吡格列酮对多囊卵巢综合征胰岛素抵抗的治疗研究

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1、吡格列酮对多囊卵巢综合征胰岛素抵抗的治疗研究作者：魏静，王蕊，罗晓燕，姚路，李春霞，梁竹巍【摘要】目的探讨吡格列酮对多囊卵巢综合征（PCOS）患者全身及子宫内膜局部胰岛素抵抗的治疗效果。方法实验组为伴有胰岛素抵抗的PCOS25例，诱发排卵组为实验组中服用吡格列酮3个月后监测有排卵者8例，对照组1为同期输卵管性不孕者15例，对照组2为同期PCOS自发排卵者8例。实验组给予吡格列酮15mgbid口服3个月，观察血清胰岛素的变化。诱发排卵组、对照组1及对照组2均于排卵后第7天采集子宫内膜，应用免疫组化方法测定胰岛素受体（IR）的表达。结果实验

2、组服药后空腹、2h血清胰岛素及胰岛素稳态模型指数（HOMA-IR）较服药前明显降低；诱发排卵组与对照组1相比内膜间质和腺体的IR表达无显著性差异；诱发排卵组与对照组2相比腺体上IR表达明显增高，内膜间质的IR表达没有差异。结论吡格列酮可以改善PCOS患者全身及子宫内膜局部的胰岛素抵抗。【关键词】多囊卵巢综合征；胰岛素抵抗；胰岛素受体；吡格列酮Abstract:ObjectiveToevaluatethetherapeuticeffectsofpioglitazoneontheinsulinresistanceinboththewhole

3、body10andendometrialsitusinpatientswithpolycysticovarysyndrome(PCOS).Methods25patientswithPCOSplusinsulinresistanceweredesignatedastheexperimentgroup,ofwhich8ovulatorycaseswhohadreceivedpioglitazoneservedastheinducedovulationgroup.15tubalinfertilitycasesand8PCOScaseswith

4、spontaneousovulationweredesignatedascontrolgroup1andcontrolgroup2,respectively.Thepatientsintheexperimentgroupweretreatedwithpioglitazone15mgtwicedailyfor3monthstoobservethevariationsofseruminsulinlevelsbeforeandafterthetreatment.Endometrialsampleswereobtainedfromtheindu

5、cedovulationgroup,controlgroup1andcontrolgroup2ontheseventhdayafterovulation.Immunohistochemicalstainingwasperformedtodeterminetheexpressionofinsulinreceptor(IR).ResultsAfterthetreatment,thefastinginsulinand2-hourinsulinlevelsaswellasHOMA-IRmarkedlydecreasedintheexperime

6、ntgroupascomparedtotheperiodbeforethetreatment.NosignificantdifferenceswereobservedinIRbetweentheinducedovulationgroupandcontrolgroup1,whilecomparedwithcontrolgroup2,theexpressionlevelofIRofepithelialcellsweresignificantlyupregulated,withnosignificantdifferenceinIRexpres

7、sionofstromalcells.ConclusionPioglitazonecanamelioratetheinsulin10resistanceinbothwholebodyandendometriumofPCOSpatients.Keywords：polycysticovarysyndrome;insulinresistance;insulinreceptor;pioglitazone多囊卵巢综合征（polycysticovariansyndrome，PCOS）是生育期妇女常见的内分泌紊乱性疾病。研究表明50%～70%的PCO

8、S患者存在不同程度的胰岛素抵抗（insulinresistance），高胰岛素血症在PCOS病理生理改变中发挥着早期和重要的作用［1］。吡格列酮是噻唑烷二酮第2代产品，临床上已广泛应用于2型糖尿病的治疗。本