOS, hs-CRP correlated with HOMA-IR (r = 0.54), waist circumference (r = 0.52) and IL-6 (r = 0.61). On multivariable regression, HOMA-IR, waist circumference and free androgen index were independent predictors of hs-CRP (adjusted R² = 0.43). Conclusion: Insulin resistance and low-grade inflammation are most pronounced in the hyperandrogenic phenotypes of PCOS, especially phenotype A, and are closely interlinked with central adiposity. Phenotype-based stratification may help target cardiometabolic screening in women with PCOS.

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