吡格列酮对多囊卵巢综合征胰岛素抵抗的治疗研究

目的探讨吡格列酮对多囊卵巢综合征（PCOS）患者全身及子宫内膜局部胰岛素抵抗的治疗效果。方法实验组为伴有胰岛素抵抗的PCOS25例，诱发排卵组为实验组中服用毗格列酮3个月后监测有排卵者8例，对照组1为同期输卵管性不孕者15例，对照组2为同期PCOS自发排卵者8例。实验组给予吡格列酮15mg bid口服3个月，观察血清胰岛素的变化。诱发排卵组、对照组1及对照组2均于排卵后第7天采集子宫内膜，应用免疫组化方法测定胰岛素受体（IR）的表达。结果实验组服药后空腹、2h血清胰岛素及胰岛素稳态模型指数（HOMA～IR）较服药前明显降低；诱发排卵组与对照组1相比内膜间质和腺体的IR表达无显著性差异；诱发排卵组与对照组2相比腺体上IR表达明显增高，内膜间质的IR表达没有差异。结论吡格列酮可以改善PCOS患者全身及子宫内膜局部的胰岛素抵抗。

Study on the therapeutic effects of pioglitazone on insulin resistance in polycystic ovary syndrome

Objective To evaluate the therapeutic effects of pioglitazone on the insulin resistance in both the whole body and endometrial situs in patients with polyeystic ovary syndrome （PCOS）. Methods 25 patients with PCOS plus insulin resistance were designated as the experiment group, of which 8 ovulatory eases who had received pioglitazone served as the induced ovulation group. 15 tubal infertility cases and 8 PCOS cases with spontaneous ovulation were designated as control group 1 and control group 2, respectively. The patients in the experiment group were treated with pioglitazone 15 mg twice daily for 3 months to observe the variations of serum insulin levels before and after the treatment. Endometrial samples were obtained from the induced ovulation group, control group 1 and control group 2 on the seventh day after ovulation. Immunohistochemical staining was performed to determine the expression of insulin receptor （IR）. Resuits After the treatment, the fasting insulin and 2 - hour insulin levels as well as HOMA - IR markedly decreased in the experiment group as compared to the period before the treatment. No significant differences were observed in IR between the induced ovulation group and control group 1, while compared with control group 2, the expression level of IR of epithelial cells were significantly upregulated, with no significant difference in IR expression of stromal cells. Conclusion Pioglitazone can ameliorate the insulin resistance in both whole body and endometrium of PCOS patients.