Of the 30 patients included in the study group, 18 (60%) were female and 12 (40%) were male. The age of patients with acrochordon ranged between 21-66 years, with a mean age of 48.17 ± 12.08 years. The control group consisted of 17 women (56.7%) and 13 men (43.3%). The age of patients in the control group ranged between 18-77 years, with a mean age of 48.37 ± 13.81 years. There was no statistically significant difference between the two groups in terms of age and sex distribution (p = 0.953 and p = 0.793, respectively). The disease duration of the group with acrochordon ranged from 1 to 35 years, with a mean duration of 7.9 ± 7.07 years (median = 5 years). Twenty-three of the patients with acrochordon had lesions in multiple locations.
The mean BMI value was 30.55 ± 5.09 kg/m2 in the acrochordon group, and 28.17 ± 6.19 kg/m2 in the control group. The mean BMI of the study group with acrochordon was significantly higher than that of the control group (p = 0.040). In the patient group, there was no significant correlation between current acrochordon count and BMI value (p = 0.206).
When we examined the fasting blood glucose (FBG) level of the study group 9 (30%) patients had impaired FBG levels in the patient group and 17 (56.7%) subjects had impaired FBG levels in the control group (p=0.060). There were also no statistically significant difference between the groups with regard to OGTT results (p = 0.16).
The mean HbA1c value was 5.83 ± 0.62 % in the acrochordon group and 6.06 ± 0.67 % in the control group (p = 0.037). Mean serum insulin level was 13.87 ± 12.53 uU / ml in the acrochordon group and 10.45 ± 9.61 uU / ml in the control group (p = 0.031). The mean HOMA-IR value of the acrochordon group was slightly higher but statistically similar to controls (p=0.069).
There were no statistically significant differences between the control group and acrochordon group in terms of triglyceride, total cholesterol, VLDL, HDL, LDL cholesterol, FFA levels and total cholesterol/HDL and LDL/HDL ratios (p>0.05, for all). The mean serum leptin level was 11228.97 ± 4.56 pg / ml in the acrochordon group and 9970.30 ± 4.49 pg / ml in the control group (p = 0.352).
The mean serum IGF-1 value was 63.89 ± 40.96 ng / ml in the acrochordon group and 92.3 ±73.98 ng / ml in the control group (p=0.193) In addition, there was no significant correlation between serum IGF-1 level and acrochordon count (p = 0.671).
Positive staining for IGF-1R and IGF-2R was identified in almost all patients with acrochordon (p <0.001 for both). Only 5 controls had positive staining for IGF-1R (mild staining) and only 6 had staining for IGF-2R (Table 1). Negative IGF-1R staining in normal tissue is shown in Figure 1a, IGF-1R with mild (+), moderate (++) and severe (+++) staining in Figure 1b, 1c and 1d, respectively. An image showing mild (+), moderate (++) and intense (++) staining with IGF-2R in acrochordon tissue is shown in Figure 2.
Table 1. The distribution of IGF-1R and IGF-2R staining levels according to groups
|
No staining (-)
n (%)
|
Mild (+)
n (%)
|
Moderate
(++) n (%)
|
Intense (+++)
n (%)
|
IGF-1R staining
|
|
|
|
|
Patients
|
1 (3.3)
|
12 (40)
|
14 (46.7)
|
3 (10)
|
Controls
|
25 (83.3)
|
5 (16.7)
|
0 (0)
|
0 (0)
|
IGF-2R staining
|
|
|
|
|
Patients
|
-
|
1 (3,3)
|
5 (16,7)
|
24 (80)
|
Controls
|
24 (80)
|
6 (20)
|
-
|
-
|
The levels of IGF-1R and IGF-2R staining did not demonstrate any relationships with gender, age, the number and localization of lesions, lesion duration and HOMA-IR. However, the frequencies of positive staining with IGF-1R and IGF-2R were significantly higher in normoglycemic patients with acrochordon compared to controls (p <0.01). Although the relationships were minor, we found that the intensity of IGF-1 staining was correlated with serum IGF-1 levels (r = 0.028, p = 0.003) and BMI (r = 0.257, p = 0.048). On the other hand, when staining intensity was assessed, we found that IGF-2R staining intensity was significantly correlated with BMI (r = 0.375, p = 0.003) and serum insulin levels (r = 0.27, p = 0.037).
In logistic regression analysis, independent factors associated with the presence of acrochordon were investigated. None of the variables included in the model (BMI, serum insulin levels, IGF-1R and IGF-2R staining) were found to be independently associated with the presence of acrochordon (Table 2)
Table 2. Logistic regression results of potential factors associated with the presence of acrochordon
p value
|
%95 Confidence interval
|
Upper limit
|
Lower limit
|
BMI
|
0.743
|
0.827
|
1.306
|
IGF-1R
|
0.337
|
0.175
|
162.59
|
IGF-2R
|
0.996
|
0
|
|
Insulin
|
0.179
|
0.554
|
1.11
|
The evaluation of variables (HOMA-IR, BMI, insulin and IGF-1) in terms of their effects on the presence/absence of IGF-1R and IGF-2R staining showed that IGF-1, insulin and HOMA-IR values were independently associated with staining (Table 3).
Table 3. The logistic regression analysis of independent variables associated with IGF-1R and IGF-2R staining
p value
|
%95 Confidence interval
|
Upper limit
|
Lower limit
|
IGF-1R staining
|
|
|
HOMA-IR
|
0.021
|
0.027
|
0.749
|
BMI
|
0.314
|
0.945
|
1.191
|
Insulin
|
0.020
|
1.100
|
2.987
|
IGF-1
|
0.032
|
0.976
|
0.999
|
IGF-2R staining
|
|
|
|
HOMA-IR
|
0.023
|
0.023
|
0.758
|
BMI
|
0.084
|
0.985
|
1.275
|
Insulin
|
0.022
|
1.091
|
3.114
|
IGF-1
|
0.039
|
0.977
|
0.999
|