PCOS患者子宫内膜病变和胰岛素受体表达的临床研究

目的:研究多囊卵巢综合征(PCOS)患者子宫内膜病变和内膜胰岛素受体(IR)的表达,探讨PCOS子宫内膜改变的影响。方法:测定30例PCOS患者外周血清雌二醇(E2)、睾酮(T)、空腹血糖及胰岛素水平,计算稳定模型胰岛素抵抗指数(HOMA-IR),检查子宫内膜病理改变及内膜IR的表达;以不孕症患者(非排卵障碍)30例为对照组。结果:PCOS组43.3%子宫内膜呈增生性改变,内膜癌占3.4%,非增生性子宫内膜占53.3%;内膜增生症、内膜癌及非增生症患者血清E2、T无差异(P>0.05);增生症患者HOMA-IR高于非增生症患者(P<0.05),子宫内膜IR表达高于非增生症患者(P<0.05),子宫内膜IR表达与HOMA-IR呈正相关(r=0.576,P<0.01)。结论:近50%PCOS患者子宫内膜呈不同程度增生性改变,可能与长期持续低量雌激素刺激、胰岛素抵抗-高胰岛素血症有关;高胰岛素血症使胰岛素受体上调,导致子宫内膜的异常增生。

Endometrial pathological changes and expression of insulin receptor protein in the patients with polycystic ovary syndrome

Objective: To study the endometrial histopathology and the expression of insulin receptor in the endometrium of the patients with polycystic ovary syndrome (PCOS). Methods: A total of 60 patients were recruited, with 30 PCOS patients in the study group and 30 non-PCOS patients with infertility in the control group. Serum levels of estradiol, testosterone, fasting plasma glucose and fasting insulin were determined, and homeostasis model assessment of insulin resistance (HOMA-IR) were calculate. The endometrial pathology was checked by HE stain, and the expression of insulin receptor in the endometrium was detected by immunohistochemical methods. Results: (1)The normal endometrium, endometrial hyperplasia, endometrial adenocarcinoma were found in 53.3%, 43.3% and 3.4% of PCOS patients, respectively. (2) The serum levels of estradiol, testosterone were not significantly different in the PCOS patients with different endometrial pathological changes (P>0.05). HOMA-IR was significantly higher in PCOS patients with endometrial hyperplasia than in PCOS patients with normal endometrium (P<0.05). (3)The endometrial expression of insulin receptor in the patients with endometrial hyperplasia was significantly higher than that of those with normal endometrium (P<0.05). The expression of insulin receptor in the endometrium was positively correlated with HOMA-IR (r= 0.576, P<0.01). Conclusion: Endometrial hyperplastic changes were found in nearly half of the PCOS patients, which may be associated with insulin resistance, hyperinsulinemia and resultant higher endometrial expression of insulin receptor.