多囊卵巢综合征患者红细胞胰岛素受体体内自身磷酸化研究

Autophosphorylation of Erythrocyte Insulin Receptors in Patients with Polycystic Ovary Syndrome

目的了解多囊卵巢综合征(PCOS)患者胰岛素受体在人体内环境不同胰岛素水平下自磷酸化状况及其与胰岛素抵抗(IR)状态的相关关系。方法40例PCOS患者以空腹胰岛素水平>15mIU/L为高胰岛素血症(HI)标准,按年龄、体重指数配对原则将其分为HI-PCOS组(n=20)和无HI(non HI-PCOS)组(n=20),并按年龄、体重指数配对设立有排卵及规律月经的育龄女性为正常对照组(n=20)。分别测定卵泡早期血清性激素水平,做75g口服葡萄糖耐量实验(OGTT)及胰岛素释放实验,计算胰岛素抵抗指数(HOMA-IR)。并在OGTT的5个时间点(空腹及口服75g葡萄糖后30、60、120和180min)抽血获红细胞,夹心ELISA法分别检测红细胞的总胰岛素受体(TIR)及酪氨酸残基磷酸化胰岛素受体(APIR)。体内不同胰岛素水平下的胰岛素受体自身磷酸化程度用APIR/TIR表示。结果HI-PCOS组在OGTT5个时间点的红细胞APIR/TIR均低于non-HI-PCOS组及对照组,但仅口服75g葡萄糖后60min差异有统计学意义(P<0.05);non-HI-PCOS组与对照组的红细胞APIR/TIR无差异(P>0.05)。结论伴高胰岛素血症PCOS患者存在胰岛素受体体内自磷酸化异常,这可能是PCOS患者发生IR的分子机制之一。

Objective To investigate the tyrosine autophosphorylation of insulin receptors in patients with polycystic ovary syndrome （PCOS）. Methods Forty patients with PCOS and 20 age- and body mass index matched healthy women were included in the study. The patients with PCOS were classified as HI-PCOS （n=20） or non-HIPCOS （n=20） based on the fasting insulin level （〉 or≤15 mIU/L）. （1）Serum gonadotropins and ovarian steroids were determined. Oral glucose tolerance tests （OGTT） and insulin releasing tests were performed to calculate the insulin resistance index （HOMA-IR）. （2） Blood samples were obtained at five time-points during the OGTT （Fasting and 30 min, 60 min, 120 min, and 180 min after taking 75 g glucose orally）. The erythrocytes were isolated and the autophosphorylation insulin receptors （APIR） and total insulin receptors （TIR） were measured by enzymatic immunoassay. （3） The in vivo autophosphorylation of insulin receptors was indicated by the APIR/TIR ratio. Results The HI-PCOS patients had lower APIR/TIR ratio than the non-HI-PCOS patients and healthy controls at the 60^th minute after OGTT （P〈0.05）. No differences in other time-points were significant, Conclusion The autophosphorylation of insulin receptors in HI-PCOS patients decrease, which might be a mechanism for insulin resistance in patients with PCOS.