多囊卵巢综合征临床内分泌代谢对子宫内膜病变的影响

The effect of the clinical endocrinic and metabolic changes on endometrium pathology in polycystic ovary syndrome

目的 探讨多囊卵巢综合征 (PCOS)患者临床内分泌代谢改变对子宫内膜病变的影响。方法 用组织学方法检测 94例PCOS患者子宫内膜病理改变 ,用放射免疫学方法测定血清泌乳素、黄体生成激素、卵泡刺激素、雌二醇、睾酮、雄烯二酮水平 ,82例同时行糖耐量及胰岛素释放实验。结果 ① 70例PCOS患者子宫内膜为无排卵型 ,其中增殖期内膜 45例 ,增殖症 2 5例 (单纯增生 2 3例、不典型增生 2例 ) ;2 4例为排卵型子宫内膜 ,其中13例分泌反应不佳 ,11例分泌反应良好。②无排卵型子宫内膜组与排卵型子宫内膜组比较 ,前者血清空腹及糖负荷后 6 0min、12 0min的胰岛素水平和胰岛素曲线下面积明显增高 (P均 <0 0 5 )。③子宫内膜增殖症患者与增殖期内膜患者比较 ,前者胰岛素曲线下面积明显增高 (P <0 0 5 ) ,其中单纯增生患者糖负荷后 6 0min、12 0min的胰岛素水平和胰岛素曲线下面积比增殖期内膜患者明显增高 (P均 <0 0 5 )。结论 PCOS患者高胰岛素血症是导致无排卵型子宫内膜的重要因素之一 ,增高的胰岛素对子宫内膜的异常增生也可能起促进作用。

Objective\ To study the endometrium pathologic characteristics in polycystic ovary syndrome(PCOS)and the effects of the clinical endocrinic and metabolic changes on endometrium.Methods\ The endometrium of 94 PCOS patients were investigated by histopathologic HE stain and sera were assayed for prolactin(PRL),luteinizing hormone (LH),follicle stimulating hormone(FSH),estradiol(E 2),testosterone(T),androstenedione(A).Meanwhile,glycemia and insulin(INS)response to the tolerance test with 75g oral glucose load were assessed in 82 PCOS patients.Results\ ①There were 70 PCOS patients showed anovulatory proliferative phase endometrium,including 45 proliferation,23 single hyperplasia,2 atypic hyperplasia.The other 24 PCOS patients showed ovulatory secretary phase endometrium.②The INS levels at 0,60,120min and area under curve of INS(AUC I)were higher in the anovulation endometrium group than those in ovulation endometrium group (P<0 05).③AUC I were higher in the hyperplasia endometrium group than that of proliferation endometrium group (P<0 05),the INS level at 60,120min post-OGTT and AUC I were elevated obviously in the single hyperplasia group compared with that in the proliferation group(P<0 05).Conclusion\ Hyperinsulinemia plays an important role in the anovulation endometrium of PCOS and the increased insulin may promote abnormal hyperplasia of endometrium.