多囊卵巢综合征早期自然流产患者IGFBP-1水平测定及临床意义

Expression and clinical significance of IGFBP-1 in early spontaneous abortion patients with polycystic ovary syndrome

目的探讨胰岛素样生长因子结合蛋白1（IGFBP-1）在多囊卵巢综合征（polycysticovarysyn—drome，PCOS）早期自然流产患者中的表达及临床意义。方法选择妊娠〈12周的PCOS流产患者77例为试验组，同期正常妊娠〈12周要求人工流产者68例为对照组。2组均于孕3～5周、孕6～8周和孕9～11周采用酶联免疫吸附法（enzyme—linkedimmunosorbentassay，ELISA）检测早期外周静脉血中IGFBP-1、IGF-1、人性激素结合球蛋白（SHBG）、空腹胰岛素、空腹血糖、睾酮和游离睾酮，同时采用流式细胞术检测蜕膜组织中IGFBP-1和IGF-1的表达。结果试验纽孕3～5周和孕9—11周空腹血清胰岛素水平及孕3～5周空腹血糖显著高于对照组（P〈0．01），但孕6—8周血清胰岛素水平及孕6—8周和孕9～11周空腹血糖与对照组比较差异无统计学意义（P〉0．05）。不同孕周试验组睾酮和游离睾酮均显著高于对照组（P〈0．01），IGFBP．1和SHBG水平显著低于对照组（P〈0．05或〈0．01），IGF．1水平与对照组比较差异无统计学意义（P〉0．05）。以B—actin作为内参照，试验组不同孕周蜕膜组织中IGFBP—l蛋白的表达显著低于对照组（P〈0．05），而IGF-1蛋白的表达显著高于对照组（P〈0．05）。结论PCOS早期自然流产患者血清中IGFBP-1、SHBG水平降低以及流产蜕膜组织中IGFBP-1、IGF-1蛋白表达的减少，提示子宫内膜上皮及间质功能障碍可能是PCOS患者发生流产的重要环节。

Objective To investigate the expression and clinical significance of IGFBP-1 in early spontaneous abortion patients with polycystic ovary syndrome. Methods 77 early spontaneous abortion patients with PCOS （pregnant period 〈 12 weeks） were enrolled as experimental group, and 68 normal pregnant women （pregnant period 〈 12 weeks ） who asked for induced abortion were enrolled as control group. The levels of IGFBP-1 ,IGF-1 ,SHBG, fasting insulin, fasting glucose, total testosterone and free testosterone in peripheral vein blood were detected by ELISA respectively in 3 N 5 weeks, 6 ~ 8 weeks, 9 ~ 11 weeks after pregnancy for both groups. The expression levels of IGFBP-1 and IGF-1 in decidua tissue were detected by flow cytometry. Results As compared with those in control group, the levels of fasting insulin in 3 - 5wk and 9 -11wk and fasting glucose in 3 - 5wk were significantly increased in experimental group （ P 〈 0.01 ）, however, there were no significant differences in the levels of fasting insulin in 6 - 8wk and fasting glucose in 6 - 8wk and 9 - llwk between experimental group and control group （ P 〉 O. 05 ）. The levels of testosterone and free testosterone in the three experimental groups were significantly higher than those in control group （ P 〈 0. O1 ）, however, the levels of IGFBP-land SHBG were significantly lower than those in control group （ P 〈 O. 05 or 〈 0.01 ）. There were no significant differences in the levels of IGF-1 between experimental group and control group （ P 〉 O. 05 ）. Taking 13-actin as interior reference, the expression levels of IGFBP-1 in deeidua tissue in experimental group were significantly lower than those in control group （ P 〈 O. 05）, however, the expression levels of IGF-I in decidua tissue in experimental group were significantly higher than those in control group （ P 〈 0.05 ）. Conclusion The reduction of serum IGFBP-1 and SHBG concentrations and decrease of expression levels of IGFBP-1 and IGF-1 in decidua tissue of early spontaneous abortion patients with PCOS suggests that endometrial epithelial and stromal dysfunction may play an important role in the pathogenesis of early spontaneous abortion in patients with PCOS.