多囊卵巢综合征胰岛素抵抗与调节性T细胞功能的关系

Correlation between insulin resistance and regulatory T cells in patients with polycystic ovary syndrome

目的探讨调节性T细胞（Treg）在多囊卵巢综合征（PCOS）患者胰岛素抵抗（IR）发生中的作用。方法收集IR、非IR的Pcos患者及同龄段正常妇女各20例，使用胰岛素增敏剂吡格列酮治疗IR与非IR患者，比较治疗前后外周血Treg数量、细胞因子转化生长因子B1（TGF-B1）及白介素10（IL-10）的含量，并比较两组患者胰岛素抵抗水平（HOMA—IR）、性激素水平及I临床指标的差异。结果治疗前IR组Treg、TGF—B1及IL-10均显著高于非IR组（t=3．261～15．822，P〈0．05）；治疗后两组以上三者的水平均显著低于治疗前（IR组t：2．374～8．534；非IR组t=2．894—10．292；均P〈0．05），但IR组仍显著高于非IR组（t=3．561—8．658，均P〈0．05）。IR组治疗前后的HOMA—IR均明显高于非IR组（t=2．463，2．037；均P〈0．05）；治疗后，IR组的HOMA—IR明显低于治疗前（t=2．572，P〈0．05），但该水平仍高于非IR组（t=1．723，P〈0．05）。治疗后，两组黄体生成素（LH）及睾酮（T）水平均明显低于治疗前（IR组t=3．632，1．726；非IR组t=2．017，1．246；均P〈0．05），但治疗后IR组LH水平仍高于非IR组（t=2．024，P〈0．05）。治疗后，两组的多毛（F—G）评分、腰围／臀围（WHR）及体重指数（BMI）均明显低于治疗前（IR组t=1．286～1．653；非IR组t=1．065～2．774，均P〈0．05），且IR组的F—G仍显著高于非IR组（t=1．241，P〈0．05）。相关性分析显示Treg与TGF—B1、IL-10、HOMA—IR、LH及F—G评分6项指标的变化具有良好的-致性，呈显著正相关性（，=0．060-O．079，均P〈0．05）。结论Treg在PCOS患者佩发生中起到重要作用，并且与IR的程度、性激素代谢及临床指标密切相关。

Objective To investigate the effect of regulatory T cell （Treg） on insulin resistance （IR） of patients with polycystic ovary syndrome （PCOS）. Methods Twenty IR and 20 non-IR patients, as well as 20 healthy women within same age range, were enrolled in this study. Pioglitazone was applied to treat IR and non-IR PCOS patients. The levels of peripheral blood Tregs and their cytokines, the transforming growth factor [31 （TGF-131） and interleukin 10 （IL-10） were compared before and after treatment, and the differences in homeostasis model assessment-IR （HOMA-IR）, sex hormone level and clinical indicators of two groups were analyzed. Results Before treatment, Tregs, TGF-I3 1 and IL-10 of IR group were significantly higher than those of non-IR group （ t = 3. 261-15. 822, P 〈 0.05 ）. After treatment, they were significantly lower than those before treatment in two groups （ IR group ： t = 2. 374-8. 534 ; non-IR group ： t = 2. 894-10. 292; both P 〈 0.05）, hut they were significantly higher in IR group than in non-IR group （t = 3. 561-8. 658 ;both P 〈 0.05 ）. HOMA-IR of IR group was significantly higher than that of non-IR group both before and after treatment （ t value was 2. 463 and 2. 037, respectively, bothP 〈 0.05）. After treatment, HOMA-IR of IR group was obviously lower than that before treatment （ t = 2. 572, P 〈 0.05）, but it was still higher than that of non-IR group （ t = 1. 723, P 〈 0. 05 ）. After treatment, luteinizing hormone （LH） and testosterone （T） levels of two groups were significantly lower than those before treatment （IR group： t value was 3. 632 and 1. 726, respectively; non-IR group ： t value was 2.017 and 1. 246, respectively ; all P 〈 0.05）, but LH level of IR group was still higher than that of non-IR group （ t = 2. 024,P 〈 0.05）. After treatment, Ferriman Gallwey score （ F-G score）, waist/hip ratio （WHR） and body mass index （BMI） of two groups were significantly lower than before treatment （ IR group ： t = 1. 286-1. 653 ; non-IR group ： t = 1. 065-2.774 ; all P 〈 0.05 ）, and F-G of IR group was significantly higher than non-IR group （t = 1. 241, P 〈 0.05）. Correlation analysis showed that the level of Tregs changed consistently with TGF-B 1, IL-10, HOMA-IR, LH and F-G score, and they were positively correlated （r = 0.060- 0. 079 ,P 〈 0.05）. Conclusion Tregs play an important role in the pathogenesis of IR in patients with PCOS, and they are closely related with IR. sex hormone metabolism and clinical indicators.