PCOS患者卵泡液微环境中的亚急性炎症反应

Subacute inflammatory reaction in follicular fluid of Chinese PCOS patients

目的:回顾性分析多囊卵巢综合征(PCOS)患者及对照者卵泡液微环境中局部脂代谢紊乱及炎症反应状态及其形成机制。方法:比较2组患者外周血清脂代谢指标、性激素、炎症细胞及炎症介质水平差异;测定卵泡液中炎症介质及载脂蛋白含量;分析卵巢颗粒细胞中炎症介质及载脂蛋白基因表达。结果:PCOS患者具备典型肥胖、高脂血症及高雄激素血症,外周血中炎症细胞及各类炎症介质水平显著增加;卵泡液中同样具有显著增加的炎症细胞因子浸润,颗粒细胞内炎症介质及载脂蛋白基因表达增加。结论:PCOS组患者卵泡液内所含高水平载脂蛋白表明卵泡液内可能存在高脂蛋白状态。循环中的高脂血症及亚急性炎症各类因子可能通过血清-卵泡液屏障主动渗透。颗粒细胞通过主动摄取(例如载脂蛋白A)抑或自主合成(如炎症因子IL-1、IL-6及TNF-α等)等多种方式进行卵泡液局部微环境的稳态调节。卵子发育生理性卵泡液微环境的脂质代谢紊乱、炎症细胞浸润、高雄激素血症等均可能影响到卵母细胞和胚胎的正常发育。

AIM：To retrospectively analyze the lipid metabolism disturbance and subacute inflammation within the microenvironment of follicular fluid between Chinese polycystic ovarian syndrome （ PCOS ） patients and the controls . METHODS：Serum lipid indexes , steroid hormone levels , and inflammatory cell counts were analyzed .The inflammatory cytokine and apolipoprotein levels were detected in the serum and follicular fluid .The mRNA expression of apolipoproteins and cytokines in the granulose cells was determined by real-time PCR.RESULTS： PCOS patients showed typical obesity accompanied with hyperlipidemia and hyperandrogenemia .Significantly elevated inflammatory cell number and cytokine lev-els were detected in both serum and follicular fluid .The mRNA expression levels of the inflammatory cytokines and apoli-poproteins in the granulose cells from the PCOS patients were higher than those from the controls .CONCLUSION：Elevat-ed apolipoproteins reflect systematic hyperlipidemia in the follicular fluid .Serum lipids and cytokines penetrate follicle-ser-um barrier and get into follicle fluid .Meanwhile , increased intake of apolipoproteins or elevated synthesis of cytokines （ IL-1, IL-6 and TNF-α） by granulose cells could also be crucial to stabilize microenvironment of follicular fluid .Oocyte and subsequent embryos are sensitive to the originaal follicular environment .The lipid metabolism disturbance , inflammatory cell infiltration and hyperandrogenemia may possibly disturb oocyte developmental potential .