多囊卵巢综合征患者胰岛素、胰岛素样生长因子及其受体的表达

目的: 探讨胰岛素(Ins)、胰岛素样生长因子(IGFs)及其受体在多囊卵巢综合征(PCOS)发展中的作用。方法:应用放射免疫方法检测病例组22例PCOS患者和对照组14例卵巢冠囊肿患者空腹血清Ins、IGF-Ⅰ、睾酮(T)和卵泡液内IGF-Ⅱ水平;应用免疫组化法检测卵泡组织中胰岛素受体(Ir)、IGF-Ⅰ受体(IGF-Ⅰr)的表达及分布情况。结果:①病例组空腹血清 Ins(22.51±10.23 mIU/mL)及IGF-Ⅰ(115.55±35.06 ng/mL)均明显高于对照组(分别为10.95±2.82 mIU/mL、57.96±37.46 ng/mL),P<0.001;②病例组空腹血糖/空腹胰岛素(G/I)比值(4.56±1.42)和卵泡液IGF-Ⅱ(0.133±0.02 ng/mL)均低于对照组(分别为9.36±2.85、0.200±0.04 ng/mL),P<0.001;③病例组内T与Ins(r=0.636,P<0.001)、 T与G/I(r=-0.558,P<0.01)呈明显直线相关;④卵泡组织石蜡切片显示,Ir定位于细胞膜,在卵泡膜细胞、颗粒细胞和间质细胞均有表达,尤其在血管内皮细胞表达更丰富,病例组和对照组间Ir表达强度差别无显著性;⑤各组切片均未见IGF-Ⅰr表达。结论:Ins、IGFs可能通过Ir参与促进PCOS患者的雄激素分泌及卵泡成熟障碍,这为PCOS的临床治疗提供了新的启示。

Expression of Insulin, Insulin-like Growth Factors and Their Receptors in Patients with Polycystic Ovarian Syndrome

Objective: To investigate the effects of insulin (Ins), insulin-like growth factors (IGFs) and theirreceptors on the development of polycystic ovarian syndrome (PCOS) and the implications for therapy. Methods: Thelevels of Ins, T(testosterone) and IGF-I in serum and IGF-Ⅱin follicle fluids were assayed from 22 cases withPCOS and 14 normally ovulating control women with parovarian cyst by radioimmunoassay (RIA). Expression ofIr and IGF-Ir protein in the follicle tissue was examined by immunostaining assay. Results: We found that theconcentrations of Ins (22.51±10.23μIU/mL)and IGF-I(115.55±35.06 ng/mL)in PCOS group werehigher than those in controls (10.95±2.82 mIU/mL、57.96±37.46 ng/mL respectively) . The level of G/I ratio(4.56±1.42)and follicular IGF-Ⅱ(0.133±0.02 ng/mL)were lower than those in controls (9.36±2.85、0.200±0.04 ng/mL, respectively); There was strong correlation between T and Ins (r=0.636, P<0.001),T and G/I ratio(r=-0.558,P<0.01)in the PCOS group;The expression of Ir was positive in thecal cells, granulosecells, stromal cells, especially in the vascular endothelial cells, but there was no difference between the two groups.Expression of IGF-Ir was negative in all subjects. Conclusion: The abnormal expression of Ins and IGFs mayplay an important role in the development of PCOS through Ir, which may bring some implications for therapy.