妊娠相关蛋白在多囊卵巢综合征早期自然流产患者的表达及临床意义

目的 探讨妊娠相关蛋白（glycodelin）在多囊卵巢综合征（polycystic ovary syndrome,PCOS）早期自然流产患者的表达及临床意义.方法 选择2012年4月-2013年4月妊娠〈12周的PCOS流产患者77例为试验组,同期正常妊娠〈12周要求人工流产者68例为对照组.2组均于孕3～5周、孕6～8周和孕9～11周采用酶联免疫吸附法（Enzyme-Linked Immunosorbent Assay,ELISA）检测外周静脉血中glycodelin、人性激素结合球蛋白（SHBG）、空腹胰岛素、空腹血糖、睾酮和游离睾酮,同时采用Western blot方法检测蜕膜组织中glycodelin的表达,分析glycodelin与PCOS早期自然流产的关系.结果 试验组孕3～5周和孕6～8周母体外周血中glycodelin的水平与对照组比较差异有统计学意义（P＜0.01）.将β-actin作为内参照,试验组蜕膜组织中glycodelin蛋白的表达显著低于对照组,试验组不同孕周蜕膜组织中glycodelin蛋白的表达显著低于对照组（P＜0.05）.试验组孕3～5周和孕9～11周空腹血清胰岛素水平及孕3～5周空腹血糖显著高于同孕周对照组（P＜0.01）,但孕6～8周血清胰岛素水平及孕6～8周和孕9～11周空腹血糖与对照组比较差异无统计学意义（P＞0.05）.不同孕周试验组睾酮和游离睾酮均显著高于对照组（P＜0.01）,而SHBG水平显著低于对照组（P＜0.05）.结论 PCOS早期自然流产患者血清中glycodelin、SHBG水平降低以及流产蜕膜组织中glycodelin蛋白表达的减少,提示子宫内膜上皮及间质功能障碍可能是PCOS患者发生流产的重要环节.

Expression and Clinical Significance of Glycodelin Level in Patients with Polycystic Ovary Syndrome during Early Spontaneous Abortion

Objective To explore the expression and clinical significance of glycodelin in patients with polycystic ovary syndrome （PCOS） during early spontaneous abortion. Methods During April 2012 and April 2013, 77 patients who suffered PCOS combined with early spontaneous abortion within 12 weeks of pregnancy were enrolled in a experiment group, and 68 healthy women who required artificial abortion within 12 weeks of pregnancy were as a control group. During 3rd- 5th weeks, 6th- 8th weeks and 9th- 11th weeks of pregnancy, glycodelin, sex hormone binding globulin （SHBG） , fasting insulin, fasting blood glueose, testosterone and free testosterone in peripherie venous blood of the two groups were detected by enzyme linked immunosorbent assay （ELISA） , while glycodelin expression in deciduas tissue was detected by Western blot, and the relationship between glycodelin and PCOS during early spontaneous abortion were also analyzed. Results The differences of glycodelin level in the two groups in peripheral blood of matrix during 3rd- 5th weeks and 6th- 8th weeks were statistically significant （P 〈 0. 01 ）. When β-actin was as reference, glycodelin expressions in decidual tissue were significantly lower in experiment group in every stage than those in control group （ P 〈 0. 05 ）.Levels of fasting insulin during 3rd- 5＇h weeks and 9th- 11t＇h weeks, and fasting blood, glucose during 3rd- 5th weeks in experiment group were significantly higher than those in control group at the same period （P 〈 0.01 ） , but the differences in levels of fasting insulin during 6th- 8th weeks and fasting blood glucose during 9th- 11th weeks showed no statistical significance （P 〉 0. 05 ）. The levels of testosterone and free testosterone in experiment group were significantly higher in every stage than those in control group （P 〈 0. 01 ） , but SHBG levels were significantly lower than those in control group （P 〈 0.05 ）. Conclusion levels of glycodelin and SHBG reduction in serum of patients with PCOS during early spontaneous abortion, and glycodelin reduction in decidual tissue may prompt endometrial epithelial and stromal dysfunction, which may be an important link for PCOS patients have spontaneous abortion.