吡格列酮对多囊卵巢综合征胰岛素抵抗的治疗研究_论文.doc

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1、毗格列酮对多囊卵巢综合征胰岛素抵抗的治疗研究作者：魏静，王蕊，罗晓燕，姚路，李春霞，梁竹巍【摘要】目的探讨毗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。实验组给予毗格列酮15mgbid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(

2、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。结论毗格列酮可以改善PCOS患者全身及子宫内膜局部的胰岛素抵抗。【关键词】多囊卵巢综合征；胰岛素抵抗；胰岛素受体；毗格列酮Abstract：ObjectiveToevaluatethetherapeuticeffectsofpioglitazoneontheinsulinresistanceinboththewholebodyandendometrialsitusinpatientswithpolycysticova

3、rysyndrome(PCOS)・Methods25patientswithPCOSplusinsulinresistanceweredesignatedastheexperimentgroup,ofwhich8ovulatorycaseswhohadreceivedpioglitazoneservedastheinducedovulationgroup.15tubalinfertilitycasesand8PCOScaseswithspontaneousovulationweredesignatedascontrolgroup1andcontrolgroup2,respectivel

4、y.Thepatientsintheexperimentgroupweretreatedwithpioglitazone15mgtwicedailyfor3monthstoobservethevariationsofseruminsulinlevelsbeforeandafterthetreatment.Endometrialsampleswereobtainedfromtheinducedovulationgroup,controlgroup1andcontrolgroup2ontheseventhdayafterovulation.Immunohistochemicalstaini

5、ngwasperformedtodeterminetheexpressionofinsulinreceptor(1R)・ResuItsAfterthetreatment,thefastinginsulinand2-hourinsulinlevelsaswellasHOMA-IRmarkedlydecreasedintheexperimentgroupascomparedtotheperiodbeforethetreatment・NosignificantdifferenceswereobservedinIRbetweentheinducedovulationgroupandcontro

6、lgroup1,whilecomparedwithcontrolgroup2,theexpressionlevelofIRofepithelialcellsweresignificantlyupregulated,withnosignificantdiffereneeinIRexpressionofstromalPioglitazonecanamelioratetheinsulinresistanceinbothwholebodyandendometriumofPCOSpatients.Keywords:polycysticovarysyndrome；insulinresistance

7、；insulinreceptor；pioglitazone多囊卵巢综合征(polycysticovariansyndrome,PCOS)是生育期妇女常见的内分泌紊乱性疾病。研究表明50%〜70%的PCOS患者存在不同程度的胰岛素抵抗(insulinresistance),高胰岛素血症在PCOS病理生理改变中发挥着早期和重要的作用［1］。毗格列酮是嚷哩烷二酮第2代产品，临床上已广泛应用于2型糖尿病的治疗。本研究应用毗格列酮治疗PCOS,观察其对P