二甲双胍治疗对PCOS患者子宫内膜胰岛素抵抗的影响

目的:探讨PCOS患者子宫内膜GLUT4,INS蛋白的表达情况,明确二甲双胍治疗对子宫内膜胰岛素抵抗的影响。方法:收集胰岛素抵抗的肥胖PCOS患者(PCOS组)20例及非PCOS肥胖患者(对照组)20例。测定2组患者血清FSH、LH、E2、T、FSG、FINS水平,并应用免疫组化法检测两组患者子宫内膜GLUT4、INS蛋白表达,对PCOS组应用二甲双胍治疗(500 mg/次,3次/d,连续3个月),比较治疗前后上述指标的改变。结果:PCOS组T、FINS水平高于对照组(P<0.01),子宫内膜GLUT4表达低于对照组,INS表达高于对照组。二甲双胍治疗后,子宫内膜GLUT4表达升高,INS表达降低,3组比较差异均有统计学意义(P<0.001)。结论:PCOS患者子宫内膜存在IR,二甲双胍可能通过上调PCOS患者子宫内膜GLUT4水平从而改善子宫内膜IR状况。

The effect of metformin on the endometrial insulin resistance in PCOS patients

Objective: To study the expression of GLUT4 in the endometrium of PCOS patients,clarify the efficacy of metformin to improve the status of the endometrial insulin resistance(IR) in PCOS patients. Methods: We enrolled 20 obses patients diagnosed PCOS with IR(PCOS group),20 obses non-PCOS patients with infertility caused by tubal or pelvic factors(control group).assayed the serum FSH(follicle stimulating hormone),LH(luteinizing hormone),E2(estradiol-2),T(testosterone),FSG(fasting serum glucose),FINS(fasting insulin serum),Endometrial GLUT4 and INS(insulin) protein expression was measured by immunohistochemical respectively.These parameters were determined before and after oral administration of metfomin 500 mg three times daily for three months in PCOS patients. Results: The levels of serum T,FINS were significantly higher in PCOS group than those in control group(P<0.01).The expression level of GLUT4 protein in PCOS patients was significantly lower(P<0.01),INS protein was significantly higher(P<0.01) than those in control group.After three months of treatment,a significant increasing occurred in GLUT4 protein expression and a significant reduction occurred in INS protein expressions in PCOS patients(P<0.01). Conclusion: The level of GLUT4 expression was significantly lower in endometrial epithelial cells of PCOS patients than that in normal patients.Metformin therapy could upregulate the expression level of endometrial GLUT4 to improve the status of the endometrial IR in PCOS patients.