AMHR、INSR及其基因甲基化与PCOS相关病变关系研究进展

Progress in research on relationship between the AMHR,INSR and their gene methylations and the pathological changes of PCOS

多囊卵巢综合征(PCOS)是指以月经紊乱、持续排卵障碍、高雄激素症、卵巢多囊样变为特征的病变。其病理特征主要表现为窦前卵泡发育过多而优势卵泡发育受阻,卵巢血管增生引起的卵巢增大,包膜增厚等病理改变。关于PCOS的发病机制非常复杂,目前已经认识到PCOS是涉及内分泌、代谢和遗传等许多因素的内分泌与代谢紊乱的疾病。而其所引起的不孕症是现代社会所面临的严重问题。目前公认为高胰岛素血症、高雄激素血症是PCOS的两大内分泌特征,由其所引起的全身及局部的一系列病理变化是导致不孕的主要原因,而无排卵及子宫内膜容受性差是不孕不育最直接的原因。抗苗勒管激素(AMH)作为卵巢局部一种调节因子,目前认识到其与卵泡生长发育及闭锁有关,甚至参与了高雄激素血症的发生,其主要通过抗苗勒管激素受体(AMHR)发挥作用,近年来已成为研究热点。胰岛素主要通过胰岛素受体(INSR)、受体后信号发挥生物学作用,且认为与子宫内膜、卵巢组织增生有关,并且影响着子宫内膜的容受性,由此可见AMHR与INSR在PCOS发病中起着承前启后的重要作用,并有学者认为其数目甚至功能的变化与PCOS及其并发症的产生有直接或者间接的关系,目前关于AMHR及INSR在PCOS患者中的分布及作用研究多集中于血液、卵巢局部及动物实验阶段,并尝试逐渐深入基因水平,而现阶段大多数学者认为PCOS是一种遗传与环境共同作用全身性疾病,表观遗传学被认为是解释其发病的最合理的解释,而表观遗传学最基本的修饰方式为DNA的甲基化,本研究现将AMHR及INSR的分布、表达及其基因水平的变化(甲基化)与PCOS相关病变的关系做一综述。

Polycystic ovary syndrome （PCOS） is a disease with the characteristic lesions which are menstrual disorders, per- sistent anovulation, hyperandrogenism disease, ovarian polycystic sample. The pathological features mainly are that preantral follicular development too much but the dominant follicle stunting, enlarged ovaries caused by ovarian angiogenesis, capsule thickening and so on. Pathogenesis of PCOS is very complex, and has been recognized that PCOS is related to many factors such as the endocrine, metabolic and genetic endocrine and metabolic disorders diseases. And the infertility caused by PCOS is a seri- ous problem in modern society. Hyperinsulinemia and hyperandrogenism are currently recognized as two endocrine characteristics of PCOS, and a series of systemic and local pathological changes caused by them are the main cause of infertility. Ovulation and poor endometrial receptivity are the most direct causes. AMH as an ovarian partial regulatory factor, currently recognized with follicular growth and atresia related, or even involved in the occurrence of hyperandrogenism, mainly through AMHR having a role. And has become a hot topic in recent years. Insulin plays a biological role primarily through INSR, receptor signaling, which considers endometrial, ovarian tissue hyperplasia and affection of receptivity of the endometrium. Thus INSR and AMHR play an important role in the pathogenesis of PCOS and some people think that their number and even function changes have di- rectly or indirectly related to PCOS and its complications. About AMHR and INSR mostly concentrated in the research phase of the blood, ovary and animal experiments, someone tries to deep in genetic level. But at this stage the majority of scholars believe that PCOS is a common genetic and environmental effects of systemic diseases. But PCOS is a systemic disease involving multiple systems. Epigenetics is considered to explain the onset of the most plausible explanation, and the basic epigenetic modification is DNA methylation manner. So this paper will do a review with AMHR distribution and INSR expression and its gene expression and its relationship with PCOS pathological change.