达英联合二甲双胍治疗对胰岛素抵抗的多囊卵巢综合征患者子宫内膜胰岛素受体表达的影响

目的:探讨达英-35联合二甲双胍治疗对胰岛素抵抗的多囊卵巢综合征患者子宫内膜胰岛素受体表达的影响。方法:对50例有胰岛素抵抗或高胰岛素血症的PCOS患者行达英-35联合二甲双胍治疗(A组),治疗前后进行子宫内膜组织学分析及胰岛素受体在子宫内膜表达的半定量分析,以50例有胰岛素抵抗或高胰岛素的PCOS患者行达英-35治疗为对照组(B组),比较两组患者治疗前后子宫内膜组织学的变化及胰岛素受体表达的变化。结果:①A组治疗后子宫内膜增生症的患者明显减少,治疗前后有统计学差异(P<0.01),治疗后增生症的子宫内膜全部转变为正常增生期内膜。B组治疗前后子宫内膜增生症的患者有所减少,但无统计学差异(P>0.05)。②A、B两组治疗前子宫内膜增生症的患者所占的比例无统计学差异(P>0.05),但治疗后子宫内膜增生症的患者所占的比例比较有统计学差异(P<0.01)。③A、B两组治疗前后子宫内膜胰岛素受体表达分析,A组患者药物治疗前后胰岛素受体在子宫内膜的表达有显著改变(P<0.01),具体表现为15例增生症的患者治疗后胰岛素受体在子宫内膜的腺体细胞上的表达明显减弱,而在间质细胞上胰岛素受体的表达无显著改变,B组患者药物治疗前后胰岛素受体在子宫内膜的表达无统计学差异(P>0.05)。④两组子宫内膜组织学为增生症的患者治疗前子宫内膜胰岛素受体表达,无统计学差异(P>0.05),治疗后发现在子宫内膜的腺细胞上的表达有统计学差异(P<0.01),而在间质细胞上的表达无统计学差异(P>0.05)。结论:达英-35联合二甲双胍治疗使部分胰岛素抵抗的多囊卵巢综合征患者子宫内膜胰岛素受体表达发生改变,提示子宫内膜的异常增生与胰岛素受体表达增强有关。

Effect of Diane combined with metformin on expression of insulin receptor in endometrium of patients with insulin-resistant polycystic ovary syndrome

Objective:To explore the effect of Diane-35 combined with metformin on expression of insulin receptor in endometrium of patients with insulin-resistant polycystic ovary syndrome (PCOS).Methods:50 PCOS patients with insulin resistance or hyperinsulinism were treated with Diane-35 combined with metformin (group A),histological analysis of endometrium and semi-quantitative analysis of insulin receptor in endometrium were conducted before and after treatment;50 PCOS patients with insulin resistance or hyperinsulinism were treated with Diane-35 (group B),the histological changes of endometrium and changes of insulin receptor expression before and after treatment were compared between the two groups.Results:The incidence of endometrial hyperplasia in group A after treatment decreased significantly,there was significant difference before and after treatment (P<0.01);after treatment,endometrial hyperplasia changed to normal endometrium at proliferative phase.The incidence of endometrial hyperplasia in group B after treatment decreased,but there was no significant difference before and after treatment (P>0.05);before treatment,there was no significant difference in the proportion of patients with endometrial hyperplasia between group A and group B (P>0.05),but there was significant difference after treatment (P<0.01).There was significant difference in expression of insulin receptor in endometrium before and after treatment in group A (P<0.01),after treatment,the expression of insulin receptor in glandular cells of endometrium decreased significantly in 15 patients with endometrial hyperplasia,but the expression of insulin receptor in stromal cells changed insignificantly,there was no significant difference in expression of insulin receptor in endometrium before and after treatment in group B (P>0.05);before treatment,there was no significant difference in expression of insulin receptor in endometrium between the two groups (P>0.05),but there was significant difference in expression of insulin receptor in glandular cells of endometrium after treatment between the two groups (P<0.01).Conclusion:Diane-35 combined with metformin can change the expression of insulin receptor in endometrium of some patients with insulin-resistant PCOS,which indicates that abnormal hyperplasia of endometrium is related to enhancement of insulin receptor expression.