多囊卵巢综合征患者子宫内膜mPGES-1和COX-2表达的研究

Study of microsomal prostaglandin E_2 synthase-1 and cyclooxygenase-2 expression in endometrium of patients with polycystic ovary syndrome

目的:探讨多囊卵巢综合征(PCOS)患者膜结合型前列腺素合酶-1(mPGES-1)和环氧合酶-2(COX-2)在子宫内膜组织的表达及临床意义。方法:选择2005年6月至2007年6月华北煤炭医学院生殖内分泌门诊诊断为PCOS的患者21例为PCOS组,卵巢功能正常的不孕患者20例为对照组。PCOS组采用二甲双胍/达英-35联合治疗。病例均测体重、身高、性激素六项及75g葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)。并于月经干净3～5天(闭经患者确认为卵泡期)取子宫内膜组织,采用免疫组织化学技术检测PCOS组治疗前后及对照组中mPGES-1和COX-2的表达。结果:PCOS组患者BMI、HOMA-IR、空腹胰岛素(I0)、75g葡萄糖负荷后2h胰岛素(I120)及T均明显高于对照组患者(P均<0.05);治疗前PCOS组mPGES-1和COX-2在子宫内膜的表达显著高于对照组(P<0.01),治疗后两因子的表达与治疗前比较明显下降(P<0.01)。结论:PCOS患者子宫内膜可能处于一种慢性炎症状态,子宫内膜mPGES-1和COX-2过度表达可能是导致患者子宫内膜异常增生和不孕的原因之一,二甲双胍/达英-35联合应用可逆转该炎症状态,可能有利于孕卵着床和预防子宫内膜癌发生。

Objective：To study the expression and role of microsomal prostaglandin E2 synthase-1（mPGES-1） and cyclooxygenase-2（COX-2） in endometrium of patients with polycystic ovary syndrome（PCOS）.Methods：16 PCOS cases（PCOS group） and 20 infertile women with normal ovary function（control group） were selected,and PCOS cases were treated with Metformin/Diane-35.Body mass index（BMI）,sex hormone concentration,75g oral glucose tolerance tests（OGTT） and insulin release tests（IRT） were tested in all cases,and Homeostatic model assessment insulin resistance index（HOMA-IR） were calculated.The expression of mPGES-1 and COX-2 in endometrium of the PCOS group（before and after therapy） and control group were detected by immunohistochemical method.Results：In PCOS group,mPGES-1 and COX-2 expression before therapy were significantly higher than that in control group（P0.01）,but decreased significantly after therapy（P0.01）.Conclusion：Chronic inflammation maybe exist in endometrium of patients with PCOS.Increased mPGES-1 and COX-2 may be a potential reason for the neoplastic transformation of endometrium and the infertility.United treament of metformin /diane-35 can inhibit chronic inflammation in endometrium,and is good for embryo implantation and preventing endometium cancer.